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Calcifications refer to the abnormal deposition of calcium salts (primarily calcium hydroxyapatite) in soft tissues of the body.
Calcification is a normal process throughout the body, but it can also be a sign of disease.
Pathological calcifications can occur in various tissues, including the heart, arteries, veins, lungs, kidneys, brain, and skin.
The physiopathology of calcification is not fully understood but it is thought to be a result of an imbalance between factors that promote and inhibit calcification.
Promoters of calcification include:
Inhibitors of calcification include:
When the balance between promoters and inhibitors of calcification is disrupted, calcium salts can begin to deposit in tissues and organs.
This can lead to a variety of problems, including:
As described above the specific physiopathology of calcifications can vary depending on the type and location of the calcification, as well as the underlying disease or condition responsible for it.
In this blog post, we are going to analyze more specifically calcifications that affect the musculoskeletal system.
Calcifications most often are the result of micro-tears or other traumas to a tendon or other tissues such as muscle fibers.
Surgery could be another cause of tissue disturbance that can lead to a build-up of calcium deposits.
Calcifications occur in different tissues but the most common is on a tendon tissue. For example, after a tendon tear is very common a build-up of calcification if there has been not proper physiotherapy treatment.
Calcium build-up is most often a result of chronic inflammation after a muscle or tendon injury.
Chronic Inflammation can promote the release of factors that induce calcification. Macrophages, inflammatory cytokines, and reactive oxygen species can all play a role in initiating calcification processes.
Dystrophic Calcification occurs in damaged or necrotic tissues, where calcium deposits in areas of existing injury or tissue degeneration. It’s commonly observed in chronic inflammatory conditions and areas of tissue damage.
As described above, as the main causes of calcifications of the musculoskeletal system are traumatic or chronic inflammation, it is important to get an early diagnosis if we experience pain for more than 3/4 weeks.
The most common diagnostic investigations to assess the calcifications are:
Your doctor or sports physiotherapist should choose these three types of diagnostic depending on the pain area and the gravity of the injury.
The images below show a right Gluteus Maximus post-injury scar tissue formation identified by an Ultrasound Scan.
Despite the fact that most of the calcification of the musculoskeletal system could be prevented with early diagnostic and physiotherapy treatment, even the most advanced calcification can be treated.
The treatments for soft tissue and tendinous calcification are:
The most common hands-on physiotherapy treatments are those performed with physiotherapy tools.
The most common physio technique is the so-called Instrument Assisted Soft Tissue Mobilization (IASTM). This treatment is performed with special stainless steel tools with different shapes and sizes to fit the specific part of the body.
The lesser-known physiotherapy technique is Diacutaneous Fibrolysis, a type of soft tissue mobilisation physiotherapy technique. This is performed with specific stainless steel hooks with different dimensions to perform a more aggressive treatment to break down calcification and adhesion.
Shockwave physiotherapy is performed with a radial shockwave machine, which generates therapeutic pressure shock waves.
A few months ago, in our sports clinic in London, we got a patient with an old Achilles tear and a consequent conspicuous build-up of calcification.
The build-up of calcification after a tendon tear is a quite common issue if we don’t perform proper physiotherapy.
In our specific case, the patient tried different physiotherapy and surgical approaches, but without too much benefit.
He got ten sections of Shock Wave therapy without big benefits in terms of pain, ankle range of motion, and tendon and muscle flexibility.
When He came to our sports clinic, he had his last surgery about 6 months earlier.
We decided to perform our own physiotherapy protocol with a mix of physio treatments such as:
After 5 sessions of our injury rehabilitation protocol, the patient has improved a lot its Achilles and ankle biomechanics and symptoms in terms of:
After another block of 5 sessions, we plan to do another X-ray to check the entity of reduction of the Achilles calcification.
Shockwaves therapy is a very effective physiotherapy to reduce calcifications both in Achilles and Plantar Fasciitis.
High-pressure waves can break down the calcium deposit around the tendon and fascia, speeding up the healing and tissue remodelling process.
The effectiveness of the shockwave therapy depends on different factors, such as:
The effectiveness of shockwaves therapy is cumulative, and the average of good results comes after the first 3 sessions.
At least 6 sessions of Shockwave therapy are advisable for calcifications.
In our sports injury clinic in London, we have reached the most effective results for tendons calcification with the best and most powerful shockwave machine on the market, such as the EMS Machine made in Switzerland.
Adhesions occur when different types of tissues stick together that, normally, should be separated.
Adhesions are fibrous bands of tissue that can form between organs, tissues, or structures in the body.
They are typically the result of a healing process following surgery, infection, inflammation, or injury.
Adhesions can form in various parts of the body, including the abdominal cavity, pelvic region, and joints.
the physiopathology of adhesions is a complex process but the main actors are the fibroblasts, specialized cells involved in tissue repair and wound healing, which deposit collagen in response to tissue injury or any other kind of tissue insult such as surgery. Excessive deposits of connective tissue can form fibrous bands that bind tissues or organs together.
Another important factor in adhesion formation is Fibrin Formation. During the early stages of healing, fibrin forms a temporary scaffold to support cell migration and tissue repair. In some cases, excessive fibrin deposition can contribute to the development of adhesions.
As adhesion is a condition that occurs during the healing process of tissues, the most important causes of adhesion are any kind of tissue insult such as:
All of these three main causes of adhesion cause trauma for the tissue or status of chronic inflammation that activates the healing process during which we can have adhesion formation.
Certain factors can increase the risk of adhesion formation.
The main risk factors of adhesion formation are:
Diagnosing adhesions typically involves a combination of clinical evaluation, medical history, and various imaging and diagnostic tests.
A physical examination may be performed to assess tenderness, palpable masses, or other signs that suggest adhesions.
Imaging Tests are often used to visualize adhesions and their impact on internal structures.
These tests may include:
More invasive diagnostic tests include:
There are several treatment options for adhesions, depending on the severity of the condition and the symptoms it causes.
For adhesions of the bowel, for example, surgery may be necessary if they cause severe pain, bowel obstructions, or other serious complications.
Laparoscopic Surgery is a minimally invasive surgery that can be used to remove adhesions. This approach involves smaller incisions and less tissue disruption, leading to quicker recovery.
For adhesions that affect the musculoskeletal system, such as muscle fascia, tendons, and other soft tissues, non-invasive physiotherapy techniques can be used, such as:
Myofascial release with a Shockwaves therapy machine is a little-known feature which, if it is properly performed, can be a game-changer in many musculoskeletal conditions.
With shockwave therapy machine, an expert sports physiotherapist can perform the most powerful myofascial release, which can target different conditions, such as:
The key factor in the optimal execution of myofascial release with shockwave therapy machine is the expertise of the physiotherapist and the right shockwave transmitter (header).
Based on our experience, the best shockwave transmitter has a dimension of 40 mm.
This is, in our opinion, the best shockwaves applicator for Myofascil Release as it does not induce too much patient pain and guarantees a good myofascial release power.
Seek always the help of your doctor or trusted physiotherapist to treat any condition of calcification and adhesions.
Adhesions and calcification are both quite serious medical conditions that require a good diagnosis and exceptional physiotherapy treatment.
Avoid any kind of self-therapy or drugs without a consultation with your doctor!
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