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 

giphy - Risus sit optima medica

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!

Have you ever suffered from back pain at least once in your life? The majority would probably show afflicted faces. Indeed, it is a very common issue which affects around 43% of the population in the UK. Despite most of the time the pain comes for just a few days, some of us can be affected by chronic back pain. In this case, back pain could negatively affect your daily life such as your performances at work, your mood or mental health.

Thankfully, relief is possible for adopting some remedies to cope with it:

 

 

 

Probably your first thought is to skip work and lie on your couch until the pain goes away. However, sitting can cause more stress for your hurting back whereas staying active and try activities such as yoga or pilates can be really helpful to minimise pain. You will learn how to keep the right posture and how to increase strength and flexibility at once. Also, it is good to reduce your stress which is due to all challenges of life and this will help your muscles to relax. Obviously, if you feel that your body is too under pressure, you can ask for help for certain poses to be sure you are performing it correctly without causing excessive strain for your back. In a nutshell, yoga therapy can be your medicine for your body and your mental wellbeing.

 

 

 

 

Stress level is often very high within back pain patients and can be an influencing factor for avoiding everyday activities to be sure not to feel the pain. Also, emotions like fear and anxiety can be the cause for your back pain according to Harvard Medical School. Indeed, the mind can make you feel the pain as a protective barrier in order not to focus on these emotions which could generate a psychological breakdown. Psychotherapy can support the emergence of these hidden emotions and you will discover the cause of your negative feelings and how to accept and live with them. In this way, the mind will send negative input to our body since the breakdown danger disappeared.

 

TOGETHER We can do it!

 

The best thing to do if you are looking for help is combining physical and psychological treatments. Taking a holistic answer to this issue which considers not only the physical aspect but also other factors influencing the pain which are the social and psychological factors could be very effective to deal with this recurrent and disabling condition. Always think about wellness and balance in every daily activity which is vital to make positive changes about medical conditions such as low back pain.

References:

https://www.health.harvard.edu/blog/yoga-and-back-pain-2018041413652

It’s a bit of a cliche isn’t it? The stereotype of the headachey woman who uses ‘one of her heads’ as an excuse for anything from not wanting sex to skiving off work or just not wanting to deal with an emotionally-tense situation. As with most stereotypes there is certainly some truth in this one – science has proven that women really do suffer from more headaches. But science has also shown that headaches are not just in women’s ‘heads’ – in their minds – and we now understand much better why women are more prone to headaches than men.

Hysterical women?

It’s not that long ago that many doctors believed that headaches in women were due to ‘hysteria’  and an inability to manage stress. Women who experienced headaches (or mental health issues) were often ridiculed and dismissed when seeking help for their headaches and even seen as malingerers.

Thankfully our clinical understanding of headaches has moved on significantly with the advancement of research and clinical practice in fields including endocrinology, imaging and pharmacology. Historically the vast majority of medical research has been carried out using male patients but we increasingly understand that in many ways women’s bodies do not respond in the same way as men’s. In the case of headaches there are different things happening physiologically in the bodies of men and women, and ultimately, headaches are rooted in biology.

Women and Headaches

Many studies have been conducted that suggest women are more prone to migraines (around 3 times as many women as men) and they’re actually more prone to other types of general headaches as well.

One of the biggest reasons why women get more headaches is hormone fluctuation during the menstrual cycle. Oestrogen is a hormone that has been closely linked to headaches and it is much more prevalent in women. Both in terms of headaches and other types of chronic pain there is evidence that levels of pain tend to vary based through a woman’s menstrual cycle, and that some pains feel worse during the premenstrual period and during menstruation.

There’s also a phenomenon called cortical spreading depression (CSD) that is believed to cause headaches, and evidence that women may have a lower threshold for CSD compared to males. Another theory is that females have thicker gray matter in parts of the brain that manage pain processing, whereas other studies point to adverse childhood experiences and more exposure to physical abuse as reasons why women have more headaches.

Researchers have also found that women tend to experience stronger episodes of chronic pain that lasts longer than men. This goes beyond pain in the head and can extend to the neck, back, knee, and shoulder too. Other conditions, like fibromyalgia, rheumatoid arthritis, and irritable bowel syndrome, are also more common among women. When several of these conditions occur simultaneously in the body, the pain can become unbearable and lead to psychological problems and permanent disability. Too often these pain symptoms and conditions are seen and treated as ‘separate’ illnesses where they may actually have similar underlying causes and ‘interact’ with one another. Treatment for some conditions can even have side effects that worsen other pain symptoms (have a look at the possible side effects leaflets of many over the counter and prescription medications and ‘headaches’ will very often be inclued).

Men and Headaches

Although women are more prone to headaches overall, that certainly doesn’t mean that men don’t get them. Younger boys have more headaches than young girls – until girls reach puberty. Although headaches are more common among women there are specific types of headaches that disproportionately occur in men – cluster headaches, for example, are six times more frequent in men. Men in their 20s to 50s are most likely to develop these types of headaches, with genetics, smoking, and alcohol use

Some psychologists and doctors believe that in general, men focus on the physical effects of pain, while women focus on the emotional effects. Since emotions associated with pain are usually ‘negative’, those who focus on emotions may feel a second dimension of pain on top of the physical.

What can you do about your headaches?

If you suffer with severe or frequent headaches it can be debilitating. Fortunately in the vast majority of cases the underlying causes are not sinister (e.g. brain tumours) but it can be frustratingly difficult to identify what factors are causing your particular headaches to recur as it is often a combination of things.

There are a number of underlying medical conditions that can cause chronic headache symptoms – for example anaemia (low iron, B12, folate), Vitamin D deficiency and menopause – many of which can be checked for with a blood test and are quite easily treated. If you suffer with chronic headaches and your GP hasn’t spoken to you or looked into these possibilities it’s well worth speaking to them again.

Having an understanding of some of the things that can cause headaches specifically in women and keeping a headache diary might help you to identify patterns and triggers for your headaches and this can also be really useful information for your doctor or clinician. Your doctor may be able to advise lifestyle changes that might help – for example, reducing consumption of alcohol, caffeine and carbonated soft drinks.

If you’ve ruled out any sinister or underlying causes, tried some lifestyle adjustments, and you find that you are still having headaches, you might consider a consultation with a physical therapist – like a chiropractor or osteopath who specialises in treating patients with chronic headaches. Recurring headaches can often originate from, be made worse by, or be accompanied by, symptoms in the face,  jaw, neck, shoulders, and upper back. By looking at the patterns of tension and alignment in your whole upper body, and treating areas surrounding and connecting into your head, therapists may be able to  help you to achieve a gradual – or in some cases a rapid- improvement in both the frequency and severity of their headaches.

For many headache sufferers even knowing that their headaches are not ‘all in their head’ and finding a clinician who is able to look at their headaches from different perspectives and ‘believes’ them can be a powerful first step.

We have a deathly fear of pain in the Western world today. At the slightest hint of it we reach for the medication and head for a consultation with Dr Google. Could it be cancer? Might it be MS? Am I having an attack of angina? Our minds have made their way halfway to A&E before we remember that, oh yes, I did spend the whole day sat hunched over my laptop yesterday so perhaps that’s why I have a headache rather than a brain tumour.

Whether it’s the psychological pain of depression or anxiety, the physical pain of a herniated disc, or the whole-family pain of Alzheimer’s, our immediate instinct is to reach for the pills. Time-pressured GPs have less than 10 minutes per patient to greet, speak, and treat. That is by no stretch of the imagination long enough, either for the doctor or the patient.  Most GPs feel that the best they can do for many patients in these situations is simply to decide a) is this a prescribable problem and b) what should I prescribe. If it’s not, the remaining minute or two of the consultation gives scant opportunity to consider or discuss alternative treatment options or even to fully explore a more specific diagnosis.

Our collective terror of pain is preventing us from hearing what our pain is trying to tell us.

If we immediately reach for the anti-depressants to stop us feeling, and if, as is sadly so often the case, we get ‘stuck’ on them, we are deprived from hearing many of the messages that sit behind our pain. Is it completely understandable that someone in distress wants to have it taken away, even if just by applying a pharmaceutical plaster? Yes! Is it understandable that doctors might want to meet that need – especially where the waiting list for alternative therapies such as CBT is long and the patient is desperate for something, anything? Yes! Is this, overall, the best way to feel into our pain and give us the best chance to fix it? No, I don’t think so.

By the time a patient with a chronic (long-standing) complex (having multiple underlying causes) comes to Core Clinics, they have become experts in pain; suffering from it, trying to manage it, trying different things to fix it, having it take over their lives, trying to treat it. All too often the treatment approaches that they have been recommended to try to seem to work, to an extent, for a while…but then the problem either returns in the same spot or pops up somewhere else in the body, like a symptom-chasing game of whack a mole. We regularly see patients who have had spinal surgery but are still in pain. Hip replacements but now have knee and back pain. They’re chasing the pain, chasing it away, instead of listening to it. It’s not their fault – it’s what many healthcare practitioners do too until they eventually get to the end of the line and say ‘there’s nothing more we can do’. Not what you want to hear when you’re still in pain and trying to have a life.

All too often doctors and other clinicians look at the pain itself and try to manage it by using drugs to make the brain think it’s not there. It’s like thinking you’ve fixed the fault in your car engine because you’ve stuck a plastic over the furiously flashing light on your dashboard.

Pain is the warning light on your dashboard. Think about that.

It doesn’t necessarily signify disaster. It might be a small electrical fault. It might be that your car’s trip computer needs a service. It might be the start of a small but treatable problem in the engine. Or it might be an urgent warning that your car is about to blow up.

If you only look at the pain warning light and you only cover it up with a pharmaceutical plaster, you are not looking under the bonnet to understand what’s causing the pain and whether you need a wire replacing or an ambulance to A&E.

Pain is a gift. Yep, I just said that.

Imagine a world where you couldn’t feel pain. There are some poor souls who suffer from a rare condition that causes them to be unable to feel pain at all, or in specific ways. Life is pretty bloody difficult and hellish for them. You could break a limb and not know it. Accidentally cut half your finger off with the paring knife and not realise until you notice a pool of blood on the kitchen counter. You’d have no idea that you were developing a serious health problem until it had just about killed you.

Pain is your mind’s and your body’s way of getting your attention so that you can take action to help yourself survive (if it’s the pain of a heart attack) or thrive (if it’s recurring headaches).

If you suffer from pain on a chronic basis, your best and only hope to heal is to get to the bottom of what is causing and sustaining that pain. It can be a complicated business to work out, and Dr Google is not your friend (or your doctor) in these cases. Ask people you know and trust, who have had similar pain or symptoms, if they have been helped by anyone. Go in search of someone who specialises – really specialises – in the type of pain in the type of places that you think you are suffering with. Go to someone who has successfully treated lots of people who have pain problems like yours. And by treated, I mean ‘healed’ not ‘cured’.

In our work with thousands of patients suffering from chronic back pain, we have identified a number of common pain patterns where pain experienced in different ways and different places around the body tend to be associated to a fairly homogenous combination of underlying causes. Having identified and treated each of those causes we set in motion a domino-run of healing within the body. Of course, there is the odd ‘shit happens’ case here and there where another random factor eludes us and we don’t get the full hoped-for result. But even in those cases, we can usually make a significant improvement.

So, if you’re in pain, or next time you’re in pain, don’t be so quick to pop a pill or panic. If it’s sudden and ominous, a potential sign of a heart attack, stroke or another emergency, then dial 999. If it’s not, then sit with it for a moment and listen to what it’s telling you. Most of us aren’t very good at reading our own pain after a lifetime of trying to ignore it and silence it. So if you’re struggling to hear, or you can hear but you don’t know what it’s saying, go and get help from someone who can interpret that kind of pain.

That’s what we do at Core Clinics. Every day. And that’s how we work with pain and through pain to change lives.