The Physio Matters Podcast

Challenging Pain Orthodoxies - Chewing It Over with Asaf Weisman

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. Don't turn theoretical models into established biological facts. Models can help generate hypotheses and guide research without every component of the model having been empirically demonstrated. The brain isn't being dismissed. Asaf's position is more nuanced than “pain is peripheral”. He explicitly accepts that the brain processes and modulates pain and that stress and psychosocial circumstances can change the resulting experience. Language matters clinically. Terms such as “pain output”, “threat”, “nociception” and “biopsychosocial” carry assumptions. Using them casually can make a proposed mechanism sound more established than it actually is. Don't let the theoretical debate distract from modifiable factors. Whatever model a clinician favours, the practical priority remains identifying things that can meaningfully be changed — including activity, physical health and relevant psychosocial stressors — and helping the patient address them. 5 clinical/professional takeaways

The MSKAwards 2026! Chewing It Over with Laura Beaven

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.

Make Data Driven Smart Decisions Don’t Fly Blind! - Chewing It Over with Elona Bregasi and Xhesika Tusha of Dataplayer

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.

AI Is Coming For Your Job in the best possible way - Chewing It Over with Caelum Trott of Preve

Preve.co | Discount code Chew26What if AI in physiotherapy could do more than write your notes?In this episode of Chewing It Over, Jack speaks with physiotherapist, clinic owner and Preev co-founder Calum Trott about using AI to tackle one of private MSK practice's biggest challenges: patients dropping out before completing their planned care.Preev has been designed around more than clinician efficiency. It aims to turn information from the consultation into a clear patient treatment plan, helping patients understand where they're going, what happens next and why continuing their care matters.Jack and Calum discuss the problem with traditional metrics such as patient visit average, why expectation management matters, and whether clinics should instead be measuring how successfully patients complete the individual treatment plan actually recommended to them.They also explore:Why AI scribes are only the beginningPatient drop-off and self-dischargeCreating personalised treatment plansImproving communication between appointmentsReducing administrative burden for cliniciansPatient retention versus simply increasing appointment numbersThe limitations of PVA/PBA as a clinic metricMeasuring planned completion ratesUsing AI to identify patients falling off their recovery pathwayEarly results from clinics using PreevWhere AI-supported MSK care could go nextCalum shares early examples of clinics reporting significant improvements in rebooking among patients receiving treatment plans, including one clinic where average visits per case reportedly increased from around 4.5 to 7 following implementation.The bigger question is whether healthcare AI should simply make existing work faster—or help us deliver a fundamentally better patient experience.🧠 5 clinical/professional takeawaysAI doesn't have to stop at documentation. The more interesting opportunity may be using information already captured during consultations to improve what happens between appointments.Expectation management is part of treatment. A patient who understands the proposed journey, expected number of appointments and purpose of each stage is better equipped to engage with their care.PVA/PBA can be a crude metric. Seven appointments might represent excellent care for one presentation and incomplete care for another. The number alone lacks clinical context.Planned completion could be a better measure. Comparing the clinician's recommended plan with what the patient actually completes creates a more individualised measure of engagement.Efficiency and patient experience are connected. Asking clinicians to produce detailed plans and follow up every disengaged patient manually creates more work. The opportunity for AI is to make better care easier to deliver consistently—not simply to make notes faster.

The Biggest Wins In The NHS Are Cheap! - Chewing It Over with Luke Kellaway

In this episode of Chewing It Over, Jack speaks with Luke Kellaway about his MSKMag article, The Biggest Wins in the NHS Are Cheap, exploring whether healthcare innovation has become too focused on expensive technology at the expense of simpler solutions that already work. Luke highlights the enormous burden musculoskeletal conditions place on the NHS and argues that relatively inexpensive initiatives can produce substantial improvements in waiting lists, patient outcomes and service efficiency. Yet these less glamorous interventions can struggle to attract the attention given to AI and digital health pilots. The conversation questions what healthcare actually means by efficiency. Saving clinicians time with technology sounds valuable, but if that additional capacity simply allows more patients to enter an already constrained pathway, it may increase spending rather than reduce it. Improving one part of a system also achieves little if patients simply reach the next bottleneck faster. Jack and Luke discuss the importance of examining and redesigning clinical workflows before adding technology. Rather than assuming AI will fix inefficient systems, organisations should first understand where delays occur, streamline existing processes and then identify where technology genuinely adds value. They also explore the challenges surrounding healthcare AI, procurement and medical-device regulation. As increasingly sophisticated technology enters clinical practice, both managers and clinicians need enough digital literacy to question how these systems work, whether they are appropriately regulated and what they mean for patient safety. Ultimately, the discussion makes the case for pragmatic innovation: empower clinicians, improve pathways, scale interventions that already work and introduce technology where it solves a clearly defined problem—not simply because it is new.

Disrupting And Developing Better Clinic Software - Chewing It Over with Ben Boulter of Notara

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A Remarkable Story of Rehabilitation and Resilliance - Laurie Peake MBE

In this inspiring episode of Chewing It Over, Jack speaks with Laurie, whose remarkable story spans decades of living with the consequences of a devastating childhood injury, multiple reconstructive surgeries, and an extraordinary journey back to mobility. Laurie reflects on undergoing complex limb reconstruction surgery after living with altered biomechanics and chronic pain for over 40 years. Her rehabilitation became even more challenging when the COVID-19 pandemic prevented access to the specialist physiotherapy service that had been planned, forcing her to largely guide her own recovery. The conversation explores how she gradually relearned to walk, rebuilt strength, and adapted through careful trial and error. Despite setbacks, including muscle weakness and knee problems caused by years of altered movement, Laurie describes how she slowly regained confidence and function. Today she is pain-free, regularly attends the gym, and continues to surprise herself with what she is capable of achieving. Jack uses Laurie's story to challenge the common assumption that decades of abnormal movement patterns permanently limit rehabilitation potential. Instead, her experience highlights the remarkable adaptability of the human body when combined with persistence, patience, and realistic expectations. The discussion also touches on resilience, mindset, and the value of lived experience. Laurie explains that while she is unsure whether optimism can be taught, she believes sharing experiences with others beginning similar rehabilitation journeys can provide reassurance and hope. This is an uplifting conversation about recovery, perseverance, and the importance of believing that meaningful improvement remains possible—even after decades of disability. The human body can continue adapting after decades of altered movement. Long-standing biomechanical changes do not automatically prevent meaningful recovery. Patient-led rehabilitation can still be highly successful. When supported by sound principles, self-directed recovery can produce impressive outcomes, particularly when circumstances limit access to healthcare. Recovery is rarely linear. Setbacks, muscle weakness, and periods of uncertainty are often part of successful long-term rehabilitation. Mindset and persistence matter. Optimism alone is not enough, but resilience and willingness to keep progressing can profoundly influence rehabilitation. 5 clinical/professional takeaways

Sports Medicine And The Pelvic Floor | Chewing It Over with Grainne Donnelly

In this episode of Chewing It Over, Jack sits down with Dr Grainne Donnelly to discuss her newly published textbook on pelvic health in sport, the journey of becoming an editor, and the evolving role of physiotherapists in advancing evidence-based care. Grainne reflects on the enormous challenge of leading a first-edition textbook while simultaneously balancing clinical work, research, teaching, and a PhD. Although initially hesitant to take on such a significant project, she describes how a leap of faith—and encouragement from those around her—led to a resource designed to fill a major gap in sports medicine literature. The conversation explores the growing recognition of pelvic health as a critical component of athletic performance and participation. Grainne discusses the need for better education across professions and highlights the importance of multidisciplinary collaboration in addressing issues that have historically been under-recognised or poorly understood. A particularly interesting section focuses on her research into pelvic floor dysfunction, athletic performance, and the role of compression garments. While acknowledging the influence of confidence, perception, and reduced vulnerability on movement, Grainne also discusses emerging evidence suggesting measurable biomechanical effects, including improved shock attenuation and smoother running mechanics. Throughout the discussion, Jack highlights Grainne’s rare ability to bridge clinical practice, research, education, and policy. The episode becomes a wider conversation about curiosity, scientific rigour, and the value of asking better questions rather than rushing to simple answers. Overall, this is an insightful discussion for clinicians interested in sports medicine, women’s health, pelvic health, performance, and the future direction of physiotherapy research.

Digital Triage & Beyond - Chewing It Over with Peter Grinbergs of EQL Ltd.

AI, health tech, digital systems, clinician workflows… are we entering healthcare’s biggest technological shift yet? In this episode of Chewing It Over, Jack sits down with Pete Greenberg (EQL) to discuss the evolving world of healthcare technology and what it means for clinicians, clinics, and patients. Topics include: Why healthcare is finally having its “tech moment” AI hype vs meaningful innovation The challenges clinicians face navigating new technology Digital overwhelm and decision fatigue How health tech should support—not replace—human care Data, trust, workflows, and adoption barriers What clinics should be paying attention to now The future relationship between technology and MSK practice This isn’t a conversation about replacing clinicians with AI. It is a discussion about using technology wisely, protecting the human side of healthcare, and understanding where innovation genuinely adds value. 🎧 Ideal for: Physiotherapists MSK clinicians Clinic owners Healthcare leaders Digital health enthusiasts Anyone curious about AI in healthcare 💬 How are you using technology in clinic right now? Helpful tool or growing headache? 👍 Like | 💬 Comment | 🔔 Subscribe

Is Shockwave Shocking? Chewing It Over with Nick Ilic

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.

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Booking.com for MSK... Chewing It Over with Wesley Clarke-Sullivan

In this episode of Chewing It Over, Jack speaks with Wesley Clark Sullivan about Medimo, a marketplace designed to make private MSK care easier to find and book. The central idea is simple: in most sectors, people are used to consumer-friendly platforms like Booking.com, Uber, or Deliveroo, yet private healthcare still often relies on clunky directories, fragmented websites, and high-friction booking journeys. Wesley explains that the idea emerged from his background in marketing and e-commerce, combined with insight from private insurance pathways where even approved patients often fail to complete the final step of actually booking care. That gap led him to spot a wider opportunity: a marketplace that helps patients search by postcode, compare options, view live availability, and make an appointment quickly. A major theme of the conversation is fairness and visibility for clinics. Smaller independent practices often do not have the time, budget, or expertise to compete with bigger players in SEO, paid advertising, or constant social media output. Medimo aims to level that playing field by acting as a neutral marketplace where clinics can be found more easily, without needing large marketing budgets. Jack explores both the promise and the risks of this model, including concerns around patient data, platform dependency, and whether the service might simply intercept patients clinics would have acquired anyway. Wesley responds by outlining Medimo’s approach to data security, its free-to-list structure, and its revenue model based only on the first appointment. Overall, the episode is about improving patient access while helping clinics reach the right people more efficiently, without compromising trust or standards. https://medimo.co.uk/

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A Collaborative View For Industry Support - Chewing It Over with Jim Carr | Eos Active

eosactive.co.uk In this episode of Chewing It Over, Jack speaks with Jim Carr from EOS Active about a part of MSK practice that often gets overlooked or handled poorly: the relationship between products, pathways, branding, and patient communication. Although EOS Active technically sells products into the MSK space, Jim is clear that he does not want to be seen as simply “selling injections.” Instead, he argues that products only make sense when they are nested within a wider, well-reasoned patient pathway. An injection, brace, cryotherapy device, or sleeve is not the story in itself; it is only one possible component of a longer management process shaped by rehabilitation, education, timing, and patient context. A major theme of the conversation is that clinics often inherit their marketing language from manufacturers without fully realising it. Glossy flyers, miracle-style testimonials, and product-led messaging can slowly become part of a clinic’s identity, even if they do not reflect how that clinic actually wants to practise. Jim’s answer is to help clinics present information in a more neutral, patient-centred way that supports trust rather than hype. The discussion also explores why Jim feels unusually aligned with private clinics. He sees parallels between building a distribution business and building a clinical service: both require strategy, long-term thinking, and careful management of brand and reputation. Rather than pushing the newest thing, he prefers established, sensible options that fit real-world practice. Overall, this episode is about thinking beyond transactions. It asks clinics to be more intentional about what they communicate, how they communicate it, and how commercial choices shape the care experience patients receive. Cingal® as a multi-joint injection is now EU MDR certified. The certification includes expanded indications for multiple synovial joints, including the knee, hip, shoulder and ankle, supporting broader clinical application. As part of the MDR transition, the manufacturer is completing the final administrative steps to ensure update IFUs and supporting documentation are available in line with regulatory requirements. Further information will be shared in due course. Eos active as te UK partner are preparing updated marterials allowing you to communicate appropriatley with patients in clinic and can answer questions and quiries about this recent update.

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That AI Physio Service - Chewing It Over with Finn Stevenson

In this episode of Chewing It Over, Jack speaks with Finn Stevenson about Flok Health and the idea of an AI physiotherapy service for back pain. Finn frames the problem clearly: in musculoskeletal care, especially within the NHS, the issue is often not knowing what works, but getting timely access to the care that already exists. With demand rising faster than workforce growth, traditional one-to-one care models struggle to keep up. Finn explains that Flok is not positioned as a software tool sold to clinicians, but as a regulated clinical service that combines AI with remote human physiotherapy support. Its current focus is spinal pain, particularly the large group of patients who can benefit from personalised exercise, reassurance, behaviour change support, education, and psychologically informed care. The ambition is to automate large parts of the pathway safely and consistently, while freeing face-to-face clinicians to focus on more complex cases. A major part of the conversation explores how this works. Finn distinguishes Flok’s system from standard large language model chatbots, arguing that healthcare needs much tighter behavioural control. He describes a rule-based clinical reasoning system combined with a video-based interaction model built around “Kirsty,” a real physiotherapist whose filmed responses are assembled in real time to create a more human and engaging consultation experience. The discussion also tackles controversy: what counts as “physiotherapy,” whether this threatens the profession, and what happens when technology enters clinical care at scale. Jack remains probing but open-minded, while Finn argues that the bigger ethical issue is leaving patients stuck on long waits for care we already know how to deliver. Like, Comment, Subscribe all that good stuff :)

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A View From The Top - Chewing It Over with Andrew Walton

In this episode of Chewing It Over, Jack speaks with Andrew Walton, offering what Andrew describes as “a view from the top” of healthcare leadership and professional practice . The conversation explores Andrew’s career journey and the lessons that come from working across clinical practice, leadership roles, and wider healthcare systems. Rather than focusing purely on clinical skills, Andrew highlights the importance of systems thinking, collaboration, and understanding the broader context in which healthcare operates. A key theme of the discussion is the gap that can exist between frontline clinicians and decision-making structures. Andrew reflects on how leaders must balance competing pressures: workforce constraints, service demands, financial limitations, and patient outcomes. From this perspective, clinical excellence alone is not enough — meaningful change requires clinicians to engage with the organisational and strategic dimensions of healthcare. Jack and Andrew also discuss how clinicians can develop leadership capabilities throughout their careers. Leadership is not framed as a job title but as a mindset and responsibility, where clinicians contribute to improving services, supporting colleagues, and advocating for better patient care. Importantly, Andrew emphasises that leadership roles can feel distant or inaccessible to many clinicians. However, understanding how decisions are made — and how clinicians can influence them — helps bridge the gap between policy, management, and clinical practice. Ultimately, the episode offers a reflective look at the profession from a strategic vantage point, encouraging clinicians to think beyond individual patient encounters and consider their wider role in shaping healthcare systems.

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Scars And Their Management - Chewing It Over with Hannah Poulton

In this episode of Chewing It Over, Jack is joined by Hannah Poulton to explore a topic that clinicians encounter frequently but often feel underprepared to manage: scars and their rehabilitation . The conversation examines the wide-ranging impact that scars can have on patients. While scars are often thought of as purely cosmetic issues, Hannah explains that they can influence pain, movement, tissue sensitivity, and psychological wellbeing. Depending on their depth, location, and the tissue layers involved, scars may contribute to stiffness, restricted movement, or altered sensory responses. Hannah discusses how clinicians should approach scar management from a broader perspective rather than focusing solely on appearance. Scar assessment involves understanding tissue behaviour, mobility, and sensitivity as well as recognising the emotional and psychological significance scars can hold for patients. The discussion also highlights common misconceptions around scar treatment. While many manual techniques and topical approaches are promoted in practice, the evidence base remains mixed, meaning clinicians must combine available research with clinical reasoning and patient goals. Importantly, Hannah emphasises the value of early education and patient empowerment. Helping patients understand how scars mature, adapt, and respond to loading can reduce fear and improve engagement with rehabilitation. Ultimately, this episode reframes scars not simply as marks on the skin, but as dynamic biological structures that interact with movement, sensation, and patient experience. With thoughtful assessment and a patient-centred approach, clinicians can play a meaningful role in improving both function and confidence for people living with scars. Like, Subscribe, Follow, Comment, tell your friends...

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Which Dynamometer Is Best? Chewing It Over with Claire Minshull

Which dynamometer should you buy? The answer is… it depends. In this episode of Chewing It Over, Jack speaks with Dr Claire Minshull about the rapidly growing world of force measurement tech in rehab and MSK practice . We discuss: • Why “just buy the one your mate has” is risky • Sampling frequency (Hz) — and why it matters for RFD • Load capacity vs intended use • Calibration, data fidelity & measurement error • Why handheld dynamometry increases variability • External fixation and reducing clinician error • The myth of chasing normative values • Building your own in-clinic strength database Claire also introduces WhichDynamometer.com — a free, side-by-side comparison tool built after over a year of collecting technical specifications directly from manufacturers. This episode is essential listening for: ✔️ Physiotherapists ✔️ Sports rehab clinicians ✔️ S&C coaches ✔️ Clinic owners making capital purchases ✔️ Anyone wanting to use objective data properly Force measurement isn’t a magic bullet — but used well, it can enhance decision-making, patient confidence, and rehabilitation progression. 💬 Do you use dynamometry in your clinic? What matters most to you — price, portability, sampling frequency, or something else? 👍 Like | 💬 Comment | 🔔 Subscribe For all Claire's info - getbacktosport.com

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Real Growth - Chewing It Over with Andy Thomas

In this episode of Chewing It Over, Jack is joined by Andy Thomas, founder of Physiquip and host of the Real Health podcast, to discuss his new book Real Growth and the thinking behind it. Rather than presenting another abstract business or personal development manual, Andy explains that Real Growth is built from real conversations, real careers, and real lived experience, drawn from more than 200 long-form podcast interviews across sport, healthcare, and business . The discussion explores why “real” growth matters. Andy contrasts authentic development with surface-level metrics and performative success, arguing that growth is rooted in values such as authenticity, positivity, humility, enjoyment, and reflection. The book weaves together insights from elite sport practitioners, clinicians, business leaders, and entrepreneurs, showing how lessons learned in one domain often translate powerfully into others. Andy describes the challenge of turning hundreds of conversations into a coherent structure, ultimately creating 30 short, accessible chapters grouped into themes. Each chapter ends with reflective questions designed to help readers apply insights to their own lives and work. The format mirrors how Andy himself learns: practical, digestible, and easy to dip into. The conversation also links Real Growth to Andy’s wider work with Physiquip. He explains his belief that profitability, trust, and purpose are not opposites, but essential ingredients for sustainable healthcare businesses. Technology, he argues, is not about novelty, but about fit—supporting a clinic’s vision rather than defining it. Overall, this episode is a thoughtful reflection on growth as a human process: built through curiosity, connection, optimism, and doing meaningful work well over time.

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The Return To Work Mentor - Chewing It Over with Heather Mclellan

In this episode of Chewing It Over, Jack is joined by Heather Mclellan, physiotherapist, occupational health specialist, and founder of The Return to Work Mentor, to explore a largely invisible gap in healthcare: what happens when people—especially small business owners and the self-employed—become ill or injured and have no access to occupational health support. Heather explains that while large organisations often have structured return-to-work systems, most UK workers are employed by micro-businesses with fewer than ten staff, where occupational health simply doesn’t exist. As a result, people are left to “chance it”: either staying off work longer than necessary due to fear and uncertainty, or returning too early without a plan, risking relapse or failure. The conversation becomes deeply personal as Heather shares her own experience of suffering a rare stroke caused by an underlying blood cancer. Despite decades of expertise in vocational rehabilitation, she found herself navigating illness, identity, and work with virtually no formal support. Even income protection policies failed her—not because she lacked cover, but because she hadn’t “played the game” correctly by formally stopping work and obtaining a sick note. Together, Jack and Heather unpack the emotional, cognitive, and financial strain of trying to hold a business together while managing a life-changing diagnosis. They discuss how performance, identity, and responsibility often mask distress, and why pathway-based or insurance-led systems routinely fail people at their most vulnerable. Heather introduces her “before, during, after” framework for health crises, which underpins The Return to Work Mentor. The goal is simple but powerful: to give people calm, practical guidance—direct to the individual—so they’re not left alone to navigate one of the hardest transitions of their working lives.

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Unreasonable Adjustments Discussed/Disgust - Chewing It Over with Rosi Sexton

In this episode of Chewing It Over, Jack is joined by Rosie Sexton — osteopath, former MMA fighter, academic, and commentator — for a deep, nuanced conversation on “reasonable adjustments”, neurodivergence, and where workplace accommodation becomes ethically, practically, and emotionally complex. The discussion is sparked by a satirical MSK Mag article, Unreasonable Adjustments, written under the Glenohumeral pseudonym. Rosie explains why the piece felt frustrating and harmful to her: not because unreasonable adjustments don’t exist, but because satire can slide from critique into reinforcing stereotypes, particularly around neurodivergence. She highlights how portrayals of “comfort-seeking” or “trend-driven diagnoses” can discourage people from requesting adjustments that would genuinely allow them to work better and avoid burnout. Jack responds by situating the article within its satirical intent and wider editorial context, acknowledging both its provocations and its blind spots. A central tension emerges: how do we hold space for individual needs while also recognising system-level constraints, particularly in under-resourced environments like the NHS? Both agree that unreasonable requests can exist — but they strongly resist framing this as neurodivergent staff versus patient care. Instead, they explore how adjustments can conflict with one another, how severity and context matter, and why careful, good-faith conversation is essential. Rosie argues that dismissing needs as “trivial” is dangerous, while Jack reflects on the uncomfortable reality of triage, scarcity, and competing demands. This episode doesn’t offer neat answers. Instead, it models something rarer: a respectful, intellectually honest disagreement, showing how complex issues can be explored without shutting conversation down.

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What Has Changed For Lower Back Pain - Chewing It Over with David Evans

In this episode of Chewing It Over, Jack speaks with researcher and osteopath David Evans about what has actually changed in low back pain care over the past 20 years — and what hasn’t. Using data from a unique follow-up study comparing physiotherapists, osteopaths, and chiropractors, David reveals that the story is more nuanced than the usual “hands-on vs hands-off” narrative. Spinal manipulation use has fallen across all three professions — not just physios — while massage and acupuncture have increased, suggesting clinicians haven’t abandoned hands-on care, but have shifted the type of intervention used. Specific exercises have declined while general exercise has risen, aligning more closely with guideline messaging around activity and self-management. Interestingly, these trends don’t map neatly onto clinical guidelines, raising questions about what really drives practice change: pain science discourse, safety concerns, professional identity, training exposure, and system pressures all emerge as possible influences. The conversation moves beyond techniques to bigger issues in MSK care: the limits of pathway-based models, the “average effect” problem in RCTs, and why back pain research may be set up to underestimate treatment impact by measuring outcomes many months later. A major theme is the long-standing struggle to move beyond “non-specific low back pain.” David argues the future may lie in mechanism-based subgrouping (nociceptive, neuropathic, nociplastic, inflammatory) — if diagnostic precision can improve enough to meaningfully guide treatment.

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