Nick Ilic Physio Clinician

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

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

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

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. 💬

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

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

26/01/2026

Later this morning, we will farewell my father, Voy Ilic.

His life was a story of ability with a disability — and of what becomes possible when systems are good enough to meet effort halfway.

Public healthcare when it mattered most.
Rehabilitation that turned survival into contribution.
Education that was accessible.
Aged Care that valued humanity.
Disability and veterans’ support that once worked — not perfectly, but well enough.

I’ve written about his life not just to grieve and remember, but to reflect on something bigger:

When systems slip below “good enough”, it’s not money we save — it’s people we waste.

As we continue to debate Aged Care, the NDIS and DVA, I hope we don’t forget what’s actually at stake.

Vale Dad —
soon to be laid to rest, finally at peace.

If you’d like to read more, the full piece is here:
👉 https://nickilicphysio.substack.com/p/a-life-built-in-a-good-enough-system

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.


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