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.
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.
Please Call the clinic if you are in anyway unsure
We remain open during the COVID 19 Welsh Lockdown. Following the governement announcement today (19th October) our Swansea Physiotherapy clinic will be kept open because we 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.
OPEN SAFE HANDS FACE SPACE
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.
In light of the current situation announced on the 19th of October, please familiarise yourself with the Welsh Government:
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.
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.
How is cortisone 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 steroids are placed around a chronically inflamed tendon or joint.
What conditions are treated with cortisone?
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 Golfers elbow in elite sports players who are required to continue with their sports activities.
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 in order to engage in a rehabilitation programme, which will provide the long-term solution to most problems.
Will the injection hurt?
Minor discomfort is common however the vast majority of patients report the injection was far less painful than they thought. The use of ultrasound to guide injections helps significantly reduce pain as the target structure can be accurately located with minimal needle movements.
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.
What can I expect from the Injection?
The cortisone is mixed 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.
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.
When used appropriately cortisone is very effective and safe and has been used for decades in medicine. It is used around the world as one of the most trusted methods to treat a majority of joint, tendon and nerve pain.
Extracorporeal shockwave therapy uses high-powered sound waves to stimulate the healing of chronically injured tissues. Shockwave therapy has been used in medicine for over 20 years and has a large body of evidence proving its effectiveness at treating many chronic tendinopathies. Shockwave therapy has 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.
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:
Increased blood flow to tissues that promotes healing of chronic injuries.
Stimulates the production of fibroblast cells. Fibroblasts are the cells that promote tendon health through collagen production.
Induces a controlled inflammatory reaction within tissues that re-stimulates the healing of injuries that are failing to heal.
Improves the health of bones through direct mechanical stimulation and has been shown to be very effective at healing non-union fractures.
Highly effective at relieving pain in tissues that have been painful for a long period of time, typically over 12 weeks. The shockwaves do this through reducing the chemical substance P and decreasing the sensitivity of tissues permanently.
CLICK ON THE VIDEO BELOW:
When Should You Consider Shockwave Therapy?
If you have been suffering with a tendon problem for over 12 weeks.
If you have tried normal stretching and physiotherapy treatment for 3 months and your pain does not seem to be improving.
If you have been diagnosed with one of the following conditions:
Calcific Rotator cuff tendinitis
What are the success rates of shockwave therapy?
Shockwave therapy has been shown to provide a 70-80% 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.
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 are also very proud to announce that both focused and radial shockwave therapy are available for use – one of only 6 clinics in the UK to offer this. The advantage of utilising both radial and focused shockwave therapy is that more energy can be used and therefore superior results achieved.
Our injections service in Reading and Tilehurst is very unique because we are one of the few clinics in the UK where we can assess, prescribe and inject during one session. Our injection and diagnostic specialist uses only Ultrasound to guide the injection and only after conducting a thorough examination, history and ultrasound scan. The steroid injection service in Reading and Tilehurst is a fast one stop clinic where you can bypass your GP or ask your GP to refer to our speciliasts where you can receive all your care in one place. All our practices are with the highest standards.
When to use Steroid injections (Corticosteroid) ?
Corticosteroid injections are used when there is chronic inflammation within a joint or around a tendon that is not settling within normal time limits, typically 8-12 weeks. Corticosteroid is a naturally occurring hormone within the body. It is a powerful anti-inflammatory and is very effective at
reducing the pain of inflamed areas.
Many people associate corticosteroids with only short-term relief and there are many negative reports in the media regarding steroids. There are some truths in this, however when used correctly in small doses they often provide fast-acting long-term solutions for many conditions.
In particular corticosteroids are excellent for:
· Wrist Pain
Our injection therapist is a leader in his field and is a specilaist scanner and uses Ultrasound to accurately identify the lesion before the injection is administered. (Please note an extra charge is made for the Scan prior to the injeciton).
We use the latest in injection techniques and only deliver the injection where we know it will make a difference.
ALL of our injections are Ultrasound guided. Research has shown significantly better outcomes when using guided versus unguided injections simply because you can be sure to target the specific injury.
"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.