If you suffer with frequent or severe headaches here are some top tips to treat them.

By Dr Marie Vossen (DC) and Katie North, osteopath.

1. Headaches have started or worsened recently:

Headaches are very common and usually not something to worry about too much. They are usually self-limiting (which means they will usually get better on their own in a few hours). Taking it easy, drinking plenty of fluids to keep hydrated and taking an over the counter painkiller are usually the best treatments for an isolated headache.

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2. Headaches that have been present for a month or more/ are there 1+ times per week

If your headaches have been present a few times over the course of a month it may be a lifestyle factor that is influencing your headaches. Stress, sleep, posture, diet, alcohol intake and neck pain are just a few of the more common triggers of an escalation in headaches. It’s worth keeping a diary of these or using a headaches app to record your headaches and any potential triggers. If one or more of these common causes seems likely to be affecting you, you can make strategies to improve things.

At this point, seeking the advice of someone who specialises in headaches is likely to be beneficial, as you’re likely to see more rapid improvement when well guided.

If you are getting the headaches frequently and the pain is quite severe you should consider discussing medications with your doctor. It is important to realise that the medication you take can also play a role in causing headaches, so it is important to discuss this with someone who understands it.

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3. Headaches that have been present for more than 3 months.

At this point you should definitely have sought professional advice and if not, you should seek it now.

If you find medications don’t manage your symptoms as you would like you may benefit from trying alternative modes of treatment such as manual therapy (e.g. osteopathy, chiropractic) to see if it suits you better. This treatment option will also benefit you if you don’t like taking medication regularly.

There is often a musculoskeletal element to chronic headaches (i.e. problems with the spine, neck and muscles) that respond well to manual therapy.

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4. Urgent symptoms to seek immediate medical attention:

If headaches are new to you or you’ve noticed a recent increase in the frequency and severity of your headaches, and you present any of the urgent symptoms listed below you should seek medical advice. These symptoms can sometimes mean that your headache could be caused by a more serious underlying problem (although less than 4% of people who present to a doctor with headaches have a serious underlying cause it’s better to be safe than sorry).

Contact your GP, NHS 111 or go to A&E as a matter of urgency. Again, remember, there’s every likelihood that your headache will not have any serious underlying cause but just knowing that is likely to help you feel better.

If you’d like us to answer any of your headache-related questions please email us at patientcare@coreclinics.co.uk and we’ll be happy to help.

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In our latest vlog post Core Clinic’s Movement and Running Coach David Brown talks about how common foot position and movement problems (including pronation and supination) can affect your running and running shoe wear patterns.

Watch it here






This summer we’ve decided to take advantage of the beautiful grounds around the clinic by introducing outdoor exercise facilities for our personal training clients and group outdoor exercise classes.

When the sun is shining, heading to the gym can seem like a waste of a beautiful day; now you can combine your workouts and time in the sunshine to soak up your daily dose of vitamin D (1 in 5 adults in the UK are deficient in Vitamin D and exposure to sunshine is a great way to top yours up).

But there’s more to outdoor exercise than sunshine. Compared to indoor training, working out in out in nature could offer a number of added benefits, according to research.

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1) You’ll exercise for longer and burn more calories

The natural elements and variations in outdoor terrain act as natural resistance when you exercise outside so your body works just a little harder. Research by physiologist Professor Andrew Jones found treadmill runners expended less energy to cover the same distance as those running outside. His study suggested that to replicate outdoor running, treadmill runners would need to adjust their machine incline. Outdoor running -with its changing views and terrains – offers natural resistance, interval training and variety to motivate you to exercise for longer.

If you combine the benefits of outdoor exercise with working with a personal trainer or in a group class it’s easy to see why you’re likely to work harder, for longer, than if you were just plodding away by yourself in the gym.

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2) It boosts self-esteem

In addition to reducing stress and other negative emotions outdoor exercise has been connected to improved self-esteem. A study by the University of Essex found while exercise in any environment significantly reduced blood pressure, increased self-esteem, and had a positive, significant effect on four of six mood measures; viewing pleasant outdoor scenery during exercise produced a significantly greater positive effect on self-esteem than when exercising without the views. Viewing unpleasant urban scenes whilst exercising had the worst outcome, prompting the researchers to conclude that ‘green exercise’ has important health benefits.

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3) It’s good for motivation

If you want to find a fitness regime that will get you motivated and keep you feeling that way, working out in the fresh air could be the key. Participants in the Peninsula College of Medicine and Dentistry review also reported greater enjoyment and satisfaction with outdoor activity and declared a greater intent to repeat the activity at a later date.

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4) It’s cheaper and better than the gym

Taking your cardio session outdoors is easy: swap the treadmill and exercise bike for outdoor running and cycling. And as for the weights and resistance training? Why not try a free initial session at Core Camp?

Rob Butler, head of Strength and Conditioning at Core says “working out outdoors can be every bit as effective as a weights session in the gym if you know how to use your body weight and imagination. Squats, lunges, press-ups and crunches can all be done outdoors using without any specific kit. At our outdoor exercise sessions we do have some kit and working in a group extends the possibilities but fundamentally it’s about using your body rather than relying on machines in the gym.”

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5) The unpredictability of the outdoors makes it fun

Working out in a gym which is at the same temperature and light-level whatever time of day or year can be a bit soulless. Although the British summer weather can be notoriously unpredictable, once you get your trainers on and get outside, you’ll hardly notice – except in a good way.

A bit of wind or a light shower can we very invigorating on a run or outdoor class. And even on a slightly chilly morning, an outdoor exercise session will soon warm you up naturally – burning more calories in the process than if you were working out in a climate-controlled gym.

If we’ve convinced you of the benefits of outdoor exercise why not try a free first session at Core Camp?

Call 01926 801111 or email patientcare@coreclinics.co.uk to book now (staring the 8th May).



Dr Jeff Foster on Testosterone Deficiency

Testosterone deficiency 

Testosterone deficiency is a common condition that many people don’t know exists. Whilst there is still a long way to go, awareness of the effects of hormonal changes many women experience around menopause is gradually improving. But men can also be significantly affected by hormonal changes – especially testosterone – and the effects can begin to be felt as early as the age of 30.

Testosterone deficiency is common in men over the age of 40, and affects up to 12% of men aged 50 and over.  Affecting more than 790,000 men in the UK, this treatable condition can cause symptoms including tiredness, irritability, depression, low sex drive, loss of muscle and weight gain.

What are the signs and symptoms of testosterone deficiency?

Testosterone deficiency is associated with sexual, physical and mental symptoms that can affect your everyday life:

Your sex life

  • Low sex drive
  • Problems with erections
  • Difficulty achieving orgasm

How you feel

  • Low mood or irritability
  • Tiredness
  • Reduced wellbeing
  • Loss of concentration
  • Hot flushes and sweats

How you look

  • More body fat
  • Male breasts
  • Loss of muscle and strength

What is testosterone deficiency?
Testosterone plays an important role in physical and emotional wellbeing. Its roles include maintaining muscle and bone strength, sperm production, and the desire to have sex (libido). Testosterone deficiency is a failure of the body to produce enough testosterone to maintain healthy levels.

Who gets testosterone deficiency?
The reasons for having testosterone deficiency are not always clear. After the age of 30 our testosterone levels naturally begin to drop but in some cases they drop so far that it can cause the health and wellbeing of a man to suffer quite significantly. The chances of becoming testosterone deficient are higher in men who have certain other conditions, including:

  • Diabetes (up to 50% of men with type 2 diabetes also have low testosterone levels)
  • Obesity
  • High blood pressure / raised cholesterol
  • Heart disease
  • Any chronic inflammatory condition (such as asthma or arthritis)
  • Men who take medications (a large number of prescription drugs can also reduce testosterone levels)
  • Men undergoing cancer treatment

What can you do to increase your testosterone levels naturally?

Improving your overall health can help to boost testosterone levels (as explained in the video on this page). Particularly good ways to increase your testosterone levels naturally include:

  • Maintain a healthy weight. Losing weight can help increase testosterone levels. Aim for a healthy, balanced diet with plenty of vegetables and protein (and low in sugar, saturated fat and processed food)
  • Stay active. Regular physical activity helps your brain send out testosterone-boosting signals.
  • High intensity and weight-bearing exercise. Current evidence suggests it is the intensity that is most beneficial for health rather than the type of exercise.  Short bursts of high impact/high intensity exercise appear to the produce the best results in metabolic stimulation and hormone production. Including a mix of high-intensity, weight-bearing, and aerobic exercise in your activities also keeps it interesting which means you’re more likely to stick with it.
  • Reduce stress. While you might not always be able to remove or avoid the causes of stress, you can change your response to it. Being in good shape physically can help you to manage stress better and as can mindfulness or meditation, or simply talking about it (whether that’s to friends and family, or to a counsellor).
  • Sleep tight. Try to get at least 7 hours good quality sleep a night. If you’re doing all of the above you’ll often find that your sleep improves; if you’re still struggling to get a good night’s sleep on a regular basis it’s worth speaking to your GP.
  • Have more sex. Ironically, although testosterone deficiency can cause problems with sexual desire and performance, having sex can actually increase your testosterone production. If you are having sex very infrequently this is likely to reduce your testosterone levels.

How can testosterone deficiency be treated?

Testosterone deficiency can be diagnosed easily in most cases by listening to your symptoms and arranging some simple bloods tests. Based on the results of these tests, we can decide whether testosterone replacement therapy (TRT), is suitable for you. There is excellent evidence that, when used properly, TRT can help alleviate all of the symptoms listed above.

Recent good quality evidence suggests that safe use of TRT in men may be associated with a decreased risk of cardiovascular events, such as heart attacks and stroke.

There are different treatments for testosterone deficiency; the one that’s best for you can be discussed during your consultation. Options include:

  • Gels applied to the skin each day
  • Injections into the muscle (every 2-3 weeks or every 10–14 weeks)

Once you start treatment it is important to attend follow-up appointments so that we can make sure your treatment is working, and doing so in a safe manner.

Do you think you or your partner could have testosterone deficiency?

The ADAM questionnaire is a useful screening tool used by doctors to see if you might suffer with low testosterone. If you answer “yes” to questions 1 or 7, or three or more of the below questions, we suggest that you might need a testosterone blood test – you can contact us to book your consultation.

The ADAM questions

  1. Do you have a decrease in libido (sex drive)?
  2. Do you have a lack of energy?
  3. Do you have a decrease in strength and/or endurance?
  4. Have you lost height?
  5. Have you noticed a decreased “enjoyment of life”?
  6. Are you sad and/or grumpy?
  7. Are your erections less strong?
  8. Have you noticed a recent deterioration in your ability to play sports?
  9. Are you falling asleep after dinner?
  10. Has there been a recent deterioration in your work performance?

Above all remember: testosterone deficiency can be treated and you don’t have to (and shouldn’t) put up with the symptoms as a ‘natural’ part of ageing. 

If you want further information or wish to make an appointment please contact Dr Foster or speak to our reception team on 01926 801111.

A final note on supplements, vitamins and minerals

  • There is no medical evidence that any over-the-counter supplements (including tribulus, taurine, fenugreek, or ginger) will produce increases in testosterone levels.
  • For healthy individuals on a balanced diet, additional vitamins and minerals will make no difference to testosterone production in men. However, there is some evidence that additional zinc or selenium can be linked to sperm quality, but not overall testosterone production.

We had a patient in the clinic this week who came in with a complaint of lower back pain. After a thorough assessment and treatment with our osteopath Katie, the patient commented that ‘you didn’t treat my lower back at all’ to which Katie responded: ‘that’s because it’s where the pain is, it isn’t where the problem is’.

This concept seems to be a huge revelation to patients, but it’s an important one to understand if you suffer with chronic pain.

To give a couple of common examples, ‘sciatica’ is a condition where pain and other symptoms are often felt in the legs but the ’cause’ of true sciatica is rooted in the discs and nerves in the lower part of the spine. If you try to treat sciatic pain in the legs by directly working on the legs it won’t work. To make matters even more complicated, there is almost always a combination of ‘underlying’ reasons why someone gets discal problems in the first place (in the case of sciatica it’s usually around the area that doctors call LS4/5 S1) and those problems are NOT just related to the back. For some people that point in the back is a ‘place of least resistance’ where a host of underlying biomechanical issues are culminating. Like the point in a dam where a flood breaks through. So problems can arise in the feet, manifest in the lower spine, and cause symptoms in the legs. (Yes, really).

There’s also the phenomena of ‘referred pain’ whereby you might feel pain or other symptoms like numbness or pins and needles in one part of your body due to a problem somewhere else. A common example is neck and shoulder aches and inflammation that cause numbness or tingling down the outside of the arm and into the fingers. You feel the symptoms in your hand but a good therapist will work on the appropriate points in your shoulder where the problem is originating.

It’s sometimes easier to think of it in terms of analogies. Like…

Water flowing down a mountain doesn’t flow in a straight line. It follows the path of least resistance which depends on the contours of the land and the hard or softness of the material (soil = soft, rock = hard). In the same way stresses and strains experienced in one part of your body (or mind) sometimes flow through the path of least resistance and you can get symptoms where you least expect them.

When you have a rubbish day at work and your boss chews your head off you can’t take it out on them in case you lose your job so you go home and shout at your family (or kick your dog). In the same way you might experience ’emotional stress’ as physical symptoms like back pain.

When the axle is out by a few millimetres on your car it can set your wheel balance out so badly you feel like you’re driving around in a fairground ride. In the same way you can experience major symptoms in your body (the car) if your ‘axle’ (your ankle, hip, or other major joints) are ‘out’ even a little. Trying to treat the symptoms directly is like giving the passengers a big cushion to sit on rather than fixing the tracking.

When there’s a puddle of water on your floor you can ‘treat’ it by mopping it up or putting a bucket under it. In this analogy let’s say the puddle is ‘back pain’ and the mop is a pain-killer; the bucket is a back support vest.  So, unless you identify whether the puddle (or the back pain) is caused by a leak in your roof, a leak in your plumbing, rising damp or your dog knocking over its water bowl (in retaliation at your kicking it instead of your boss, perhaps?) you can’t permanently ‘treat’ a puddle by mopping it up. In the same way, you can’t successfully treat chronic back pain with a painkiller or a support vest.

So…if you have chronic pain, particularly if it has a big musculoskeletal component, don’t be surprised if your clinician focuses their treatment away from the place you’re experiencing pain or other symptoms. In fact, if they do focus exclusively on where the symptoms are, they’re probably missing the bigger picture and it might be time to get a second opinion.



For further information on the Vossen technique click here: Risus sit optima medica 

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Happy April Fool’s Day!

Will love and laughter from the team at Core Clinics.

But seriously…Laughter really is a wonder remedy!

Endorphins produced when you laugh promote an overall sense of well-being and can even temporarily relieve pain.

Laughter protects the heart.

Laughter improves the function of blood vessels and increases blood flow, which can help protect you against a heart attack and other cardiovascular problems.

Laughter burns calories.

Laughter improves your quality of sleep.

Laughter helps you manage stress.

So – get Vossening!