The Physio Matters Podcast

In this episode of Chewing It Over, Jack speaks with Nick Ilic about shockwave therapy, clinical uncertainty, and the problem with taking overly confident positions in MSK practice.
Nick argues that shockwave is only really “shocking” when clinicians either oversell it as a powerful long-term solution or dismiss it entirely without proper consideration. Much of the conversation sits deliberately in the middle ground: shockwave may have a role, but the evidence does not support grand claims across broad MSK conditions.
The discussion explores the tension between proposed mechanisms and clinical outcomes. Shockwave is often described as creating a pro-inflammatory or mechanotransductive stimulus, potentially “restarting” a repair process in chronic tissue. However, Nick is cautious about mechanistic certainty, noting that many MSK interventions have attractive theoretical explanations that become far less convincing when tested rigorously.
They also discuss how shockwave may simply act as another form of neuromodulation, particularly when outcomes appear similar between focused and radial approaches, or when benefits are mainly short term. Nick is especially critical of “condition creep,” where a modality gradually becomes marketed for more and more problems despite limited supporting evidence.
Importantly, he does not dismiss shockwave altogether. He acknowledges stronger evidence for indications such as calcific tendinopathy and non-union fractures, where the mechanism and evidence appear more plausible. But for common tendinopathies and broader pain presentations, he remains sceptical of inflated claims, especially when patients are paying privately.
Overall, this is a funny, sharp, and thoughtful conversation about evidence, uncertainty, informed consent, and why clinicians should be wary of both hype and lazy scepticism.
5 clinical/professional takeaways
Avoid overconfidence in either direction. Shockwave should not be sold as a miracle treatment, but dismissing it completely may also be too simplistic.
Mechanistic plausibility is not enough. Claims about pro-inflammatory effects, mechanotransduction, or tissue “restart” need to be matched by meaningful clinical outcomes.
Context matters. Shockwave may be more defensible in areas like calcific tendinopathy or non-union fractures than in broad tendinopathy or general pain presentations.
Short-term pain relief is not the same as recovery. Clinicians should be careful not to confuse temporary neuromodulation with long-term tissue change.
Consent and expectation-setting are crucial. If patients are paying privately, they deserve a clear explanation of likely benefits, uncertainty, cost, and alternative options.

In this episode of Chewing It Over, Jack speaks with Wesley Clark Sullivan about Medimo, a marketplace designed to make private MSK care easier to find and book. The central idea is simple: in most sectors, people are used to consumer-friendly platforms like Booking.com, Uber, or Deliveroo, yet private healthcare still often relies on clunky directories, fragmented websites, and high-friction booking journeys.
Wesley explains that the idea emerged from his background in marketing and e-commerce, combined with insight from private insurance pathways where even approved patients often fail to complete the final step of actually booking care. That gap led him to spot a wider opportunity: a marketplace that helps patients search by postcode, compare options, view live availability, and make an appointment quickly.
A major theme of the conversation is fairness and visibility for clinics. Smaller independent practices often do not have the time, budget, or expertise to compete with bigger players in SEO, paid advertising, or constant social media output. Medimo aims to level that playing field by acting as a neutral marketplace where clinics can be found more easily, without needing large marketing budgets.
Jack explores both the promise and the risks of this model, including concerns around patient data, platform dependency, and whether the service might simply intercept patients clinics would have acquired anyway. Wesley responds by outlining Medimo’s approach to data security, its free-to-list structure, and its revenue model based only on the first appointment.
Overall, the episode is about improving patient access while helping clinics reach the right people more efficiently, without compromising trust or standards.
https://medimo.co.uk/

eosactive.co.uk
In this episode of Chewing It Over, Jack speaks with Jim Carr from EOS Active about a part of MSK practice that often gets overlooked or handled poorly: the relationship between products, pathways, branding, and patient communication.
Although EOS Active technically sells products into the MSK space, Jim is clear that he does not want to be seen as simply “selling injections.” Instead, he argues that products only make sense when they are nested within a wider, well-reasoned patient pathway. An injection, brace, cryotherapy device, or sleeve is not the story in itself; it is only one possible component of a longer management process shaped by rehabilitation, education, timing, and patient context.
A major theme of the conversation is that clinics often inherit their marketing language from manufacturers without fully realising it. Glossy flyers, miracle-style testimonials, and product-led messaging can slowly become part of a clinic’s identity, even if they do not reflect how that clinic actually wants to practise. Jim’s answer is to help clinics present information in a more neutral, patient-centred way that supports trust rather than hype.
The discussion also explores why Jim feels unusually aligned with private clinics. He sees parallels between building a distribution business and building a clinical service: both require strategy, long-term thinking, and careful management of brand and reputation. Rather than pushing the newest thing, he prefers established, sensible options that fit real-world practice.
Overall, this episode is about thinking beyond transactions. It asks clinics to be more intentional about what they communicate, how they communicate it, and how commercial choices shape the care experience patients receive.

Cingal® as a multi-joint injection is now EU MDR certified.

The certification includes expanded indications for multiple synovial joints, including the knee, hip, shoulder and ankle, supporting broader clinical application.

As part of the MDR transition, the manufacturer is completing the final administrative steps to ensure update IFUs and supporting documentation are available in line with regulatory requirements. Further information will be shared in due course. Eos active as te UK partner are preparing updated marterials allowing you to communicate appropriatley with patients in clinic and can answer questions and quiries about this recent update.

In this episode of Chewing It Over, Jack speaks with Finn Stevenson about Flok Health and the idea of an AI physiotherapy service for back pain. Finn frames the problem clearly: in musculoskeletal care, especially within the NHS, the issue is often not knowing what works, but getting timely access to the care that already exists. With demand rising faster than workforce growth, traditional one-to-one care models struggle to keep up.
Finn explains that Flok is not positioned as a software tool sold to clinicians, but as a regulated clinical service that combines AI with remote human physiotherapy support. Its current focus is spinal pain, particularly the large group of patients who can benefit from personalised exercise, reassurance, behaviour change support, education, and psychologically informed care. The ambition is to automate large parts of the pathway safely and consistently, while freeing face-to-face clinicians to focus on more complex cases.
A major part of the conversation explores how this works. Finn distinguishes Flok’s system from standard large language model chatbots, arguing that healthcare needs much tighter behavioural control. He describes a rule-based clinical reasoning system combined with a video-based interaction model built around “Kirsty,” a real physiotherapist whose filmed responses are assembled in real time to create a more human and engaging consultation experience.
The discussion also tackles controversy: what counts as “physiotherapy,” whether this threatens the profession, and what happens when technology enters clinical care at scale. Jack remains probing but open-minded, while Finn argues that the bigger ethical issue is leaving patients stuck on long waits for care we already know how to deliver.
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In this episode of Chewing It Over, Jack speaks with Andrew Walton, offering what Andrew describes as “a view from the top” of healthcare leadership and professional practice .
The conversation explores Andrew’s career journey and the lessons that come from working across clinical practice, leadership roles, and wider healthcare systems. Rather than focusing purely on clinical skills, Andrew highlights the importance of systems thinking, collaboration, and understanding the broader context in which healthcare operates.
A key theme of the discussion is the gap that can exist between frontline clinicians and decision-making structures. Andrew reflects on how leaders must balance competing pressures: workforce constraints, service demands, financial limitations, and patient outcomes. From this perspective, clinical excellence alone is not enough — meaningful change requires clinicians to engage with the organisational and strategic dimensions of healthcare.
Jack and Andrew also discuss how clinicians can develop leadership capabilities throughout their careers. Leadership is not framed as a job title but as a mindset and responsibility, where clinicians contribute to improving services, supporting colleagues, and advocating for better patient care.
Importantly, Andrew emphasises that leadership roles can feel distant or inaccessible to many clinicians. However, understanding how decisions are made — and how clinicians can influence them — helps bridge the gap between policy, management, and clinical practice.
Ultimately, the episode offers a reflective look at the profession from a strategic vantage point, encouraging clinicians to think beyond individual patient encounters and consider their wider role in shaping healthcare systems.