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:
Percutaneous posterior tibial nerve stimulation (PTNS) for overactive bladders has become a well-established and non-invasive therapy for overactive bladder syndrome (OBS).
Overactive bladder syndrome is a difficult to treat condition where the bladder becomes over sensitive resulting in a constant need to urinate or the feeling that you urgently need to pass urine.
This debilitating condition has stretched the many medical and surgical specialists to find a cure with often mixed results.
PTNS is a well practised modality the treatment for overactive bladder syndrome. Many patients seeking this treatment are often amazed at the results from a relatively simple procedure.
PTNS is performed by placing a needle on the inside of the lower leg, inserted into the skin and close to the Posterior branch of the Tibial nerve. An electrode patch or second needle is then placed on the foot. A current is then passed through the needle and electrode, stimulating the posterior branch of the tibial nerve.
Via a process of retrograde stimulation this procedure achieves neuromodulation in the sacral plexus. The posterior tibial nerve contains nerves that are mixed with sensory and motor nerves originating from the same spinal segments as the nerves innervating the bladder and pelvic muscles or pelvic floor. As a result, it is therefore possible to influence these nerves and the central nervous system. Through a process of sensory bombardment, the nerves of the bladder begin to desensitise becoming less reactive. The symptoms of OAB are then suppressed. The exact process of how this mechanism works is still unclear. Some speculate that symptom relief is achieved via a pain gate mechanism or sensory overload.
The procedure is carried out by a specialist physiotherapist with 20 years + post graduate experience and over 15 yrs using acupuncture. The points to locate the tibial nerve are carefully planned and expertly placed.
It can take up to 12 weekly sessions of 30 minutes for the patient to achieve symptoms relief with a change in symptoms not showing until the 5th session.
A RCT of 100 patients reported 80% improved and 55% cured. Another RCT showed that after 1 year 23% of a group were considered cured with 80% better immediately after treatment.
The therapy is recommended by NICE and is therefor considered a cost effective and efficacious modality to tackle this debilitating condition.
More information on evidence can be found here https://www.nice.org.uk/guidance/ipg362/evidence/overview-pdf-495585181
Treatment is exceptionally safe when compared to Botox injection, medication and even surgery.
Injection with Corticosteroids and Hyaluronic Acid
At Core Body Clinic in Swansea we will be providing injections using Corticosteroids and Hyaluronic Acid.
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 - NB 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:
Carpel Tunnel Syndrome
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.
Please Call the clinic if you are in anyway unsure
We remain open. The landscape for Covid is continually changing and the lockdown is easing (12th of April 2021). Our Physiotherapy clinics are an essential service and should you need an assessment for a pain or injury then we will be able to provide this for you. We follow a strict protocol of infection control and our clinics are COVID safe and secure. Please read the following information below which remains largely unchanged from the guidance provided by the government since March.
Please Note: You will not be treated at Core Body Clinic if you are ill or a staff member suspects you are ill. Please respect the clinical decision of the healthcare professional. They are trained to triage patients who are presenting as unwell. They will offer advice provided it does not compromise their safety.
Signs of COVID 19:
Fever (Temp above 37.8)
Persistent and Dry Cough
Loss of taste and/or smell
Everyone has a different level of risk. Please consider your own.
Core Body Clinic, Ltd. Infection Control Policy: COVID-19 Updated 19th October 2020
It comes as no surprise that our current recommendation is that you do not attend or book in for physiotherapy treatment if you are suffering with COVID 19 symptoms until you are sure that you are no longer able to transmit your virus and you are able to confirm you do not have the COVID-19. In the current circumstances, we ask you to telephone the clinic if you have any doubts as to whether you should attend a scheduled appointment. If this is on the morning of the appointment, then we have no objection and no fee will apply for last minute cancellations. Your health and safety are our priority. We appreciate that most people will not have the virus and will be suffering from a cold or flu like virus. However, we are encouraging patients to pay due diligence to their situation prior to making plans and adhere to the directions of the DOH.
Core Body Clinic adheres to high standards of hygiene.:
The of the most effective ways to prevent transmission are wash HANDS , cover FACE, make SPACE
All patients consider their health and wellbing prior to booking and sign our consent form.
All patients must sign a consent form declaring they are not ill
All patients wear a mask (if not in posession then the clinic can provide a mask for £1)
Patients may NOT enter unless invited and are instructed to remain outside the clinic, unless raining
You must follow the physiotherapists instructions when entering the building
You must wash hands with alcohol
You will be temperature tested and if high you will not be treated
Other than a coat or bag please do not bring in other items
Bags and coats will be placed on the floor or designated area
You will sit on a plinth that is covered with towel
All staff wear Mask (N95), apron and gloves. A visor or goggles may be worn when less than 2m distance
Donning and Doffing of PPE is done with extreme care
On leaving the clinic you will not handle doors and you will follow the physiotherapists instructions
The rooms are well ventilated and regularly cleaned
Pillow covers are covered in plastic and changed every session
use antiviral/bacterial, soap and alcohol spray before anyone uses the breathing holes in the treatment couches
Patients who display any signs of ill health will be asked to leave the clinic. No charge wil be made as the decision will be at the discretion of the clinic.
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. Shockwave therapy is very different from ultrasound therapy and can mechanically stimulate tissues deep within the body unlike other types of sound wave therapies. At Core Body Clinic, we use FOCUS shockwave.
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):
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
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:
Tendinopathies like Achilles Tendinopathy
Bone and Stress Fractures
Delayed bone-non unions/bone healing
Knee & Joint arthritis / Medial Knee OA
Osteitis Pubis -Groin Pain
Insertional Achilles Pain
Tibialis Posterior Tendon Syndrome/ankle sprain
Medial Tibial Stress Syndrome / Shin Splints
Tib Post/ Peroneal Tendons
Avascular Necrosis of Hip
Carpal Tunnel Syndrome
Chronic Pelvic 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.
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.
"Getting a scan is your gateway to the correct treatment and could save you time and money!"
Scans form part of your assessment and help build a picture of what your problem is.
Over the past 10 years diagnostic ultrasound technology has improved greatly and is now considered better than MRI for visualising many tendons, ligaments and muscle injuries. The advantage of ultrasound imaging is the real-time fast diagnosis of injuries. Patients can expect to see their injuries on screen during their appointment. This means that treatment can be specifically targeted to individual problems allowing a more effective rehabilitation process. Ultrasound is also very safe as there is no radiation unlike X-ray and CT scans. At Core Body Clinic we use it to diagnose tendon and MSK pain in additon to training and assessing the pelvic floor.
"Get a diagnosis that is correct!"
What to expect?
For the ultrasound scan the injured body part will need to be exposed. Patients are encouraged to dress accordingly for a scan. If you have a lower limb injury then it is requested you bring a pair of shorts with you. For shoulder injuries vest tops are preferable.
The physiotherapist will take a full history of your problem and then perform a physical assessment, which will involve moving the injured region and testing strength of the area. The area will then be scanned with all findings explained at the end of the consultation. This will include a treatment plan or onwards referral for further imaging or specialist review as required.
What is Diagnostic Ultrasound Useful for?
Diagnostic ultrasound is ideal for evaluating the following areas:
Rotator cuff tears
What do we not use ultrasound scans for:
Lumps and Bumps
The abdominal Region
You are advised to see your GP for this. A letter of referral will be supplied if such annomolies are identifed.
Do I need a GP referral?
No. You can book yourself in for an ultrasound scan without a referral from a healthcare professional. However, your GP may refer to our clinic.
Do I need an Ultrasound scan?
If you are unsure if you require an ultrasound scan then contact the clinic for a free phone consultation to discuss you injury. We are more than happy to direct you towards the best pathway for you.
In the video above we can see the bladder working to contract the pelvic muscles. We can accurately check for timing, strength and appropriate contractions. Patients who benefit from this include both male and female patients with conditions treated listed below (note – not limited to).
Pelvic Floor Re-training
If you would like to find out more then please email or call the clinic.
Prevention is better than cure and we firmly believe in making sure all our mum's are fit physically and are not suffering from pelvic girdle pain or dysfunction. That's why we run a mummy check service. You can book this by selecting the Women's Health Physiotherapy option online or by calling the clinic. We want you to be confident when coughing and sneezing after you have had your baby and this is why we are following government guidelines and best evidence based practice by offering this service.
Everyone wants to be there absolute best when pregnant and we want to support you as and when you need us. We see many women with pregnancy back pain, neck pain, joint pain and sciatica. This is quite common and something we can help with.
After your baby, the last thing you think about is YOU! Believe us - we have had children and we know what it does to the body.
After the celebrations have settled and you are merely feeding, walking and enjoying your baby, ask yourself - "am I ok?"
After 6 weeks your body will be getting back to normal. Your stomach muscles will be making their way back to becoming one again, your pelvic muscles will be feeling less stretched and you will start to get more energy (though this is because you are getting used to being a parent and sleepless nights are becoming the norm). Your pelvic muscles should get back to normal. But, after a good stretch and months of a baby pressing down on the bladder there may be some weaknesses that persist. The other thing to consider is that, while the womb contracts and the pelvic anatomy go through some changes with dilation and distension, the passage of the baby may cause stretching. This may not revert back to its normal length. Some women experience trauma and in these cases the tissues in the vagina become stretched leading to alterations that may not improve over time and without specialist assessment. Seeing a women’s health physiotherapist could help you identify a prolapse early on and prevent this from stretching further and weakening over time. It will also help you answer some important questions:
When should I exercise? How hard?
We advise a 6-week check to make sure everything is ok and that you know what you are doing to help your body recover. Think of it like a MUMMY CHECK.
What about if its past 6 weeks and how do you know you are better and back to normal?
Try these simple questions:
How strong do you feel and how long is reasonable before your pelvic floor gets back to normal?
Do you feel confident laughing or coughing?
Are you resuming intercourse with confidence?
Can you get on a trampoline?
Does running feel comfortable?
Do you think your pelvic floor is strong?
Do you think its ok to have a weak pelvic floor?
If you have answered any of the above, then you need to have an assessment by a women’s health physiotherapist.
Checks are simple and straightforward and will save you money and time in the future by preventing a weak pelvic floor from getting weaker.
If you would like to come and see us for a Mummy Check then book in a Women’s Health Assessment for 1 hour and get yourself on the track to recovery.
Core Body Clinic is now working in partnership with Formthotics to deliver this fantastic product.
Formthotics insole orthotic solutions have been in use for the last 30 years and have provided physiotherapists with an immediate solution to foot, ankle and lower limb biomechanical problems. These easy to apply and low-cost insoles can be added during your consultation to remedy an endless number lower limb problems.
At Core Body Clinic we are trained to assess foot and lower limb posture to determine whether the Formthotics solution is right for you. We have used this product oursleves for nearly 15 years after Adrian Wagstaff worked in New Zealand and was introduced to the founder of the Formthotics system, Dr Charlie Baycroft. Dr Baycroft wanted a simple solution for his patients. Adrian was amazed by the low-cost alternative to the costly and often over priced custom built insoles that offer little over these easy to fit orthotic solutions. Adrian who has worn insoles himself for ankle and knee pain for the last 20 years gives his full backing after dicovering this product while in New Zealand. He has not been able to recommend another product over this one in 15 years.
These easy to fit insoles can be molded to your shoes and more importantly to your foot in a matter of minutes using a special heat molding machine that we have at both our clinics in Reading and Tilehurst. This saves time, allows you to rehabilitate pain free instead of waiting The machine softens the insoles cauing them to deepen at the appropriate sites to allow the foot to be manipulated, dropping the joint of the big toe down and supporting the instep of the foot, therby creating an arch support.
Using foot lowerr limb biomechanical knowledge, it is possible to influence the foot and dramatically enhance the efficiancy of the lowerr limb allowing a quick solution to running and lower limb pain.
Formthotics can be fitted to almost any shoe from ski boot to work shoe, from welly boot to running trainer. We use a combination of tests to understand how your leg moves and foot distorts through walking and running. It is essential that we fit the correctly shaped orthotic with the appropriate firmness, width and for the activity type.
Your trainer or sports shoe may have come with an insole. The firmness and quality will depend greatly on the shoe manufacturer. Over the years, products have been released to the market with a lesser quality insole with many company’s opting to leave the decision for the individual as to whether they continue to use the insole already with the shoe or a more custom fitted product.
What can Formthitics be used for?
Achilles Tenonitis / Tendinopathy
Knee pain / Patella pain
Lower Back Pain (where there is a clear biomechanical issue)
Bursitis of the Hip and Knee
Insoles are often used in combination with a treatment regime to help you to continue to train, function or rehabilitate with less pain. It is sometimes necessary to continue to wear the insoles long after your treatment is complete. Some patients may only require the insoles for a short period and the product can be removed after treatment is complete. However, the mechanical and preventative properties of the Formthotic system means you may continue to use the system because of the enhanced mechanical posture of the foot and lower limb. We often recommend you extend these benefits to all walks of your life by fitting formthotics to all of your shoes.
What does the reseach say?
Research has proven Formthotics™ to be effective in reducing pain, treating and preventing injuries and improving patient comfort. In many cases they have been found to be as good, and in some cases better, than custom casted orthotics in the treatment of lower extremity dysfunction.
Larsen et. al 2002 found that customised Formthotics™ drastically decreased incidence of back pain by 20% and lower limb injury such as shin splints by over 10% in military recruits.
Improving foot function and minimising pain
Chia et al. 2009 and Landorf et. al 2006 found Formthotics™ to be very successful in the treatment of plantar fasciitis. Formthotics™ decreased plantar peak forces significantly providing better relief of symptoms than both custom moulded orthotics and competitor pre-fabricated products. Both these studies also found Formthotics™ improve general foot function and minimised pain, improving patient comfort.
Strengthening muscles and tendons
Formthotics™ also encourage “flat feet” to function more like that of a normal arched foot, in turn preventing injury through strengthening otherwise at risk muscles and tendons. This was confirmed by Murley et.al 2010 who compared activity of tibialis posterior and peroneus longus in those with flat feet with Formthotics™ and custom casted devices. He found that tibial posterior activity was significantly increased with use of both types of orthotics, however only Formthotics™ showed improvement of peroneus longus.
The cost of the custom insole formthotic system: £45 (this is in addition to the session your are attending. It is a medical device and may not be covered by your insurer).