Chris Tuckett reviews the 'peerless' 'The Shoulder: Theory and Practice', edited by two physios

The Shoulder: Theory and practice

Editors: Jeremy Lewis and César Fernández-de-las-Peñas

Publisher: Handspring Publishing

Price: £70

Pages: 712

ISBN: 9781913426170 (Hardback and e-book)

The Shoulder: Theory and practice is a textbook of mammoth proportions. At more than 650 pages, it encompasses everything that is currently known about the shoulder: from the evolution of this complex joint all the way up to using virtual reality applications in rehabilitation programmes. It truly is the de-facto reference resource for long-established shoulder experts and students alike.

Host of experts

While I consider myself to be a musculoskeletal specialist, it seems somewhat foolhardy to attempt to critique the depth, substance or detail of this book’s contents. As alluded to earlier, it is biblical in its appraisal of the shoulder and its editors (physiotherapists Jeremy Lewis and César Fernández-de-las-Peñas) have commendably drafted in a veritable who’s-who of clinical and academic shoulder experts to assist them in addressing each chapter.

As such I am very comfortable in declaring that this text is essential for any clinician wishing to address knowledge gaps in their anatomy, assessment or rehabilitation of the shoulder through having a reliable source of contemporaneous information.

It is the broader themes that I feel warrant a comment, as these are often where clinicians vary in their approach in the delivery of physiotherapy. Are you a therapist who is very mechanistic and eschews the ‘softer’ skills of contemplative listening and reflecting with patients preferring to dive straight into special tests and measuring? Or are you a therapist who embraces the deep conversation and counselling of patients while leaving the physical assessment and rehab to much later in the process? Of course, in truth we mostly fall somewhere along such spectrums and move within them depending on the patient we are presented with.

A 'real revelation'

When a book's title begins with ‘The Shoulder’ we might presume that its contents will focus on anatomy and be prescriptive in tone, offering copious details about how to ‘correctly’ test for the many different injuries, maladies and potential sources of pain that we were taught about at university. And this is where this book was a real revelation.

The text firmly and decisively moves the conversation on from the special tests we all spent so long perfecting, providing reassurance to the many therapists who (like me) always felt that something was missing from such a reductive assessment process. It promotes the broader diagnosis of RCRSP (rotator cuff related shoulder pain) over the false premise of tissue specific diagnoses. Yet all the while the patient is placed firmly at the centre of the critical thinking, and the authors suggest we should be focusing on the patients' ICE (ideas, concerns and expectations). I recognise that many will read this and think ‘well that’s obvious!’ but I do not underestimate the importance of such an authoritative book declaring that the power dynamic should tilt firmly towards the patient.

'Peerless' reference tool

The authors also emphasise the centrality of ‘lifestyle’ factors and general wellbeing in the successful recovery from shoulder pain and injury. This is a significant declaration that physiotherapists really should start to consider themselves advocates for public health improvement. And, at the same time, it may provide succour for therapists who have battled unsuccessfully to achieve a good outcome for a patient with shoulder pain, despite lacking the capacity or resources to allow them to have from 20 to 30 minutes speaking with a patient before having to rebook them in four weeks’ time. This text re-emphasises the importance of the therapeutic relationship, how this cannot be rushed and how a truly holistic assessment cannot be completed by sprinting to the physical assessment.

The book touches on posture (lacking evidence), strengthening (very high value), surgery (somewhat debatable) and much, much more. As a reference tool it is peerless, as a book it is highly engaging. I would strongly recommend it.

Chris Tuckett BSc, MSc, MCSP, is a director of allied health professions in an NHS trust

Twitter: @HealthPhysio

To read a PhysioUpdate Q&A interview with Jeremy Lewis, which was published earlier this year, visit:  https://www.physioupdate.co.uk/news/physiotherapist-jeremy-lewis-talks-about-his-new-book-on-the-shoulder-which-sold-out-in-two-weeks-/