Nick Ilic Physio Clinician

07/01/2026

“You’re really tight.”
“You’re very stiff.”

We hear these phrases all the time — and they sound scientific.
But what do they actually mean?

Short version: tightness and stiffness are sensations, not tissue read-outs.
And the evidence shows they’re poorly correlated with what your muscles or joints are actually doing.

I’ve written a new post that:
🔹 Reviews the research on tightness, stiffness, and tissue properties
🔹 Explains why feeling stiff ≠ being mechanically stiff
🔹 Explores how body perception and context shape what we feel
🔹 Looks at how this narrative got out of hand — and why it’s costly for patients and the health system
🔹 Separates “this feels good” care from claims of structural correction

This isn’t anti-manual therapy.
It’s pro-accuracy, pro-literacy, and pro-helping people exit beliefs that quietly increase fear, dependency, and cost.

If you’ve ever been told you’re “tight”, “out”, or “locked up” — this one’s for you.

🔗 Read here: https://open.substack.com/pub/nickilicphysio/p/clinicians-corner-what-is-all-this

06/01/2026

A common question I get from clinicians is:

“How do you manage TFCC injuries?”

My usual response is:

“How do you know it’s TFCC in the first place?”

That pause that follows is familiar.

Confirmed, symptomatic TFCC tears are rare in routine MSK practice. Even MRI can struggle — what’s reported as TFCC often turns out to be LT ligament or proximal carpal pathology, and sometimes the reverse.

In many non-traumatic cases, the specific “TFCC” label doesn’t actually change management.
What it can change is how a patient understands (and fears) their wrist pain — especially once they go home and Google worst-case scenarios.

This is why I often prefer terms like “ulnar-sided wrist pain” or “ulnar compartment irritation” when certainty is limited. Same management. Less threat.

I’ve written a full Clinician’s Corner post on this — covering:
• why true TFCC tears are uncommon
• why MRI isn’t definitive
• why ECU pathology is often more likely
• and why restraint is sometimes the most skilled clinical decision

👉 Full post here:
https://nickilicphysio.substack.com/p/clinicians-corner-ulnar-wrist-pain

04/01/2026

Here's the research version of my blog
https://nickilicphysio.substack.com/p/the-year-is-2035-and-physiotherapists

The editorial “Defining Our Future”, published in the Journal of Physiotherapy (2025), delivers a powerful message: the future of the physiotherapy profession depends on the standardisation of levels of practice—a foundation for safer patient care, stronger career pathways, and greater impact on population health.

💡SHAPING THE FUTURE OF PHYSIOTHERAPY: STANDARDISING LEVELS OF PRACTICE AS A FOUNDATION FOR GLOBAL SUSTAINABLE DEVELOPMENT**

🔆 Physiotherapy at a Historical Turning Point
In the context of profound transformation within global healthcare systems, the role of physiotherapy has never been more critical. Rapid population ageing, the growing burden of chronic disease, and increasing demand for comprehensive rehabilitation require physiotherapists to move beyond merely “treating symptoms” toward innovation, leadership, and integration within modern healthcare models.

However, variations in terminology, educational levels, and models of practice across countries have become significant barriers to harmonised professional development and international recognition of competence.

🔆 Three Contemporary Levels of Physiotherapy Practice
The authors Tim Noblet, Richard Newsham-West, Catherine Dean, and Alison Rushton (2025) propose a three-level model of physiotherapy practice, regarded as a strategic framework for the future of the profession globally.

1️⃣ Clinical Specialist
• Physiotherapists with advanced expertise in a specific domain (e.g., neurology, musculoskeletal, cardiorespiratory, paediatrics).
• Capable of independent clinical decision-making and managing complex cases.
• Typically recognised through Fellowship programs or specialist certification.
➡️ Focus: Advanced clinical expertise to optimise patient outcomes.

2️⃣ Advanced Practitioner
• Integrates advanced clinical expertise with four core capability pillars: Clinical Practice – Leadership & Management – Education – Research.
• Serves as a catalyst for innovation and system integration.
• Typically aligned with postgraduate education (master’s level or higher).
➡️ Focus: Integrating expertise, leadership, and research to shape modern models of care.

3️⃣ Expert Practitioner
• Represents the highest level of professional and academic influence.
• Engages not only in clinical practice but also in policy leadership, research, and international professional development.
• Often holds doctoral or postdoctoral qualifications and occupies senior academic or strategic leadership roles.
➡️ Focus: Shaping the future through innovation and system-level impact.

🔆 Standardising Levels of Practice – For Patients and for the Profession
The authors emphasise that clearly defining and standardising levels of practice will:
• Enhance quality and safety of patient care,
• Strengthen career development and professional capability,
• Facilitate international workforce mobility,
• Ensure a unified professional voice within global healthcare systems.

Examples from the United Kingdom, Canada, Australia, New Zealand, and Singapore demonstrate that when levels of practice are standardised, physiotherapy becomes more influential, strategically positioned within healthcare, and more widely recognised by society.

🔆 The “Four Pillars” of Advanced Physiotherapy Practice

The authors describe four pillars underpinning Advanced Practice Physiotherapy:
1. Clinical Practice: Advanced diagnostic reasoning and evidence-based management of complex conditions.
2. Leadership & Management: Service leadership, innovation in care models, and interdisciplinary collaboration.
3. Education: Teaching, mentoring, and supporting lifelong learning.
4. Research: Participation in or leadership of research, evaluation, and quality improvement.
These four pillars are presented as a global capability framework for contemporary physiotherapists—ensuring balanced development across clinical, academic, and societal domains.

✴️ Impact and Future Directions
If the global physiotherapy profession adopts a unified framework for levels of practice, the potential benefits are substantial:
• For individuals: Clear, structured career pathways and opportunities for professional advancement.
• For healthcare systems: Improved efficiency, cost-effectiveness, and quality of care.
• For communities: More equitable access to safe, high-quality rehabilitation services.

❤️ “Standardised levels = Safer care, Stronger careers, Greater impact.”
(Tim Noblet et al., Journal of Physiotherapy, 2025)

10/12/2025

🔎 New Clinician’s Corner blog
💪 “Nope. Kids Do Not Get Tennis Elbow.”
https://nickilicphysio.substack.com/p/clinicians-corner-nope-kids-do-not

I’m still seeing so many active kids (especially tennis players) told they have “tennis elbow” and given straps, stretches, icing, or adult-style rehab programs.

The truth?
Kids are not little adults.

Their elbows don’t develop tendinopathy.
They don’t get “tennis elbow.”
And a strap or forearm stretches won’t fix an irritated growth plate.

So what do kids get?
👉 Growth-plate irritation
👉 Apophyseal overload
👉 Bone stress
👉 Cartilage overload
👉 Overuse injuries linked to rapid growth + high training loads

When we understand the biology, everything changes:
• We choose the right exercises
• We avoid the wrong ones
• We protect growth plates
• We guide the type of rest they actually need
• And we help kids get back to sport safely and confidently

This new article breaks down what lateral elbow pain in active 10–16yo athletes really means — and why correct diagnosis matters so much for young, high-load tennis players.

👇 Read the full post here
https://nickilicphysio.substack.com/p/clinicians-corner-nope-kids-do-not

More from my “Kids don’t get adult stuff (most of the time…)” series:

🔹 Kids don’t get plantar fasciitis
https://nickilicphysio.substack.com/p/clinicians-corner-their-kiddo-has

🔹 Active kids don’t get rotator-cuff problems
https://nickilicphysio.substack.com/p/clinicians-corner-servers-shoulder

🔹 Active kids shouldn’t have persistent back pain
https://nickilicphysio.substack.com/p/parents-playbook-kids-should-not

02/12/2025

🎬 NEW Clinician’s Corner Elbow Case Study
“Smoke on MRI, Fire in the Scope”
(Featuring the one and only Doctor Montana Joans 🧢🏺🐍)

🔗 Read it here:
https://nickilicphysio.substack.com/p/clinicians-corner-case-study-stiff

Ever had a patient with an elbow that’s cranky, inflamed, stiff, and keeps rebounding every time you try to restore ROM or function?

This case is exactly that — and it turned into an adventure worthy of its own movie poster.

Inside this case study, we explore:

🔹 Why “tennis elbow” often isn’t tennis elbow
🔹 Why a persistent loss of elbow extension is a clinical red flag
🔹 MRI “smoke” vs arthroscopy “fire” (and how easily loose bodies are missed)
🔹 How decades-old trauma can come back to haunt the joint
🔹 And yes… the elbow cave so full of synovitis & scar tissue it needed its own theme 🎞️🕸️

To stay on the friendly side of a certain Hollywood studio, my mental co-pilot for this case is:

🧢 Doctor Montana Joans — part Clinician, part Surgeon, full-time mythical adventurer.

Inside the full post you’ll find:

🕳️ Imaging pitfalls
🦴 Clinical reasoning & decision-making
🧭 Triage strategy
🔪 Surgical insights
📸 Intra-op photos (shared with full patient consent along with the case ❤️)
💡 Why CT > MRI in certain older-elbow scenarios

👉 Free preview is now live
👉 Full breakdown & clinical pearls inside the subscriber section

If you enjoy high-value MSK content delivered with humour (and caffeine), this one’s for you ☕😂

🔗 Read it here:
https://nickilicphysio.substack.com/p/clinicians-corner-case-study-stiff

💪🦴 Let’s keep demystifying joints — one cranky elbow at a time.


(not)

24/11/2025

🦺 New Blog: Should You Walk With a Weighted Vest?

Why the trending “vest walks” aren’t the bone-building shortcut the internet says they are
🔗 https://open.substack.com/pub/nickilicphysio/p/patients-playbook-do-you-have-a-vested

Weighted vests are everywhere right now — TikTok, Insta reels, fitness pages, friends telling friends.

And the claims are huge:
💥 “Build bone density”
💥 “Burn heaps more calories”
💥 “Boost strength just by walking”

So I reviewed the actual research — 13 controlled studies across bone health, metabolism, weight loss, strength, balance, and fitness.

Here’s the real story 👇

✅ Weighted vests help in strength/impact training
✅ They can help maintain bone BUT⛔️ no more so than exercise without it.
🤏 They burn only a tiny bit more energy
⛔️ They don’t increase resting metabolism
⛔️ They don’t make you stronger through walking
⛔️ They don’t improve fitness more than normal aerobic exercise

And even Nike and Harvard Health advise caution for long vest-walks — especially if you have back pain, neck pain, joint issues, or are pregnant.

In this no-paywall article, I cover:
✔ What forms of exercise actually build bone
✔ Why popular claims miss the mark
✔ Guidance from SDA and ESSA (Sports Dietitians Australia and Exercise Sports Science Australia)
✔ A safe, simple progression if you still want to try a vest
✔ Links to my blogs on overuse and joint injuries if things flare up

If you’ve been thinking about buying a vest — or someone’s tried to convince you — give this a read first.

🔗 Full article:
https://open.substack.com/pub/nickilicphysio/p/patients-playbook-do-you-have-a-vested

18/11/2025

✨🎤 Swifty Style… or Meniscus Trial? 🦵📊

I made a game in my new blog on Management of Knee Meniscus Injuries:
It’s unhinged.
And it will test both your pop-culture knowledge AND your MSK nerd credentials.

Here’s the challenge:

👉 Which titles are Taylor Swift albums…
and which ones are real meniscus clinical trial acronyms?

Some are obvious.
Some are diabolical.
Some will make you question whether researchers are Swifties too.

(Warning: once you start seeing RCTs as pop albums… you can’t go back.)

Full blog at: https://open.substack.com/pub/nickilicphysio/p/clinicians-corner-brace-yourselves

18/11/2025

🎧🦵🎬 Clinicians Corner | Brace Yourselves – Meniscus Rehab is Coming

Meniscus tear? MRI panic? Knee doing random “Whoopsies”?
This new guide breaks down what actually matters when managing meniscus injuries — whether you’re a teen athlete, a weekend warrior, or somewhere in between.

Inside the post 👇
🔹 Why structure ≠ symptoms (yep… MRIs lie sometimes)
🔹 When rehab works — and when it really doesn’t
🔹 The “Whoopsies” checklist (locking, swelling, giving way)
🔹 Why bracing isn’t a neoprene sleeve you found in a drawer
🔹 What to track before considering surgery
🔹 Plus: a second-opinion case study where “failed rehab” turned out to be… failed process

And yes — the post has a Swifty quiz.
Pop album or meniscus trial acronym?
Come for the knee science, stay for the chaos.

🔗 Read the full blog:
https://nickilicphysio.substack.com/p/clinicians-corner-brace-yourselves

If your knee’s giving mixed signals, or you’re deciding between rehab vs surgery — this one will make things a whole lot clearer.

Let’s cut through the noise.
Let’s make complex MSK stuff simple.

04/11/2025

Finally, after many month, it's here:
✈️ Take-off to Touchdown | Chapter II | Management of The Older Shoulder
🔗 Read here: https://nickilicphysio.substack.com/p/take-off-to-touchdown-chapter-ii

🦁 Cuffs and 🐯 Bursas and 🐻 Tears, Oh My!!

This chapter in the Take-off to Touchdown series covers what to do when management of the older shoulder (40+) isn’t going to plan — when progress stalls, imaging gets confusing, or the patient’s “rotator cuff” pain turns out to be something else entirely.

It’s easy to take off, cruise, and land — but are you still in control when there’s turbulence? What about when you need to make an emergency landing?

Inside, we go through:
🧭 The Clinician’s Checklist for the older shoulder
🦒 Why you should always, always rule out the neck
💥 GOOSe vs FLASH — the slow waddle vs the sudden crash
🩻 Which imaging matters (and when)
🎯 Subscapularis – the true anterior anchor
🧲 Long Head of Biceps – the canary in the coal mine
💤 Bursitis – and why it’s far less often the real villain
…and did I mention ruling out* the neck?
(*how much is it contributing to the symptoms)

This series is a structured guide for clinicians — how to triage, manage turbulence, and keep your patients safely in the air when things don’t go by the book.

✈️ Catch up on the series:
🗺️ Prologue | Flight Plans for Musculoskeletal Clinicians
👉 https://nickilicphysio.substack.com/p/take-off-to-touchdown-prologue-flight

🛫 Chapter I | Neck and Low Back Pain
👉 https://nickilicphysio.substack.com/p/take-off-to-touchdown-a-pilots-checklist-for-the-clinician-on-the-management-of-neck-and-low-back-c3243b493be4

📖 Want to read this one for free? Subscribe now and get a free preview: https://nickilicphysio.substack.com/

21/10/2025

🧒🎾 “He’s only 13 – I didn’t think it could be anything serious… just tightness that needs stretching.”

🧠 New Parent’s Playbook blog:
Kids Should Not Get Persistent Back Pain
📍 https://nickilicphysio.substack.com/p/kids-should-not-get-persistent-back

Yes, most back pain in kids settles quickly.
But when it lingers past 2 weeks… or keeps flaring despite “just a week off” between matches or comps?
🚩 That’s not tightness. That’s a red flag.

In this blog I cover:
🔹 Why adolescent bone stress injuries are on the rise
🔹 How screen time & posture are often wrongly blamed
🔹 Who to see first: GP or MSK Physio
🔹 Why not all providers are trained for growing bodies
🔹 MRI referral tips for clinicians (specific sequences that matter)

✅ Free preview = key advice for parents & coaches
🔓 Paid tier = practical pathways, clinical pearls, and what to do next
🧠 Start your 7-day free trial and unlock it all

13/10/2025

New free Blog:
👉 Patient Playbook | BPC-157: The Miracle Molecule That Isn’t
https://open.substack.com/pub/nickilicphysio/p/patient-playbook-bpc-157-the-miracle
.now pepped up with a 🚀 Roger Ramjet Proton Pill reference (just to show my age).

🥕 🥛 💊 Nutrition is important for tissue repair. Physios sometimes have to delve into diet, nutrition, and supplements when answering questions from patients - especially for those with persistent pain looking for answers in a pill bottle, sometimes endorsed by influencers.

Lately, one name keeps popping up in consults and gym conversations: BPC-157 — “Body Protection Compound 157”.

It's been around for a while but I've had a few ask about it in the past 2 weeks.

But here’s the catch with BPC-157:
❌ No quality human studies
🐀 Most research is on rats and mice
🚫 Banned by the FDA and WADA
⚠️ Not approved for medical use anywhere reputable
Yet people are paying 💸 for it.

Australian athletes need to be VERY careful — it’s banned in competition and out of competition across many sports, according to a quick search on GlobalDRO (www.globalDRO.com).

In my latest Patient Playbook blog, I cover
🔹 Why the hype around BPC-157
🔹 What peptides actually are — and how they differ from proteins
🔹 The real role of dietary protein in soft tissue repair
🔹 And why your liver is quietly panicking when you buy mystery powders online
💬 If it sounds too good to be true — it probably is.

Read the full post here: https://open.substack.com/pub/nickilicphysio/p/patient-playbook-bpc-157-the-miracle

Eat well. Train smart.
And trust the most powerful peptide system on Earth — your own body.

For more on diet and supplements in sports and exercise, check out the Sports Dietitians Australia website, it's a fantastic resource https://lnkd.in/gTNXwHNT

07/10/2025

“I’ve Got The Bursa!” … Now What?
👉 https://open.substack.com/pub/nickilicphysio/p/patient-playbook-ive-got-the-bursa

You’ve had your ultrasound.
It says: “Subacromial-subdeltoid bursitis with impingement on abduction.”
The GP says: “You’ve got bursitis.”

But here’s the twist 👇

✅ Everyone has bursae — around 8–12 in each shoulder.
✅ “Thickened” or “impinging” on scan doesn’t mean it’s painful.
✅ The bursa’s job is to glide and cushion under the bone.

So how do you really know if bursitis is the culprit?
By the story — not just the scan.

In this week’s Patient Playbook, I cover:
💡 What a bursa actually is
💡 Why ultrasounds can be misleading
💡 Simple ways to settle it down
💡 When to escalate to imaging or injection

📖 Read the full post on Substack:
🔗 nickilicphysio.substack.com

New subscribers get free access to their first paywalled article, then it’s just $5/month or $50/year — cheap as pub chips! 🍟