Heterotopic Ossification

Heterotopic Ossification or HO is an abnormal bone growth in the non skeletal tissues. This includes your body’s muscles, tendons, and other soft tissues. When HO develops, new bone will grow at a rate of three times its normal which results in your joints being jagged and painful.

The Causes of Heterotopic Ossification

HO can only occur below your injury level and is an unknown occurrence after spinal cord injury. It is known to occur within 3-12 weeks after injury though but has developed four years later. However, HO has occurred after other injuries as well. These include traumatic brain injury, stroke, tetanus, MS, and severe burns.
While these are just a few theories on why HO occurs, there are quite a few other theories too. These include:
  • Trauma/Injury
  • Paralysis/Immobilization
  • Muscle Spasms
  • Loss of Oxygen
  • Severe Bleeding
  • Inflammation
  • Genetics
  • Prolonged pressure on your hips


Symptoms include:

  • Decreased ROM
  • Swelling/warmth of the joints area
    • hip, knee, elbow, shoulder, thigh, the entire leg)
  • Fever
  • Increased Spasticity
  • Joint/Muscle pain
  • Autonomic Dysreflexia
    • AD is an emergency situation and is also known as autonomic hyperreflexia. This is an abnormal response that happens when the body experiences pain/discomfort below your spinal cord injury. Because of the area of injury, your body can not get the message of pain and discomfort to the brain. This causes your blood pressure to increase to dangerous levels.

Diagnosing and Treatment

Tests are done to help confirm Heterotopic Ossification. These include; blood tests, CT scans, ultrasounds, a 3-phase bone scan, and x-rays. If HO is not found in time, many parts of your life can be affected. Not being able to move your joints freely restricts freedoms such as depending on yourself to cook, drive, and use the restroom. Also, HO can cause your skin to breakdown because of the increased amount of pressure that is applied to your tissues under boney areas. Other ways you can be affected include blood clots or DVT.

Physical therapy is a great way to help treat HO. Your therapist will work with you to develop a plan that works for to get you back to your “normal”. Treatment may include gentle ROM exercises, stretching, and strengthening activities. Along with activities you can easily do at home too. With therapy, your doctor may prescribe some medicine as well. If therapy and medicine doesn’t work, surgery may be needed.

If you live in Central Florida Hohman Rehab is here to help! Or if you live in Florida you can do a Telehealth appointment with us and get back to your “normal” too! Click here to schedule now!