Nick Ilic
@nickilicphysio.bsky.social
Musculoskeletal Clinician and Rehabilitation Physio
I ✍️ real-world, evidence-informed blogs about musculoskeletal healthcare — helping clinicians bridge the gap between textbooks and the messy reality of clinical practice.
📬 nickilicphysio.substack.com
I ✍️ real-world, evidence-informed blogs about musculoskeletal healthcare — helping clinicians bridge the gap between textbooks and the messy reality of clinical practice.
📬 nickilicphysio.substack.com
9/
🆓 Free preview live now
🔒 Full clinical pearls for subscribers
If MSK adventure stories + high-value clinical insights are your vibe, you’ll enjoy this one.
🔗 nickilicphysio.substack.com/p/clinicians...
Let’s keep demystifying joints — one cranky #elbow at a time. 💪🦴
🆓 Free preview live now
🔒 Full clinical pearls for subscribers
If MSK adventure stories + high-value clinical insights are your vibe, you’ll enjoy this one.
🔗 nickilicphysio.substack.com/p/clinicians...
Let’s keep demystifying joints — one cranky #elbow at a time. 💪🦴
Clinician's Corner | Case Study: Stiff and Sore Elbow - Smoke on MRI, Fire in the Scope
A case study featuring synovitis, missing radial head real estate, hidden loose bodies… and an Indiana Jones cave made of scar tissue.
nickilicphysio.substack.com
December 2, 2025 at 12:01 AM
9/
🆓 Free preview live now
🔒 Full clinical pearls for subscribers
If MSK adventure stories + high-value clinical insights are your vibe, you’ll enjoy this one.
🔗 nickilicphysio.substack.com/p/clinicians...
Let’s keep demystifying joints — one cranky #elbow at a time. 💪🦴
🆓 Free preview live now
🔒 Full clinical pearls for subscribers
If MSK adventure stories + high-value clinical insights are your vibe, you’ll enjoy this one.
🔗 nickilicphysio.substack.com/p/clinicians...
Let’s keep demystifying joints — one cranky #elbow at a time. 💪🦴
8/
The full case breakdown:
📌 Imaging pitfalls
📌 Clinical reasoning decisions
📌 When to pull the trigger on referral
📌 Surgical pearls
📌 Post-op curveballs
📌 And elbow pics worthy of a museum exhibit
The full case breakdown:
📌 Imaging pitfalls
📌 Clinical reasoning decisions
📌 When to pull the trigger on referral
📌 Surgical pearls
📌 Post-op curveballs
📌 And elbow pics worthy of a museum exhibit
December 2, 2025 at 12:01 AM
8/
The full case breakdown:
📌 Imaging pitfalls
📌 Clinical reasoning decisions
📌 When to pull the trigger on referral
📌 Surgical pearls
📌 Post-op curveballs
📌 And elbow pics worthy of a museum exhibit
The full case breakdown:
📌 Imaging pitfalls
📌 Clinical reasoning decisions
📌 When to pull the trigger on referral
📌 Surgical pearls
📌 Post-op curveballs
📌 And elbow pics worthy of a museum exhibit
7/
Key clinical lesson (and the reason I wrote this case study):
CT > MRI when:
Older elbow
Prior fracture
Persistent loss of extension
Global pain
Synovitis
Suspected loose bodies
MRI shows irritation.
CT shows the reason.
Key clinical lesson (and the reason I wrote this case study):
CT > MRI when:
Older elbow
Prior fracture
Persistent loss of extension
Global pain
Synovitis
Suspected loose bodies
MRI shows irritation.
CT shows the reason.
December 2, 2025 at 12:01 AM
7/
Key clinical lesson (and the reason I wrote this case study):
CT > MRI when:
Older elbow
Prior fracture
Persistent loss of extension
Global pain
Synovitis
Suspected loose bodies
MRI shows irritation.
CT shows the reason.
Key clinical lesson (and the reason I wrote this case study):
CT > MRI when:
Older elbow
Prior fracture
Persistent loss of extension
Global pain
Synovitis
Suspected loose bodies
MRI shows irritation.
CT shows the reason.
6/
In theatre, the truth came out:
🧱 Multiple loose bodies
🍥 Osteophytes
🕸️ Scar tissue everywhere
🕳️ 1/3 of the radial head articular surface missing
The MRI only saw the smoke.
Arthroscopy saw the fire.
In theatre, the truth came out:
🧱 Multiple loose bodies
🍥 Osteophytes
🕸️ Scar tissue everywhere
🕳️ 1/3 of the radial head articular surface missing
The MRI only saw the smoke.
Arthroscopy saw the fire.
December 2, 2025 at 12:01 AM
6/
In theatre, the truth came out:
🧱 Multiple loose bodies
🍥 Osteophytes
🕸️ Scar tissue everywhere
🕳️ 1/3 of the radial head articular surface missing
The MRI only saw the smoke.
Arthroscopy saw the fire.
In theatre, the truth came out:
🧱 Multiple loose bodies
🍥 Osteophytes
🕸️ Scar tissue everywhere
🕳️ 1/3 of the radial head articular surface missing
The MRI only saw the smoke.
Arthroscopy saw the fire.
5/
Cue:
🎩 Doctor Montana Joans — Healthcare Warrior, Cave Explorer, Slayer of Scar Tissue.
Because when the elbow looks like a snarling synovitic cavern full of cobwebs…
You need an adventurer.
Cue:
🎩 Doctor Montana Joans — Healthcare Warrior, Cave Explorer, Slayer of Scar Tissue.
Because when the elbow looks like a snarling synovitic cavern full of cobwebs…
You need an adventurer.
December 2, 2025 at 12:01 AM
5/
Cue:
🎩 Doctor Montana Joans — Healthcare Warrior, Cave Explorer, Slayer of Scar Tissue.
Because when the elbow looks like a snarling synovitic cavern full of cobwebs…
You need an adventurer.
Cue:
🎩 Doctor Montana Joans — Healthcare Warrior, Cave Explorer, Slayer of Scar Tissue.
Because when the elbow looks like a snarling synovitic cavern full of cobwebs…
You need an adventurer.
4/
The MRI?
Absolutely billowing with smoke:
🔥 Synovitis
🔥 Effusion
🔥 Degenerative changes
…
But no loose bodies reported.
That’s when your clinical spidey senses go:
“If there’s this much smoke… something’s burning.”
The MRI?
Absolutely billowing with smoke:
🔥 Synovitis
🔥 Effusion
🔥 Degenerative changes
…
But no loose bodies reported.
That’s when your clinical spidey senses go:
“If there’s this much smoke… something’s burning.”
December 2, 2025 at 12:01 AM
4/
The MRI?
Absolutely billowing with smoke:
🔥 Synovitis
🔥 Effusion
🔥 Degenerative changes
…
But no loose bodies reported.
That’s when your clinical spidey senses go:
“If there’s this much smoke… something’s burning.”
The MRI?
Absolutely billowing with smoke:
🔥 Synovitis
🔥 Effusion
🔥 Degenerative changes
…
But no loose bodies reported.
That’s when your clinical spidey senses go:
“If there’s this much smoke… something’s burning.”
3/
🤚 Spoiler:
It wasn’t “tennis elbow.”
(Hot take: most elbows labelled “tennis elbow” aren’t.)
This was a joint-driven, not tendon-driven, disaster.
🤚 Spoiler:
It wasn’t “tennis elbow.”
(Hot take: most elbows labelled “tennis elbow” aren’t.)
This was a joint-driven, not tendon-driven, disaster.
December 2, 2025 at 12:01 AM
3/
🤚 Spoiler:
It wasn’t “tennis elbow.”
(Hot take: most elbows labelled “tennis elbow” aren’t.)
This was a joint-driven, not tendon-driven, disaster.
🤚 Spoiler:
It wasn’t “tennis elbow.”
(Hot take: most elbows labelled “tennis elbow” aren’t.)
This was a joint-driven, not tendon-driven, disaster.
2/
Ever had a cranky elbow that would not play nice?
Loss of extension… failed ROM gains… inflammatory rebound…
And a traumatic injury decades earlier haunting the joint like a bad sequel?
This one was exactly that.
Ever had a cranky elbow that would not play nice?
Loss of extension… failed ROM gains… inflammatory rebound…
And a traumatic injury decades earlier haunting the joint like a bad sequel?
This one was exactly that.
December 2, 2025 at 12:01 AM
2/
Ever had a cranky elbow that would not play nice?
Loss of extension… failed ROM gains… inflammatory rebound…
And a traumatic injury decades earlier haunting the joint like a bad sequel?
This one was exactly that.
Ever had a cranky elbow that would not play nice?
Loss of extension… failed ROM gains… inflammatory rebound…
And a traumatic injury decades earlier haunting the joint like a bad sequel?
This one was exactly that.
7/
If you’re considering buying a vest (or someone is trying to convince you), read this first.
Patients Playbook | Do You Have a Vested Interest?
👉 open.substack.com/pub/nickilic...
#WeightedVest #WeightedVestTraining
If you’re considering buying a vest (or someone is trying to convince you), read this first.
Patients Playbook | Do You Have a Vested Interest?
👉 open.substack.com/pub/nickilic...
#WeightedVest #WeightedVestTraining
Patients Playbook | Do You Have a Vested Interest?
Why Weighted Vest Walking Isn’t the Bone-Building Shortcut You’ve Been Told It Is
open.substack.com
November 24, 2025 at 9:27 PM
7/
If you’re considering buying a vest (or someone is trying to convince you), read this first.
Patients Playbook | Do You Have a Vested Interest?
👉 open.substack.com/pub/nickilic...
#WeightedVest #WeightedVestTraining
If you’re considering buying a vest (or someone is trying to convince you), read this first.
Patients Playbook | Do You Have a Vested Interest?
👉 open.substack.com/pub/nickilic...
#WeightedVest #WeightedVestTraining
I also included a safe, simple progression if you still want to try a vest — for people already walking 30–40 mins, 3×/week with no joint issues.
And links to my blogs on:
• Overuse knee pain
• Hip pain
• Tendinopathy
• Ankle sprains
• Wobbly/unstable knees
And links to my blogs on:
• Overuse knee pain
• Hip pain
• Tendinopathy
• Ankle sprains
• Wobbly/unstable knees
November 24, 2025 at 9:27 PM
I also included a safe, simple progression if you still want to try a vest — for people already walking 30–40 mins, 3×/week with no joint issues.
And links to my blogs on:
• Overuse knee pain
• Hip pain
• Tendinopathy
• Ankle sprains
• Wobbly/unstable knees
And links to my blogs on:
• Overuse knee pain
• Hip pain
• Tendinopathy
• Ankle sprains
• Wobbly/unstable knees
5/
Even Nike and Harvard Health advise caution with vest walking — especially if you have:
• Back pain
• Neck pain
• Hip/knee arthritis
• Joint injuries
• Pregnancy
More load ≠ better load.
Even Nike and Harvard Health advise caution with vest walking — especially if you have:
• Back pain
• Neck pain
• Hip/knee arthritis
• Joint injuries
• Pregnancy
More load ≠ better load.
November 24, 2025 at 9:27 PM
5/
Even Nike and Harvard Health advise caution with vest walking — especially if you have:
• Back pain
• Neck pain
• Hip/knee arthritis
• Joint injuries
• Pregnancy
More load ≠ better load.
Even Nike and Harvard Health advise caution with vest walking — especially if you have:
• Back pain
• Neck pain
• Hip/knee arthritis
• Joint injuries
• Pregnancy
More load ≠ better load.
4/
Bone responds to impact and heavy resistance.
Not slow, continuous walking — weighted or otherwise.
A 40-min vest walk loads your joints, not your bones.
If your goal is bone health, do:
• Heavy resistance
• Small impact drills
• Adequate calcium + Vit D
• Progressive loading
Bone responds to impact and heavy resistance.
Not slow, continuous walking — weighted or otherwise.
A 40-min vest walk loads your joints, not your bones.
If your goal is bone health, do:
• Heavy resistance
• Small impact drills
• Adequate calcium + Vit D
• Progressive loading
November 24, 2025 at 9:27 PM
4/
Bone responds to impact and heavy resistance.
Not slow, continuous walking — weighted or otherwise.
A 40-min vest walk loads your joints, not your bones.
If your goal is bone health, do:
• Heavy resistance
• Small impact drills
• Adequate calcium + Vit D
• Progressive loading
Bone responds to impact and heavy resistance.
Not slow, continuous walking — weighted or otherwise.
A 40-min vest walk loads your joints, not your bones.
If your goal is bone health, do:
• Heavy resistance
• Small impact drills
• Adequate calcium + Vit D
• Progressive loading
3/
What does hold up?
Weighted vests can help when they’re used in:
✔ Strength training
✔ Impact training
✔ Balance/functional exercises
✔ Combined gym-based programs
Not walking.
Not long-distance rucking.
Not “just add weight.”
What does hold up?
Weighted vests can help when they’re used in:
✔ Strength training
✔ Impact training
✔ Balance/functional exercises
✔ Combined gym-based programs
Not walking.
Not long-distance rucking.
Not “just add weight.”
November 24, 2025 at 9:27 PM
3/
What does hold up?
Weighted vests can help when they’re used in:
✔ Strength training
✔ Impact training
✔ Balance/functional exercises
✔ Combined gym-based programs
Not walking.
Not long-distance rucking.
Not “just add weight.”
What does hold up?
Weighted vests can help when they’re used in:
✔ Strength training
✔ Impact training
✔ Balance/functional exercises
✔ Combined gym-based programs
Not walking.
Not long-distance rucking.
Not “just add weight.”
2/
Across 13 controlled studies, weighted-vest walking does not:
⛔️ Build bone
⛔️ Increase resting metabolism
⛔️ Improve strength
⛔️ Improve fitness
.....more than normal aerobic exercise
The hype and the evidence do NOT line up.
Across 13 controlled studies, weighted-vest walking does not:
⛔️ Build bone
⛔️ Increase resting metabolism
⛔️ Improve strength
⛔️ Improve fitness
.....more than normal aerobic exercise
The hype and the evidence do NOT line up.
November 24, 2025 at 9:27 PM
2/
Across 13 controlled studies, weighted-vest walking does not:
⛔️ Build bone
⛔️ Increase resting metabolism
⛔️ Improve strength
⛔️ Improve fitness
.....more than normal aerobic exercise
The hype and the evidence do NOT line up.
Across 13 controlled studies, weighted-vest walking does not:
⛔️ Build bone
⛔️ Increase resting metabolism
⛔️ Improve strength
⛔️ Improve fitness
.....more than normal aerobic exercise
The hype and the evidence do NOT line up.
15/
For more:
Bursitis for Clinicians: nickilicphysio.substack.com/p/clinicians...
Bursitis for Patients:
nickilicphysio.substack.com/p/patient-pl...
The Rotator Cuff Cable:
nickilicphysio.substack.com/p/clinicians...
When is a 'Shoulder' not a Shoulder:
nickilicphysio.substack.com/p/when-is-a-...
For more:
Bursitis for Clinicians: nickilicphysio.substack.com/p/clinicians...
Bursitis for Patients:
nickilicphysio.substack.com/p/patient-pl...
The Rotator Cuff Cable:
nickilicphysio.substack.com/p/clinicians...
When is a 'Shoulder' not a Shoulder:
nickilicphysio.substack.com/p/when-is-a-...
November 5, 2025 at 7:56 AM
15/
For more:
Bursitis for Clinicians: nickilicphysio.substack.com/p/clinicians...
Bursitis for Patients:
nickilicphysio.substack.com/p/patient-pl...
The Rotator Cuff Cable:
nickilicphysio.substack.com/p/clinicians...
When is a 'Shoulder' not a Shoulder:
nickilicphysio.substack.com/p/when-is-a-...
For more:
Bursitis for Clinicians: nickilicphysio.substack.com/p/clinicians...
Bursitis for Patients:
nickilicphysio.substack.com/p/patient-pl...
The Rotator Cuff Cable:
nickilicphysio.substack.com/p/clinicians...
When is a 'Shoulder' not a Shoulder:
nickilicphysio.substack.com/p/when-is-a-...
14/
🎬 Final Boarding Call
The full post (with clinical pathways, imaging criteria, and management pearls) is now live:
👉 nickilicphysio.substack.com
🔒 Paywall at cruising altitude — because that’s where the gold is.
#Physiotherapy #ShoulderPain #RotatorCuff #Rehab
🎬 Final Boarding Call
The full post (with clinical pathways, imaging criteria, and management pearls) is now live:
👉 nickilicphysio.substack.com
🔒 Paywall at cruising altitude — because that’s where the gold is.
#Physiotherapy #ShoulderPain #RotatorCuff #Rehab
Nick Ilic | Physio Clinician | Substack
I cut through the noise in musculoskeletal healthcare, offering clear, practical insights for patients & clinicians. Expect deep dives, case studies, and no-nonsense injury management. Subscribe for e...
nickilicphysio.substack.com
November 5, 2025 at 7:56 AM
14/
🎬 Final Boarding Call
The full post (with clinical pathways, imaging criteria, and management pearls) is now live:
👉 nickilicphysio.substack.com
🔒 Paywall at cruising altitude — because that’s where the gold is.
#Physiotherapy #ShoulderPain #RotatorCuff #Rehab
🎬 Final Boarding Call
The full post (with clinical pathways, imaging criteria, and management pearls) is now live:
👉 nickilicphysio.substack.com
🔒 Paywall at cruising altitude — because that’s where the gold is.
#Physiotherapy #ShoulderPain #RotatorCuff #Rehab
13/
🧾 Scans and Stories
In older shoulders, imaging finds something in almost everyone.
Pain-free rotator cuff tears, “bursitis” in half the population, OA in most.
Use scans to confirm your theory—not to build it.
🧾 Scans and Stories
In older shoulders, imaging finds something in almost everyone.
Pain-free rotator cuff tears, “bursitis” in half the population, OA in most.
Use scans to confirm your theory—not to build it.
November 5, 2025 at 7:56 AM
13/
🧾 Scans and Stories
In older shoulders, imaging finds something in almost everyone.
Pain-free rotator cuff tears, “bursitis” in half the population, OA in most.
Use scans to confirm your theory—not to build it.
🧾 Scans and Stories
In older shoulders, imaging finds something in almost everyone.
Pain-free rotator cuff tears, “bursitis” in half the population, OA in most.
Use scans to confirm your theory—not to build it.
12/
🌉 The Rotator Cuff Cable
The reason some big tears keep flying while others nosedive.
Think suspension bridge, not shredded fabric.
The load distribution story matters more than the MRI headline.
🌉 The Rotator Cuff Cable
The reason some big tears keep flying while others nosedive.
Think suspension bridge, not shredded fabric.
The load distribution story matters more than the MRI headline.
November 5, 2025 at 7:56 AM
12/
🌉 The Rotator Cuff Cable
The reason some big tears keep flying while others nosedive.
Think suspension bridge, not shredded fabric.
The load distribution story matters more than the MRI headline.
🌉 The Rotator Cuff Cable
The reason some big tears keep flying while others nosedive.
Think suspension bridge, not shredded fabric.
The load distribution story matters more than the MRI headline.
11/
🎯 The Biceps Canary
When the long head chirps, it’s usually telling you something upstream is wrong.
It’s tender, it’s tired, and it’s tattling on the rest of the team.
🎯 The Biceps Canary
When the long head chirps, it’s usually telling you something upstream is wrong.
It’s tender, it’s tired, and it’s tattling on the rest of the team.
November 5, 2025 at 7:56 AM
11/
🎯 The Biceps Canary
When the long head chirps, it’s usually telling you something upstream is wrong.
It’s tender, it’s tired, and it’s tattling on the rest of the team.
🎯 The Biceps Canary
When the long head chirps, it’s usually telling you something upstream is wrong.
It’s tender, it’s tired, and it’s tattling on the rest of the team.
10/
🧩 Subscapularis – The Forgotten Anchor
Lose it, and the whole cuff loses its compass.
Rehab here isn’t “more external rotation.”
It’s restoring anterior stability and force balance.
🧩 Subscapularis – The Forgotten Anchor
Lose it, and the whole cuff loses its compass.
Rehab here isn’t “more external rotation.”
It’s restoring anterior stability and force balance.
November 5, 2025 at 7:56 AM
10/
🧩 Subscapularis – The Forgotten Anchor
Lose it, and the whole cuff loses its compass.
Rehab here isn’t “more external rotation.”
It’s restoring anterior stability and force balance.
🧩 Subscapularis – The Forgotten Anchor
Lose it, and the whole cuff loses its compass.
Rehab here isn’t “more external rotation.”
It’s restoring anterior stability and force balance.
9/
💥 The Bursitis Brouhaha
If every ultrasound says “bursitis,” maybe the machine’s not broken — maybe our reasoning is.
Scans describe structure, not pain.
A good story trumps a grainy screenshot every time.
💥 The Bursitis Brouhaha
If every ultrasound says “bursitis,” maybe the machine’s not broken — maybe our reasoning is.
Scans describe structure, not pain.
A good story trumps a grainy screenshot every time.
November 5, 2025 at 7:56 AM
9/
💥 The Bursitis Brouhaha
If every ultrasound says “bursitis,” maybe the machine’s not broken — maybe our reasoning is.
Scans describe structure, not pain.
A good story trumps a grainy screenshot every time.
💥 The Bursitis Brouhaha
If every ultrasound says “bursitis,” maybe the machine’s not broken — maybe our reasoning is.
Scans describe structure, not pain.
A good story trumps a grainy screenshot every time.
8/
🧠 Neck First. Always.
If the “shoulder pain” lives between the blades, or the deltoid’s fine but the story’s weird…
Check the neck.
Otherwise, you’ll chase a ghost and call it bursitis.
🧠 Neck First. Always.
If the “shoulder pain” lives between the blades, or the deltoid’s fine but the story’s weird…
Check the neck.
Otherwise, you’ll chase a ghost and call it bursitis.
November 5, 2025 at 7:56 AM
8/
🧠 Neck First. Always.
If the “shoulder pain” lives between the blades, or the deltoid’s fine but the story’s weird…
Check the neck.
Otherwise, you’ll chase a ghost and call it bursitis.
🧠 Neck First. Always.
If the “shoulder pain” lives between the blades, or the deltoid’s fine but the story’s weird…
Check the neck.
Otherwise, you’ll chase a ghost and call it bursitis.