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Calcific Tendinitis of the Rotator Cuff (CTRC)

Calcific Tendinitis of the Rotator Cuff (CTRC)

Mar 13, 2025

Calcific tendinitis of the rotator cuff (CTRC) is the accumulation of calcium phosphate within a tendon and is often chronic and recurrent. The majority of CTRC cases are located within 1–2 cm of the insertion of the supraspinatus, leading to a restricted range of motion in the shoulder and potentially causing severe pain (Maja et al., 2023). Interestingly, CTRC commonly occurs between the ages of 30 and 50 and is twice as likely to affect women (Kim et al., 2020). There are two proposed theories regarding the formation of CTRC: the degenerative theory and the reactive theory. The degenerative theory suggests that age-related changes in the tendon lead to a reduction in blood vessel distribution. This results in a hypoxic environment, causing necrosis and/or tendon tearing, which can subsequently lead to calcification (Kim et al., 2020). The reactive theory, on the other hand, describes three phases of calcification: the precalcific phase, the calcific phase, and the post-calcific phase. The precalcific phase involves the ‘transformation of the tendon into fibrocartilaginous tissue’ (Maja et al., 2023), facilitating calcium deposition. The calcific phase is when the actual deposition of calcium occurs, while the post-calcific phase involves the remodelling of the tendon around the calcium deposit. However, neither theory has been definitively proven (Maja et al., 2023). Secondary complications such as bursitis and synovitis are common in CTRC due to the chemical irritation caused by calcium deposits. Treatment for CTRC can be either conservative or surgical. Conservative management has a success rate of 30–80%. Non-steroidal anti-inflammatory drugs (NSAIDs) provide effective pain relief, and corticosteroid injections are beneficial during the resorptive phase. Barbotage has been shown to relieve pain in 70% of patients due to its decompression effects. Ultrasound therapy has also been found to improve quality of life and pain relief; however, it requires regular attendance over a six-week period. Extracorporeal shockwave therapy (ESWT) has the highest success rate for chronic calcific tendinitis and achieves results comparable to surgery (Kim et al., 2020). ESWT is effective in improving function and reducing pain, with greater efficacy when combined with physiotherapy (Maja et al., 2023). Therefore, conservative treatment should be prioritised and implemented for at least six months before considering surgical intervention (Maja et al., 2023). If you are experiencing symptoms of calcific tendinitis, it is important to seek professional medical advice. Booking an appointment with sports medicine doctor Dr David Porter (link to bio) can help you explore a range of treatment options tailored to your specific condition. Early intervention and expert guidance can significantly improve your recovery and long-term shoulder health.

Reference List

Kim, M.-S., Kim, I.-W., Lee, S. and Shin, S.-J. (2020). Diagnosis and treatment of calcific tendinitis of the shoulder. Clinics in Shoulder and Elbow, [online] 23(4), pp.203–209. doi:https://doi.org/10.5397/cise.2020.00318. Маја Manoleva, Erieta Nikolic Dimitrova, Koevska, V., Biljana Mitrevska, Marija Gocevska Gjerakaroska, Cvetanka Savevska, Biljana Kalchovska Ivanovska, Lidija Stojanoska Matjanoska, Gecevska, D., Jugova, T. and Liljana Malinovska Nikolovska (2023). Comparison of Immediate Effects of Extracorporeal Shockwave Therapy and Conventional Physical Therapy in Patients with Calcific Tendinitis of the Shoulder Rotator Cuff. Academic Medical Journal, 3(1), pp.99–109. doi:https://doi.org/10.53582/amj2331099m.
A New Approach to Managing Osteoarthritis: The Role of Stem Cell Therapy and Regenerative Medicine

A New Approach to Managing Osteoarthritis: The Role of Stem Cell Therapy and Regenerative Medicine

Feb 21, 2025

Understanding Osteoarthritis and Its Impact

Osteoarthritis (OA) is one of the most common joint conditions, affecting millions of people worldwide. It develops when the protective cartilage that cushions the joints gradually wears away, leading to pain, stiffness, and reduced mobility. Over time, the condition can significantly impact daily activities, making tasks such as walking, climbing stairs, or even getting out of bed challenging.

Traditional treatments for OA include pain relief medications, physiotherapy , steroid injections, and, in severe cases, joint replacement surgery. While these treatments help manage symptoms, they do not address the underlying cause, cartilage loss. This has led to growing interest in regenerative medicine, an emerging field focused on helping the body repair itself.

One area of regenerative medicine that has gained attention in recent years is stem cell therapy . Although this treatment is still undergoing research and development, early findings suggest it may offer a new approach to joint health by supporting tissue repair and reducing inflammation.

What Are Stem Cells?

Stem cells are special types of cells that have the potential to develop into different cell types in the body. This ability makes them important for healing and regeneration. The human body contains various types of stem cells, but mesenchymal stem cells (MSCs) are of particular interest when it comes to joint health.

MSCs can be obtained from several sources, including:

  • Bone marrow (from inside bones)
  • Adipose tissue (fat cells)
  • Umbilical cord tissue (from donated umbilical cords after birth)

Among these, umbilical cord-derived MSCs (UC-MSCs) have been widely studied for their potential role in joint repair.

How Can Stem Cells Help in Osteoarthritis?

While osteoarthritis is typically considered irreversible, ongoing research is exploring how stem cells might help slow its progression, reduce symptoms, and potentially support cartilage repair.

The Role of UC-MSCs in Joint Health

Umbilical cord-derived mesenchymal stem cells (UC-MSCs) are being studied for their ability to:

  • Reduce inflammation in the joint – Inflammation plays a key role in osteoarthritis and contributes to pain and stiffness.
  • Support cartilage maintenance – While research is ongoing, UC-MSCs are believed to release factors that encourage cartilage cells to survive and function.
  • Improve joint lubrication – UC-MSCs may help enhance the quality of synovial fluid, the natural lubricant in joints, improving movement.
  • Modulate the immune system – Osteoarthritis has been linked to immune system activity. UC-MSCs have the potential to balance immune responses in the joint.

Research into UC-MSCs is still ongoing, and while early results are promising, more studies are needed to determine their long-term effects and optimal use.

What Does the Latest Research Say?

Over the past few years, several studies have explored the potential of umbilical cord-derived stem cells in osteoarthritis treatment. Some notable findings include:

  1. Potential for Knee Cartilage Repair
    A review published in Medicine (2025) examined the use of UC-MSCs for knee osteoarthritis. The study found that these cells may contribute to reduced pain, improved function, and potential cartilage preservation. (Liao et al., 2025).
    📄 Read More: LWW Journal
  2. Stem Cell-Based Hydrogels for Cartilage Support
    A study in ACS Biomaterials Science (2025) investigated biodegradable hydrogels combined with UC-MSCs to enhance cartilage repair. The findings suggested improved joint function and reduced inflammation. (Ghosal et al., 2025).
    📄 Read More: ACS Publications
  3. Exosome Therapy for Osteoarthritis
    Scientists are also studying exosomes—tiny particles released by UC-MSCs – which may have anti-inflammatory and regenerative effects. A study in Advanced Functional Materials (2025) showed that exosomes from UC-MSCs supported cartilage repair and joint function in osteoarthritis models. (Lv et al., 2025).
    📄 Read More: Wiley Online Library
  4. UC-MSCs and Joint Injections
    Clinical trials published in Stem Cell Research & Therapy (2025) evaluated the safety and effects of UC-MSC injections for knee OA. The study noted improvements in pain, mobility, and joint function after six months. (Lei et al., 2025).
    📄 Read More: Springer

These studies represent a growing body of research exploring how stem cells may contribute to joint health and osteoarthritis management.

Important Considerations

While the idea of regenerative treatments for osteoarthritis is exciting, there are a few important points to keep in mind:

1. Research is Ongoing

Stem cell treatments, including those using umbilical cord-derived stem cells, are still being researched. Scientists continue to investigate their effectiveness, best application methods, and long-term safety.

2. Treatments Are Not Yet Widely Approved

While some countries have introduced regenerative medicine into clinical practice, regulatory authorities such as the UK’s MHRA (Medicines and Healthcare products Regulatory Agency) are still assessing these treatments. Opus, unlike many other clinics, is the UKs only licenced and regulated provider. It is essential to stay informed and seek advice from medical professionals before considering any new treatment options.

3. Every Patient is Different

Osteoarthritis can vary widely between individuals, meaning that treatment responses may differ. What works for one person may not work in the same way for another.

4. A Holistic Approach is Best

Stem cell therapy, if proven to be effective in the future, is unlikely to be a standalone cure for osteoarthritis. It is always best considered alongside other approaches such as:

  • Maintaining a healthy weight to reduce joint strain.
  • Engaging in regular, low-impact exercise (such as swimming or cycling).
  • Using joint-friendly supplements (such as glucosamine and omega-3 fatty acids).
  • Following a balanced diet to support joint health.

 

The Future of Regenerative Medicine

Research into umbilical cord-derived stem cells for osteoarthritis is advancing rapidly, with promising early results. Scientists are also exploring combination therapies, including:

  • Stem cells with growth factors to enhance repair.
  • 3D-printed cartilage scaffolds to create personalised joint implants.
  • Gene editing to enhance stem cell performance.

As research continues, the goal is to develop treatments that not only relieve symptoms but also support the long-term health of joints.

Conclusion

Osteoarthritis remains a challenging condition, but advances in stem cell research and regenerative medicine are opening up new possibilities. While umbilical cord-derived stem cells are still being studied, they hold promise as a potential tool for reducing inflammation, supporting joint function, and promoting cartilage health.

For now, education and staying informed about scientific advancements are key. As more research emerges, individuals seeking alternative approaches to joint care will have a better understanding of the options available.

If you are considering different ways to manage osteoarthritis, always consult a healthcare professional for personalised advice.

 

References

  1. Liao, Z.K. et al. (2025). Clinical research progress of umbilical cord blood mesenchymal stem cells in knee articular cartilage repair. Medicine.
    📄 Read More
  2. Lei, J. et al. (2025). Therapeutic efficacy of intra-articular injection of UC-MSCs in knee OA. Stem Cell Research & Therapy.
    📄 Read More

 

Osteoarthritis

The Role of Compression Therapy in Musculoskeletal Physiotherapy

The Role of Compression Therapy in Musculoskeletal Physiotherapy

Feb 5, 2025

Compression therapy is a widely used technique in musculoskeletal physiotherapy, offering benefits for both recovery and performance enhancement. It involves the application of controlled pressure to muscles, joints, or soft tissues using compression devices such as the Therabody Jet Boots we use here at OPUS. pneumatic compression pumps.

This therapy has been extensively utilised in injury management, post-surgical rehabilitation, and athletic performance optimisation. We are all well accustomed to seeing Premier League players posting the routine image of them with their feet up, in a set of these boots, watching the La Liga late kick off following their Saturday afternoon match. So there must be a reason why!

Compression Therapy

Mechanism of Action

Compression therapy works by enhancing circulation, reducing swelling, and promoting tissue healing. The applied pressure assists venous return, helping deoxygenated blood and metabolic waste products move back toward the heart more efficiently.

This improved circulation delivers oxygen-rich blood and essential nutrients to tissues, facilitating faster repair and reducing inflammation. Additionally, compression can support the lymphatic system, helping to prevent fluid accumulation in injured or overworked tissues.

Benefits for Recovery

  1. Reduction of Swelling and Inflammation One of the primary benefits of compression therapy is its ability to minimize swelling, a common symptom in musculoskeletal injuries such as sprains, strains, and post-surgical recovery. By applying pressure, excess fluid is prevented from accumulating in the injured area, reducing discomfort and expediting the healing process (Priego-Quesada et al., 2020).
  2. Pain ManagementCompression garments and bandages provide gentle pressure that can reduce pain by limiting excessive movement and stabilizing the affected area. This can be particularly beneficial for individuals recovering from ligament injuries, fractures, or joint surgeries, such as ACL reconstruction or total knee replacements (Born et al., 2013).
  3. Improved Muscle Oxygenation and Tissue HealingEnhanced blood flow through compression ensures an increased supply of oxygen and essential nutrients to the affected muscles and joints. This accelerates tissue regeneration, which is crucial in conditions such as tendinopathies and muscle tears. Faster healing times can reduce the risk of chronic issues and long-term disability (MacRae et al., 2012).
  4. Prevention of Deep Vein Thrombosis (DVT)For individuals undergoing prolonged immobilization following musculoskeletal injuries or surgeries, compression therapy can help prevent deep vein thrombosis. By promoting circulation in the lower limbs, it reduces the risk of blood clot formation, a serious complication in post-surgical patients (Brophy-Williams et al., 2017).

Benefits for Performance

  1. Enhanced Muscle Recovery Athletes and active individuals use compression therapy to recover faster after intense training sessions. Compression garments aid in reducing muscle soreness and fatigue by clearing metabolic waste, such as lactic acid, from the muscles more efficiently (Houghton et al., 2019).
  2. Improved Proprioception and Stability Compression sleeves and supports provide sensory feedback, improving proprioception—the body’s awareness of joint position and movement. This can be beneficial for injury prevention, as better joint stability reduces the risk of excessive strain and misalignment (Duffield et al., 2010).
  3. Reduced Muscle Oscillation and Fatigue During high-impact activities such as running or jumping, muscles experience micro-vibrations that contribute to fatigue. Compression gear minimizes these oscillations, reducing muscle fatigue and improving endurance over prolonged periods of activity (Hill et al., 2014).

Conclusion

Compression therapy can be a useful tool in musculoskeletal physiotherapy, aiding in both recovery and performance. Its ability to reduce swelling, alleviate pain, and enhance circulation makes it a valuable tool in injury management and rehabilitation.

Additionally, athletes and active individuals benefit from its performance-enhancing effects, including faster muscle recovery and improved stability. Whether used for acute injury management or long-term athletic optimisation, compression therapy remains an effective and accessible treatment modality in physiotherapy practice.

References

  • Born, D., Sperlich, B., & Holmberg, H. C. (2013). Bringing light into the dark: effects of compression clothing on performance and recovery. Sports Medicine, 43(6), 533-549.
  • Brophy-Williams, N., Driller, M. W., & Shing, C. M. (2017). Acute and chronic effects of compression garments on recovery from exercise-induced muscle damage. Journal of Science and Medicine in Sport, 20(6), 527-531.
  • Duffield, R., Cannon, J., & King, M. (2010). The effects of compression garments on recovery of muscle performance following high-intensity sprint and plyometric exercise. Journal of Science and Medicine in Sport, 13(1), 136-140.
  • Hill, J., Howatson, G., van Someren, K. A., & Gaze, D. C. (2014). The influence of compression garments on physiological and performance responses to exercise: a systematic review. Sports Medicine, 44(6), 791-803.
  • Houghton, L. A., Dawson, B., & Maloney, S. K. (2019). Effects of compression garments on recovery following exercise: A meta-analysis. Physiology & Behaviour, 210, 112671.
  • MacRae, B. A., Cotter, J. D., & Laing, R. M. (2012). Compression garments and exercise: garment considerations, physiology and performance. Sports Medicine, 42(10), 819-843.
  • Priego-Quesada, J. I., et al. (2020). Effects of compression garments on sports performance and recovery: A systematic review. Journal of Sports Sciences, 38(12), 1287-1304.

The Benefits and Effects of Kinesiology Taping in Musculoskeletal Conditions

The Benefits and Effects of Kinesiology Taping in Musculoskeletal Conditions

Jan 23, 2025

Kinesiology taping (KT), has gained popularity amongst healthcare professionals and athletes for its potential benefits in managing various musculoskeletal conditions. Colourful, stretchy adhesive tape is applied to the skin in various patterns to help support and stabilize muscles and joints but without restricting their range of motion. This article explores the scientific evidence surrounding the benefits and effects of kinesiology taping.

Pain Reduction

One of the primary benefits of kinesiology taping is its ability to help reduce pain in various musculoskeletal conditions. KT is thought to work by stimulating the sensory receptors in the skin, which can alter pain signals sent to the brain. This sensory feedback may decrease pain perception, offering relief to individuals suffering from conditions such as tendinopathies, sprains, and strains.

Research in the Journal of Orthopaedic & Sports Physical Therapy (2013) found that KT was beneficial in reducing pain and improving functionality in individuals with conditions like patellofemoral pain syndrome and rotator cuff injuries.

Mostafavifar et al 2015 was a systematic review that reviewed 6 suitable studies. Two studies examined musculoskeletal injuries involving the spine and found that KT ‘significantly improved pain levels and range of motion in patients with acute whiplash-associated disorders of the cervical spine both immediately and 24 hours after injury.’

Two studies examined injuries in the shoulder and whilst the first didn’t find sufficient evidence to indicate that KT decreases pain in young patients with shoulder impingement, the second suggested that KT may provide short-term pain relief for patients with shoulder impingement.

Enhanced Muscle Function and Performance

Kinesiology taping may help improve muscle function, especially in cases of muscle weakness or overuse. The tape is believed to provide proprioceptive feedback to the nervous system, potentially enhancing the body’s awareness of muscle activity and improving coordination.

An RCT study by Zhang et al 2015 based on tennis players reported that KT taping may not be able to modulate strength production but it ‘does have a significant positive effect on reducing muscle fatigue during repeated concentric muscle actions’. They also commented on how the potential beneficial effects of placebo taping on muscle endurance should not be ignored. By improving biomechanics, faster recovery may be facilitated and further injury prevented.

Joint Support and Stability

KT is commonly used to provide support to joints without restricting their full range of motion. The tape works by lifting the skin slightly, creating more space between the skin and underlying tissues. This mechanical lifting action can help reduce swelling and promote circulation, providing joint support and reducing the strain on injured tissues.

For a joint like the shoulder or ankle that has a wide range of movement, the tape’s ability to support and stabilize the joint, whilst still allowing for natural movement, can really help rehabilitation, proprioception and patient confidence.

Reduction of Swelling and oedema

Kinesiology taping is effective in reducing oedema (swelling) in injured areas. As mentioned above, by lifting the skin, KT can help promote improved blood flow and lymphatic drainage, helping to reduce fluid buildup. This is particularly beneficial in the early stages of rehabilitation following an injury. A slightly different taping technique is used for this.

Postural Correction and Alignment

Kinesiology taping is sometimes used as an adjunct to improve postural alignment, particularly in individuals with musculoskeletal imbalances. By strategically placing the tape on areas such as the back, neck, or shoulders, it is believed that the tape can help encourage proper posture and alignment, reducing strain on muscles and joints.

Conclusion

Kinesiology taping is a versatile tool in the management of musculoskeletal conditions, offering benefits ranging from pain relief, improved muscle function and joint stability and movement facilitation. Although more research is needed to fully understand its mechanisms of action, current evidence supports the efficacy of KT in treating a variety of musculoskeletal injuries and conditions, such as sprains, strains, tendinopathies, and chronic pain disorders. It can be very patient specific too.

Physiotherapists, chiropractors, and athletic trainers, continue to integrate kinesiology taping into their treatment protocols to support rehabilitation and enhance recovery outcomes.

Reference List

 

  • Lins, C.A., Souza, A.R., & Gomes, P.R. (2012). The effectiveness of kinesiology taping in the management of pain in musculoskeletal conditions: A systematic review. Journal of Physiotherapy, 58(4), 220-228.
  • Kase, K., Wallis, J., & Kase, T. (2013). Kinesiology Taping Perfect Manual. Kenzo Kase’s Kinesiology Taping Association.
  • Araujo, E.M., & Lima, M.A. (2014). Kinesiology taping for the treatment of musculoskeletal injuries. Journal of Sport Rehabilitation, 23(3), 163-175.
  • Williams, S., & Klavuhn, S. (2015). Kinesiology tape for muscle strength and endurance. Journal of Strength and Conditioning Research, 29(6), 1657-1665.
  • Kase, K., & Hashimoto, T. (2015). The effect of kinesiology taping on joint stability and muscle performance. Sports Medicine, 45(3), 211-220.
  • Mehran Mostafavir, Jess Wertz, James Borchers (2015) Systematic Review of the Effectiveness of Kinesio Taping for Musculoskeletal Injury, clinical focus Pain management Pgs 33-40
  • Shen Zhang, Weijie Fu, Jiahao Pan, Lin Wang , Rui Xia , Yu Liu (2016): Acute effects of Kinesio taping on muscle strength and fatigue in the forearm of tennis players; J Sci Med Sport 459-64

Why Pain is so painful

Why Pain is so painful

Jan 9, 2025

Pain. It’s the most common issue we hear in the clinic, and everyone’s experienced it at some point – whether it’s a stubbed toe, a banging headache, or a twisted knee. But what is pain, really? Is it simply a physical reaction to injury, or is there something more going on? The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Wiech, 2016). The words “sensory” and “emotional” tell us that pain is more than just damage to our body; it’s heavily influenced by what we focus on, expect, remember, and feel. In fact, research confirms that these psychological and social factors play a huge role in how intense pain feels (Atlas & Wager, 2018). Consider this example: imagine a man walking his dog in the Australian Outback. He feels a small prick on his leg, then looks down to see he’s been bitten by a snake. His body reacts with a rush of burning pain, just as he’d expected. He receives treatment, recovers, and gets back to his routine. Two years later, while hiking in a similar setting, he feels a prick in his leg again. He immediately recalls that painful memory and responds with the same intensity of pain – only to find out it’s nothing but a thorn.
So, what’s really happening here? Here’s how our mind shapes pain:
  • Attention: Focusing too much on a painful area tends to make it feel worse. When we concentrate on pain, our brain gives it more significance, which increases perceived intensity (Sharpe et al., 2020; Wiech, 2016).

  • Expectations: What we expect to feel can also make pain better or worse. Research has shown that expecting pain to be severe makes us experience it that way. On the flip side, positive expectations can actually lessen the pain we feel (Atlas & Wager, 2018).

  • Past Experiences: Pain memories are powerful. When we experience pain, our brain stores it, priming us to react strongly in similar situations. This response may have evolutionary roots, helping us avoid harm, but it also means our past pain experiences can amplify new, less serious ones (Tracey & Mantyh, 2017).

  • Emotional State: Emotions like anxiety and fear can trigger a more intense pain experience. Negative feelings amplify our pain responses, while more neutral or positive mindsets tend to reduce them (Thompson et al., 2018; Wiech, 2016).
Pain, then, is more than a physical sensation. Our expectations, focus, memories, and emotions each shape how we experience it, giving us some insight into how to manage it effectively.

Reference List

 

  • Atlas, L.Y., & Wager, T.D. (2018). How expectations shape pain. Neuroscience Letters, 693, 24–31.
  • Sharpe, L., Jones, E., Ashton-James, C., et al. (2020). Attention and pain: mechanisms and clinical implications. Journal of Pain, 21(3–4), 233–244.
  • Thompson, K.A., Tran, B., & Geaghan-Breiner, C. (2018). Biopsychosocial factors influencing pain perception. Pain Medicine, 19(6), 1107–1115.
  • Tracey, I., & Mantyh, P.W. (2017). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377–391.
  • Wiech, K. (2016). Deconstructing the sensation of pain: The influence of cognitive and emotional factors. Nature Reviews Neuroscience, 17(2), 83–92.