Reading and Tilehurst's Physiotherapy, Spinal and Sports Specialists

"Treating the cause to help you move pain free and perform better"

Tilehurst Clinic 4 Chapel Hill, RG31 5DG
Reading Clinic Sports Park, University of Reading, RG6 6UR

  

Call: 0118 9310053 (24hrs)

 

Enquiries: info@corebodyclinic.co.uk

 

 

About Our Treatments

At Core Body Clinic, Reading we balance our physiotherapy treatments to include 'Hands on' and manipulative therapies coupled with education, activity pacing and exercise to combine the very best in evidence based practice.  We also know that experience counts and the 'when to use and not to use' are important factors that research can not always help us with.  Research does not always help us with the 'individual' so we use evidence as a guide and apply our clinical experience to determine the best physiotherapy treatments. Our range of treatments include:

Visceral Manipulation

Visceral Manipulation is a highly specialised therapeutic approach for the treatment of pain and dysfunction.  It encourages the normal mobility of the internal organs, also called viscera, and their connective tissuesaround them such as muscles, blood vessels and nerves. All tissues must be free to move in their anatomical way to prevent disease and dysfunction.  However, often our organs lose their normal mobility becoming tight and unable to move as they should within the body. When this happens the organs can give rise to symptoms and pain syndromes which can often mimic other common ailments or pains.  These may be conditions like chronic fatigue, fibromyalgia, migraine and even sciatica.  There are also situations where spinal dysfunctions compromise the normal harmony of the viscera leading to pain and dysfunction.

Different factors may contribute to our viscera losing their normal mobility; including: physical trauma, surgery, lifestyle, infection, diet, posture and pregnancy.  These factors causethe development of adhesions and myofascial contractions hampering the normal mobility of the viscera.

Visceral manipulation techniques are very gentle and are useful for even the most stubborn of conditions, often where other treatments have failed.  The techniques combine gentle compression, oscillating mobilisations and elongation of the viscera, surrounding soft tissues, and nervous system.  Visceral manipulation techniques restore normal mobility to the viscera improving nutrition, blood flow and nerve conduction.    This improved metabolic environment will release unhealthy restrictions and ultimately decrease pain and dysfunction in the whole body.

 

Conditions that visceral manipulation can be used to treat include:

  • Migraines and Headaches,
  • Chronic Neck and Back Pain,
  • Fibromyalgia,
  • Chronic Fatigue,
  • Stress and Tension-Related Disorders,
  • Orthopedic Problems,
  • Car accident injuries,
  • Sports-related pain,
  • Back pain,
  • Digestive issues,
  • Scar tissue problems that are common after surgery and c-sections,
  • Irritable Bowel Syndrome,
  • Chronic period pain,
  • and many others

 

How Does it feel?

Visceral Manipulation should feel very gentle.  However, it can have a very strong effect sometimes leaving the patient feeling very tired.  The treatment can also make a patient feel energised.  It is largely dependent on the presenting condition and the dosage offered by the treating therapist, physio or Osteopath. 

Is it for everyone?

The treatment rarely has any side effects and therefore can be used to treat any condition.  However, in keeping with evidence based practice, at Core Body Clinic we carefully select the most appropriate treatment to ensure we are successful in treating our patients.

 

 

 

Medial Tibial Stress Syndrome (MTSS)

 

A.K.A. “Shin splints”

 

    Running Clinic       Sports Physiotherapy                                 

Common in runners to varying degrees, medial “shin splints” is a generic term given to pain on the inside of the lower leg.  We do also get anterior shin splints but this article talks about the pain on the inside or the medial (inside) aspect of the tibia. Medial tibial stress syndrome is perhaps a more appropriate term since is describes exactly what is going on – Stress!  Its a condition associated with over training and is therefore common place for some individuals. 

Historically, it was thought to be the result of periositis or inflammation of the periosteum or membrane that surrounds the bone for muscle and tendon attachment.  However, histological studies failed to identify any signs of such pathology.  We now know that the stress causes breakdown in the balance of bony production and remodelling.  Resorption of bone outpaces the formation of bone in the tibial cortex.  Oddly, the physical exam is enough for diagnosis.  MRI, Xray and CT add little value in how to manage it.

Because of the loss in balance between production and resorption of bone there appears to be a factor of over-training involved. So, train too much and too often with little rest and you might end up with MTSS.

 

 

 

Risk Factors

  1. Female athletes have greater likilhood for development
  2. Possibly greater pronation or loss in its control
  3. There is a relationship between excessive hip rotation
  4. Body Mass Index (BMI)
  5. Previous history of pain in the same region

 

Assessment:

At Core Body Clinic we subjectively assess every patient so you can tell us about the pain, its behaviour and how it started. We will assess training methods to ensure we correct training mistakes and ensure they don’t happen again.  We screen every patient who comes through the door for biomechanical factors.  We look at whole lower chain biomechanics and also assess footwear.  Poorly fitting shoes can cause the lower chain to behave in a very different way and therefore make your nervous system and muscles work a lot harder.  The result is an eventual failure and a loss of purposeful and appropriate functional posture. The tissues are abnormally loaded and pose a risk to MTSS.  We look at running styles as part of our specialised Running Clinic but more importantly we assess muscle length, strength and endurance to give us a clearer picture of how your body functions during sport.

 

Symptoms:

  1. Pain in the lower medial 1/3rd of the tibia
  2. Pain on palpation of the tibia
  3. Possible signs of swelling / odema
  4. Generalised tenderness in the while shaft of the bone and even calf
  5. Pain on running with the foot striking the floor or on foot take off
  6. Pain with descending stairs more than ascending
  7. Pain in the morning with the first steps
  8. In severe cases the patient may wake at night

 

Treatment:

After diagnosis the first line is to re-schedule your training regime.  Correct over training methods and work out a plan for appropriate rest and then graduated return to activity.Correction of foot biomechanics using tape, orthotics or change of shoes is highly effective at reducing pain and preventing future problems.Massage and dry needling have been shown in our clinic to be effective in reducing pain in the short term.Graduated strengthening of local and global muscles – from the foot to the head…….we kid you not! What good is a strong ankle if your neck fatigues and you cant balance properly??? – not thought of that? Well, maybe not quite but the theory is a good one.  Essentially we are saying we like our patients to think about every aspect of their training before returning to sport.

 

Prognosis:

A couple of week off of running is usually enough to start a graduated return to running program.  We recommend for moderate cases that a 6 week program be followed. More severe cases need to follow a more graduated regime to ensure the problem does not return. Remember, this is bone stress and not just a muscle pull.  

 

Unsure? Call or Book Online

Sports Therapist

Rachel Mealyer BSc (Hons) Sports Therapy

Sports, musculoskeletal and Women's Health therapist

  

Member of the Society of Sports Therapists 

Rachel is a graduate from University of Chichester and holds a BSc (Hons) in Sports Therapy.  She is also a member of the Society of Sports Therapists.  She has extensive experience in sport and exercise therapy having worked with Beaconsfield FC as their sports therapist providing pitch side treatment, soft tissue therapies and rehabilitation to players.  In addition, she has is well known to local trampolining and gymnastic clubs treating their squad gymnasts, coaches and parents.

Outside of work Rachel enjoys keeping active, horse riding and playing lacrosse.  She is also a hockey player for Sonning Hockey Club.

Rachel is qualified to assess and diagnose problems affecting the musculoskeletal system (i.e. joints, muscles, ligaments and tendons).  She sees both sporting and non-sports related injuries.  Having a special interst in Women's Health and Pelvic pain, Rachel is also qualified to assess and treat problems affecting the pelvic floor, including: pregnancy pre and post partum; incontinence; pain during sex; and pelvic pain.  She has been trained by the well known Dr Ruth Jones and also mentored by Abarna Devi and Adrian Wagstaff.

Rachel is trained in the use of techniques similar to that of a physiotherapist with her skill set including: Massage therapy, joint mobilisation, sports strapping, exercise prescription and rehabilitation. 

Achilles Tendon Pain

Achilles Tendinopathy 

 

  Running Clinic     Sports Physiotherapy      Treatment

 

Formally known as Achilles Tendonitis the new and preferred term for pain in the Achilles region is ‘Tendinopathy’.  This essentially means Painful Tendon.  Helpful diagnosis!

Now, there are two types of tendon pain: Mid portion Tendinopathy and Insertional Tendinopathy.  Now don’t get too worried about diagnosis as that’s our job to identify and diagnose it appropriately.

The mid portion one is the most common to folk and while there are risk factors it seems absolutely anyone could get this condition.

When a tendon becomes painful it appears to ‘react’ to the load or exercise it has been exposed to.  This loading causes pain.  The tendon essentially becomes intolerant to the exercise and activates nerves to tell your brain. The result is pain! 

Tendons are composed of tenocytes and are therefore structurally different from other tissues in the body.  Initially, there is some inflammation but it appears this is not the main driving force behind the condition.  Because of pain, the calf muscle (in the case of the Achilles) is not able to deliver as much force or contraction. The tendon is loaded to a lesser extent and over time becomes ‘deconditioned’.  The tenocyte matrix is less organised and is again less tolerant to loading. There may be the presence of different cells like proteoglycans which are big sponges and can give the tendon its inflamed appearance.  There is also a suggestion of scar tissue build up but again this is to a lesser extent and perhaps a too simple a model of how the tendon heals itself. 

There does not to be an association between tendon pain in the Achilles and the tendon snapping.  If there is a tendon rupture then this appears to be an acute event without preceding pain.  

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Extended Scope Physiotherapy

At Core Body Clinic in Reading we want to provide an awesome service for our patients. For this we need equally awesome physiotherapists.  So, we have recently added Greg Pullum to our team. Greg works at both our Tilehurst (RG31 5DG) and Reading (RG2 7BW) clinics. 

Greg is a thoroughly nice chap and just happens to be a super skilled and very knowledgeable physiotherapist.  However, Greg is no ordinary physio.  Like Adrian, Greg also holds a post graduate qualification in manual therapy (MACP) and has completed specialist modules in advanced physiotherapy practice.  But, just to make Greg that little bit more super, he also practices as a Spinal ESP – this should stand for “Exceptionally Superb Physio”, what is actually stands for is ‘Extended Scope Physiotherapist’. The term ESP refers to an experienced physiotherapist who has received further appropriate training to work outside their normal scope of practice normally expected from a physiotherapist.  This might include extensive experience, additional competencies, a Masters (MSc) degree or membership of a specialist organisation like the MACP.  Greg’s current role focuses upon Spinal Diagnostic triage and advanced decision making to ensure patients have appropriate investigations and are referred to the right speciality in a timely fashion. 

   

 

 

 Other Extended services include:  Sports Physiotherapy     Running Clinic    Men's Health Physiotherapy


He also currently works within a specialised multidisciplinary service called the Integrated Pain and Spinal Service (IPASS) in the NHS, and Greg combines this with his role at Core Body Clinic.  IPASS is quite cool and recently won the 2016 British Society of Rheumatology’s ‘Emerging Best Practice Award’. People referred to this service often have chronic and complex spinal pain and/or ‘referred’ symptoms, like sciatica.  They may have already seen a physio, osteopath or chiropractor, or have not been responsive to GP intervention and simple pain medication. Their symptoms may include: difficult to manage pain; unusual pain; a loss in strength; altered or absent sensation; and, they may have a change in normal every day function.  Leg pain is not always sciatica and clinicians often miss the subtleties of vascular (problems with the blood vessels) complications.  Therefore, Greg is used to seeing very challenging and complex cases of spinal, back and leg pain and it is his job to track down the most likely cause of a patient’s problem and find a solution to treating it.   

Having Greg at the practice (Core Body Clinic) really helps to add to the effectiveness of the team and also provides us with up to date referral pathways and processes should patients need to be referred on or require specialist tests like specific blood tests. Simple blood tests are sometimes not enough and it is often beyond the remit of your physio to appropriately refer to the right consultant service. Having the knowledge base between Greg and Adrian really helps to refine the referral process and assist your family GP should we need to refer patients onwards.  It cuts down the GP’s time, reduces the likelihood of inappropriate tests and saves the patients time.                                                                          

Greg’s Specific roles include

  1. Delivery of a specialist spinal assessment (Clinical tests of joint, muscle and nerve function 
  2. Organisation of appropriate further investigations such as MRI scans, XRays, blood tests or Nerve Conduction Studies via Neurology
  3. Prompt onward referral to the most appropriate secondary care hospital specialities.
  4. Consultant liaison (Orthopaedic Spinal Consultants at Royal Berkshire Hospital, alongside Physiotherapy Services, Rheumatology, The Metabolic Bone Clinic, Pain Clinic and Pain Specialist Physiotherapists, Vascular Surgeons, Neurology and all other Orthopaedic Consultants)
  5. Mentoring and Supervision and Training input for Musculoskeletal Physiotherapists
  6. Soft tissue and joint Injections for conditions like ‘Shoulder Impingement’; ‘Bursitis’; ‘Tennis Elbow’.

 

Greg is now using his working spinal assessment and diagnostic skills at Core Body Clinic to provide a more comprehensive treatment service for our patients.  If you need a specialist test or scan, Greg can relay this information to the GP, look to fast track you to another service or refer and request specific services.  On the NHS we cannot access scans unless via your GP but we are able to refer you privately at Core Body Clinic (See - Here).

 

If you are suffering from a lack of progression, poor diagnosis or ineffective treatment then give Greg or Adrian a call and we can help you understand your pain and problem.

The cost of Extended Scope is the same as regular physio.  

Call or Book Online!.

 

Joint Mobilisation

 

Physiotherapy joint mobilisations are part of the manual and hands-on therapies that we perform at our Reading clinics.  Our physiotherapists at core body clinic are experts in delivering these techniques.  They can be performed on any joint in the body and are used to treat pain and stiffness affecting the mobility of a spinal or peripheral (ie shoulder or knee) joint.  Mobilisations are graded oscillations of pressure directed at a joint an applied in a highly specific manner.  They are performed for a duration of 1-3 minutes and tailored according to a patient's pain level and tissue stiffness.  The purpose of mobilisation is to enhance movement by reducing stiffness and pain.  The physiotherapists at Core Body Clinic are trained to masters level and have undergone 1000's of clinical hours to perfect the skill of joint mobilisation.

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Medial Tibial Stress Syndrome (MTSS)

 

A.K.A. “Shin splints”

 

                                                              Running Clinic                        Sports Physiotherapy                                 

Common in runners to varying degrees, medial “shin splints” is a generic term given to pain on the inside of the lower leg.  Essentially, on the medial (inside) aspect of the tibia. Medial tibial stress syndrome is perhaps a more appropriate term since is describes exactly what is going on – Stress!  Its a condition associated with over training and is therefore common place for some individuals. 

Historically, it was thought to be the result of periositis or inflammation of the periosteum or membrane that surrounds the bone for muscle and tendon attachment.  However, histological studies failed to identify any signs of such pathology.  We now know that the stress causes breakdown in the balance of bony production and remodelling.  Resorption of bone outpaces the formation of bone in the tibial cortex.  Oddly, the physical exam is enough for diagnosis.  MRI, Xray and CT add little value in how to manage it.

Because of the loss in balance between production and resorption of bone there appears to be a factor of over-training involved. So, train too much and too often with little rest and you might end up with MTSS.

 

Risk Factors:

  1. Female athletes have greater likilhood for development
  2. Possibly greater pronation or loss in its control
  3. There is a relationship between excessive hip rotation
  4. Body Mass Index (BMI)
  5. Previous history of pain in the same region

 

Assessment:

At Core Body Clinic we subjectively assess every patient so you can tell us about the pain, its behaviour and how it started. We will assess training methods to ensure we correct training mistakes and ensure they don’t happen again.  We screen every patient who comes through the door for biomechanical factors.  We look at whole lower chain biomechanics and also assess footwear.  Poorly fitting shoes can cause the lower chain to behave in a very different way and therefore make your nervous system and muscles work a lot harder.  The result is an eventual failure and a loss of purposeful and appropriate functional posture. The tissues are abnormally loaded and pose a risk to MTSS.  We look at running styles as part of our specialised Running Clinic but more importantly we assess muscle length, strength and endurance to give us a clearer picture of how your body functions during sport.

 

Symptoms:

  1. Pain in the lower medial 1/3rd of the tibia
  2. Pain on running with the foot striking the floor or on foot take off
  3. Pain with descending stairs more than ascending
  4. Pain in the morning with the first steps
  5. In severe cases the patient may wake at night

 

Treatment:

After diagnosis the first line is to re-schedule your training regime.  Correct over training methods and work out a plan for appropriate rest and then graduated return to activity.

Correction of foot biomechanics using tape, orthotics or change of shoes is highly effective at reducing pain and preventing future problems.

Massage and dry needling have been shown in our clinic to be effective in reducing pain in the short term.

Graduated strengthening of local and global muscles – from the foot to the head…….we kid you not! What good is a strong ankle if your neck fatigues and you cant balance properly??? – not thought of that? Well, maybe not quite but the theory is a good one.  Essentially we are saying we like our patients to think about every aspect of their training before returning to sport.

 

Prognosis:

A couple of week off of running is usually enough to start a graduated return to running program.  We recommend for moderate cases that a 6 week program be followed. More severe cases need to follow a more graduated regime to ensure the problem does not return. Remember, this is bone stress and not just a muscle pull.  

 

Unsure? Call or Book Online

Spinal Manipulation

Physiotherapists at Core Body Clinic are experts in the delivery of Spinal manipulation.  It is very useful for lower back pain, mid back pain and neck pain and is similar to that used by Chiropractors and Osteopaths.  It can also be used to treat shoulder pain by improving the dynamics of the thorax and rib cage.  

 

It is characterised by a sudden and sharp movement performed by the physiotherapist and is often associated with an audible 'click' or 'popping' sound.  It is almost always accompanied by pain relief.

The physiotherapists at Core Body Clinic are highly trained in the art of Spinal Manipulation having undergone post graduate training and 1000s hours of supervised clinical practice and application.  Adrian Wagstaff is the Lead physio at Core Body Clinic and is also a teacher of Spinal manipulation.  He teaches Masters students the theory and practice of spinal manual therapy, travelling both nationally and internationally.

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