Charterhouse Physiotherapy, Pilates & Lymphoedema Clinic


Eye health

Dear Good Friends and Patients,
Throughout the past 10 months I have been penning regular newsletters to you all, with hopefully helpful hints and exercises. As you all know exercises lead to a sense of well-being and positivity. Originally, I concentrated on ergonomics and self-help exercises to do in your work breaks. Continuing in this vein I decided to add eye exercises to your ‘to do’ list. These will strengthen your eye muscles, but not improve your vision (this can be helped by nutrition and diet), and overall your eyes will feel better.
Remember take a 2 minute work break every 30 minutes!
Flexing- Keep your head in a comfortable position whilst seated. Move your eyes from side to side
and up and down, whilst still holding your head in a neutral position.
Blinking- This refreshes the eyes and maintains focus for longer. Practice blinking every x 5 seconds in a 2 minute rest period.
Focusing near and far- Hold your thumb about 10” away from your eyes, then focus on something about 10-20 feet away. Repeat.
Palming- Hold the palms of your hands over your eyes gently so that you can still blink comfortably for x minutes. The warmth from your hands and darkness are an excellent stress reliever.
Zooming- Hold your thumb in a hitchhiker position, then draw it in towards you so that it is 3” away from your eyes. Slowly move it away to the starting position. Repeat.
Figure of 8- Imagine a figure of 8 turned on its side. Follow the pattern with your eyes. Rest-This needs no explanation!
Sending you all good wishes. Please remember we are here to help in these extraordinary times!
Caro, Elizabeth and Suzanne Charterhouse Physiotherapy

Not goodbye from us in Long Lane but Au Revoir

Dear Good Friends and Patients,

We are leaving this wonderful part of London soon to concentrate on our West End physio practice at 55 Harley Street, W1G 8QR, (020-7323-4263). I started the City practice originally in January 1992 in Cloth Fair, opposite St Barts The Great, the same year as ‘Four Weddings and a Funeral’ came out. I remember, greatly daring, offering my business card to the actors as they were waiting to go on set! Since then, more filming has taken place in this historic church.

Eight years ago, we then moved next door and were sited on 64/65 Long Lane and have shared premises with Dentistry100, a very happy unit. Suzanne, my Practice Manager, will remain in our office here to look after things. Home visits are still offered to all patients either in the Barbican area or West End! Please do ring us on our number 020 7606 2435 or email us at [email protected]. We are hoping our band of regulars will find their way to 55 Harley Street – literally 25 minutes from one practice to the other and with the advent of the Elizabeth line opposite the practice, it will take 5 minutes to Bond St and then an 8 minute walk to us in Harley Street!

We will greatly miss the area, the friends we have made and obviously all the local residents.
Please do keep in touch!

With best wishes from us all.

Caro, Elizabeth and Suzanne

Dirt is good for you!

Dear Good Friends and Patients,

Did you know that regular contact with soil in your garden or flowerpots/troughs can boost your immune system, and keep you healthier, by increasing your exposure to a variety of beneficial microbes? Read on …

Dirt is Good for You!

Modern lifestyles mean that many people have less contact with these microbes which in turn is leading to an increase in autoimmune conditions such as asthma and allergies. Due to the overuse of antibiotics, eating pasteurized food, and children playing less outdoors, we are no longer exposed to the same range and quantity of microbes. As long as targeted hygiene is observed such as wearing gloves if you have scratches or cuts or are not sure of the soil content, plus hand washing after bathroom visits, you will build up a healthy microbiome from exposure to good bacteria. See below.

There a significant number of these microbes which are key to our health. Bacteria, viruses and protozoa are among the most numerous microbes and can cause illness. Fungi and algae are more beneficial. The most famous fungus comes from Penicillim, found in the soil, and from this came the antibiotic, penicillin, whereas Vancomycin, is an antibiotic made from soil bacteria.

Our human system works rather like computer software that needs to be fed data to work effectively. This ‘data’ is in the form of diverse microbes that help the immune system what is a threat to the body and what is beneficial. Humans have literally trillions of microbes living in or on them – a phenomenon known as the human microbiome.

Interestingly soil research offers hope for a new antibiotic, Teixobactin, which comes from bacterium called Eleftheria terrae. This has been proven to be effective against drug- resistant bacteria such as Staphylococcus aureus (MRSA)’ responsible against many human diseases, and Mycobacterium tuberculosis, the bacteria that causes TB.

Many scientists show a clear link between childhood exposure to microbes in the soil and food and higher rates of immunity rates as adults- giving us the perfect excuse to go outdoors and get digging with the kids!

Meanwhile here at Charterhouse Physiotherapy we wish you happy digging, planting bulbs and generally enjoying the outside.

Caro, Elizabeth and Suzanne.

Breast cancer awareness month (October)

Dear Good Friends and Patients,

This month is Breast Cancer Month and we would like to draw your attention to the routine checks everyone (yes this means women AND MEN) should be undertaking weekly to ensure there have been no changes in their breasts.

The changes include:-

* lumps/swelling
* skin changes
* nipple changes
* rash/ crusting around the nipple
* unusual liquid/ discharge from the nipple
* size/shape changes
* pain in breast/armpit

Remember to check regularly all parts of your breasts, armpits and up to your collarbones for changes.

Touch your breasts.
Look for changes.
Check any changes with your GP.

With all good wishes to each of you-

Caro, Elizabeth and Suzanne at Charterhouse Physiotherapy
We treat post breast cancer Lymphoedema-please contact us for help.


Dear Good Friends and Patients,

Such glorious weather this week, I feel if you have a balcony or garden it would be wonderful to perform your Pilates movements outside. When I go for my daily walk I often see people exercising in the parks so why not add this idea as well? No one seems to mind as the populace go thro their routines!

To continue with our Pilates from last week. Remember we are now exploring side and front positions. Repeat each exercise x 5-10 times. Start low and gradually increase your reps. Try alternate side lying positions. Place a folded towel under your head if needed.

  1. Clam Level 1 

Start position:- Lie on your side with your shoulders and hips stacked and underneath arm outstretched in alignment with the trunk. Remember to ensure your back is in neutral position and centre engaged. Hips are bent to 45 degrees and knees to 90 degrees.

Inhale to prepare and as you exhale, lift your top knee upwards keeping the feet together. Inhale and close your knees together.

I would add that it is important beforehand to engage your top buttock muscles. Place your top hand, as it were, in your back pocket and get your buttock muscles squeezing. It really helps the whole exercise.

  1. Clam Level 2

Start side lying position as described above, then lift both feet into the air approximately 8 inches above the floor.

Inhale to prepare and on your out breath, lift the top knee upwards keeping the feet together and lifted off the mat. (So this is similar to the first Clam but with more effort as the feet remain up above). As you then breathe in lower the top knee onto the bottom leg, still keeping the feet lifted off the mat.

  1. Side kick 

Start side lying  position, inhale to prepare, then on the exhalation, lift your top leg to hip height and glide this leg forwards from your hip joint. Keep the knee bent and the leg lifted at hip height.

Inhale and glide your top leg back above your underneath leg, keeping the knee bent and leg lifted at hip height. Repeat

  1. Arm Openings 

Start side lying position; your arms should be reaching out in front of your body and resting one on top of the other.

Inhale, then on exhalation, reach the top arm towards the ceiling and continue moving out to the side, rotating your upper trunk at the same time so that it too opens out to the ceiling. Allow your head to follow the movement of the arm. Hold the stretch and on the next exhalation rotate the arm and body back to the starting position.

Imagine holding a piece of chalk in your top hand and drawing a rainbow over the body. (This is very appropriate with all the children’s rainbow pictures that decorate our front windows). 

  1. Breast stroke prep 

Start position:- lie on your stomach with a cushion for support if required. Make sure your centre is engaged, your shoulder blades are drawn down and back and the back of your neck is long. Your arms are by your side, palms facing upwards.

As you exhale, bring your shoulders blades down and inwards, simultaneously hover your arms off the mat. Your head remains resting on the mat and your neck long.

Inhale and continue reaching your arms. Exhale and rest your shoulder blades and arms on the mat.

  1. ‘Swimming movement’ Level  1

Start position as above, but this time your forehead is resting on the back of your hands. Remember to engage your core!

Inhale to prepare, then on exhalation reach your left leg backwards and off the floor allowing it to hover 1 inch off the mat. Inhale and lower the leg. Repeat with alternating legs.

These simple but effective exercises should help keep you supple. Do a few each day taking some from the old lists and some from this week’s tips – this way you cannot get bored ”with the same old.”

Keep well and upbeat!

Caro, Elizabeth and Suzanne

Charterhouse Physiotherapy 

Home working

Dear Good Friends and patients,

Home working, for most of us, can lead to the following complaints from colleagues and you alike re back and neck pain predominantly. So let’s address these problems with a few simple postural exercises.

Most of us habitually look at our mobiles, laptops and/or desktops with what is called FHP or forward head posture. In other words:-

* slouched posture

* chin poking forward

* shoulders hunched forwards

Easily rectified with 3 easy exercises! You can do these in any order…….

1.If already seated:- 

Take your chin gently backwards from this forward position,(not downwards or upwards). Continue and you will find your whole posture changes completely. Stretch your trunk and head upwards, shoulders relaxed and core muscles gently engaged. Hold for 10 seconds.

  1. Standing:- 

Stand against a wall, shoulders relaxed. Engage your core, lift up your sternum (breast bone) and slide your head backwards till it touches the wall. Sometimes if you have a very rounded back through years of poor posture, it may not be possible to do this. If this is the case do not tilt your head back! Still keep it upright and hold for 10 seconds.

  1. 3. Lying:- 

Pop a rolled towel under your head (not your neck). Press your head into the towel and lengthen your neck. Hold for 10 seconds.

Keep active, check your posture regularly and remember those work breaks.


Charterhouse Physiotherapy


Dear Good Friends and Patients,

Are you sitting comfortably? Then I will begin….. for those of you who really have no idea what I am talking about I will tell you later, but today it is a letter to help you with working at home.

Most of you are in self isolation or with immediate family/flatmates and I am sure you know the basics of ergonomics which is surely good plain common sense, but maybe I can add some new working tips…

Sit to Stand Desks

These have long been the ‘go to’ choice of ergonomists. The real secret is to alter your posture throughout the day. Using furniture that fits this idea, or on an added riser or stack of books that elevate your desk top or laptop, is the key. Try this for 20-30 minutes at a time.

Standing brings the benefit of clearer thinking, improved breathing control and digestion. It just makes sense!

Many are on the market at reasonable prices:-

Ikea has a range from £115-£195 sells one for £83.99 by Symple Stuff

Sitting comfortably 

A good working chair should:-

* be able to swivel, rise up and down.

  • have an adjustable seat that can slide forwards and backwards to take into account the length of your thighs
  • adjustable arms to fit your height. Arms can block your chair from easing under the table/desk, forcing you to lean forwards to use your keyboard.
  • search around for a good second hand chair, at www,
  • the alternative is a Swiss Ball. Our recommended stockists are Performance HealthUK at, or Sissel, at

Try a Swiss Ball

Fun, inexpensive (£35 or less from most good outlets, including a pump), collapsible and definitely ergonomic, it is a great asset for all the family whether at work or play. If you have the fidget gene then one of these is definitely for you! Seated on one, you are constantly readjusting your centre of balance, even with minute movements.

Excellent for core work outs and work ins.


Now you are working at home think about a collapsible photographic backdrop which may be preferable to one of your kitchen when taking a conference call. Many curtain and blind companies sell these – try, for as little as £50. You could also purchase a green screen from Amazon for as little as £20, which works very well for video conferencing. Or you can try a bookshelf, which seems to be very popular with online media!


If you are only using a laptop I would strongly suggest you buy a separate keyboard to use with it. This way you can use the screen part of the laptop (on risers/ books) at eye height and the separate keyboard on your table. This way you are mimicking a desktop computer at a fraction of the price. Ergonomic keyboards are also available. Try Microsoft Natural Ergonomic Keyboard 4000 (UK Layout) on Amazon, approx. £40.

And of course, the most important of all are the work breaks. These were stipulated by the EU long ago when Europe was having a RSI crisis. For every 30 minutes, take 2 – 5 minutes off to stretch, work out on that Swiss Ball or just go to your balcony or garden or front door step and do some deep breathing.

Good luck!

Please email if I can be of any help! 

[email protected]

Also available on Zoom, FaceTime or mobile 07971833443

Keep well and safe,

Caro, Elizabeth and Suzanne at Charterhouse Physiotherapy  





We thought this spring newsletter would feature diabetes, an increasingly common disease with serious long-term consequences.


400 million in the world have diabetes.

43 million people in the UK have diabetes.

35 million are diagnosed.

People nowadays can have a full productive life with Type 1. Shining examples are Steve Redgrave and Theresa May. Globally it has been increasing steadily in proportion to the amount of disease in UK and the world. In 1990 it became the 8th most common cause of morbidity.

Insulin was isolated from the Islets of Langerhan in the pancreas (discovered originally by Paul Langerhan in 1867), extracted and purified and found to be the great medical discovery

Ethnicity and Diabetes

Asian origin:- x9 more likely to have diabetes.

African origin:- x6 more likely to have diabetes.

There is also a higher risk of gestational diabetes.

Essence of Diabetes

The body’s need to keep glucose within a narrow perimeter- too much glucose produces high blood sugar levels and too little will causes organs, especially the brain, to malfunction. The ‘B’ cells within the Islets of Langerhan produce the hormone insulin, in response to high glucose levels. Other cells respond to this, by storing energy in the liver, fat cells and muscle.

Type 1 Diabetes (10%of diabetes)

In childhood or early adulthood the ‘B’ cells start to die and stop producing insulin. Without this the body cannot regulate glucose or energy. It is thought that Type 1 may be an autoimmune disease. Genetically if a family member suffers from this then the percentage rises slightly in being passed down to offspring. If the patient has DKA (diabetic ketoacidosis), then as the blood glucose increases so does the ketone level causing the blood to become acidic, which can lead to a coma. If there is a high level of glucose without ketones then infection or illnesses can occur.

Type 2 Diabetes

This can start in middle age. Here the body responds abnormally to insulin production and does not reduce the glucose levels as much as it should. A combination of genes and behavioural element is the cause. 80-85% is accounted for by people being overweight and this in turn can lead to obesity. Link is causal in many cases.

Gestational Diabetes

This can occur in 5% of pregnancies during the 2nd/3rd trimesters, resulting in a heavier baby. Usually it is resolved when the child is born. There is a x7 % risk that the mother can develop Type 2.

Untreated Diabetes (both Type 1 and 2)

Frequency of passing urine



Skin infections such as Thrush

Delayed wound healing

Weight loss

Insulin Treatment

This is usually given by injection or pump. We try to mimic by using insulin to control the glucose levels in the most natural way throughout the day. If too much insulin is administered, then hypoglycaemia can occur and the patient can lapse into a coma. Carrying a Mars bar or similar at all times is a good idea.

Type 2 Diabetes treatment and help

Usually diet is paramount and here the Government can help by:-

Taxing fizzy drinks and sugar.

Restrict direct advertising to children.

Restrict fast food outlets near schools.

Engage with industry.

The aim is not to stop enjoyment but reduce unnecessary energy level intake.


Is usually Sulphonylureas, which stimulates the pancreas to produce more insulin, or Metformin, which reduces the glucose production and DPP-4i drugs, which inhibit the breakdown of gut enzymes which reduce the production of glucose.

Bariatric surgery is also used, where replumbing the stomach and upper gut can lead to weight loss and drastic increase in glucose control.


Written by Caroline Rugman March 2020


Dear Good Friends and Patients,

Just to make you smile as we begin another week of easier lockdown, I was asked by my lovely neighbour to give a few Pilates lessons to her and her lodger. We have a shoulder high garden wall separating the gardens. So accordingly, I stood on my garden bench and oversaw the girls next door perform their Pilates moves from a distance. Much laughter and enjoyment from all 3 of us! Fingers crossed their core muscles were being used correctly!

Are you ready for the next Pilates exercises? All set?! So off we go…

  1. One Leg Stretch 

Resting position – remember this is lying on your back with your knees bent and feet resting hip width apart, shoulders drawn in and down and neck long with your centre engaged.

Breathe in to prepare and as you breathe out slide your left heel forwards along the floor, lengthening your leg. As you breathe in again slide your foot back along the floor to the original bent position. Repeat, alternating legs.

  1. Hip Twist 

Resting position – breathe in to prepare and then as you breathe out, allow your left leg to fold outwards from your body. Breathe in and return your left leg until your left knee is in alignment with the left hip. Repeat alternating legs.

  1. Scissors 

Resting position – breathe in to prepare and on your out breath slide your right foot inwards towards your sitting bone and float this leg upwards into “tabletop position”. Hold this position as you breathe in again and as you exhale, lower the leg to the mat. Repeat alternating legs.

  1. Hundreds 

Resting position – breathe in to prepare and as you exhale, float your right knee up to tabletop position leg position. Hold this position and focus on 5 breath cycles. You can gently move your arms up and down x5 times. On the fifth breath lower your leg to assume the rest position. Repeat with your opposite leg.

  1. Shoulder Bridge 

Resting position – inhale to prepare and as you exhale gently roll your lower back into the mat, scoop your tailbone upwards and continue to peel your spine off the mat, bone by bone, until you are resting on your shoulder blades. Inhale and hold this position. Then as you exhale lower the shoulder bridge one bone at a time to the mat, beginning with the highest vertebrae of your bridge and finishing with your tailbone to return to neutral position.

  1. Hip Twist 

Resting position – your arms out to the side just below shoulder height and palms facing upwards. Connect your legs together and hold a rolled towel/small ball between your knees.

Inhale to prepare and as you exhale, roll both knees to the right and continue to roll your pelvis, waist and then lower back towards the right. Then roll your head and neck towards your opposite shoulder, keeping your neck long. Breathe in and hold. Then as you exhale again, roll your head and neck back to the midline and roll your lower back, pelvis and finally legs to neutral position (midline).

Next week I shall add more positions and exercises to trial. We will move into side-lying and prone (tummy-lying) positions. Hopefully you now have all accomplished the resting position and maybe some of you have managed the breathing idea. Not to worry if this is still a challenge-I promise you it will happen!

I am seeing patients at 55 Harley Street W1G 8QR if anyone is in need of Physiotherapy, Lymphoedema/Lipoedema treatment or acupuncture. The City practice hopefully will open soon. We await the owner’s decision on the date who is following Government guidelines.

All the best from us at Charterhouse Physiotherapy. 

Caro, Elizabeth and Suzanne


Dear Good Friends and Patients,

To make sure you are all as exercise conscious as possible I am adding more each week with a different flavour to keep your exercise taste buds active and raring to go! Remember the great thing is to take from each week a new exercise that challenges you a little and add it to your repertoire. Discard it in favour of another one when you have mastered it and need another challenge. Challenges are the way forward in maintaining a healthy exercise appetite.

So this week I am going to introduce you to some basic Pilates moves. Remember Pilates is a mixture of yoga, ballet, physio exercises, weight and circus (!)training and the combination works wonders for grumbling backs and poor posture.

  1. Breathing, centering and rib cage

 Repeat each exercise several times 

I would emphasise that people get a bit preoccupied with the breathing. It comes with practice. Do not worry if initially you find it hard to combine it with the movements!

For all three of the above exercises, lie on your back with your hips and knees bent up and feet resting on a mat. Pop a folded towel under your head if you feel your chin is poking upwards. Place your hands on the lower half of your rib cage, with fingers slightly interlaced. Breathe in and allow your lower rib cage to expand widthways and imagine the back of your rib cage spreading wide  into the mat beneath you. As you breathe out, your rib cage will sink downwards and inwards and your fingers may interlace again.

Next, try again in the same resting position try centering. Place your hands in a diamond shape: thumbs in naval and fingers down onto the pelvic bones. Tilt your spine, exaggerating the arch and then flatten your back a few times. Position  your pelvic diamond in the middle of these two movements- this is neutral-spine position.

Next is finding your core or deep abdominal muscles, which form a natural corset, which have notches in them like a belt. By breathing in to prepare and then out, slowly draw in your corset some 3 notches. You will feel your abdominal muscles beneath your fingers slowly draw away. Hold this and continue breathing normally. This should be a very gentle exercise-don’t overdo it!

Rib cage

Here you are in the same resting position but arms are resting alongside your body. Breathe in to prepare and engage your core as you breathe out, lifting your arms up overhead whilst keeping the back of your rib cage on the mat underneath you. Continue breathing and lift your arms over your shoulders. Repeat, taking care not to lift your rib cage off your mat.

Shoulder blades

Again use the same resting position as above. Float your arms up vertically to the ceiling, then reach gently further upwards so that your shoulder blades glide apart from each other. Breathe out and allow your shoulder blades to draw back towards one another.

You can then try this exercise where your arms are resting by your side:- glide your shoulder blades upwards towards the ceiling and then gently downwards away from your ears. Remember to breathe in to prepare and out, as you begin the exercise. 

Head and Neck (excellent for neck ache and headaches)

Again, lying in the resting position with arms by your side. Place a shiny magazine on top of the folded towel for the bony area at the back of your head to rest on.

Lengthen the bony part of your head away from the base of your neck. Hold for 2-3 seconds then relax. Alternatively imagine that your hair on the crown of your head is gently being pulled.

Try these very simple introductory exercises! I will add some more to add to your repertoire next week. Have a good Bank Holiday Weekend! 

From us all at Charterhouse Physiotherapy,

Caro, Elizabeth and Suzanne

Back exercises

Dear Good Friend and Patients,

Most people are missing their work routine which gave a real meaning to their day, with the thought of the weekend to keep up their morale. But these are different and more challenging times and our politicians are using war phrases to perhaps give us more backbone.

So we need to make our own work routines and allow for enough exercise to keep mind and body active. Exercise releases endorphins and gives us that feel good factor, necessary for mental happiness and well being. Go for it!

So, for those back sufferers I have put together some very easy exercises. I do urge you to do these plus to remember those work break ones!

Back Exercises 

Try to do each one x10

Remember go up to the pain and NOT into it!

Start with lying prone (on your front):-

  1. Sacral rocking. Try gently rocking your bottom side to side, gradually increasing your range of movement, keeping within your pain level.
  1. Raise your head and shoulders so you are resting on your forearms in the Sphinx position. Continue with the first exercise.
  1. Brace your tummy and buttocks and keep your hands by your sides. Lift alternate legs a few centimetres high and each leg lift and hold for 10 seconds. If this is too strenuous then reduce this to 5-7 seconds and gradually increase this to 10 seconds.
  1. Brace your tummy and buttocks. Tuck your chin in and raise your head and shoulders up a little. Slide alternate hands down your side.

Proceed to lying supine (on your back):-

  1. Bend your knees, resting your feet on the floor. Brace your tummy muscles and swing your knees side to side, gradually increasing your range of movement.
  1. Tuck your chin in, clasp one knee and bend forwards so that both knee and chin come towards each other. Repeat with the other knee. The more supple of you may manage to touch chin to knee! Then try a ’bridge’- this is where you lift up your trunk, remembering to also brace!
  1. Bend your knee up and over towards your opposite shoulder. Hold your knee this position for 10 seconds.
  1. Bend your knees, cross your legs, with your right foot resting on your left knee. Clasp your left thigh and lift. You will feel a stretch in your right buttock.

Alternatively if this is too difficult, then try pushing your right knee away as it rests on your left knee.

Whichever is easier try with each leg position.

Again let us know if there is anything we can help you with be it a simple exercise or treatment.

Caro, Elizabeth and Suzanne

Charterhouse Physiotherapy