Shockwave for Erectile Dysfunction


Erectile dysfunction describes a condition where an erection is either not possible or not sufficient for the desired task of sexual activity. 


One of the main drivers causing erectile dysfunction is poor vascular blood flow and patients who respond well or fair to PDE5i medication are shown to have the best outcome.  Patients who are non-responders have shown to improve and become good responders to PDE5i medication following Focus Shockwave .   

At Core Body Clinic we also use Focus ShockWave in the treatment of Pelvic Pain in both men and women, and we are currently using in Hard Flaccid syndrome and erectile function after Prostatectomy.

You can find out more by calling or emailing the clinic or booking online

How does Shock wave help Erectile Dysfunction?

While medication like PDE5 inhibitors provide a solution to erectile dysfunction, they do not change the underlying pathophysiology of loss in vascular supply and reduced nitric oxide release.  Focus shockwave has angiogenic properties and delivers electro shock impulses into the target tissue stimulating healing through the process of angiogenesis.  New blood vessels are formed and the release of nitric oxide is enhanced dialating blood vessles and increasing cell permeability.  The overall effect increases and enhances perfusion and thus provides a longer standing change in erectile tissue physiology and therefore enahnced erectile function. 

Research has shown that these changes achieve better and even spontaneous erectile function, where this might have been unachieveable.  Some patients experience pain during an erection and ShockWave therapy can help by modulating the release of substance P, a powerful peripheral nerve neurotransmitter responsible for the reduction of pain.



Research has demonstrated that Focus ShockWave therapy can lead to a significant improvement in erectile function and has been shown to improve the International Index of Erectile Function which lasts at least 9 months .  A systematic review (pooling of lots of randomised controlled trials) with a cohort of over 800 patients treated for erectile dysfunction using focus shockwave therapy found that the treatment was indeed highly effective, safe and led to significant improvements in erectile function. Further reading can be found here.


How many sessions are required?

It is necessary to repeat the sessions for at least 6 weeks and in a consistent weekly manner.  In some instances it is necessary to repeat 2 sessions a week.

6 to 8 sessions are needed in most cases.  This can last for up to 18 months with a repeat course recommended after this time. 


Is it safe?

Shock Wave therapy is very safe provided it is delivered by trained practitioners.  Some patients experience a little ache like pain during the treatment that can last for 24 to 48 hours afterwards. 


Is this the only treatment I need?

Erectile dysfunction can have many causes that interact to cause ED.  Therefore, having a holistic approach to treatment is key in ensuring you get the best out of the Shock wave therapy. Other treatments may include:

  • Pelvic floor exercises to release your pelvic floor

  • Specialised Breathing and relaxation work.  Relaxation through breathing has been found to be hugely beneficial for all types of conditions.

  • Re-education of the  pelvic floor, hip and abdominal musculature

  • General exercise



more reading.........

How does an erection happen?

An erection occurs when we become aroused and messages from the brain signal the penile muscles (Corpus Carvernosa) to relax.  Blood enters the erectile tissue (Corpus Carvenosa) via the pudendal artery and inflates the penis.  The Tunica Albugenia then contracts to trap the blood in the penis and keep it in an erect state.

The erectile tissue  of the Corpus Carvenosa and Corpus spongiosum are under autonomic control are extensions of the pelvic muscles of the skeletal and consciously controlled Bulbospongiosus and Ischiocarvenosus.  It must be noted that these are different. 


What Causes Erectile Dysfunction?

There are many causes of erectile dysfunction and finding out the likely cause is a good starting point in getting the right treatment.  This is a list of possible causes:

  • Problems affecting the flow of blood to your penis

  • Conditions of the nervous system, which is made up of your brain, nerves and spinal cord

  • Changes or disease causing change in hormone levels

  • Physical structure problems in the penis

  • Diabetes

  • Smoking

  • Psychological and emotional well-being

  • Intra-pelvic pain syndromes like Chronic Pelvic pain

  • Hard Flaccid or HF

  • Post surgical injury to nerves and muscular tissue (Prostatectomy / TURPS)

  • Cycling

We could always recommend you see your GP 1st to rule out any other co-morbid factors.


To find out more

Please email the clinic or call. 

Ask for Adrian Wagstaff to call you back. 

If you are confident you require Shock wave then simply book online using the online services.


Shockwave Therapy

What Is Shockwave Therapy?

Extracorporeal shockwave therapy uses high-powered sound waves to stimulate the healing of chronically injured tissues like tendons or over the painful joints of osetoarthritis.  We also use shockwave for vascular erectile dysfunction and it has also found application in pelvic pain. Shockwave therapy has been used in medicine for over 20 years and has a large body of evidence proving its effectiveness having been adapted from lithotripsy treatment that is still used today as a treatment to break down kidney stones.

This is only available at our Mumbles and Swansea Clinics. 

Shockwave therapy is very different from ultrasound therapy and can mechanically stimulate tissues deep within the body unlike other types of sound wave therapies. 





There are TWO types of shockwave therapy.  Radial and Focus.......At Core Body Clinic, we use FOCUS shockwave and there is a good reason why: 



How does shockwave therapy work?

Shockwave therapy works through a variety of biological mechanisms. The powerful sound waves created by the therapy have been shown to cause a cellular level vibration within injured tissues that have a number of beneficial effects from mechanical stimultion to regenerative effects in tissues (Focus only):

Key effects: 

Increase of cell wall permeability

Stimulation of Microcirculation (Blood, Lymph)

Release of Substance P Neurotransmitter responsible for pain modulation.

It is a powerful vasodilator, causing considerable hypotension

Cavitation Release of nitric oxide (increased cell metabolism, neoangogenesis, anti-inflammatory effect)

Stimulation of growth factors









When Should You Consider Shockwave Therapy?

Shockwave can be used at varying points of the injury cycle and like all injuries we tend to leave things until its not got better.  While it is not a panacea and should be used as part of a clinical rehab and treatment plan, it is known to have particular application in the following conditions: 

  • Plantar Fasciitis
  • Tendinopathies like Achilles Tendinopathy 
  • Bone and Stress Fractures
  • Delayed bone-non unions/bone healing
  • Acute injuries
  • Knee & Joint arthritis / Medial Knee OA
  • Osteitis Pubis -Groin Pain
  • Haglunds Deformity
  • Insertional Achilles Pain
  • Tibialis Posterior Tendon Syndrome/ankle sprain
  • Morton Neuroma
  • Medial Tibial Stress Syndrome / Shin Splints
  • Tib Post/ Peroneal Tendons
  • Avascular Necrosis of Hip
  • Trigger Finger
  • Carpal Tunnel Syndrome
  • Chronic Pelvic Pain
  • Coccydynia
  • Myofascial Pain
  • Urological indications (ED) Male Impotence or Erectile dysfunction.Dysfunction / Chronic Pelvic Pain / Peryonie’s
  • Wound Healing and other dermatological and aesthetic indications


Can Shockwave help with Erectile Dysfunction?

Yes. Piezo electric sound stimulation can help in up to 80% of cases in vasular erectile dysfunction**.  Making Shockwave a good choice for erectile problems.  This, combined with our Mens Health Program at Core Body Clinic is the best chance we can offer men with erectile problems. 


What are the success rates of shockwave therapy?

Shockwave therapy has been shown to provide a 80-90% success rate in reducing chronic tendinitis pain within 12 weeks of starting treatment.



What are the contra-indications?

  • Shockwave Therapy can not be used:
  • If you are pregnant
  • Over open growth plates
  • Over the lungs
  • Over major blood vessels
  • Over infected areas
  • If you have had a recent steroid injection
  • If you are on anti-coagulant medication
  • If you have an active cancer



Is shockwave therapy safe?

Yes. Shockwave therapy is extremely safe having been used on millions of patients around the world with virtually no negative side effects. Recent NICE guidelines recommend the use of shockwave therapy and emphasise the safety of the therapy.


Side-effects include:

  • A temporary reddening of the area treated
  • A temporary increase in pain fro 24 hours after treatment
  • Mild to moderate pain during treatment
  • Low level bruising if the treated area


What to expect during Shockwave therapy treatment?

Prior to engaging in shockwave therapy your diagnosis will need to be confirmed by a diagnostic ultrasound scan. This is to ensure you are a good candidate for the therapy and to optimise results.

Once diagnosis has been confirmed your therapist will apply the shockwaves to the injured tissue. Typically this will correlate with some tender areas located around your injury. The treatment is non-invasive so no needles are used. There is also no need for local anaesthetic. The treatments itself lasts no longer than 8-10 minutes. During the treatment you should expect to feel some mild to moderate discomfort, this is required in order to achieve maximum benefits. The energy levels applied during treatment can be adapted to suit each individual patient.




What Do I need to do after treatment?

One of the main advantages of shockwave therapy is there are no major restrictions on patients after treatments. It is recommended that heavy impact activity is restricted for 24 hours after treatment but patients will be fine to drive and return to work after treatments.

Many athletes and elite sports teams use shockwave therapy over injections to manage injuries as it allows them to continue training and playing throughout the season.


Do I need to do any other treatments with Shockwave therapy?

Yes. In order to maximally benefit from shockwave therapy it must be combined with a specific stretching or strengthening home exercise programme. The exercises required will be demonstrated and progressed by your therapist during each session.


When will I notice improvements?

Most people will notice an almost instant decrease in pain after treatment. This will be a temporary decrease as the tissue has been desensitised. Over time the pain relief becomes more permanent. Typically most people notice a significant improvement in symptoms 3-6 weeks after their first session. The optimal results of shockwave therapy are realised at 12 weeks after the first treatment.


How many treatments will I need?

Every patient will require a minimum dose of 3 treatments performed at weekly intervals. After the 3rd treatment patients will be reviewed at 6 weeks to assess response to treatment – at that point a decision on further treatment can be made. If an injury has been present for a long-time then a further 3 treatments may be required. Typically patients do not require more than 6 sessions.

For shockwave in erectile dysfunction patients and pelvic pain, the delivery of treatment is longer and the number of sessions is higher with 6 to 8 sessions more typical. 


What device do CoreBodyClinic use?

At Core Body Clinics we only use the highest-grade medical shockwave therapy equipment. The devices used are the original Swiss made shockwave therapy machines as used in the NICE guideline recommendation trials.  We use the Storz Duolith Focus Shockwave system.




Injection Service


Injection with Corticosteroids and Hyaluronic Acid


At Core Body Clinic we are now be providing injections using Corticosteroids and Hyaluronic Acid. 

Please CALL or EMAIL the clinic to speak to a specialist. 

Corticosteroid is a controlled drug and requires prescription which we will be able to provide. Hyaluronic acid is not a controlled drug and requires no prescription - N.B. both have their merits and they are administered based on your injury status.  This means the service is a one-stop service where you can have your diagnosis and treatment at one location.  Because we are one of the few clinics in the area to provide Ultrasound diagnosis we can assess you, perform a point of contact scan to assist in diagnosis and clearly identify your eligibility for an injection. 

You should contact the clinic 1st to check you are eligible for an injection and you would normally undertake an initial physiotherapy with ultrasound assessment prior to having the injection to ensure you are appropriate and to ensure that you will benefit.  All patients are carefully screened by telephone prior to having an injection to ensure also that the prescription is safe for use. 


What are the injections? 


Cortisone is the name of a group of medicines that are very strong anti-inflammatories. Corticosteroids are naturally occurring hormones already present within the human body, they are very different to anabolic steroids as used by some bodybuilders. Cortisone can help reduce the pain of a tendon, joint or nerve that is inflamed.

What us Hyaluronic Acid?

Hyaluronic acid occurs naturally in the body meaning injections are very safe.  These injections can be used for painful joints like arthritis or where you have degenerative changes in the joint and you are not able to perform exercise.  Using these types of injections is sometimes preferrable to cortisone for joints because they are less aggressive.  There are different injections available with hyaluronic acid. It depends if you will benefit from a series of injections vs a single treatment.  Depending on your condition, the treating clinician will assist in helping you find the right solution. 


How are injections given?

Cortisone can be taken by mouth but an injection is usually more effective as the medication is placed exactly where it is needed, meaning smaller doses can be used. Typically they are placed around a chronically inflamed tendon or into joint. Both Hyaluronic acid and cortisone are delivered via a needle and syringe.


What conditions are treated with cortisone?

Hyaluronic acid is for the treatment of joint conditions that are of a degenerative nature. 

Most painful tendons can be treated effectively with cortisone injections. Inflammatory joint pain from osteoarthritis can be rapidly reduced with cortisone, as can nerve inflammation such as carpal tunnel syndrome.  Some of the common conditions include: 

  • Tendon Pain
  • Frozen Shoulder
  • Joint pain
  • Nerve Pain
  • Carpel Tunnel Syndrome
  • Tennis Elbow


Is cortisone a cure or a temporary fix?

  • Cortisone can be a cure for any pain that is entirely due to an inflamed structure such as frozen shoulder and tenosynovitis.
  • Cortisone can also be a temporary fix for any pain that is due to a minor injury, but the patient is unable to take the required time for the injury to heal itself. For example, with Golfer’s elbow in elite sports players who are required to continue with their sports activities.
  • Hyaluronic Acid can last anywhere between 6 and 9 months. 


How frequently can cortisone be given?

  • There are no lifetime limits on cortisone injections however expert medical consensus suggests there should be a 3-month gap between the administration of cortisone. Typically, if you do require more than 2 cortisone injections then you may be advised to consider other treatment options.
  • It is important to understand that cortisone is an excellent way to reduce pain quickly to engage in a rehabilitation programme, which will provide the long-term solution to most problems.
  • Hyaluronic acid does not have any side effects and therefore can be administered on multiple occasions provided it is effective. 

Will the injection hurt?

  • Minor discomfort is common however most patients report the injection was far less painful than they thought. There may be the need to use ultrasound to guide injections, where deemed appropriate. 

Are there any complications?

  • Short term: A small number of people will experience a temporary increase in their pain as the cortisone is working. This is nothing to be concerned about and will pass after 24-48 hours.
  • Long Term: Too many cortisone injections can cause tendon damage or worsening osteoarthritis. If you are concerned about this then your practitioner will be happy to discuss your specific case with you.
  • Many patients are concerned that steroid injections will make them gain weight. This is extremely unlikely after a corticosteroid injection as the doses are very small in comparison to oral steroids.
  • Hyaluronic acid carries very few side effects.  Pain is perhaps the only side effect because of soreness after having the injection.  
  • The rate and risk of infection is very very low.


What can I expect from the Injection?

The cortisone can be given with a local anaesthetic so you will usually experience a mild numbness and pain relief for a few hours. When the local anaesthetic wears off many people experience a dull ache or throbbing sensation. A small percentage of people will get a temporary increase in their pain; know as a ‘steroid flare’. This is nothing to be concerned about and painkillers such as paracetamol can be used to help calm symptoms, this will settle quickly.

Hyaluronic acid can also be given with a local anesthetic and again can cause some flair up once the pain killer wears off.  This is because we often feel better and tend to do a little more before we are ready. 

  • It is often best to consider driving arrangements after an injection as the local anaesthetic can cause some localised numbness, therefore driving may be best avoided.
  • If you are having a joint injected then it is advised to avoid strenuous activity for at least 2 days. If an inflamed tendon is to be injected then 10-14 days of relative rest from sport activities is recommended.
  • Cortisone will actively work to reduce your inflammation for 21 days. This means that the benefits of cortisone are seen within 3 weeks. The vast majority of people will start to feel benefits within 7 days after the injection. 


Please call or email the clinic to speak to Adrian about Injection therapy and whether this is the right thing for you. 


Hard Flaccid Syndrome

"No two patients with hard flaccid are the same. We must treat every patient as an individual".

Adrian Wagstaff, Male Pelvic Physio 

For Online bookings please click here

What is Hard Flaccid Syndrome? 

Hard Flaccid Syndrome is a condition affecting the penis and is of unknown aetiology among men.  However, our observations suggest hard flaccid syndrome to be more prevalent between the ages of 18 and 35.  It is characterised by a change in penis size, shape and feel.  Penile stiffness or swelling when the penis is in a flaccid state and flaccid size is a common characteristic.  The penis is sometimes firmer to the touch, it is engorged and rubber in texture, and is often accompanied by a change in size or shape of erection.  There may be a loss in nocturnal erections, and it may require a greater degree of stimulation to achieve an erection.  There is often a loss in libido and a shattering of confidence.  However, the most common reason for someone seeking help when suffering from hard flaccid is because of alarming changes in penile shape and size.  Patients often self-diagnose hard flaccid from reading online forums.  It is different from peyronnie’s disease because there are no visible signs of tissue scarring and plaque formation. Nevertheless, hard flaccid is a distressing and poorly understood condition.  At Core Body clinic, our pelvic physiotherapists are experts in the treatment of Hard Flaccid syndrome. 

Until recently any male pelvic pain syndrome would fall under the umbrella term of Chronic non-bacterial prostatitis often leaving men in the no-man’s land of diagnostic labelling and therefore at a loss as to how their pain and symptoms could be rectified.

Hard Flaccid syndrome has largely been the subject of discussion and debate on male pelvic pain forums with little or no clinical information about the condition.  Therefore, diagnosis is difficult to the untrained eye and often clinicians are at a loss about treatment.  Seeing a male pelvic physiotherapist who has expertise in male pelvic pain and pelvic dysfunction is the best thing to get you on the road to recovery. 


What causes it?

With little by way of clinical research concerning hard flaccid, much of the theories relating to the pathophysiology are based on our observations of the patients who present in clinic.  However, in combination with the knowledge of anatomy and pain mechanisms an understanding has been developed which has enabled us to provide treatment solutions.

Injury to the penis and stress are likely drivers for this condition.  Our own practice at Core Body Clinic has observed many patients who present having engaged in excessive masturbation, exhaustive sex or who have attempted penis enhancement stretching, like jelking.  Such situations see the penile muscles in sustained contractile states leading to venous compression in the penis.  The blood vessels therefore failing to empty when in a flaccid state with blood remaining in the erectile tissue.  Erectile tissue fatigue occurs, as one would see in many other muscle tissues in the body.  An almost spasm like behaviour where the regulatory control of erectile function is lost, and the erectile tissue fails to disengage fully.  We think if it as a pseudo priapism where the blood becomes almost trapped.  Likewise, in a continued semi stimulated state, the tissue struggles to fully erect because it has lost the normal feedback mechanism.  Autonomic and central nervous systems control erectile function and in states of fatigue the central and parasympathetic nervous system can no longer regulate this function.  Pain is sometimes a feature due to tissue injury and chemical irritation of nerve endings, caused by fatigue chemicals.  This further results in anxiety and distress. We know that psychological drivers transfer into biological processes and also the phyical injury gives rise to anxiety.  Stress causes the release of cortisol, adrenaline and no-adrenaline resulting in increased blood flow to the pelvic area.  This exposes already traumatised blood vessels to increased blood flow only helping to drive the process and maintain a hard-flaccid state.  Treatments that stimulate the release of nitric oxide, like focus shockwave, may have application in these patients.

It has been suggested that tension in the pelvis is strongly linked to stress and this in turn will help to maintain the poor regulation of blood flow in the pelvic floor.  The origin of the penile muscles from within the pelvis allows for easy influence of the tight pelvic muscles on the penile erectile tissue.  There is often associated tension over the perineal and anus regions.

However, tightness can often be confused with strong muscles and to further confound diagnosis patient often present with voiding complications.  They may dribble after micturition, finish toileting only to feel like their bladder has not fully emptied or experience pain after voiding. While there may be tension in the pelvis, we have found the strength of the pelvic floor to be poor and on testing using our diagnostic ultrasound scanning we find movement of the pelvic floor is often limited.


What can be done to treat hard flaccid? 

At Core Body Clinic we have a lot of success in treating this condition with all our patients achieving a greater than 75% improvement**

Understanding the patient’s drivers and educating our patients about their condition helps with anxiety about the condition.  Information concerning the onset of symptoms is essential in removing any harmful behaviours or practices and emotional drivers.  Often this is a distressing and difficult time for the patient, and in some cases the cause is elusive and requires careful history taking to unpick the possible triggers.

Relaxation plays a significant role in re-establishing normal breathing patterns thereby facilitating appropriate abdominal movement.  Interruption of the normal diaphragmatic excursions during breathing is closely associated with pelvic tension.   Hard flaccid is distressing and leaves the patient in a state of anxiety causing shallow breathing, abdominal bracing and abdominal muscle fatigue.   

Focus Shock Wave therapy has been proven to enhance the blood flow in patients suffering erectile dysfunction.  Hard Flaccid patients are increasingly finding resolution of symptoms from this therapy.  Shock Wave stimulates the release of nitric oxide which promotes the relaxation of blood vessels in the penile tissue and pelvic region.  This treatment has been found to be highly successful in complementing recovery. 

Physical therapies such as trigger point release and massage to the perienal area and internally within the pelvic floor may help some patients by providing feedback to patient and clinician about tension in the pelvis.  With careful and skilled practice it is possible to remove this tension to alleviate pain and tissue tension. However, there may be no tension at all. We also use diagnostic ultrasound to examine the pelvic floor and determine whether movements are limited and whether this is a result of tension or trigger points.  We must stress that trigger points merely relate to painful areas in the pelvic floor. The key to successful trigger point diagnosis is the reproduction of the patients pain. True trigger points in the pelvis are rare, we have found, in the case of hard flaccid  

Exercises to restore normal pelvic floor control is essential. Quite often online forums encourage the ‘Kegal’ exercises to strengthen the pelvic floor for enhancing sexual performance and many men attend the practice having done these only to end up in a worse state.  The confusion is that they have over exercised using kegals. It is often found that they have injured themselves and blamed the kegals.  One would then tend to focus on the ‘reverse kegal’.  This differs from the kegal by pushing the pelvic floor down rather than lifting it up. It aims and is believed to de-tension the pelvic muscles.  However, we must restore balance in the pelvis to ensure reciprocal operation of the pelvic muscles and therefore using diagnostic ultrasound feedback we teach the patients how to balance the normal rhythm of the pelvic floor muscles. We want them to do kegals and reverse kegals. These movements are normal for the pelvic floor and are often dysfunctional in hard flaccid states  Using diagnostic Ultrasound s a highly effective technique for such conditions and at Core Body Clinic it is Gold Standard for treating the pelvis. 

Hard flaccid is also thought to occur with weight lifting and patients believe that they have lifted excessively as the cause for the initial onset of symptoms.  Therefore, there is a reluctance to get back to training and part of our therapy is to coach the patient about normal lifting practices and ensure their breathing pattern and pelvic muscle control is appropriate. It is often they have injured themselves and then find weight training exacerbates their symptoms rather than a cause. Assessment of the pelvic muscles during exercise is key.

We also direct the patient through a set routine of stretches and loading activities to rehabilitate the pelvis. We look at hip, knee, ankle and spinal ranges of movement. Our aim it to get the body back to physical prime. That way patients are mentally and physically confident in their bodies. We also want to reduce as far as possible the facial interplay of connective tissue tension across the pelvis. While there is little evidence to support the concept that fascia in the body causes hard flaccid, getting our patients back to sound physical conditioning is well known to help mental wellness and pain. Our experience is that is hugely helps reduce symptoms in pelvic pain patients and also the symptoms of hard flaccid. 


Hard flaccid is a difficult condition to treat.  Specific men’s health physiotherapy is highly successful in resolving this condition. More importantly having a physiotherapist that understands the condition and knows how to treat an individual is key. 

Core Body Clinics are specialist centres for the treatment of Hard Flaccid and we are a designated shock wave clinic for the treatment of erectil dysfunction. 


Achilles Tendon Clinic

Achilles Tendon Pain


At our tendon clinic we see lots of Achilles Tendinopathies and Achilles Heel pain.  We use our expertise in diagnosis using over 20 years of experience and ultrasound scanning to understand your problem and how best to fix it.  Our unique clinic combines all of our knowledge to understand how your pain started and what we can do to stop your pain coming back. 

There are two types of Achilles tendon pain: Mid portion Tendinopathy and Insertional Tendinopathy.

The mid portion one is the most commonly injured part of the tendon.  People often present with pain after they have been running and start to develop pain in the region or they may feel a sudden onset of pain in the tendon.  They typically find the tendon becomes stiff when first walking in the morning and they may have pain when running or after running.  On occasions, there is severe pain and you are not able to run.  Typical patients at Core Body Clinic are runners who have been training very hard or are attempting to compete.  Our desire gets the better and we run through pain.  Tendons become injured when they are overloaded.  We keep running beyond the capacity of the tendon and therefore we get tendon reaction and eventually the signs of degeneration.  Simply, the tendon can no longer cope and starts to thicken up with inflammatory tissue, scar and excess debris.


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 as the tendon tries to heal itself.

"I wasnt even training hard!"

In any case these tendons are not functioning and your capacity to run and eventually walk pain free becomes limited.  You are able to run a little and then not at all.  It gets better for a few days and then it worse again. Very frustrating.  The key to success is in the understanding of how the pathology and biology of your tendon has changed.  Only then will you become aware of the parameters of training to enable you to appropriately rehabilitate the tendon without over loading it. 

Sometimes, you may not even be aware of over loading the tendon.  You may have enjoyed a problem free year without pain, normal training and excellent times.  You may have been running on the sunny promenade on a day like any other, and then develop a sharp pain.  The key here is that your training may have become attritional and plateaued.  Your tendon starts to go backwards and is no longer functionally capable of loading without injury. This is the danger zone and makes you vulnerable to injury. or stiffness in the tendon.

"Im not very fit" or "Im new to running"

If you are severly out of condition, perhaps you have suffered a long illness or you have taken steroids for a long period of time.  Such persons are more susceptible to Achilles Tendon Pain. 

Snapped tendons or ruptured tendons tend to occur without warning.  It is not common to have a history of tendon pain and then rupture your tendon.  



  1. Pain in the middle of the tendon 
  2. Pain on running
  3. Pain may get better or worse with activity
  4. Pain in the morning for the first 5 or 100 steps
  5. Pain on descending the stairs.
  6. Pain on hopping


What you will not have:

With Achilles diagnosis you will not experience burning pain and Pins and needles

You also will not suffer pain shooting up the leg and into the back



At Core Body Clinic we have a dedicated Tendon clinic for assessing the Achilles tendon.  We use a combination of history (what happened), examination and also Ultrasound Scanning.  The scan helps us to understand to what extent the tendon is damaged and this provides you with a prognosis.  We will use a battery of tests to diagnose your problem with checks of your balance, knee alignment during function, foot posture and strength.  



Tendon Scanning 





We will also check your hamstring strength and length, hip flexor length and also the ranges of movement in your spine.

We will look at calf strength and ankle flexibility and probably give the tendon a poke and prod.  While this helps to show us where the issue is it does not tell us



We know that activity is good for tendons. They love it! But in the early stages gentle massage, rest, ultrasound (big placebo but can be therapeutic), taping, R.I.C.E and Anti-inflammatories (NSAIDS) can all help.  But none of these will sort your tendon out.

Once we have confirmed diagnosis we will set about prescribing a bespoke plan of action to get you back to your normal functional level.

Isometric exercises are thought to be helpful by contracting the calf muscle, like a heel raise and holding the position for 30-60 seconds.  

Graduated exercises are the main stay once pain begins to settle. These are carefully constructed and prescribed in consistency with your pain. Over doing the exercises too quickly will land you back to square one. They need to be gradual and increase in load so that getting you back to climbing the stairs or Everest is a smooth pathway of recovery

Massage and Ultrasound can be helpful to manage pain to allow you to exercixse and load the tendon.

For more difficult tendon pains we can use Shockwave therapy and in very small numbers PRP injections are helpful. 


We may also use taping if you are struggling with pain and orthotics if we feel your footwear is a factor in your Achilles Tendon pain. 

Return to Running

At Core Body Clinic the focus of our Sports Physiotherapists is to work with you to get you back running.  We will NEVER say don’t run unless we truly belive it will do you harm.  If you are a keen runner then we will aim to get you running again at the earliest possible convenience.

We can manage your pain and symptoms with effective strategies like appropriate footwear, taping, load management (how much running and how much exercise you should do) and direct therapies (Massage, ultrasound).

Graduated running is KEY.  Start small.  Walk for 5 minutes, run for 5 minutes, walk, run, walk, run – get the picture? The tendon essentially stores kinetic energy and if in a state of reaction it will become more tender and painful over the time of the run.  Key is to stop before it becomes too sensitised.

Avoid hills to begin with (Hard to do in Reading and Tilehurst!) and have no expectations.  You may need a week or two off.  Aqua jogging is a great alternative early on and changing activity to cycling can be a great way to keep your cardio fitness up.


New Mumbles Physiotherapy Clinic: Core Body Clinic, Swansea!

New Mumbles & Swansea Physiotherapy, Pelvic Pain and Sports Injury Clinic - OPEN!  


About our new Swansea Physiotherapy and Mumbles Physiotherapy Clinics

It is with great pleasure to announce that Core Body Clinic has opened their first and now second Physiotherapy clinic in Swansea and a second in Mumbles.  One clinic is based at the Swansea Wellbeing Centreand the other is at the Mumbles Dental Spa.  They are great places to base the clinics and so well located to allow access for the whole of the Swansea Bay area.

Mae'n bleser mawr gennyf gyhoeddi bod Clinig Corff Craidd wedi agor eu clinig Ffisiotherapi cyntaf yn Abertawe ac ail mewn Mwmbwls. Mae ein clinigau wedi'u lleoli yng Nghanoflan Lles Abertawe a yn yr sba deintyddol y mwmblws.  Maent yn lleoed gwych i gael clinig ac maent mewn sefylla dda i ganiatáu mynediad ar gyfer holl ardal Bae Abertawe.


Will physio help?

Yes!  But if you are wondering what the difference is between Physiotherapy, Osteopathy and Chiropractic then read our article HERE













What do we treat?



















The list is endless and we treat all sort of problems from BACK PAIN to SPORTS INJURIES and we are also the ONLY clinic to treat MALE PELVIC PAIN in Wales.  We also treat PELVIC PAIN in women and we are experts at rehabilitation, spinal manipulation, sports and soft tissue massage.  Simple click HERE and be redirected to our WHAT WE TREAT page.  If your problem is not listed then please email the clinic as there are conditions that share common signs and symptoms.

  • Back Pain
  • Neck Pain
  • Sciatica
  • Sports injuries
  • Ankle Sprains
  • Tendon Injuries
  • Rehab after an Operation (Like ACL or FAI)
  • Plantarfasciitis
  • Breaks and Fractures
  • Pelvic pain
  • TMJ (Jaw) Pain
  • Headaaches



What Therapists Treat at Core Body Clinic physiotherapy Mumbles and Swansea?


Adrian Wagstaff (originally from North Wales, and also Welsh speaking!) is the director and founder of Core Body Clinic in Reading.  He has built up an international reputation since he qualified in 2001 with a BSc (Hons) in Physiotherapy and then again in 2012 with an MSc in Manual Therapy.  He is a member of the MACP and is one of just 1200 physiotherapists world wide to hold the qualification of this advanced status in MSK care.  Having worked in 2 premiership football clubs (Manchester City & Wolves), the NHS, private practie in the UK and in New Zealand Adrian has a broad experience from chronic back pain to ligament rehabilitation in the elite sports person.  Adrian specialises in the diagnosis and treatment of musculoskeletal pain and has an interest in chronic pain and pelvic pain.  He is one of the few practitioners to treat Male Pelvic pain in the whole of the UK and is trained to use diagnostic ultrasound to help with diagnosis and to retrain the pelvic floor.  Adrian is a teacher of spinal manual therapy and manipulation having taught on the Masters degree at Coventry university, he also travels to teach this very skilled hands on technique.  Read more about Adrian here




How to Book:

You can call 01792369535 (our Reading Central Office) or 07748152377.  We also have a booking system that is integrated into the diary meaning you can see appointment times in real-time.  All you need to do is click BOOK ONLINE and register using either your tablet, iPad, phone or computer.  

Once you are set up you can book an appointment. It is very easy and should you suddenly find your appointment is no longer convenient you can simply change the appointment at any time.  Of course, you can still email or call the clinic and one of the staff members will be more than happy to guide you through the booking process.  Hours for online booking are 24 hours. 

If you have a particularly difficult problem and you are not sure if we can help then please call the clinic and ask to speak to someone.  This could be a difficult back pain or sciatica that you have had for a long time.  It could be a chronic tendon problem that has not resolved.  You might be suffering form chronic headaches or pelvic pain for which no one else has been able to help.  Its worth picking up the phone or emailing and asking for our advice.  Its simple to email  - This email address is being protected from spambots. You need JavaScript enabled to view it., or send a text to 07748152377 and ask for a call back.









What happens at the appointment?


The process of examination and diagnosis:



 We will first work out what the problem is by assessing the causes.  This will involve a comprehensive discussion about the history of your complaint, how it started, what makes it better and worse, when does it hurt most in the day, does it disturb your sleep and do you have any other symptoms beside pain.  We will also take a history of your past medical conditions.  We will ask about medication and also about what sports and activites you like to do.  We will ask about your home life ad what you do for a living, whether you drive to work and how often you take time off. 

All of this is called the 'subjective history' and it is really important because it gives us the information to work out what is wrong.  We may ask you a lot of questions and this is called differential questioning and helps us to diagnose one condition from another. It may follow the format of a medical examination similar to what you may experience when seeing a doctor or surgeon.


In this part of the assessment we will look at the range of bodily movement or joint.  We will test muscle strength, neurological fuction and normal everyday movements.  We will also perform some special tests to isolate certain structures.    Physiotherapists are trained in delicate handling of the body. However, testing may cause some discomfort.   

Sometimes it is necessary to ask your GP to arrange bloods tests or xrays.  Physiotherapists are trained to look for common conditions and are particularly good at looking for problems not ameanable to physioatherapy.  We can tell if you need to see a surgeon and will refer you to the GP should we deem this necessary.



See our list on treatments to see the types of techniques we offer. 


What about Covid and Lockdown?

No probelms, we run a COVID SAFE clinic so you are in safe hands.  This means that during the Swansea Lockdown, you can still attend for physiotherapy appointments.  We cant have people in pain and throughout the pandmic we kept our Reading clinics open for emergency Face to Face and online sessions.  Pain and injury causes misery to millions each year.  With little access to GP or hospital, we have been a life line to patients and this will continue with the opening of our Swansea clinic.  We wear full PPE, as you to wear a mask, ensure you have signed our consent form and check your temperature on your way in.  We like to call it a belt and braces approach.  We have tons of hand sanitiser so we have now officially swapped our hand shake with a blob of hand sanitiser.  Of course, if you dont feel safe then you can select an ONLINE appointment instead of a F2F.  We have been conducting online video appointments for the last 5 years, covering the whole of the UK and the entire world! So, we know they work - just ask the last patient we treated in Dubai! 

You can read all about COVID and our safety procedures here and our online appointments here


Our “my pain is still there" Service

Even if you have visited 20 physios, 10 chiropractors, 5 osteopaths, an acupuncturist, the GP or 2 orthopaedic surgeons………..we would still love the opportunity to take a look.  Challenge us with the problem!.   


We look forward to seeing you soon! 


The Truth about Frozen Shoulders


"Many patients are told they have a ‘Frozen Shoulder’ when they walk into the Doctors office with severe arm pain. Frozen shoulders are one of the most common causes of shoulder pain in middle-aged people. Typically patients are told to take regular painkillers and the injury will get better by itself! However this is not always the best advice.