Tuesday, November 9, 2010
Thursday, October 14, 2010
Sunday, October 3, 2010
Soft Tissue Pain: Calcific Tendinitis by Whitney Lowe
http://www.massagetoday.com/mpacms/mt/article.php?id=14287
By Whitney Lowe, LMT
Calcific tendinitis in the shoulder is a soft-tissue pain complaint that may be acute but is usually chronic, and affects the rotator cuff tendons. Its symptoms somewhat mimic other conditions such as adhesive capsulitis, rotator cuff disorders, shoulder impingement syndrome, or traditional tendinitis characterized by tendon fiber inflammation.
Because of these similar symptoms, knowing the evaluation procedures that will distinguish this condition from others is a priority for treatment. Treatment strategies also differ so attention to the particular treatment protocols for this condition is necessary for pain resolution or management.
Calcium deposits can accumulate in any tendon, but occur most often in the supraspinatus, but also the infraspinatus, teres minor, and subscapularis tendons (in that order) (Fig. 1). Calcium deposits develop for no apparent reason (idiopathically), and may disappear and reabsorb without intervention.
Sometimes the tendon tissue gradually returns to normal and the calcium deposits reabsorb. In chronic calcific tendinitis, the healing process is interrupted and the condition becomes exacerbated, prolonged, and deposits may continue to develop. In some cases, there may be compression of the supraspinatus tendon fibers against the underside of the acromion process. However, there is controversy about whether the impingement process contributes to tendon pathology.
Figure 1: The supraspinatus tendon: a common location for calcific tendinitis. 3D anatomy images. Copyright of Primal Pictures Ltd. www.primalpictures.com Some cases of calcific tendinitis have an active inflammatory process, but research has yet to provide a cause. It may be that it is the inflammatory process that produces the calcium deposits, but inflammation may also result from their development. In either case, inflammation may not be apparent as it may reside under the acromion process. Anti-inflammatory medications, both oral and injected, are often successfully used to provide pain relief, so this would indicate some inflammatory process.
Assessment
Calcific tendinitis can be mistaken for other shoulder pathologies including adhesive capsulitis, shoulder impingement, bursitis, rotator cuff tears, or other disorders. Evaluating for calcium deposits is usually done through the history and physical exam because they may not show up in X-rays. However, both X-ray and ultrasound are sometimes used for diagnosis.
The relationship between calcium deposits and pain is unpredictable, as there are people who have deposits yet no symptoms of pain or limitation in movement. Nor does there seem to be a direct correlation between the size of the calcium deposit and the amount of pain it produces. For those who do have symptoms, pain can present rapidly - frequently within 24-48 hours - and be severe. Pain is usually described as deep or throbbing in nature (similar to a toothache).
This presentation is in sharp contrast to overuse conditions in the shoulder where symptoms emerge gradually and are more clearly a result of repetitive overuse. Calcific tendinitis pain usually increases in a short period of time, and motion of the shoulder may aggravate the pain. In addition, resting the affected joint often resolves the pain of classic impingement and tendinitis complaints. With calcific tendinitis pain may persist even with a significant period of rest from activities that are painful.
With classic supraspinatus tendinitis, pain is most likely to be exaggerated with abduction of the shoulder, either with active motion or resisted abduction. In calcific tendinitis, pain is not as dependent on activity or movement; though movement can increase the pain, it can also occur when the arm is motionless at the client's side.
Figure 2: Greater tuberosity of humerus where pain is often felt 3D anatomy images. Copyright of Primal Pictures Ltd. www.primalpictures.com Particularly notable with calcific tendinitis is pain with palpation over the greater tuberosity of the humerus (Fig. 2). Pain is not predominant at the greater tuberosity of the humerus with other types of rotator cuff problems. For example, with shoulder impingement syndrome pain may be felt under the acromion process with the arm abducted. But if the greater tuberosity is palpated with the shoulder in a neutral position, there won't be as much discomfort if shoulder impingement is the problem. In contrast, palpation of this area is likely to be very painful with calcific tendinitis.
Calcific tendinitis can be distinguished from adhesive capsulitis or frozen shoulder as there is no capsular pattern with this condition. The capsular pattern of restriction (greatest motion limitations in lateral rotation and then abduction) is a primary criteria for evaluation in the frozen shoulder. Shoulder bursitis can produce pain with various motions, but is usually not aggravated with resisted shoulder abduction. The resisted abduction usually increases discomfort in calcific tendinitis.
Treatment
Treatment for calcific tendinitis differs from treatment of other shoulder disorders. A predictable pathological process has not been identified, and natural resolution of the condition can take years (3 to more than 10, with sometimes no improvement). It is generally dealt with conservatively, using non-operative modalities and with many cases responding positively to some of these approaches. Anti-inflammatories and steroid injections are usually recommended, along with transcutaneous electrical nerve stimulation and physical therapy, but these have limited benefit for this condition. Rest from offending activities also doesn't result in much improvement.
Ultrasound has shown the most positive results, but recent research indicates higher levels of ultrasound are required for improvement and that little to no improvement results from lower levels. Another recent study resulted in complete dissolution of the calcium deposits in 86.6 percent of treatment subjects with application of radial shock wave therapy, which is an application of a low- to medium-energy shock wave to the affected tissues.1 These modalities both aim to break up the calcium deposits.
A role for massage for calcific tendinitis has not been determined at this point. A study from 1999 found deep friction massage treatment combined with phonophoresis to be beneficial.2 Phonophoresis uses ultrasound to drive medication (usually anti-inflammatory medication) into the skin. More research is needed to evaluate the two treatments individually. Even if deep friction massage could possibly function to break up calcification in the tissue, it would likely be uncomfortable for the client.
Further, massage could aggravate the client's condition. For this reason, applying direct massage on tendons with calcifications is not recommended. If calcific tendinitis is suspected, the massage practitioner should refer the client to a physician. However massage could be used for general pain relief in associated tissues and general relaxation, unless it produces pain. Because calcific tendinitis can lead to frozen shoulder from restricted mobility, massage (in the non-calcified tissues) and passive range of motion may be used as prevention by keeping the shoulder mobile.
Finally, complicated cases may be treated by a physician with a needling technique if conservative treatments have provided no pain relief or benefit. This is a technique in which a hypodermic needle is inserted into the calcium deposit. The needle is then used like a probe to break up the calcified deposits in the tendon tissue. A local anesthetic or corticosteroids are used in conjunction.
An individual with calcific tendinitis may seek the help of a massage practitioner believing they have some other type of pain condition in the shoulder. If the pain pattern for that individual is similar to that described above, calcific tendinitis should be considered. Thorough assessment and evaluation will be helpful to discriminate between calcific tendinitis and other soft-tissue disorders such as rotator cuff pathology, impingement, or adhesive capsulitis. Making these distinctions is important for this condition. Clients suspected to have calcific tendinitis should be referred to a physician, even if the client chooses to continue massage for mild pain relief.
References
Cacchio A, Paoloni M, Barile A, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther, May 2006;86(5):672-82.
Gimblett PA, Saville J, Ebrall P. A conservative management protocol for calcific tendinitis of the shoulder. JMPT, 1999;22(9):622-7.
--------------------------------------------------------------------------------
Click here for more information about Whitney Lowe, LMT.
By Whitney Lowe, LMT
Calcific tendinitis in the shoulder is a soft-tissue pain complaint that may be acute but is usually chronic, and affects the rotator cuff tendons. Its symptoms somewhat mimic other conditions such as adhesive capsulitis, rotator cuff disorders, shoulder impingement syndrome, or traditional tendinitis characterized by tendon fiber inflammation.
Because of these similar symptoms, knowing the evaluation procedures that will distinguish this condition from others is a priority for treatment. Treatment strategies also differ so attention to the particular treatment protocols for this condition is necessary for pain resolution or management.
Calcium deposits can accumulate in any tendon, but occur most often in the supraspinatus, but also the infraspinatus, teres minor, and subscapularis tendons (in that order) (Fig. 1). Calcium deposits develop for no apparent reason (idiopathically), and may disappear and reabsorb without intervention.
Sometimes the tendon tissue gradually returns to normal and the calcium deposits reabsorb. In chronic calcific tendinitis, the healing process is interrupted and the condition becomes exacerbated, prolonged, and deposits may continue to develop. In some cases, there may be compression of the supraspinatus tendon fibers against the underside of the acromion process. However, there is controversy about whether the impingement process contributes to tendon pathology.
Figure 1: The supraspinatus tendon: a common location for calcific tendinitis. 3D anatomy images. Copyright of Primal Pictures Ltd. www.primalpictures.com Some cases of calcific tendinitis have an active inflammatory process, but research has yet to provide a cause. It may be that it is the inflammatory process that produces the calcium deposits, but inflammation may also result from their development. In either case, inflammation may not be apparent as it may reside under the acromion process. Anti-inflammatory medications, both oral and injected, are often successfully used to provide pain relief, so this would indicate some inflammatory process.
Assessment
Calcific tendinitis can be mistaken for other shoulder pathologies including adhesive capsulitis, shoulder impingement, bursitis, rotator cuff tears, or other disorders. Evaluating for calcium deposits is usually done through the history and physical exam because they may not show up in X-rays. However, both X-ray and ultrasound are sometimes used for diagnosis.
The relationship between calcium deposits and pain is unpredictable, as there are people who have deposits yet no symptoms of pain or limitation in movement. Nor does there seem to be a direct correlation between the size of the calcium deposit and the amount of pain it produces. For those who do have symptoms, pain can present rapidly - frequently within 24-48 hours - and be severe. Pain is usually described as deep or throbbing in nature (similar to a toothache).
This presentation is in sharp contrast to overuse conditions in the shoulder where symptoms emerge gradually and are more clearly a result of repetitive overuse. Calcific tendinitis pain usually increases in a short period of time, and motion of the shoulder may aggravate the pain. In addition, resting the affected joint often resolves the pain of classic impingement and tendinitis complaints. With calcific tendinitis pain may persist even with a significant period of rest from activities that are painful.
With classic supraspinatus tendinitis, pain is most likely to be exaggerated with abduction of the shoulder, either with active motion or resisted abduction. In calcific tendinitis, pain is not as dependent on activity or movement; though movement can increase the pain, it can also occur when the arm is motionless at the client's side.
Figure 2: Greater tuberosity of humerus where pain is often felt 3D anatomy images. Copyright of Primal Pictures Ltd. www.primalpictures.com Particularly notable with calcific tendinitis is pain with palpation over the greater tuberosity of the humerus (Fig. 2). Pain is not predominant at the greater tuberosity of the humerus with other types of rotator cuff problems. For example, with shoulder impingement syndrome pain may be felt under the acromion process with the arm abducted. But if the greater tuberosity is palpated with the shoulder in a neutral position, there won't be as much discomfort if shoulder impingement is the problem. In contrast, palpation of this area is likely to be very painful with calcific tendinitis.
Calcific tendinitis can be distinguished from adhesive capsulitis or frozen shoulder as there is no capsular pattern with this condition. The capsular pattern of restriction (greatest motion limitations in lateral rotation and then abduction) is a primary criteria for evaluation in the frozen shoulder. Shoulder bursitis can produce pain with various motions, but is usually not aggravated with resisted shoulder abduction. The resisted abduction usually increases discomfort in calcific tendinitis.
Treatment
Treatment for calcific tendinitis differs from treatment of other shoulder disorders. A predictable pathological process has not been identified, and natural resolution of the condition can take years (3 to more than 10, with sometimes no improvement). It is generally dealt with conservatively, using non-operative modalities and with many cases responding positively to some of these approaches. Anti-inflammatories and steroid injections are usually recommended, along with transcutaneous electrical nerve stimulation and physical therapy, but these have limited benefit for this condition. Rest from offending activities also doesn't result in much improvement.
Ultrasound has shown the most positive results, but recent research indicates higher levels of ultrasound are required for improvement and that little to no improvement results from lower levels. Another recent study resulted in complete dissolution of the calcium deposits in 86.6 percent of treatment subjects with application of radial shock wave therapy, which is an application of a low- to medium-energy shock wave to the affected tissues.1 These modalities both aim to break up the calcium deposits.
A role for massage for calcific tendinitis has not been determined at this point. A study from 1999 found deep friction massage treatment combined with phonophoresis to be beneficial.2 Phonophoresis uses ultrasound to drive medication (usually anti-inflammatory medication) into the skin. More research is needed to evaluate the two treatments individually. Even if deep friction massage could possibly function to break up calcification in the tissue, it would likely be uncomfortable for the client.
Further, massage could aggravate the client's condition. For this reason, applying direct massage on tendons with calcifications is not recommended. If calcific tendinitis is suspected, the massage practitioner should refer the client to a physician. However massage could be used for general pain relief in associated tissues and general relaxation, unless it produces pain. Because calcific tendinitis can lead to frozen shoulder from restricted mobility, massage (in the non-calcified tissues) and passive range of motion may be used as prevention by keeping the shoulder mobile.
Finally, complicated cases may be treated by a physician with a needling technique if conservative treatments have provided no pain relief or benefit. This is a technique in which a hypodermic needle is inserted into the calcium deposit. The needle is then used like a probe to break up the calcified deposits in the tendon tissue. A local anesthetic or corticosteroids are used in conjunction.
An individual with calcific tendinitis may seek the help of a massage practitioner believing they have some other type of pain condition in the shoulder. If the pain pattern for that individual is similar to that described above, calcific tendinitis should be considered. Thorough assessment and evaluation will be helpful to discriminate between calcific tendinitis and other soft-tissue disorders such as rotator cuff pathology, impingement, or adhesive capsulitis. Making these distinctions is important for this condition. Clients suspected to have calcific tendinitis should be referred to a physician, even if the client chooses to continue massage for mild pain relief.
References
Cacchio A, Paoloni M, Barile A, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther, May 2006;86(5):672-82.
Gimblett PA, Saville J, Ebrall P. A conservative management protocol for calcific tendinitis of the shoulder. JMPT, 1999;22(9):622-7.
--------------------------------------------------------------------------------
Click here for more information about Whitney Lowe, LMT.
Sunday, September 19, 2010
Sunday, August 1, 2010
Sunday, July 4, 2010
Memory Improvement Tricks
Read this article for ways to help short memory loss.
Cool article on how to help short memory loss. Exersize for the brain!
Cool article on how to help short memory loss. Exersize for the brain!
Tuesday, June 8, 2010
7 Relaxation Tips
Using any relaxation tips you may have picked up over the years is a great way to deal with the stresses in your daily life.
Sometimes, when you're feeling stressed out, having someone tell you to relax or "chill out" is more annoying than anything else. But it's advice you should take to heart, especially if you are having a bad day - or week.
Here are 7 tips that will help you relax when you're feeling stressed.
1.Take a Warm Bath
Soaking in a tub full of warm water can work wonders when you're feeling stressed. The warm water relaxes you physically, loosening tight, stiff muscles. And, as a result, you relax mentally as well.
2.Read a Good Book
One of the best ways to deal with a stressful situation, especially if the stress is caused by something you have no control over, is to not think about it. And one of the easiest ways to get your mind off things that are bothering you is to read a good book.
You can read the latest best seller that you've been looking forward to. Or, if you don't think you will be able to concentrate on anything new, choose an old favorite that you're already familiar with.
3.Listen to Some Music
It's a proven fact that soothing music can be relaxing. The type of music you choose is entirely up to you. Buy a CD or cassette featuring soft, modern ballads, gentle classics, smooth jazz, or New Age music. When you feel stressed, pop the music into the player and let the music carry you away.
4.Take a Deep Breath
Something as simple as taking a couple of deep breaths can work wonders. So, the next time you feel stressed, take a few slow, deep breaths. And, if you can, add a full body stretch. Stretching and yawning are also relaxing.
5.Try Aromatherapy
Certain scents have been found to have a calming, relaxing effect on the human body. One of those scents is lavender.
You can buy lavender candles at a health food store or online, and place them around your home or office. Whenever you're feeling stressed, burning a lavender candle can help you relax.
Just make sure your lavender candles are made with essential oils.
6.Try Visualization
The things you visualize or imagine can actually have an effect on your mood.
The next time you are feeling stressed, take a moment to close your eyes and imagine that you are somewhere more relaxing, like on a beach. Imagine that you can feel the cool breeze against your skin, and hear the ocean waves.
If you're stressed about a situation, like giving a speech in front of a large crowd, close your eyes and visualize yourself giving the speech, and everything going perfectly.
Visualization can help you feel calmer, and better able to deal with whatever has you feeling stressed in the first place.
7.Spend Time Outdoors
Sunlight and fresh air have remarkable abilities to heal our spirit. Often something just as simple as taking a short walk around the block can help reset our priorities. Even yard work can be relaxing if approached from the right frame of mind.
Sometimes, when you're feeling stressed out, having someone tell you to relax or "chill out" is more annoying than anything else. But it's advice you should take to heart, especially if you are having a bad day - or week.
Here are 7 tips that will help you relax when you're feeling stressed.
1.Take a Warm Bath
Soaking in a tub full of warm water can work wonders when you're feeling stressed. The warm water relaxes you physically, loosening tight, stiff muscles. And, as a result, you relax mentally as well.
2.Read a Good Book
One of the best ways to deal with a stressful situation, especially if the stress is caused by something you have no control over, is to not think about it. And one of the easiest ways to get your mind off things that are bothering you is to read a good book.
You can read the latest best seller that you've been looking forward to. Or, if you don't think you will be able to concentrate on anything new, choose an old favorite that you're already familiar with.
3.Listen to Some Music
It's a proven fact that soothing music can be relaxing. The type of music you choose is entirely up to you. Buy a CD or cassette featuring soft, modern ballads, gentle classics, smooth jazz, or New Age music. When you feel stressed, pop the music into the player and let the music carry you away.
4.Take a Deep Breath
Something as simple as taking a couple of deep breaths can work wonders. So, the next time you feel stressed, take a few slow, deep breaths. And, if you can, add a full body stretch. Stretching and yawning are also relaxing.
5.Try Aromatherapy
Certain scents have been found to have a calming, relaxing effect on the human body. One of those scents is lavender.
You can buy lavender candles at a health food store or online, and place them around your home or office. Whenever you're feeling stressed, burning a lavender candle can help you relax.
Just make sure your lavender candles are made with essential oils.
6.Try Visualization
The things you visualize or imagine can actually have an effect on your mood.
The next time you are feeling stressed, take a moment to close your eyes and imagine that you are somewhere more relaxing, like on a beach. Imagine that you can feel the cool breeze against your skin, and hear the ocean waves.
If you're stressed about a situation, like giving a speech in front of a large crowd, close your eyes and visualize yourself giving the speech, and everything going perfectly.
Visualization can help you feel calmer, and better able to deal with whatever has you feeling stressed in the first place.
7.Spend Time Outdoors
Sunlight and fresh air have remarkable abilities to heal our spirit. Often something just as simple as taking a short walk around the block can help reset our priorities. Even yard work can be relaxing if approached from the right frame of mind.
Friday, May 21, 2010
Muscle Cramps..sore and miserable!
Heavy use of muscles that are normally not used can become cantankerous, or cramped. Causes for cramps can be as simple as lack of water, (dehydration) and possibly a simple glass of water will help solve the problem. Try stretches before and after the exercises, or activities. Simple things in life will keep your body happy. Hydration, healthy diet, and a good 10-15 minute activity where you can sweat off some calories from the meal you had that day. Keep a good balance in life, you may actually enjoy yourself while finding ways to enjoy this activity. Smile and keep a healthy positive outlook on life.
Note: Not everyone is created equal, also depending on medications you may be taking could be another reaction to cramps. If cramps occur often, and water is not helping, you may need to discuss the cramping with a Dr. Take care of yourself, and get a massage therapist to help assist with stretches and toxin release by enjoying the benefits of a Swedish Massage. :)
Write again next week! Let me know if you have any questions or requests.
Chrissy Brannan
Chrissy's Massage B/CS, Texas
You never know how tired your muscles are until you've had a massage!
http://www.chrissysmassage.com/
Note: Not everyone is created equal, also depending on medications you may be taking could be another reaction to cramps. If cramps occur often, and water is not helping, you may need to discuss the cramping with a Dr. Take care of yourself, and get a massage therapist to help assist with stretches and toxin release by enjoying the benefits of a Swedish Massage. :)
Write again next week! Let me know if you have any questions or requests.
Chrissy Brannan
Chrissy's Massage B/CS, Texas
You never know how tired your muscles are until you've had a massage!
http://www.chrissysmassage.com/
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