Where Are The Innovators?

I found some... but are they in the right areas?

This issue feels pretty personal. Ten years ago I had an ambitious idea called The Physio Matters Podcast but it was doomed to failure if I couldn’t persuade guests to come on a completely unproven show. A family friend of my housemate (she prefers wife) had an in with an esteemed Physio called Ian Horsley who was willing to give me a chance. His Feb 2014 episode was a hit and on we rolled! Once again he gives another of my ambitious ideas a chance in this month’s mag with an excellent article joining the dots between general MSK and elite sport; two areas that he has decades of experience in.?

Two years later I interviewed another generous expert about her clinical work demonstrating that functional rehab principles improve return to work outcomes. It led to her become a dear friend and mentor of mine who has written a brilliant article in this issue. She’s not especially optimistic about the fate of functional rehab but she would be wrong if more were to follow her lead. If you’re not aware of Heather McLellan? (formerly Watson) then you’re in for a treat.

Less of a treat for me was reading another of this month’s pieces; ‘The Rise and Fall of MSKReform’. Whilst my old mate Felicity Thow has done a great job telling the story, it is painful for me to read about the failure of what turned out to be one of my over-ambitious ideas.

Part of the MSKReform project was creating a path to uniting the MSK professions by centring clinical reasoning, evidence based practice and distributed responsibility. Around the time of its foundation, I met a man called Robert Beaven who exemplified these values. I liked how he thought and I he had the sense to create a podcast for the lay public on back pain. But he was ‘the wrong sort’… he was a Chiro. His article confessing to how odd he is makes for a great prelude to another by a more recent accomplice of mine Leanne Antoine .?

Leanne is a brilliant entrepreneur and even better communicator. She spells out how challenging it is ‘when your business needs needs more than just you’. It really is a great example of high stakes delegation that I perhaps need to take heed of as MSKMag grows thanks to your reading and sharing!

So once again I get to introduce a set of free thinkers with a diverse range of views and experiences whose innovation has moved the MSK needle in sport (Ian), functional rehab (Heather), public education (Rob) and small business (Leanne). But the story that includes some failure (Felicity’s) is in a realm where innovation remains sparse and MSKReform’s ill-fated story is unlikely to encourage many into the policy influence game. It’s a worrying shame because this is one of two areas where literally anything new or interesting would be welcome.

If innovators don’t emerge to influence policy and operational behaviours (as MSKReform sought to do) then the progress made by the various education and clinical influencers risk being largely irrelevant. The structure of our services and the parameters in which they are operated greatly influence the delivery of MSK care as pretty much every article in this month’s mag explains. I lasted a whole page without a metaphor so here’s one because I couldn’t help myself:

Lets consider the following factors to be ingredients of a delicious cake mixture:

• Brilliant evidence informed clinical care delivered by
• Expert clinicians delivering care in
• Lovely high tech facilities that are educated by
• The best and brightest teachers and mentors.

But let’s also consider that the operational behaviour and policy parameters of MSK services are the cake tins. So if services have:

• No community engagement,
• Restricted appointment volume,
• No cultural competence or demographic awareness and
• Long waiting lists facilitating chronicity…

… even glorious, award-winning cake mixtures will fall through the oven shelves if we don’t build tins.

And don’t get me started on whether anyone is willing to fund turning the oven on.