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

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.

dataplayer.ioIn 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.

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.

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.

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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

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.

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 innovationThe challenges clinicians face navigating new technologyDigital overwhelm and decision fatigueHow health tech should support—not replace—human careData, trust, workflows, and adoption barriersWhat clinics should be paying attention to nowThe future relationship between technology and MSK practiceThis 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:PhysiotherapistsMSK cliniciansClinic ownersHealthcare leadersDigital health enthusiastsAnyone curious about AI in healthcare💬 How are you using technology in clinic right now?Helpful tool or growing headache?👍 Like | 💬 Comment | 🔔 Subscribe

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 takeawaysAvoid 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.