🧵1/
New Clinician’s Corner Elbow Case Study:
“Smoke on MRI, Fire in the Scope”
(Featuring the legendary Doctor Montana Joans)
🔗 nickilicphysio.substack.com/p/clinicians...
Consent from patient kindly granted — including intra-op pics.

Being “active at work all day” ≠ exercise.
That’s the Physical Activity Paradox: physical work can increase heart risk due to long hours, heavy loads, awkward postures, and little recovery.
Exercise is what builds fitness.
🔗 bjsm.bmj.com/content/52/3...

🧵 1/
Weighted-vest walking is everywhere right now — TikTok, Insta, fitness pages, friends telling friends.
And the claims are huge:
“Build bone density!”
“Burn way more calories!”
“Boost strength just by walking!”
I went through the actual science. Here’s what’s real 👇

1/
✈️💪 New Take-off to Touchdown post: open.substack.com/pub/nickilic...
Chapter II | The Older Shoulder
(aka: Rotator Cuff Pain, Bursitis, & midlife movement mysteries).
For clinicians who want fewer “mystery shoulders” & more clarity from take-off to touchdown. 🧵

Unlike The Mad Katter, I won't punch anyone in the face if they ask ME about my Lebanese heritage.

Settlers from Kfarsghab 100yrs ago helped make 🇦🇺 great through hardwork and grit, many rising up to high community status.

www.kfarsghab.com.au/kfarsghab-hi...

#auspol

🔹 Patellofemoral Dysplasia 🔹
If your knees have always been “a bit off”…

🧠 Born with a different blueprint
🦵 Not just “maltracking”
💪 Quads, suction & load management
🧪 Dynamometry > guesswork

📖 open.substack.com/pub/nickilic...

#Physiotherapy #KneePain #MSK #SportsPhysio #PFJ

Research Review | Pain in the Bum
🔗https://nickilicphysio.substack.com/p/research-review-pain-in-the-bum-gluteal

I discuss Angie Fearon's recent Gluteal Tendinopathy Review (sciencedirect.com/science/arti...):
✅ Bursitis vs GT
✅ SIJ/Lumbar DDX
✅ +LR/-LR test breakdown
✅ Why education > gadgets

I like the idea of this platform.
I don't like the idea of manually duplicating everything I do on that "OTHER" platform just to get it on this platform.
I don't yet want to stop using that other platform.

Solutions people!? 😂 Such a first world problem

I sometimes call Manual Therapies: "Palliative Therapies" (see meaning in pic).

It shifts the focus to short-term benefits: pain relief, reduced inhibition, and improved function so we can commence active rehabilitation, without the baggage of silly, disempowering narratives.

Prognosis needs trajectory.

In their first visit when patients ask, "When will this be better?" I say it takes 2-3 visits to gauge recovery trends but add, "I wouldn't be surprised if it takes #-# weeks/months."

Patients are usually happy with that.

Reminds me of a good pic from Mr @AdamMeakins.

Psoriatic arthritis is an immune mediated inflammatory musculoskeletal disease affecting around 30% of patients with psoriasis.

This review summarises the clinical features and comorbidities characteristic of psoriatic arthritis
www.bmj.com/content/387/...

Managing Patellofemoral Pain (PFP) – A Thread 🧵
Listening to an excellent
E3Rehab podcast (pca.st/iqzgwhr4) with Dr Bradley Neal on the recent PFP Best Practice Guide (BPG).
I thought I'd share key points, as well as my practical tips from treating PFP over the years. /1

Q: When is ulnar wrist pain not an ulnar wrist injury?
A: When it’s Cubital Tunnel Syndrome.

Look for:
Good grip strength and weight-bearing tolerance
Palpation of cubital tunnel = wrist pain
Hx of repetitive compression of elbow on firm surfaces
Elbow flexed++ day +/- night

Q: When is Plantar Fasciitis not Plantar Fasciitis?
A: When it’s Baxter’s Nerve.

Not all heel pain is Plantar Fasciopathy.
Look for:
Medial heel symptoms climbing upward
Ankle injury/persistent irritation history
Pain-free calcaneal tubercle on palpation
Footwear compression

Patient: "Do you have a magic pill for my hip pain?"
Me: "I do... a magic pill-ow!"
For desk workers with hip joint pain, a high-density foam wedge might be effective at reducing hip joint referred pain and discomfort. Easy to implement in the office or car, and cheap. 🪑

When an athlete has a persistent niggle that's hard to pin down, often presents following training, but looks good by the time they are in the clinic, I often suggest they train before an MRI.
It can highlight subtle issues and make the scan more informative.
#SportsMed #MRI

Some pics from a mini in-service I just referenced for one of our New Grads who was referred a "#TennisElbow" which wasn't. The #1 thing I do in an initial consult with a potential "Tennis Elbow" (Lateral Elbow Tendinopathy) is:

Rule out Differential Diagnosis.

Commonly: C-Sp, or Posterior Elbow.