Understanding Calcific Tendinopathy: Symptoms and Physiotherapy Interventions

CALCIFIC TENDINOPATHY PHYSIOTHERAPY

Calcific tendinopathy is also known as calcium hydroxyapatite crystal deposition disease in which calcium hydroxyapatite gets deposited in predominant manner in a tendon mainly present in the rotator cuff. The condition lads to sudden onset of painful feelings in the cuff, intense pain with hindrance in shoulder movement, tenderness over rotator cuff muscles and others (Sansone et al., 2018). The physiotherapy in calcific tendinopathy is found to be effective in lowering the pain and inflammation caused due to the condition (Simpson et al., 2020).

In order to initiate physiotherapy in calcific tendinopathy, the physiotherapist is going to record and analyse history of the pain and injury along with focus on the nature of hindrance to movement faced in everyday life by the individual. The X-ray reports are to be reviewed to understand the stage of calcific tendinopathy and the level of pain perceived (Chianca et al., 2018).

At the initiation of the Calcific tendinopathy physiotherapy, the physiotherapist is going to involve the affected individual to execute proprioceptive neuro-muscular facilitation (PNF) exercises. The PNF exercise is simple stretching technique used for enhancing range of motion and flexibility in the affected area. This is because the stretching causes the muscle length to be increased and enhancing neuromuscular movement efficiency that is hindered by calcium hydroxyapatite deposition in the area (Sansone et al., 2018).

The three common PNF exercises recommended by the physiotherapist are antagonist-contract method (AC), contract-relax method (CR) and combination of the two exercises that is contract-relax-antagonist-contract (CRAC). The CR includes holding, contracting, stretching and releasing target muscles in the physiotherapy for calcific tendinopathy. The AC is referred to the dynamic or static contraction of opposite muscles, prior to stretching of the target muscle (Tedla and Sangadala, 2019).

During the initial stage of Calcific tendinopathy physiotherapy, passive range of motion is to be maintained. In this process, the own muscle of the individual is not to be used for lifting the joints because of the associated pain that limits the movement. The passive range of motion would include use of rehabilitation equipment such as poles and pulley by the therapy (Ammendolia et al., 2020). Afterward, the strengthening exercise is to be recommended by the physiotherapist once normal movement is gained by the patient by overcoming the pain (Lee et al., 2019).

The benefit of using Calcific tendinopathy physiotherapy is that it helps to enhance the mechanism of the joints and lower the burden on the exiting tendons that are affected by the calcium deposition (Bechay et al., 2020). However, the disadvantage is that injury may be received during the physiotherapy if the actions are not executed by trained therapist which may further limit the movement of the joints of the individuals (Tedla and Sangadala, 2019).

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References

Ammendolia, A., Marotta, N., Demeco, A., Marinaro, C., Moggio, L., Barletta, M. and Costantino, C., 2020. Effectiveness of Radial Shockwave Therapy in Calcific and Non-Calcific Tendinopathy of the Shoulder: a Systematic Review and Meta-Analysis. Muscles, Ligaments & Tendons Journal (MLTJ), 10(1).pp.67-90.

Bechay, J., Lawrence, C. and Namdari, S., 2020. Calcific tendinopathy of the rotator cuff: a review of operative versus nonoperative management. The Physician and Sportsmedicine, 48(3), pp.241-246.

Chianca, V., Albano, D., Messina, C., Midiri, F., Mauri, G., Aliprandi, A., Catapano, M., Pescatori, L.C., Monaco, C.G., Gitto, S. and Mainini, A.P., 2018. Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Bio Medica: Atenei Parmensis, 89(Suppl 1), p.186.

Lee, C.H., Oh, M.K. and Yoo, J.I., 2019. Ultrasonographic evaluation of the effect of extracorporeal shock wave therapy on calcific tendinopathy of the rectus femoris tendon: A case report. World journal of clinical cases, 7(22), p.3772.

Sansone, V., Maiorano, E., Galluzzo, A. and Pascale, V., 2018. Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment. Orthopedic research and reviews, 10, p.63.

Simpson, M., Pizzari, T., Cook, T., Wildman, S. and Lewis, J., 2020. Effectiveness of non-surgical interventions for rotator cuff calcific tendinopathy: a systematic review. Journal of Rehabilitation Medicine, 52(10), pp.1-15.

Tedla, J.S. and Sangadala, D.R., 2019. Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: a systematic review and meta-analysis. Journal of musculoskeletal & neuronal interactions, 19(4), p.482.