Clinical Rehabilitation
Theory and Practice
Dr Jeremy Lewis PhD
MAPA. MMPA. MCSP. MMACP.
Master of Science in Manipulative Physiotherapy
Postgraduate Diploma in Sports Physiotherapy
Postgraduate Diploma in Biomechanics
Clinical Rehabilitation: Theory and Practice
is a new course that covers in depth;
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
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Assessment and treatment of the shoulder region,
Tendon pathology around the body
Current trends in the treatment of acute and chronic low back pain
This course is open to all postgraduate physiotherapists.
This new course being taught by Jeremy Lewis is based on extensive clinical experience in
assessment, diagnosis and rehabilitation of the shoulder region, tendon pathologies, and low
back pain, as well as extensive reference to research publications from a variety of
disciplines. A wide variety of pathologies will be covered together with assessment and
treatment techniques. The evidence supporting the use of the assessment and treatment
procedures will also be presented. Participants completing this course will gain a greater
understanding of the anatomy, biomechanics, assessment and evidence-based treatment of
shoulder, tendon pathologies around the body, and for the treatment of low back pain.
About the course tutor:
Jeremy Lewis has lectured and taught post graduate courses in many countries throughout
the world. He has a Master of Science in Manipulative Physiotherapy, a Postgraduate
Diploma in Sports Physiotherapy and a Postgraduate Diploma in Biomechanics. Jeremy has
many publications in peer reviewed journals. He has extensive clinical experience and has
been involved in clinical, biomechanical and anatomical research.
Course duration:
Course content:
40 hours
On following page
This course can also be taken as modules, one subject at a time.
Course Details
Course Title:
The Shoulder: Theory and Practice
Course Tutor:
Dr Jeremy Lewis PhD. PT.
Dates:
To be set
Duration:
2 day module. (9am to 5:00pm on both days)
Venue:
Various
Email:
Jeremy.lewis@chelwest.nhs.uk
Web URL:
http://www.heseminars.com/the_shoulder.htm
MSc (Musculoskeletal Therapy)
Postgraduate Diploma in Sports Physical Therapy
Postgraduate Diploma in Biomechanics
Course Description
This evidence-based theoretical and practical course is based on extensive clinical
experience in assessment, diagnosis and rehabilitation of shoulder pathology, as well
as extensive reference to research publications from a variety of disciplines. A number
of pathologies will be discussed together with appropriate assessment and treatment
techniques, and the evidence supporting the use of these assessment and treatment
procedures will also be presented. Participants completing this course will gain a
greater understanding of the anatomy, biomechanics, assessment and evidence-based
treatment of this interesting and complicated region of the body. This course has
achieved international recognition and has been taught in numerous countries around
the world.
Course Content:
Day 1:
 Introduction and epidemiology
 Clinical anatomy and biomechanics
This session reviews the anatomy and biomechanics of the shoulder region from the
clinical perspective. Use is made of cadaver, imaging, biomechanical and video models
of the shoulder region.
 Subjective and physical examination
This clinically orientated session highlights the components of the subjective and
physical examination of the shoulder that will assist the clinician through the clinical
reasoning process. It will include scapular repositioning procedures, functional
glenohumeral repositioning tests, determining the influence of the thoracic spine on
the shoulder symptoms. The session will also consider procedures to differentiate
shoulder pain arising from the cervical spine and visceral tissues. A variety of tests to
investigate the structural integrity of the shoulder will be included, as well as clinical
sensorimotor control testing. A critical discussion on the role of soft tissue and joint
palpation involving joint mobilisation, myofascial trigger point therapy and
acupuncture therapy will also be included. A critical review of the role of imaging in
the shoulder examination will be included.
 Posture, muscle imbalance and shoulder pain
This theoretical and practical session involves a detailed and critical review of the
proposed effect of the influence of posture and muscle imbalance on shoulder
pathology. Assessment and rehabilitation programmes are presented.
 Management of acute shoulder pain
This clinically orientated session details recommendations for the management of
acute shoulder pain. This session will include a critical appraisal of the use of joint
mobilisation, acupuncture and myofascial pain syndrome in the management of the
shoulder pain and is aimed at facilitating the clinician through the clinical reasoning
process.
Day 2:
 Shoulder impingement syndrome / Rotator cuff disease
This theoretical and practical session involves a very detailed and in-depth review of
this multi-factorial problem. The current evidence based research across a number of
professions evidence regarding the aetiology and pathology of this condition will be
presented in detail. This session includes a review of the evidence supporting various
rehabilitation strategies, and will include recommendations for treatment from the
acute through chronic stages of rehabilitation, including sensorimotor techniques.
Conservative versus surgical outcomes will be considered, as will the evidence base for
steroid injections and NSAIDs in the management of this condition.
 The stiff and restricted shoulder
Theoretical and practical session including pathology, assessment and treatment
techniques for the stiff and restricted shoulders. This session involves a number of
new mobilisation techniques and a discussion on the merits of sustained versus
oscillatory styles of mobilisation including their evidence base and their clinical
effectiveness.
 Taping techniques for the shoulder
Discussion on the evidence base of taping techniques. Demonstration and practice
of techniques, and, rationale and basis for their efficacy.
 Latest developments / Patient scenarios / Discussion
Course Programme:
Day 1:
9:00-10:30
Day 2:
Introduction and Epidemiology
9:00-10:30
Shoulder Impingement Syndrome
and Rotator Cuff Disease
This theoretical and practical session involves a very
detailed and in-depth review of this multi-factorial
problem. The current evidence based research across
a number of professions evidence regarding the
aetiology and pathology of this condition will be
presented in detail.
Anatomy and biomechanics
of the shoulder
This session reviews the anatomy and biomechanics
of the shoulder region from the clinical perspective.
Use is made of cadaver, imaging, bioemechanical
and video models of the shoulder region.
10:30-10:45
Coffee / Tea Break
10:30-10:45
Coffee / Tea Break
10:45-12:30
Subjective and physical examination
This clinically orientated session highlights the
components of the subjective and physical
examination of the shoulder that will assist the
clinician in the clinical reasoning process. It will
include scapular repositioning procedures,
functional glenohumeral repositioning tests,
determining the influence of the thoracic spine on
the shoulder symptoms. The session will also
consider procedures to differentiate shoulder pain
arising from the cervical spine and visceral tissues.
10:45-12:30
Shoulder Impingement Syndrome
and Rotator Cuff Disease (cont.)
This session includes a review of the evidence
supporting various rehabilitation strategies for
impingement and rotator cuff pathology, and will
include recommendations for treatment from the acute
through chronic stages of rehabilitation, including
sensorimotor techniques. Conservative versus
surgical outcomes will be considered, as will the
evidence base for steroid injections and NSAIDs in
the management of this condition.
12:30-1:30
Lunch
12:30-1:30
Lunch
1:30-3:00
Posture and Muscle Imbalance
This theoretical and practical session involves a
detailed and critical review of the proposed effect
of the influence of posture and muscle imbalance
on shoulder pathology. The concept of patient
specific posture is discussed and practiced.
Assessment and rehabilitation programmes are
presented.
1:30-3:00
The stiff and restricted shoulder
Theoretical and practical session including pathology,
assessment and treatment techniques for the stiff and
restricted shoulders. This session involves a number
of new mobilisation techniques and a discussion on
the merits of sustained versus oscillatory styles of
mobilisation including their evidence base and their
clinical effectiveness.
3:00-3:15
Tea / Coffee Break
3:00-3:15
Tea / Coffee Break
3:15-4:00
Posture and Muscle Imbalance (cont)
Rehabilitation of posture and muscle imbalance
using patient specific posturing.
3:15-4:00
Taping Techniques for the Shoulder
Discussion on the evidence base of taping techniques.
Demonstration and practice of techniques, and,
rationale and basis for their efficacy.
4:00-5:00
Acute Shoulder Pain
This clinically orientated session details
recommendations for the management of acute
shoulder pain. This session will include a critical
appraisal of the use of joint mobilisation,
acupuncture and myofascial pain syndrome in the
management of the shoulder pain and is aimed at
facilitating the clinician through the clinical
reasoning process.
4:00-4:30
Latest Developments
Update on current clinical and laboratory research
findings.
Methods and database searching strategies to answer
clinical questions.
4:30-5:00
Patient Scenarios / Discussion
Learning Outcomes
1
To develop a better understanding and knowledge of the clinical anatomy and biomechanics
of the shoulder girdle.
2
To develop a comprehensive subjective and physical evaluation strategy for the shoulder that
considers local and referred (cervical and visceral) sources of pain and directs the clinician to
develop an appropriate management plan.
3
To develop greater confidence with the ‘hands-on’ physical assessment of the shoulder region
and a better understanding of the evidence for the use of the selected assessment
techniques.
4
To develop a greater understanding and knowledge of various pathologies of the shoulder
girdle.
5
To develop greater competency in the management of patients with a variety of shoulder
pathologies including; the acute shoulder, shoulder impingement syndrome, rotator cuff, the
stiff and restricted shoulder, the unstable shoulder, shoulder pain syndromes, and pain
referred to the shoulder.
6
To review the research evidence relating to the influence of posture and muscle imbalance
and its relationship with shoulder pathology.
7
To review the evidence underpinning the pathology, and the assessment and management of
various shoulder conditions.
8
To review the research evidence evaluating the use of diagnostic imaging as part of the
management for musculoskeletal disorders of the shoulder.
9
To review the research evidence evaluating the use of CS injections and NSAIDs as part of
the management for musculoskeletal disorders of the shoulder.
10
To develop a greater confidence in the use of taping techniques for the scapulothoracic and
glenohumeral joints and evaluation of the efficacy of the techniques.
Selected Publications
Lewis J, Green A, Wright C. Subacromial impingement syndrome: The effect of changing posture on
shoulder range of movement. Journal of Orthopaedic and Sports Physical Therapy (in press)
Lewis J, Hewitt JS, Billington L, Cole S, Byng J, Karayiannis S. A randomised clinical trial comparing
two physiotherapy interventions for chronic low back pain. Spine (in press)
Lewis J, Green A, Wright C. Subacromial impingement syndrome: The role of posture and muscle
imbalance. Journal of Shoulder and Elbow Surgery (in press)
Smith J, Lewis J, Prichard D. Physiotherapy exercise programmes: are verbal instructions sufficient?
Physiotherapy Theory and Practice (in press)
Hochstetter JK, Lewis J, Soares-Smith L. Can physiotherapy reduce breathlessness? The immediate
impact of physiotherapy rehabilitation for the breathless patient. Physiotherapy (in press)
Lewis J (2004) Subacromial impingement syndrome and posture: does a relationship exist? In
Touch. Journal of the Organisation of Chartered Physiotherapists in Private Practice. Autumn Edition
Saranga J, Green A, Lewis J and Worsfold C (2003) Effect of a lateral glide on the upper limb
neurodynamic test 1. Physiotherapy. 89 (11): 678-684.
Alexander CM, Stynes S, Thomas A, Lewis J and Harrison PJ (2003) Does tape facilitate or inhibit
the lower fibres of trapezius? Manual Therapy. 8 (1): 37-41.
Lewis J, Green A, Reichard, Z and Wright C (2002) Scapular position: the validity of skin surface
palpation. Manual Therapy. 7 (1): 26-30.
Lewis JS, Green A and Dekel S (2001) The aetiology of subacromial impingement syndrome.
Physiotherapy. 87 (9): 458-469.
Lewis J, Yizhat Z, Green A, Pennington D. (2001) Subacromial impingement syndrome: Has
evolution failed us? Physiotherapy. 87 (4): 191-198.
Lewis JS, Green AS and Wright C (2001) Reliability of a clinical device for measuring the threedimensional position of the scapula. Physiotherapy. 87 (2): 85.
Lewis J and Tehan P (1999) A blinded study investigating the use of diagnostic ultrasound for
detecting active myofascial trigger points. Pain. 79(1): 39-44.
Mendelson S, Milgrom C, Finestone A, Lewis J, Ronen M, Burr D, Fyhrie D, Hoshaw S, Simkin A and
Soudry M. (1998) Effect of cane use on tibial strain and strain rates. American Journal of Physical
Medicine and Rehabilitation. 77 (4): 333-338.
Lewis J, Ramot R and Green A (1998) Changes in mechanical tension in the median nerve: Possible
implications for the upper limb tension test. Physiotherapy. 84 (6): 254-261.
Lew P, Lewis J and Story I (1997) Intertherapist reliability in locating latent myofascial trigger
points using palpation. Manual Therapy. 2 (2):87-90.
Lewis J (1992) Muscle imbalance and its effect on posture and function: A review of the Janda
Approach. The Australian Massage Therapy Journal. Vol 5 (1): 18-22.
Lewis J (1992) Myofascial Pain Syndrome: A Review of the Literature. The Australian Massage
Therapy Journal. Vol 4 (3): 38-44.
Tendinopathy Course Programme
Day 1
Day 2
9:00 to 9:30
Normal tendon anatomy and
function
9:00 to 9:30
Tendon imaging
 What does it tell us?
 Is it worthwhile?
9:30 to 10:30
Tendinopathies
9:30 to 10:30
The patellar tendon
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What is a tendinopathy?
What causes a
tendinopathy?
Histological changes
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

Function
Pathology and
classification
Assessment
10:30 to 11:00
Coffee / Tea break
10:30 to 11:00
Coffee / Tea break
11:00 to 11:45
The evidence for and against
different models of pathology
11:00 to 11:45
The Achilles tendon
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11:45 to 12:30
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Degenerative
versus
inflammatory
To inject or not to inject
Rotator cuff tendinopathies
11:45 to 12:30
This theoretical and practical session involves a
detailed review of this multi-factorial problem.
Specialised assessment techniques, treatment
regimes and patient scenarios will also be
presented. The emerging evidence of intrinsic
rotator cuff tendinopathy as a primary cause
of pathology will be presented in detail. This
session includes a review of the evidence
supporting various rehabilitation strategies,
and presents new methods of treatment from
the acute through chronic stages of
rehabilitation.
Function
Pathology and classification
Assessment
Biomechanical assessment of the
pelvis and lower limb
Demonstration and practice of assessment
techniques, used in the rehabilitation of tendon
pathologies.
12:30 to 1:30
Lunch
12:30 to 1:30
Lunch
1:30 to 3:00
Rotator cuff tendinopathies (cont.)
1:30 to 3:00
Treatment techniques for lower limb
tendinopathies
3:00 to 3:15
Coffee / Tea break
3:00 to 3:15
Coffee / Tea break
3:15 to 4:00
Common extensor origin tendons.
3:15 to 4:00
Continuation of treatment
techniques for lower limb
tendinopathies
Theoretical and practical session involves a
detailed review of this multi-factorial problem
Questions and discussion
Clinical Rehabilitation
Theory and Practice
Part 3: Low Back Pain
Evidence based practice for the assessment and management
of acute and chronic low back pain.
Low Back Pain (1 day) Course Programme
9:00-10:15:
Anatomy and Biomechanics of the Lumbar Spine
Low Back Pain Categories
A review of the clinical anatomy and biomechanics of the lumbosacral region.
Identification of different types of low back pain.
10:15-10:30:
Coffee Break
10:30-12:00:
Palpation
The value of palpation as a diagnostic tool in the assessment of lumbosacral pathology.
A critical review of the scientific evidence. What is the place of palpation as an assessment
and treatment tool?
12:00-12:30:
Imaging
The value of imaging as a diagnostic tool in the assessment of lumbosacral pathology.
12:30-12:45:
Lunch
12:45-14:45:
Assessment and Management
A critical discussion of the current scientific literature for evidence based assessment and
management of acute and chronic LBP. Including assessment and management guidelines.
14:45-15:00:
Coffee Break
15:00-16:30:
Manual Therapy Practical Session
Demonstration and practice of selected manual therapy techniques for the lumbosacral region.
16:30- 17:00:
Questions and discussion
Courses in Israel
Course:
Clinical Rehabilitation
40 hour course, includes;



Shoulder
Tendinopathies
Low back pain
2 days
2 days
1 day
16 hours
16 hours
8 hours
---------40 hours
Can be taken as one 40 hour course, or as 3 separate courses/ modules
Course cost
Per participant (include VAT –collel MAM )
TOTAL COURSE
Clinical Rehabilitation
MODULES



2 day Shoulder
2 day Tendinopathy
1 day LBP
(40 hours)
(16 hours)
(16 hours)
(8 hours)
1440NIS
(collel MAM)
580NIS
580NIS
280NIS
(collel MAM)
(collel MAM)
(collel MAM)