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.

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...

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 databaseClaire 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 properlyForce 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 | 🔔 SubscribeFor all Claire's info - getbacktosport.com

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.

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.

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.

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.

In this episode of Chewing It Over, Jack is joined by Joshua Catlett, former physio, founder of Bodyset, and now founder of Verilo, to unpack the realities of buying and selling MSK clinics—and why it’s far more complex than most owners expect. Joshua explains that for many clinic owners, a sale is a once-in-a-lifetime event with huge consequences: get it right and it can be life-changing; get it wrong and you can lose money, damage reputation, or sell to the wrong buyer.A key theme is preparation and timing. Joshua warns against selling out of necessity (lease pressure, staff loss, burnout), and encourages owners to plan ahead so they can sell from a position of strength. He also challenges a common assumption: the “natural” exit via associate buyout is often more myth than reality, with fewer clinicians wanting (or able) to buy practices today due to funding constraints and higher borrowing costs .The conversation highlights why some practices aren’t truly “saleable”—often because they’re essentially a job: highly owner-dependent revenue, home-based setups, or limited transferable infrastructure. Joshua outlines the main levers that increase valuation and buyer confidence: reducing owner dependency by building a team, securing strong premises and lease terms (ideally 5+ years remaining), and lowering risk for the buyer .They also discuss the brokerage landscape, contrasting passive “listing” brokers with high-end corporate finance, and positioning Verillo in the middle: structured, strategic, and specialist. The episode closes with practical advice: prepare early, stabilise key risks, and get the right representation—because structured sales processes tend to achieve higher prices and higher completion ratesFREE GUIDE HERE

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In this episode of Chewing It Over, Jack is joined by pain coach and clinician Richmond Stace for a wide-ranging, thoughtful exploration of what pain coaching is, and why it matters for people living with persistent and chronic pain.Richmond traces the origins of pain coaching from his multidisciplinary background in nursing, pain science, and coaching, describing it not as a rigid framework but as an approach and a way of being. Central to this approach is meeting people exactly where they are, prioritising relationship, presence, and communication over protocols or prescriptive solutions. Pain coaching, he argues, is less about “fixing” pain and more about supporting meaningful, sustained change in a person’s life.A core theme of the conversation is the idea of pain as a lived experience or need state, rather than a purely structural or biological problem. Richmond challenges dominant biomedical narratives, suggesting that pain is information rather than error, and that persistent pain often reflects unmet needs, limiting beliefs, and misaligned ways of living rather than “broken” bodies. This perspective reframes recovery as a process of growth, insight, and updated understanding, rather than symptom eradication alone.The discussion explores why rigid beliefs, fear-based avoidance, and future-focused thinking can keep people stuck, and how coaching helps individuals reconnect with the present moment, their own strengths, and their capacity for change. Drawing on motivational interviewing, psychotherapy, and Eastern philosophy, Richmond emphasises that transformation happens through insight, relationship, and self-compassion, not through protocols or techniques alone.This episode is a deep, reflective conversation for clinicians and patients alike who want to rethink pain, recovery, and what it truly means to help people get better.https://richmondstace.substack.com/