Things worth saying.
Thirty years of physio, leadership, growth and getting things wrong has left me with a few opinions. This is where they live.
Evidence Filtered Through Judgement
Yup. I'm no longer convinced clinical research changes clinical practice nearly as much as we'd like to believe.
Who Decides?
I am a huge advocate of high-value care, which is exactly why I've started questioning who gets to define it. You, me, the insurer, the academic, the boss, or maybe even the patient? Because with time, reflection and…
Not Another Pizza Night
Let's face facts, we all drone on about our staff, team, squad or crew being our greatest asset. I agree, but it's also one of the dullest things business owners ever say.
Nobody Buys a Kitchen One Cupboard at a Time
Nobody wants to buy physiotherapy, just like nobody wants to buy a drill. They want a hole in the wall.
Consent Inside a Hierarchy
Full disclosure. I'm a middle-aged bloke, an MSK physio, and this absolutely isn't my clinical lane. But something about pelvic health training in UK physiotherapy has not been sitting right with me for a while.
Hiding in Plain Sight
Do some people simply have more entrepreneurial spark than others? I'm not sure. What I do know is that a lot of physios assume great physio automatically creates a great physio business.
Of Course You Will
Portugal is a fine country. Great beaches, great people, great food, great wine. I've been going for most of my life, but I'm still a long way from being a local. I do my best though. An obrigado here, a bom dia…
Newly Qualified Physios Have It So Easy
Newly qualified physios have it so easy, don't they? The digital revolution has made learning easier and more immersive than ever, with hi-def anatomy models, research in your pocket instead of buried in a library,…
Rehab Has Theatre Too
I am, I think, a pretty good manual therapist and a pretty decent rehabber too, which puts me in a slightly odd position. Because in MSK, my manual therapy skills are apparently the butt of most of the jokes. We're…
Most Owners Don't Fail Too Often
It sounds wonderfully punchy, but the truth is you only really believe it after you've died by a thousand cuts.
You Can't Out-Design Poor Culture
Usually looking like someone asked a chatbot to merge a wellness retreat with a fintech startup.
The Conversation We Owe Them
One of the biggest problems in modern healthcare is that we've stopped being properly honest with patients about what recovery might actually require.
There Was Not a Series in That
Twenty years ago, a television production company came to make a pilot documentary about us.
Ideas Month
Patients disappear on holiday. Schools are out. Half the team are in Greece and the other half are looking at flights to Greece. The rent, rates and salaries remain stubbornly uninterested in the school holidays.
The Discharged Patient Is Your Best Marketing Department
The best clinical outcome is also the worst short-term business outcome.
The People Who Actually Hold a Clinic Together
It might come as a surprise, but the real backbone of most physio clinics isn't the physios.
The Waiting Room That's Costing You a Fortune
We all talk about profitability like it's some dark art. It isn't.
The Limp That Disappeared
I saw something the other day that properly made me stop and think.
Strength is Easy. Movement is the Hard Bit.
We've built MSK around things we can measure. Straight edges and 90-degree corners.
The Stretching Myth We've All Been Going Along With
For something so universally done in MSK it's become white noise. Patient says "ooh I feel tight," physio tells them to stretch it, the clinic director high-fives everyone and off we go. The whole thing runs on…
The Free Blood Test That Taught Me Everything About Front of House
Every year I get my bloods done. Points on a graph and prevention is better than cure at my ripe old age.
Shockwave and the Machine We Worship This Decade
A shockwave wand being wafted over a back like a magic incense stick, alongside a neat explanation of how it treats tendon pain.
The Insurance Promise That Doesn't Quite Add Up
A pal told me recently that their very expensive, very shiny insurance had approved them for physio. It sounded great. Unlimited sessions. All taken care of. Cushty.
What the Boat Race Taught Me About Energy
Every year the Boat Race rolls around and Putney becomes absolutely chokkas. Most people there for the day out, a few claiming they knew someone who rowed and a tiny handful who actually went to Oxford or Cambridge.
The Curse of Knowledge (and the £30k Hole in the Floor)
I caught myself reading a post the other day and thinking: come on, this is obvious.
The Problem with "Exercise Prescription"
You don't need a prescribing qualification to tell someone to move a bit more. For most people it simply isn't a prescription. It's a walk. A squat. Getting up from a chair without overthinking it.
The Resistance Band Problem Nobody Talks About
Theraband and K-tape get used far too early, far too often and far too easily.
Groundhog Day in a Compression Sleeve
For those who get the cultural reference: Phil Connors spent 12,400 days stuck in Groundhog Day.
The Real Reason Patients Choose You
Most clinic owners spend ages trying to work out the magic formula for getting patients through the front door.
Why I Hired the Architect Who Said "I'll Find a Way"
At the level I'm playing at they're all pretty similar. Same constraints. Same planning rules. Same rough outcome. Just different flavours of the same thing. No one's knocking down a tired house and turning it into…
This Fancy Kit Doesn't Explain the Pain
Force plates. Hand dynamometers. Colourful graphs of all descriptions.
M&S, Waitrose and the Clinic in the Middle
A new M&S Food Hall has just opened opposite a Lidl and about 50 metres from Waitrose.
The Back That Fixed Itself (Sort Of)
I spoke to a fit mid-50s bloke this week. Runs, gyms, no medical history worth mentioning.
Something tweaked me last week - it's OK to be OK with standards.
The message was upbeat, confident and a little tub-thumping. And it made me think how easily we confuse box-ticking with competence.
I've been reading clinic reviews recently — but only the two-star ones
I think they are some of the most honest reviews. The 5* are full of gratitude and the 1* are emotion. The 2* is where the truth leaks out. I might call this the Todman 2* test.
I feel great. I have a pretty wonderful life.
But my body knows it's 57. When I run, I'm losing my 'bounce'. I can feel it. I still do the plyos. I still lift. I still move well. But the 'spring' just isn't the same.
I've got piles of old flip-charts at home.
Strategy days. Big thinking. Bubbles and breakouts. Pages of ambition and arrows. At the time it felt essential. And some of it was.
Having access is a real luxury. Premium service.
Somewhere along the way "busy" became a badge of honour in healthcare. Full diaries. Waiting lists. Out-of-office auto-replies explaining just how important you are in that wonderfully pas-agg font.
Yes, people fascinate me.
They got interviewed as well - most of them just never realised it.
The Other Chair
Physio is the easy bit. Get the people side wrong and woe betide you.
The Turbo Patient
Years ago I saw a woman with an acutely torn, locked meniscus. Classic mechanism. Classic presentation. No-brainer.
Words I've Quietly Retired
Not because language doesn't matter - but because it matters too much to be lazy with it.
You Can't Outrun Experience
Early on, I thought good physio - and good leadership - was about doing the right things faster.
Physio Bloat
There's an inflation problem in physio that gets quietly swept under the carpet.
If Nobody Winces, You're Not Leading
For those of you who've had the pleasure - or displeasure - of sitting in a boardroom where everything is impeccably polite and nothing obvious is ever said out loud, this may feel familiar.
Crashing Without a Seatbelt
For decades I kept my head down and got on with it. Not because it was noble. Not because I was doing the real work quietly.
The Tidy Version of It.
After almost thirty years in the cold - building, scaling and selling a business, it's pretty obvious I don't know everything. And I didn't get everything right.
If Nobody Winces, You're Not Leading
Bad physio is not on. Ever. But I've rarely worried about a 'bad physio'. Skill can be fixed, stuff can be taught and clinical ideas, developed.
Believe it or not, every team needs a fun bus driver.
And yes, vibe hoovers are real. Every clinic has had one at some point. They drain energy, suck the life out of meetings, and quietly lower standards. Everyone feels it, and it gets sickly fast.
Designing Out Good Care
There are plenty of people peddling the idea that the answer is simply work harder or work smarter. That's exactly the wrong conversation.
So, what does 'good' actually look like in MSK care?
In London, almost everyone is clinically good. They have to be. You don't survive here if you're not. Physio, chiro, osteo, god-knows-whatevero - the technical bar is already high because competition is brutal and…
Culture does not usually die in a big dramatic moment
That would almost be easier and would make you sit up straight. But most of the time it drifts. Slowly. Quietly. Sneakily. Like you are being slowly squeezed by an anaconda.
If nobody winces once in a while, you’re not leading
A lot of people want leadership to feel nice. They feel they've earned the pip on their collar. They want it to be supportive, very human, calm more often than not, warm and lovely.
Leadership does not get easier. You just get less easily fooled.
People love the idea that experience makes leadership easier - it doesn’t. It just helps you spot the real problem faster.
Why good clinics are built on people, not props
I very rarely used to write stuff down and put it out there - not because I had nothing to say. I was too busy actually building a business.
I publish first on LinkedIn.
The strongest pieces also live here permanently. Searchable, organised and mine.