Calcific Tendonitis: What It Is and How to Treat It

Tendinitis (tendonitis), which occurs when a tendon — a type of fibrous connective tissue that links your muscles and bones — becomes inflamed or injured, is incredibly common and can happen anywhere in your body, from your shoulders to your toes. And while it’s not usually a cause for major concern, it can be disruptive and make it hard to do everyday activities, whether that’s reaching overhead to put something on a high shelf or playing an intense game of pickleball.

One way that your body may respond to the stress and strain of tendinitis is by depositing calcium into the sore tendon, which is known as calcification. “Calcification is one of the body’s natural responses to inflammation as it tries to compensate and support the sore area by laying down deposits of calcium,” explains Samantha Stewart, PT, DPT, a physical therapist at Hinge Health. It happens fairly frequently. In fact, some studies estimate that up to 10 percent of people at any time have calcium deposits in one of their tendons, which is called calcific tendinitis, and about half show no symptoms at all.

Thankfully, calcific tendinitis often resolves on its own, reassures Dr. Stewart. But there are things you can do to feel better faster, and to relieve symptoms such as pain and stiffness. 

Read on to learn more about what causes calcific tendinitis and how to treat it, especially with exercises from our Hinge Health physical therapists.

What Is Calcific Tendinitis?

Calcific tendinitis refers to a buildup of calcium in one of your tendons as the result of inflammation. Calcific tendinitis is one of those diagnoses that sounds scary, but, in reality, it’s your body’s normal response to excess strain or stress. 

Calcific tendinitis can occur anywhere in the body, but it’s most common in the rotator cuff of the shoulder, as well as in the Achilles tendon. These are the two areas we’ll focus on in this article, but keep in mind, treatment options for all forms of calcific tendinitis are the same as for most types of tendinitis, says Dr. Stewart. “Our body is constantly changing — while it can create a calcium deposit in one of your tendons, it also can break down calcium and absorb it,” reassures Dr. Stewart.

While the body creates these calcium deposits to help with stress on the tendon, the deposits themselves can become inflamed, leading to pain and stiffness in the affected area. Take the shoulder, for instance. Calcific shoulder tendinitis is one of the leading causes of shoulder pain. “There’s not a lot of space within the shoulder joint, which is why a buildup of calcium in the area can be so painful,” explains Dr. Stewart.

There are three main stages of calcific tendinitis:

• Pre-Calcific Stage: Changes begin in the tendon that increase the likelihood that calcium deposits will form. You may experience some pain and discomfort with movement. 

• Calcific Stage: Calcium crystals are deposited into your tendon, causing more pain.

• Post-Calcific Stage: Your tendon heals with new, healthy tissue and your body reabsorbs the calcium. Pain should begin to subside, and you’ll notice less discomfort with movement.

Symptoms of Calcific Tendinitis

The symptoms of calcific tendinitis are similar to the symptoms of other forms of tendinitis. “Calcific tendinitis usually presents as pain or discomfort that builds up over time, and it tends to be worse with certain movements, leading to a limited range of motion,” says Dr. Stewart. While symptoms may vary depending on which area of the body it is affected, they often include:

• Pain or stiffness

• Pain with movement

• Pain that disrupts sleep

• Reduced range of motion

• Swelling

• Tenderness around the affected tendon

Calcific Tendinitis: A Hinge Health Perspective

Learning about conditions that cause pain can be alarming. We know from Hinge Health members and research studies that anatomical labels can backfire when it comes to your treatment and recovery. When people hear they may have a condition like calcific tendinitis, it can cause feelings of panic, like you have something "wrong" with your body that needs to be fixed. This way of thinking about pain is largely outdated.

Pain is more complex than simply what may or may not be happening in your tendons. Other factors, like life stressors, can also play a big role in how you experience pain. And for most common musculoskeletal conditions, regardless of what may or may not be contributing to pain in your tissues, the solution is often the same.

Movement — through physical and exercise therapy — builds strength, flexibility, and resilience to pain. And it’s one of the best things you can do to treat calcific tendinitis, since it helps flush out the calcium deposit and reduce swelling. “You’ll want to focus on exercises that improve your range of motion and build up tolerance to functional activities,” advises Dr. Stewart. “Gentle stretching and strengthening exercises can open up space for more pain-free movement.” 

Calcific Tendinitis Causes

Calcific tendinitis is your body’s response to irritation in the affected tendon. “Your body deposits calcium as a way to help strengthen the area when it thinks there’s not enough support,” says Dr. Stewart. While it can occur at any age, calcific tendinitis tends to occur in one’s 40s, 50s, or 60s. “If you’ve experienced an injury such as Achilles tendinitis or a frozen shoulder in the past, and you stress that same area again, your body may overreact and think it needs to provide more support with calcium,” says Dr. Stewart.

Here are some situations in which you may be more likely to develop calcific tendinitis:

• Doing too much, too soon. Your tendons are resilient and designed to take a lot of stress, but they still need time to adjust to increased demands. That’s why it’s best to gradually build up the amount and intensity of exercise, especially if it’s a new activity, advises Dr. Stewart.

• Not warming up or stretching before being active. If you dive right into a workout without warming up your muscles and tendons first, your tendons won’t have time to wake up and get ready for activity. This can shock them, causing injury if they get overstretched or strained.

• Engaging in repetitive motions. Repetitive activities, like running or throwing overhead, can lead to tendinitis, especially if you have jumped into a sport without doing the proper strengthening and stretching to prepare your body.

• Having weak or tight muscles. When muscles are weak, your tendons have to take on more. If surrounding muscles are tight, it prevents you from having a full range of motion, which can also put more strain on your tendons.

Treatment Options for Calcific Tendinitis

Calcific tendinitis is often treated the same way as other forms of tendinitis, says Dr. Stewart. That means most cases can be treated with simple, at-home strategies. Typical calcific tendinitis treatments include:

• Ice or heat. Ice is usually best for the first 48 hours after a calcific tendinitis flare up, notes Dr. Stewart. After that, she recommends that you switch to heat because it increases blood flow to the area, which helps with healing. That said, both are beneficial, so Hinge Health physical therapists recommend you use whichever feels more comfortable to you.

• Over the counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for pain resulting from calcific tendinitis. It’s important to make sure that you’re safely able to take these medications, based on your medical history.

• Physical therapy. “Working with a physical therapist (PT) can help you manage the inflammation from calcific tendinitis,” explains Dr. Stewart. “A PT can take you through movement patterns for the affected area that can help reduce swelling and pain.” A PT can also help you strengthen and stretch supportive muscles, so that, over time, you can slowly increase your range of motion. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Lifestyle modifications. If you find it hard or painful to sleep with calcific tendinitis, especially if it’s affecting your shoulder, try sleeping on the non-affected side, advises Dr. Stewart. You may also want to sleep on a wedge pillow, or propped up on several pillows, to help reduce the chance that you’ll roll over to the other side in your sleep.

While all these steps can successfully treat most cases of calcific tendinitis, there are some situations where you may need a more invasive treatment, says Dr. Stewart. These include:

• Lavage. Your medical provider will use ultrasound to “see” the calcium deposit, then place a needle directly into it to flush it out with a salt water solution.

• Shock wave therapy. In this treatment, a healthcare provider — either a PT or a physician — sends shockwaves from a device into the affected tendon to break up deposits of calcium. The waves also increase blood flow to the area, promoting healing.

• Steroid injections. If calcific tendinitis is in your shoulder, your doctor may recommend a cortisone injection to help reduce pain and inflammation. It’s usually not recommended for calcific Achilles tendinitis, however, since it can weaken the Achilles tendon and increase the risk of rupture.

Calcific tendinitis may sound scary, but PTs often recommend the same exercises that they’d use to help treat any other form of tendinitis, says Dr. Stewart. The above exercises are recommended by Hinge Health physical therapists to treat calcific tendinitis in the two most common areas: the shoulders and the Achilles tendon.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Give Your Body Time

“Calcific tendinitis almost always resolves on its own,” reassures Dr. Stewart. “Your body wants to maintain homeostasis, so over time it will break up that extra calcium and reabsorb it without you having to do anything invasive, like injections or surgery.”

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Moosmayer, S. (2024, March 25). Calcific tendinopathy of the shoulder. UpToDate. https://www.uptodate.com/contents/calcific-tendinopathy-of-the-shoulder 

2. Kim, M.-S., Kim, I.-W., Lee, S., & Shin, S.-J. (2020). Diagnosis and treatment of calcific tendinitis of the shoulder. Clinics in Shoulder and Elbow, 23(4), 203–209. doi:10.5397/cise.2020.00318

3. Verstraelen, F., Verhagen, S., Giesberts, A., Bonneux, I., Koot, H., Boer, W. den, & van der Steen, M. (2022). Needle aspiration of calcific deposits versus shock wave therapy for conservative therapy resistant calcifying tendinitis of the shoulder: protocol of a randomized, controlled trial. BMC Musculoskeletal Disorders, 23(1). doi:10.1186/s12891-022-05259-z

4. Lugani, G., Santandrea, A., Mercurio, D., Puddu, L., Silvestri, J., & Cortese, F. (2023b). Treatment of Achilles insertional tendinopathy: our surgical procedure and medium-term results. Acta Biomedica, 94(2), e2023053–e2023053. doi:10.23750/abm.v94i2.13834