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ExclusiveJun 22, 2022

Physiotherapist Jeremy Lewis talks about his new book on the shoulder, which sold out in two weeks!

Dr Jeremy Lewis's passion for physiotherapy shines out in an exclusive Q&A with PhysioUpdate editor Ian A McMillan. Jeremy was born in New Zealand, graduated in Australia and has worked in the NHS for more than two decades. He combines filling a challenging role as a consultant physiotherapist with being an in-demand trainer on shoulder issues around the world.

The Covid-19 pandemic gave him some downtime, which he used to commission and co-edit a comprehensive book titled The Shoulder: Theory and practice. It's gone down a storm since it was published earlier this year.

Q. Producing this impressive book must have been a ‘labour of love’. What fascinates you about shoulders and their treatment?

A: ‘Life is what happens to you when you're busy making other plans’ is a line in the John Lennon song ‘Beautiful boy’. My original plan was to investigate the foot and its function.

Around the time I was thinking about doing a PhD there was considerable clinical certainty about the role of posture and shoulder pain, but, paradoxically, considerable research uncertainty. As a result, I shifted my focus to the shoulder and investigated the role of posture and subacromial impingement syndrome. By the end of my PhD, I was pretty convinced there was no such thing as subacromial impingement syndrome, and it was pretty impossible to conclude very much from an assessment of static posture and shoulder symptoms.


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Recasting Quasimodo

In chapter 20 of the book, which focuses on posture, I argue that Victor Hugo's Quasimodo (The Hunchback of Notre Dame), although shunned by Parisian society for his hideous posture, was arguably the healthiest person in Paris as he was running up and down the stairs of the cathedral as well as ringing its heavy bells.

In most of healthcare, when we order investigations, such as blood tests, we accept that there is an upper and lower range that we consider normal. Strangely, for posture, it's binary: it's either perfect or not perfect. In my opinion, what we should be doing is telling patients that their static posture is well within normal limits (unless there is a definitive reason to say otherwise).

Anyway, after my PhD I just wanted to delve deeper and deeper into understanding the shoulder from both a clinical and research perspective, and this has been the focus of most of my post-PhD career.

We see the book contains more than 700 pages and has more than 100 contributors! How did you manage to coordinate the work of such a large team?

Coffee

The first print run was designed to last two or three years, but it actually sold out in two weeks and four days. The feedback I have received from all over the world from clinicians of all disciplines and, most importantly, from people with shoulder pain, has truly been beyond anything I would have allowed myself to believe would happen [Jeremy Lewis]

Are you pleased with the result and what impact would you like the book to have?

For many years I've wanted to produce a book on the shoulder and changes imposed by the coronavirus pandemic provided an opportunity to produce one. I reached out to people who have positively influenced my career and have made enormous contributions in the field of musculoskeletal (MSK) shoulder conditions and was delighted that 99.9 per cent of those I asked to participate agreed.

Chapter one was written by people who have a lived experience of shoulder pain and their voice permeates every chapter of the book because, ultimately, it's the patient who's the most important person in health care.

The original publisher, Handspring, provided the most fantastic support and guidance and produced a visually spectacular product. The first print run was designed to last two or three years, but it actually sold out in two weeks and four days. The feedback I have received from all over the world from clinicians of all disciplines and, most importantly, from people with shoulder pain, has truly been beyond anything I would have allowed myself to believe would happen.

So yes, I am delighted, and I hope that future editions of this book are able to fill in some of the uncertainties identified in this edition, as research and clinical experience, together with patient input helps to fill in the gaps in our current deficit of knowledge.

Do you also offer training on the topic? 

I love teaching and have been teaching internationally for almost three decades. I have taught in more than 50 countries and territories to a wide range of health professionals and feel incredibly privileged that this has been a substantial part of my life. The title of the course I teach is the same as the title of the book, The Shoulder: Theory and practice, and it’s always been a ‘work in progress’.

The content of my courses has always been informed by feedback from participants, new clinical perspectives, and the available research evidence, again with the principal focus being on the most important person in healthcare: the patient.

I update the course at least annually, typically more frequently than that and because of this many people have participated two or three times. I continue to teach face-to- face courses internationally but have set up a new website and by the end of this year I hope the course will be available in an ‘online in your own time’ format with all the theory and practical components available to participants in multiple languages who are not able to attend face-to-face courses, or for those who have participated in previous courses who want to revisit the updated content.

You graduated in New Zealand and then worked in Australia – countries many of people in the UK would like to emigrate to. Tell us about your early career steps?

In the first part of my career, I did every possible weekend course I could because my intention was to be the best physiotherapist I could be, aiming to fix every person who came seeking care for whatever MSK problem they were living with

I was born in New Zealand where I had an amazing childhood. My parents were part of an economic migration from New Zealand to Australia where I finished high school and initially thought I would study medicine, then registered for dentistry, and then decided on physiotherapy, where I completed my undergraduate training in Melbourne, Australia. I went on to do the one-year manipulative therapy postgraduate diploma in Melbourne, followed by the one-year sports physiotherapy postgraduate diploma (Perth, Western Australia). I've also completed postgraduate diplomas in biomechanics (Strathclyde), diagnostic ultrasound (Leeds) and modules in injection therapy (Keele). The last postgraduate course I completed was non-medical independent prescribing.

I worked for many years in hospitals, completing early career rotations and spent a lot of time working in an ICU in Melbourne, Australia. After about 10 years of practice, I drifted into MSK health and that's when I did the postgraduate manipulative therapy and sports therapy courses. In the first part of my career, I did every possible weekend course I could because my intention was to be the best physiotherapist I could be, aiming to fix every person who came seeking care for whatever MSK problem they were living with.

Around the time of my PhD, I started to realise that this was both unrealistic and unachievable. From this time onwards I reconfigured my professional DNA and stopped ‘fixing’ people and aimed to be the best health coach I could be, empowering people to get the best value out of their lives. I've been writing about this and include this as a substantial part of the philosophy within my courses for many years.

For anyone who is interested in following this up further, here are links to some free Open Access papers: https://bjsm.bmj.com/content/52/24/1543 Also: https://www.jospt.org/doi/full/10.2519/jospt.2020.0601

What brought you to the UK and what is your ‘day job’?

Two decades ago, I decided I wanted to live in London and experience the UK and Europe for a year. One year has become 22 years. There's a lot to love about living in this country and travelling in Europe and there's a lot to love about the philosophy of the NHS. Like every country I have lived in for extended periods of time there is good and there are areas where there is room for improvement.

I travel back to Australia and New Zealand regularly to teach, visit family and friends, and I really do believe my life has been enriched by living in different countries as well as the travelling I have done while teaching. There are so many more similarities between people around the world than the things that divide us.

In terms of my ‘day job’, I have a number of them I work as a professor (of MSK research) across a number of universities, and I'm currently supervising 10 PhD students. I work in an NHS community hospital as a consultant physiotherapist, I teach, I work as a consultant for several health companies based in the UK and internationally, I do some medical legal work, and provide online consultations for people with shoulder problems. I also love to write and create healthcare information and have just been awarded a research grant to produce patient information animations. No two days are the same.

Did you give yourself a well-deserved treat or holiday once the book was published?

Since the book was published earlier this year, I have taught in South Korea, Canada, Italy, Israel, Australia, Dubai, France, the US, Switzerland and Romania. Whenever I travel to teach, I try and take at least a day to explore the city I'm teaching in, visiting a park, museum or beach. I love gardening, carpentry, and Tai Chi (which I do really badly). I love exploring Hampstead Heath in London, and I'm so fortunate to live nearby. Every time I go it's different in some way, and it’s one of my favourite places.

What do you see as the future of the profession and, more specifically, what does the MSK physiotherapist of the future look like?

To make healthcare more sustainable, accessible, and equitable the cost, but not the quality, of care must be reduced. Physiotherapists provide expert rehabilitation and are perfectly placed to contribute to healthcare sustainability 

A substantial amount of research suggests that many elective orthopaedic procedures performed for non-traumatic shoulder pain that are followed by a long period of rehabilitation do not out-perform placebo surgical procedures and rehabilitation, or rehabilitation by itself.

To make healthcare more sustainable, accessible, and equitable the cost, but not the quality, of care must be reduced. Physiotherapists provide expert rehabilitation and are perfectly placed to contribute to healthcare sustainability.

The MSK physiotherapist of the future needs to be an expert in rehabilitation, and behavioural change, be non-judgmental, advocate for improvement in local environments to promote active transport and physical activity. Visit: https://www.tandfonline.com/doi/abs/10.1080/10833196.2021.1876598

The physiotherapist of the future also needs to know how to assess sleep quality, nutrition, unhealthy lifestyle practices, such as smoking and physical inactivity, and find ways, unique for an individual, to improve the quality of their life, based upon a holistic assessment of the individual.

They should use adjunctive therapies, such as manual therapy, taping and modalities, minimally and be careful not to use explanations for these interventions that are no longer supported by research. Much of this is discussed in the book and is also included in the courses I teach.

The Shoulder: Theory and practice is edited by Jeremy Lewis and César Fernández-de-las-Peñas.

For more information about the book and Jeremy's other professional activities, visit: https://drjeremylewis.com

Author: Edited by Ian A McMillan
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