Nick Ilic Physio Clinician

Nick Ilic Physio Clinician Patient-centred injury management with a focus on utilising the latest evidence-based guidelines.

Working closely as a team with patients and their other healthcare providers to get the best outcomes possible with a no-nonsense and honest approach.

Sciatica. Sounds like an arcade game from the early 1980s. 🕹️ IFYKYJHAS* (*if you know you just heard arcade sounds)New ...
29/05/2026

Sciatica.

Sounds like an arcade game from the early 1980s. 🕹️ IFYKYJHAS*
(*if you know you just heard arcade sounds)

New case series just published.

🔗 https://nickilicphysio.substack.com/p/clinicians-corner-case-series-good

Here's what's in it:

🔍 Why "sciatica" is a label that does too much work and explains too little

🔍 The difference between radicular pain (a gain) and radiculopathy (a loss) — and why they don't always come together

🔍 What else can cause leg pain that looks radicular — hip, SIJ, peripheral nerve, visceral, vascular

🔍 Why compression alone doesn't explain the pain — and what does

🔍 A walkthrough of a real lumbar spine MRI

🔍 Case 1 — Cycling Simon: acute foraminal impingement, pain to pain-free radiculopathy, 44% dorsiflexion deficit. Resolved 6–8 weeks. Essentially no treatment.

🔍 Case 2 — Deadlift Derek: L4/L5 disc herniation + suspected sequestration. Five months documented start to finish — body charts, MRI, session emails, functional benchmarks, discharge.

🔍 What the guidelines actually say — NICE, ACP, European, SPORT trial

🔍 Clinical commentary: the chilli powder analogy, heel wedges from day one, NSAIDs and why physios are too drug-averse, puddleisation vs centralisation, one thing at a time, the integrity sentence

🔍 The multidisciplinary bit — physio, GP, psychologist, EP, each doing their bit

🔍 The spectrum — from observe and support to active structured management. Neither end is the right default.

Free section covers the science + Cycling Simon.
Paid section is Deadlift Derek — start to finish.

🔗 https://nickilicphysio.substack.com/p/clinicians-corner-case-series-good

Get full access as a preview article if you subscribe for free at https://substack.com/

🧲 New blog post — and this one's for anyone who's been offered a new treatment at their physio clinic lately.EMTT. Extra...
06/05/2026

🧲 New blog post — and this one's for anyone who's been offered a new treatment at their physio clinic lately.

EMTT. Extracorporeal Magnetotransduction Therapy. Big name, expensive machine, confident marketing.

"Almost no side effects."
"Fantastic results."
"Reactivates your sodium-potassium pump."

That last one caught my attention. Your sodium-potassium pump does not need reactivating. If it stopped working, you wouldn't be at a physio clinic. You'd be dead.

So I went and read every clinical trial I could find. Here's what's actually there:

🔹 Eight MSK trials in total. Six run by researchers with declared financial ties to the manufacturer.
🔹 The flagship "double-blind" trial wasn't blind — the machine makes your skin go red, so patients knew which group they were in.
🔹 The one independent properly-blinded trial found no difference from sham.
🔹 The condition list keeps expanding — hip OA, elbow OA, herniated discs — none of which have actually been trialled.

I've tried to be fair. The in-vitro science is genuinely interesting. Short-term pain relief from a passive adjunct can be a legitimate clinical tool. But the confidence with which this is being marketed is years ahead of the evidence.

If a clinic offers you EMTT, ask one question: is this in addition to active rehab, or instead of it? If it's instead of it — leave.

Full post at the link in bio. Includes 20 references, a fictional headstone for Timothy J. Carmichael, and a Bluetooth speaker being held to a blindfolded patient's ear.

New Blog | Research Review | Shockwave Therapy — Good, Like All the Other Things🔗 Link in bio / commentsI’ve been sittin...
23/04/2026

New Blog | Research Review | Shockwave Therapy — Good, Like All the Other Things

🔗 Link in bio / comments

I’ve been sitting on this one for a while, but the recent Physio Network podcast on shockwave therapy finally pushed it into publishing.

It ended up being a useful reminder of how important it is to separate confidence, mechanism talk, and polished presentation from the underlying evidence.

Inside the blog I go through:
🔹 What shockwave therapy actually is
🔹 The focused vs radial difference
🔹 What the key papers do and do not show
🔹 Why protocol variation still matters
🔹 And how to spot when external influences or conflicts of interest may need to be considered when listening to educational content

A good read for anyone weighing up shockwave therapy clinically, commercially, or just intellectually.

🔎 Clinician’s Corner | Schmorl’s Nodes are PuzzlingSchmorl’s nodes are one of those MRI findings that can either mean so...
14/04/2026

🔎 Clinician’s Corner | Schmorl’s Nodes are Puzzling

Schmorl’s nodes are one of those MRI findings that can either mean something… or just sit there looking suspicious.

This new post is for clinicians who want a clearer framework for thinking about them — especially in kids and teens, where the story is often very different to the usual adult “disc problem” narrative.

In the free section, I cover:

🔹 Why Schmorl’s nodes are not the usual “disc bulges backwards onto a nerve” story
🔹 A better way to explain the disc, endplates, and force distribution without reaching for the tired jam-donut metaphor
🔹 Why growing spines, loading, and vulnerable endplates can create the right setup for these lesions
🔹 How symptomatic cases usually look more like a local back pain story than a classic nerve compression story
🔹 Why kids with persistent back pain should not just be treated like small adults with smaller panadol doses

Then behind the paywall, I get into the stuff that really matters in clinic:

🔸 When to stop being casual and start widening the differential
🔸 Red flags and presentations that should make you pause
🔸 MRI clues that help separate the old and irrelevant from the new and grumpy, and
🔸 Practical clinical reasoning around what matters, what does not, and how to think through a tricky case

If you’ve ever looked at a scan report saying Schmorl’s node and thought, “Right… but do I actually care?”, this one’s for you.

🔗 Blog post: https://nickilicphysio.substack.com/p/clinicians-corner-schmorls-nodes?r=257uaq

Not every pair of “tight calves” is a calf problem.Sometimes the story is:🔹 too bilateral🔹 too vague🔹 too grumbly🔹 and t...
26/03/2026

Not every pair of “tight calves” is a calf problem.

Sometimes the story is:
🔹 too bilateral
🔹 too vague
🔹 too grumbly
🔹 and the loading history just doesn’t quite add up

That’s when the medication list deserves a bit more respect.

My new Clinician’s Corner blog looks at statins and why they can matter in MSK practice.

Not because physios need to play doctor.

But because having a basic understanding of common medications can help us spot when a presentation is a bit off, and flag the patient back to their GP for review when appropriate.

In the blog I cover:
🔹 why statins matter in MSK practice
🔹 when statin-related muscle symptoms usually show up
🔹 what the pattern tends to look like
🔹 which patients are higher risk
🔹 the subjective question that may save you from treating the wrong thing for 4 sessions

This is not an anti-statin post.

Statins are important medications.

But they can muddy the musculoskeletal picture, and clinicians should be better at spotting when the story doesn’t quite add up.

Read it here:
https://nickilicphysio.substack.com/p/clinicians-corner-statins-sore-legs

The first week after ACL surgery is… confusing.Your knee is swollen.Your quad doesn’t seem to work.Every day there’s a n...
19/03/2026

The first week after ACL surgery is… confusing.

Your knee is swollen.
Your quad doesn’t seem to work.
Every day there’s a new symptom.

And most people are left wondering:

“Is this normal?”

I’ve put together a simple playbook to guide patients through that first week — focusing on what actually matters:

• Controlling swelling
• Getting the knee straight
• Waking the quad back up
• Knowing what’s normal (and what’s not)

If you’ve got surgery coming up — or you’re currently in that first week — this will help you cut through the noise and stay on track.

👇 Read it here
https://nickilicphysio.substack.com/p/patients-playbook-the-first-week

🔍 New Research ReviewFluoroquinolones: The Antibiotic That Bullies Your AchillesFluoroquinolones are powerful antibiotic...
07/03/2026

🔍 New Research Review

Fluoroquinolones: The Antibiotic That Bullies Your Achilles

Fluoroquinolones are powerful antibiotics.

They’re also one of the few medications that can occasionally show up in a musculoskeletal history in a very real way.

Most clinicians have heard about the association with tendon injury — particularly the Achilles tendon — but the online discussion around this topic often swings between two extremes:

🙅 “These antibiotics are incredibly dangerous.”
💁 “The risk is so small it doesn’t matter.”

As usual in medicine, the truth sits somewhere in the middle.

In this Research Review, I cover:

🔍 Why fluoroquinolones are used in the first place
🔍 Why they can affect tendon biology
🔍 Why the Achilles tendon seems to get blamed most often
🔍 Which patients actually carry higher risk
🔍 Why Paracelsus was still right: “the dose makes the poison.”

It’s also a reminder for clinicians that a good medication history matters — because sometimes the answer to tendon pain isn’t purely mechanical.

And there’s a small bonus at the end…
A Danny Kaye / Court Jester reference (IYKYK).

Read the full article here:

🔗 https://open.substack.com/pub/nickilicphysio/p/research-review-fluoroquinolones

🦴 New Blog: The Sacroiliac Joint — Complex Pain, Simple Truths🔗https://nickilicphysio.substack.com/p/research-review-the...
26/02/2026

🦴 New Blog: The Sacroiliac Joint — Complex Pain, Simple Truths
🔗https://nickilicphysio.substack.com/p/research-review-the-sacroiliac-joint

Low back pain that just won’t settle? 🤔
Normal scans… but still sore?
Tried stretching, “realignment”, massage, cracking… and it keeps coming back?

The 2025 international SIJ consensus guidelines confirm something important:

Sacroiliac joint (SIJ) pain is common 📊
It’s hard to image properly 🖥️
Single clinical tests don’t give clear answers 🧪
And it’s often over-simplified.

For years, this joint has lived in an awkward space — too important to ignore, yet too vague to label confidently.

That gap has been filled with myths about pelvis “misalignment”, “upslips”, and endless correction cycles 🔄

In reality, SIJ pain is rarely about something being out of place.

It’s far more often about irritation, load intolerance, and shear sensitivity ⚖️ — and occasionally it’s the first sign of an inflammatory autoimmune condition 🔬

Good management isn’t about cracking or chasing alignment.

It’s about:
• Careful assessment 🧠
• Ruling out spine and hip causes
• Calming the joint
• Smart load management 📈
• Knowing when to escalate

You can read the full breakdown via my latest post on Substack:

🔗 https://nickilicphysio.substack.com/

For a joint that barely moves, the SIJ demands a surprising amount of clinical restraint.

Let’s raise the standard of how we talk about it. 💬





🏠 When an ACL “fails”…is it the ligament?Or was the house never built properly?In ACL research, we often see surgery com...
12/02/2026

🏠 When an ACL “fails”…
is it the ligament?
Or was the house never built properly?

In ACL research, we often see surgery compared to “non-surgical management.”

But what does that actually mean?

Was the non-surgical group:

🌾 A House of Straw
🪵 A House of Sticks
🧱 A House of Bricks

Because when the environment (🐺💨) hits —
cutting, landing, fatigue, chaos —
what matters is whether the house stands up.

Not all rehab is equal.

A proper brick house includes:

✔️ Careful MRI-based patient selection
✔️ Structured early protection (e.g. defined bracing protocol)
✔️ Criteria-based progression (not just “6 weeks later…”)
✔️ Objective strength testing (dynamometry, not guessing)
✔️ Psychological readiness assessment (ACL-RSI)
✔️ A clear early exit to surgery if functional instability persists

If surgical details matter — graft type, tunnel angle, fixation —
then rehab details matter too.

My latest blog is a practical guide to help readers evaluate whether a non-surgical treatment arm in a study represents:

🌾 Straw
🪵 Sticks
or 🧱 Bricks

Because when the wind blows, the environment doesn’t care what label you chose.

🔗https://open.substack.com/pub/nickilicphysio/p/research-review-non-surgical-acl?r=257uaq&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true

New Clinician’s Corner – Part 2 👇After publishing my recent post on “tightness” and “stiffness”, a subscriber asked the ...
02/02/2026

New Clinician’s Corner – Part 2 👇

After publishing my recent post on “tightness” and “stiffness”, a subscriber asked the most important follow-up question:

👉 “Okay… but what do we actually do about it?”

So I wrote the practical sequel.

“Tightness” – What Do We Actually Do About It?
🔗 https://nickilicphysio.substack.com/p/clinicians-corner-tightness-what

This one is about real-world application:
• How to work with long-held beliefs without arguing or correcting
• Why metaphors beat explanations when things get complex
• When short-term pain relief helps — and how to frame it safely
• Why “tightness” is often not a muscle problem at all
• How to reduce harm, cost, and frustration for everyone involved

It’s not about selling miracles.
It’s about doing good work, clearly and calmly.

If you missed Part 1, it’s here:
🔗 https://nickilicphysio.substack.com/p/clinicians-corner-what-is-all-this

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