MSKMag OutLoud

Physio Matters

MSKMag combines cutting edge clinical opinion with light hearted relief from the daily grind! Featuring insights from the finest minds in the MSK industry, MSKMag will keep you up to date with best practice evidence and the best topical memes. mskmag.substack.com

  1. Jun 1

    Beware Concierge Healthcare

    The following is not a real service. That is important to say upfront, because the uncomfortable truth is that it easily could be. If it were not so off-brand for MSKMag, you would be forgiven for assuming it was legit. And by legit, I mean real rather than credible, because this space is far from credible. Across MSK, private healthcare, wellness, performance, diagnostics and so-called longevity medicine, we are seeing the ingredients of a new commercial model beginning to converge. Advanced screening. Wearables. ‘Optimised’ nutrition. Whole-body imaging. Regenerative injections. Manual therapy. Corrective exercise. Sleep tracking. Supplements. Aesthetic medicine. Concierge-style access. All wrapped in the language of prevention, personalisation and empowerment. Many of these tools have legitimate value in the right context, for the right person, with the right clinical reasoning. That is not the concern. The concern is what happens when they are bundled together into a supposedly premium service for broadly healthy people, where the business model depends on finding things to monitor, treat, correct or optimise. False positives, incidental findings, overdiagnosis, unnecessary treatment, health anxiety and the profitable cultivation of the ‘worried well’ are not fringe concerns. They are predictable consequences when reassurance is replaced by surveillance, and when uncertainty is converted into a monthly management plan. And I most feel for the victims of this fraud: the patients who perceive that they are taking their health seriously by delegating decisions to a combination of tech and supposed professionals. So here is a spoof service brief. It is deliberately exaggerated, but only just. Please read it as satire, but don’t kid yourself that it’s fantasy. Live Safer Live Better Live Longer Introducing Live Health The ultimate personalised care plan combining the latest in medical and therapy technologies to help you feel, look and be the healthiest you can be! Our patented three-step process: * The Screening * The Treatment * The Management The Screening Your dedicated longevity clinician will guide you through a tailored examination and diagnostic pathway that identifies specific issues pertinent to you right now, as well as indicators of which elements of your health require preventative attention. This will include, but not be limited to: * Full genomic sequencing * Full blood panel * Whole-body MRI * Postural screening * Live glucose monitoring * Biomechanical examination * Sleep study * Full orthopaedic testing The Treatment Optimising your health starts with a tailored report grounded in YOUR personal test data. Your screening results will identify areas that warrant treatment and establish their order of priority. Our precise testing sequence, which examines everything from your DNA to your movement patterns, informs stage two perfectly. Treatments include, but are not limited to: * Personalised nutrition plan * Timed eating schedule * Tailored supplement regimen * Meal prep * Rehabilitation * Cryotherapy * Corrective exercises * Posture restoration * Sleep monitoring * Manual therapies * Massage * Manipulation * Acupuncture * Orthotics * Pillow, mattress and bed sheet design * Injection therapies * Stem cells * Collagen * PRP * Botox The Management It is essential that the immediate gains achieved by stages 1 and 2 are maintained to ensure long-term health outcomes. Your dedicated longevity clinician will create a schedule of maintenance care that optimises your health and keeps you on track. Whilst everyone’s management plan will be unique, here is an example from our popular LiveToday tariff: Throughout * Sleep tracker * Glucose monitoring * Meal prep Weekly * Personal training * Massage therapy * Cryotherapy Fortnightly * Manipulation * Acupuncture Monthly * Supplement adjustment * Posture review Quarterly * Corrective exercise programme * PRP, collagen and Botox top-ups * Sleep device review Annual * Blood panel * MRI scan * Stem cell therapy Some things to ponder… What good is weight training if you are burning muscle and not fat due to poorly timed exercise and supplement schedules? What good is cardio if you are further damaging a slipped disc? What good is a monthly massage without a cryotherapy flush to release the scar toxins? For too long, the healthcare of individuals has been based on data collected from groups. The most important person in your health is YOU. Take charge of your health today by instructing us to personalise your care. Express your interest here to be the first to be contacted when appointments go live in our new Wimbledon, Kensington and Alderley Edge clinics. The uncomfortable part of this spoof is not that any single component is necessarily absurd. Blood tests, imaging, exercise, nutrition, sleep work, rehabilitation, manual therapy and selected interventions can all be clinically useful when there is a clear indication. The problem is the logic of the package: screen first, find something, treat everything, then maintain indefinitely. Each of these has evidence-based utility in specific circumstances, but not in combination and not regardless of demographic: * Full genomic sequencing * Full blood panel * Whole-body MRI * Postural screening * Live glucose monitoring * Biomechanical examination * Full orthopaedic testing The following ‘treatments’ do not specifically treat anything that the aforementioned screening tests would reveal. This is also not being suggested as a list of options from which one or two things will be selected. Instead, it is presented as ‘holistic’ care that includes each of these categories and implies that all can be meaningfully tailored. * Personalised nutrition plan * Timed eating schedule * Tailored supplement regimen * Meal prep * Rehabilitation * Cryotherapy * Corrective exercises * Posture restoration * Sleep monitoring * Manual therapies * Massage * Manipulation * Acupuncture * Orthotics * Pillow, mattress and bed sheet design * Injection therapies * Stem cells * Collagen * PRP * Botox This example schedule is over-treatment on every level of analysis, with no basis in evidence. There is also emerging evidence that such close scrutiny may contribute to health anxiety. Interestingly, personal training, meal prep and sleep advice are likely to improve the health of many patients, with the risk that any progress would then be attributed to the numerous other interventions. In that model, ‘personalised care’ can become a seductive justification for abandoning proportionality. Incidental findings become opportunities. Normal variation becomes pathology. Ageing becomes a defect. Prevention becomes provocation. The patient does not leave with a clearer sense of what matters; they leave with a longer list of vulnerabilities and a subscription to manage them. This matters for MSK because our sector is especially vulnerable to this drift. We already work in a world where posture, movement, scans, asymmetries, degeneration and pain are too easily over-interpreted. Add longevity branding, consumer diagnostics and high-end concierge packaging, and the risk is obvious: we could end up selling certainty where none exists, treatment where none is needed, and dependency under the banner of optimisation. The challenge is not to reject prevention, technology or personalised care. It is to ask harder questions before we package them. Who is this for? What problem are we solving? What is the likelihood of benefit? What is the risk of harm? What happens when we find something? And are we helping people live more freely, or teaching them to monitor themselves more fearfully? Because the future of healthcare does not only depend on what we can measure. It depends on whether we have the restraint, composure and fundamental ethics not to treat every measurement as meaningful. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit mskmag.substack.com/subscribe

    7 min

  2. Jun 1

    Fighting talk - Grappling with Combat Sports Rehab

    This is a free preview of a paid episode. To hear more, visit mskmag.substack.com My interest in MSK healthcare grew out of my obsession with combat sports. In 2002 I was in the final stages of completing a maths PhD. In that same year, I became one of the first women in the UK to compete in Mixed Martial Arts (MMA) – which was at the time a small and niche sport often referred to as ‘cage fighting’. One of the first things I learned about combat sports injuries is that it was almost impossible back then to get good advice on how to get back to fighting after an injury. When I mentioned my sport to a doctor or physiotherapist, they’d look at me like I’d grown another head and suggest it was a bad idea. So, as with most things about MMA back in those days, we tried to figure it out for ourselves. As a result, my knowledge of combat sports rehab grew from an eclectic mix of things learned from books, the early internet, S&C coaches, a sports therapy course, and a lot of trial and error. A few years later I went back to university to study osteopathy, which added a more systematic understanding of clinical examination, anatomy and pathology, but I can still trace the foundations of what I do in clinic every day to those early years spent in the gym and on the mat. Know your combat sports Rehabilitation is about developing tolerance for the physical demands of an activity. For a sport like football, a lot of work has already been done to analyse these requirements. We know how to get people running, jumping or changing direction. Combat sports, on the other hand, are full of weird movement patterns and unpredictable forces. There are a plethora of injury mechanisms that don’t exist in other sports. Athletes are not just facing the risk of accidental injury; they’re also up against an opponent intending to do them physical harm. Structures ranging from the knee to the lower back find themselves loaded in positions rarely found outside of combat sports, or possibly a dungeon. And that’s before we talk about the risks associated with chokes, concussions and weight cutting induced dehydration. This means that the threshold for getting fighters back to competition level following an injury is high. Too often I see athletes who have been given a generic rehab plan, and once the pain has settled, figured that they were good to go. Even those who undergo more specific rehabilitation are rarely progressed to the intensity needed for their sport. In my experience, the majority of rehabilitation failures with this patient group are related to underloading in crucial movement patterns. The first step for any MSK practitioner wanting to treat fighters is to find out what is involved. Each discipline has its own individual set of demands. A detailed understanding of biomechanics isn’t required – but having watched a match or two, understanding some key movement patterns and being able to picture what they are doing in training goes a long way. Ask lots of questions! When it comes to getting a patient to buy into your rehab plan, demonstrating that you have an appreciation for where they need to get to is non-negotiable. Key things to find out:

    3 min

  3. Jun 1

    Switching MSK practice management software: what it actually involves (and why it's probably less painful than you think)

    This is a free preview of a paid episode. To hear more, visit mskmag.substack.com If you’ve ever caught yourself muttering “there has to be a better system than this“ mid-clinic, you’re not alone. For many MSK practice owners across the UK, the frustration with outdated practice management software has become background noise — something they’ve learned to live with rather than fix. And the reason isn’t apathy. It’s fear. Fear that switching will mean weeks of disruption, lost patient records, a confused admin team, and a to-do list that somehow gets longer. The perceived pain of migrating to something new almost always feels bigger than the daily irritation of sticking with what you’ve got. But is that fear well-founded? Or is it stopping you from making a change that would genuinely transform how your practice runs? This is a guide to what switching practice management software actually involves - the real steps, the real risks, and the questions you should be asking any provider before you commit to anything. Why MSK practices put off switching The concerns are familiar: lost patient data, a team that can’t get to grips with something new, downtime you can’t afford, or the memory of a previous migration that went badly. All legitimate. All worth taking seriously. But they are also problems that a well-designed migration process is specifically built to prevent. The question is whether the provider you’re considering has actually thought this through — or whether they’re just hoping you’ll figure it out. What a good PMS migration actually looks like Here’s the honest reality: switching your practice management software is not a weekend project. But it also doesn’t have to be a crisis. A well-run migration typically involves four stages.

    2 min

  4. Jun 1

    Notes on PAD

    This is a free preview of a paid episode. To hear more, visit mskmag.substack.com Vascular claudication is angina in the legs: pain that starts when plaque narrows an artery enough that it cannot meet a working muscle’s demand for blood. One of the first English-language descriptions, from 1904, is still apt [1]: “The patient while walking experiences paresthesia and pains in the feet; tension, pain or stiffness in the calves or even above... finally an increasing difficulty of locomotion that in increasingly shortening intervals causes the sufferer to stop completely and rest. After a short rest all of the symptoms disappear, and the subject is able to walk on as usual.” Just as angina is a symptom of coronary artery disease, vascular claudication is a symptom of peripheral artery disease, or PAD. This symptom is not always present: PAD, like coronary artery disease, is often asymptomatic. But when claudication does appear, MSK clinicians are often the first to hear about it and the first to get a chance to raise the alarm. Vascular claudication points to PAD, which in turn points to systemic atherosclerotic disease. The claudication is ‘a warning sign to you and your patient’, as one professional group puts it. Within five years, 10 to 15% of people with PAD will die of plaque-related disease [2]. Where patients feel the pain depends on where the narrowing sits.

    2 min

  5. Jun 1

    AI in MSK: Useful Tool or Clever Distraction?

    This is a free preview of a paid episode. To hear more, visit mskmag.substack.com AI in MSK is not about replacing physios; it is about removing friction, improving access, and helping clinicians and patients make better decisions with better data. The challenge is adopting it in ways that preserve clinical reasoning, data security, and the human side of rehab. There is a certain kind of AI conversation in healthcare that feels like being cornered at a conference coffee stand by a man who has just discovered both automation and his own LinkedIn voice. He says ‘disruption’ a lot. He believes every complex human problem is one dashboard away from resolution. Somewhere nearby, a glowing slide deck promises transformation. For those of us in MSK, it is hard not to meet some of this with a raised eyebrow. Not because technology is irrelevant. Quite the opposite. AI is already becoming useful in healthcare. The issue is that its most valuable applications are often the least theatrical. There is no superhero landing. No machine taking over your clinic while you retreat into a life of strategic oversight and superior coffee. The real value is quieter than that. AI is most likely to help by removing friction around clinical work rather than replacing the clinician altogether. [1, 2] And friction, if we are honest, is everywhere. It lives in the note-writing, the dictation, the referral letters, the coding, the admin trail, the endless toggling between patient interaction and digital housekeeping. It is the fact that finishing a clinic is not the same as finishing work. It is opening the laptop again in the evening to clear a backlog of notes because the day was spent doing the actual job. Recent work on ambient AI scribes suggests these systems can reduce documentation burden, lower cognitive task load, and cut some after-hours work. [5][1] That matters because cognitive load is not an abstract idea. It is what a day feels like. It is the mental drag of listening, typing, remembering, filtering, deciding, and trying to stay on time without becoming robotic. It is the slow erosion caused by monotony. And monotony matters. Repetitive low-value work does not just waste time; it consumes attention. It narrows thought. It leaves less of you available for the parts of the consultation that actually require intelligence.

    3 min

  6. Jun 1

    Great Expectations - Editorial - MSKMag Issue 30

    This is a free preview of a paid episode. To hear more, visit mskmag.substack.com Is it normal to assume that whenever someone cancels their appointment, despite explicitly thanking you and saying they’re feeling better, you’ve actually made their pain worse, ruined their life, and they’re simply too polite to tell you how terrible a clinician you are? What about when someone cancels their 8.30am appointment late the night before because they have to see their workplace clinician instead and then never responds to your email reminding them of the late cancellation policy whereby there is a fee to pay? Is it normal to assume they hate you and will be telling all their friends and colleagues to avoid? Now imagine this clinician receiving an actual email that says ‘you did not meet my expectations and therefore I’d like to cancel my appointment’. It’s me; this is my inbox. A patient whom I’d seen once a few weeks ago was now detailing that they had expected hands-on treatment and advice to use TENS. When I looked back through the notes, I knew what my response had to be. I couldn’t apologise for the treatment offered because I’d still do the same thing today - there seemed no soft tissue that warranted hands on treatment - and TENS wouldn’t have been my go-to either. I think a past iteration of me would have wanted to make things right straight away - ushering this patient back in for some poorly reasoned manual therapy; in fact, it’s on the house! Instead, I located the stomach that had dropped out of my backside on receiving essentially a rejection email, thanked the patient for their honest feedback and wished them well with their recovery. For me this is the classic expectation mismatch that we’ve seen throughout MSK care - certainly since I’ve been qualified: the patient arrives with expectations of traditional (and sometimes outdated) treatments while we attempt to balance their preference with evolving evidence. For years, MSK clinicians have grown comfortable challenging expectations around passive treatments. We’ve become better at explaining why imaging isn’t always necessary, why hands-on therapy may not be indicated, or why pain isn’t synonymous with damage. But the landscape is shifting again. Patients are no longer arriving armed only with outdated beliefs; increasingly they arrive influenced with information, wearable data, AI-generated advice and wellness narratives that often sound sophisticated, evidence-based and empowering. So what about future treatments? What about now in 2026 when patients arrive with expectations of new interventions and technologies? The challenge for modern clinicians is no longer simply rejecting outdated ideas. It’s learning how to critically appraise the endless stream of new ones. Cue June’s MSKMag. Up first, Jack Chew puts freshly hyped, package-style lifestyle medicine under the spotlight and explores where innovation risks becoming performance and packaging in ‘Beware Concierge Healthcare’. Tim Colledge makes the case for being open to the friction smoothing and meaningful improvements to care that AI can bring to health professionals in ‘AI in MSK Care: Useful Tool or Clever Distraction?’ In her piece ‘Fighting Talk: Grappling with Combat Sports Rehab’, Rosi Sexton reminds us that unfamiliar sporting populations require genuine expertise, not generic rehab principles. Staff writer Tom Jesson returns to bring us back to fundamental clinical awareness on the topic of Peripheral Artery Disease in his article ‘Notes on PAD’. Finally, Natasha Miszewski of Splose shares her practical advice on changing your practice management software with behind the scenes expertise. Read about what questions you should be asking in ‘Switching MSK Practice Management Software: what it actually involves’. The uncomfortable reality of modern MSK care is that sometimes good clinicians will disappoint patients, and sometimes convincing ideas will turn out not to be very good ones at all. But whether it’s AI, lifestyle medicine, unfamiliar sporting populations, overlooked pathology or the systems underpinning our clinics, the common thread throughout this month’s issue is adaptation. Not blind acceptance of the new, nor stubborn attachment to the old, but the ongoing challenge of deciding what genuinely deserves a place in MSK care.

    5 min

  7. May 1

    Shockwave Therapy: A Love-Hate Story, and Everything In Between

    This is a free preview of a paid episode. To hear more, visit mskmag.substack.com Shockwave therapy… I was surprised to hear it hadn’t been covered in MSKMag. So, when the opportunity came to write an article on it, I jumped at the chance. Those who know me will know I work for Physiquipe, a company who sells shockwave therapy devices. And for those who don’t know me, now you know I work for a company who sells shockwave devices! Despite my ‘commercial interest’, I’m an enthusiastic Sports Therapist who is passionate about shockwave therapy, but I am no evangelist (Jack Chew can verify). I truly believe it has its place, and if you’ve invested in this technology to better serve your patients, then kudos to you. I’ll assume most of you have encountered shockwave at some point, and you are aware of radial and focused shockwaves and their differences. If not, I implore you to have a read up as this article is not going to cover this, nor be the RCT regurgitation we see at every conference. I want to share something a little different: an honest look at what the shockwave world looks like from where I’m standing. And perhaps offer something useful for those still trying to make sense of it. There are many sides to this story, so let’s start with…

    1 min

  8. May 1

    Physios are nice...and it's killing our profession

    This is a free preview of a paid episode. To hear more, visit mskmag.substack.com Putting the finishing touches to this article, I skim back over the Writer’s Guide. It encourages me to write boldly and to not be too afraid to offend because… “you’ll be surprised how polite professional challenges are in our industry.” We are a caring bunch…and this is exactly the problem. Three years into my Physiotherapy career I rotated onto an orthopaedic ward and attended the morning trauma round. It’s a cramped office in a quiet and worn out section of the hospital. X-ray after X-ray flashes up on a large projector at the front of the room and one-by-one the consultants discuss their patients and what intricate method of carpentry they will be using. It starts smoothly; there are not many questions and this silence appears to be taken as consent to continue by those presenting. But Case 5 is different. Heads look up, Candy Crush is paused and the temperature of the room heats up. Multiple consultants pile in, questioning and attacking the proposed management. The presenter fights back… “I’ve managed dozens like this non-operatively!” “Look at the posterior fragment!! If this was your ankle, you’d fix it.” “The displacement is minimal.” “That’s nonsense! If this displaces further, that’s on us.” “And if it gets infected, that’s also on us!” I catch the eye of an OT and we share a nervous wince. The ‘nonsense’ comment seemed to cross a line. However, a few minutes later the meeting ends and instead of any awkwardness or anger, the same consultants who were tearing chunks out of each other minutes before leave together, talking about the Six Nations score at the weekend. Not one hard feeling between them… and I thought it was brilliant. Only weeks before I had been on an MSK Outpatient rotation where one of our *cough* more experienced *cough* Band 8As had been training for a half marathon and developed some hamstring pain. They were complaining during team training about how they’d tried everything to resolve it without avail. ‘EVERYTHING’ seemed to be that they had been doing frictions on their hamstring… But instead of professional disagreement or debate, there was just meek silence from us all. Just a few quiet comments later in private. Some even played along at the time, humouring the outdated practice. We are a caring bunch… but we can be incredibly fragile.

    2 min
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About

MSKMag combines cutting edge clinical opinion with light hearted relief from the daily grind! Featuring insights from the finest minds in the MSK industry, MSKMag will keep you up to date with best practice evidence and the best topical memes. mskmag.substack.com

Information

  • Creator
    Physio Matters
  • Years Active
    2024 - 2026
  • Episodes
    64
  • Rating
    Clean
  • Copyright
    © Physio Matters
  • Show Website
    MSKMag OutLoud