Show Notes
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.
More from The Physio Matters Podcast
CLICK HERE FOR SPLOSE In this episode of Chewing It Over, Jack speaks with Nick, founder of Splose, about the evolution of practice management software, artificial intelligence and the challenges facing modern MSK clinics. Nick shares his unconventional journey from building websites for allied health professionals in Australia to developing an all-in-one practice management platform. After repeatedly encountering clinicians frustrated by disconnected systems, time-consuming documentation and inefficient administration, he decided to build something different. The conversation explores how Splose has evolved, particularly following the introduction of AI functionality in 2024. Its AI scribe now extends beyond simple transcription, incorporating patient histories, previous consultations and administrative information to support clinical documentation. However, Nick is clear that AI should support rather than replace clinical judgement. Jack challenges him on the future of automated objective assessments, the potential for increasingly sophisticated monitoring technologies and the risk of clinicians becoming complacent when reviewing AI-generated records. They also discuss Splose's expansion into the UK, where the complexity of private medical insurance billing initially presented unexpected challenges. Nick explains how partnerships with Healthcode and ePractice-related providers helped address these barriers. The discussion broadens into software development, customer feedback, investor expectations and the importance of maintaining a product-led philosophy while scaling a technology business. Finally, Nick identifies clinician burnout, administrative overload and financial pressures as major challenges facing allied health. Ultimately, the episode argues that the most valuable healthcare technology isn't necessarily the most autonomous. It's the technology that gives clinicians more time, attention and capacity to care for patients. 5 clinical/professional takeaways - AI scribes are becoming much more than transcription tools. Integrating previous patient history, consultation information and administrative workflows could make documentation significantly more useful, rather than simply faster. - Clinical judgement remains essential. AI can help generate and organise documentation, but clinicians must still review and approve their records. Objective assessment is particularly challenging when important findings cannot be reliably captured through audio alone. - Automation introduces new risks as well as efficiencies. The easier it becomes to produce clinical notes, the easier it may become to approve them without sufficient scrutiny. Saving time must not come at the expense of clinical accuracy. - Practice management software needs to reflect local healthcare systems. Splose's experience entering the UK demonstrates how billing, private medical insurance and payment processes can become major barriers, even when the underlying clinical software is well received. - Reducing burnout requires more than technology. Administrative automation can reduce unnecessary work, but it cannot independently solve the emotional, professional and financial pressures facing clinicians. Education, mentorship and appropriate clinical support remain essential.
MSKAwards.com
In this episode of Chewing It Over, Jack is joined again by Asaf Weisman for a deliberately challenging discussion about some of the prevailing ideas within modern pain science. Asaf argues that pain medicine has spent decades on a series of intellectual “side quests”, particularly following the development of the biopsychosocial model and modern definitions of pain in the 1970s. His criticism isn't that psychological, social or neurological factors are irrelevant, but that theoretical possibilities have sometimes been promoted with greater certainty than the evidence warrants. A central theme is nociception and the role of the brain. Asaf challenges descriptions of pain as simply an output of the brain or a neurological expression of perceived threat. Instead, he argues that pain requires underlying somatic signalling, while the brain participates in processing and modulating that experience rather than independently generating it. The discussion explores the language clinicians use around pain, the distinction between modulation and causation, and whether attempts to explain persistent pain have sometimes made the subject unnecessarily complex. Importantly, the conversation also identifies areas of agreement. Asaf accepts that psychological and social factors can substantially alter an individual's pain experience, even when underlying nociceptive signalling remains unchanged. Stress, context and other factors can influence pain through modulation. For clinicians, this creates a more practical discussion about management. Rather than becoming trapped in theoretical explanations, Asaf argues for identifying and addressing modifiable risk factors associated with persistent pain, while using exercise, modalities and other interventions where they help patients pursue meaningful activity. It's a provocative conversation that challenges clinicians not simply to replace one pain model with another, but to scrutinise the assumptions underneath both. Be precise about causation versus modulation. A psychosocial factor influencing the intensity of someone's pain doesn't necessarily establish that it independently caused the pain. That distinction is central to Asaf's argument.
In this episode of Chewing It Over, Jack is joined by Laura Bevan, Head of Communications at Physio Matters, for a complete guide to the inaugural MSK Awards — and, remarkably, Laura's first ever podcast appearance. Taking place on 27 November in Birmingham, the MSK Awards have been created as a dedicated celebration of excellence across the MSK community. Rather than another conference or educational event, the evening is designed to recognise the clinicians, leaders and teams making a genuine difference to patients and colleagues — including those whose work often happens quietly behind the scenes. Jack and Laura discuss the thinking behind the awards, the categories, nominations and judging process, as well as what attendees can expect from the evening itself. The ambition is to create something that combines a prestigious awards ceremony with a genuinely enjoyable end-of-year celebration: dinner, entertainment, networking and a proper party with the wider MSK community. They also reveal that two-time Olympic triathlon champion Alistair Brownlee will join the event as its celebrity guest speaker. Rather than simply making an appearance, Brownlee will be interviewed about his experiences of injury, rehabilitation and working with MSK professionals throughout an extraordinary elite sporting career. With leading MSK clinicians and educators attending alongside teams from across the profession, the awards are intended to become an annual opportunity to recognise the breadth of work happening across MSK healthcare. The message is simple: our profession spends plenty of time discussing how it can improve. Sometimes it should also celebrate what it's already doing brilliantly.
dataplayer.io In this episode of Chewing It Over, Jack speaks with Elona Bregasi and Xhesika Tusha from Dataplayer about why many clinic owners are effectively “flying blind” when it comes to understanding the performance of their businesses. Clinicians are trained to deliver healthcare, not necessarily to run data-driven organisations. As a result, many practices rely heavily on intuition, revenue figures and diary occupancy when making business decisions. The problem is that a busy clinic can still have significant weaknesses hidden beneath those headline numbers. Elona and Xhesika highlight patient retention as a particularly important example. A clinic may have a full diary because it continually attracts new patients, while simultaneously losing existing patients earlier than expected. Without measuring retention, cancellation rates, utilisation and future appointment coverage, owners can miss these underlying problems. The conversation also explores another growing challenge: having too much data. Information may be scattered across practice management, accounting and booking systems, while clinic owners increasingly experiment with uploading spreadsheets into generic AI tools. Without a consistent data model or appropriate expertise, this can create misleading conclusions and potentially introduce concerns around sensitive patient and business information. Dataplayer aims to bring these different sources together, turning raw operational information into dashboards and actionable insights tailored to each clinic. Ultimately, the discussion argues that good clinic data isn't about collecting everything. It's about identifying measurable, actionable metrics that help owners understand what's actually happening—and using them to make better decisions about patients, clinicians and the future of their business.