Isometrics in tendinopathy – a wonder weapon to decrease pain?
Are isometrics the wonder weapon to decrease pain in tendinopathy? In this blog, we will discuss where the isometrics “trend” came from and what the evidence says about it!
In 2015, Rio et al. started a bit of a trend when they conducted a cross-over trial on 6 volleyball players with patellar tendinopathy. Their results were astonishing with all players experiencing an immediate decrease in pain from an average of 7/10 on the NRS to 0 with only one of the 6 reporting a remaining pain of 1– for at least 45 minutes after the isometric contractions. The protocol they used was 5 sets with 45 seconds contraction in a leg extension machine and an effort of 70% of the maximal voluntary effort. They also found that isometrics were able to decrease cortical inhibition and an increase in strength of 19%. They compared the isometric intervention with an isotonic intervention and the effects seen in the isometric group could not be achieved in the isotonic group:
So while isometrics are certainly no magic bullet, what role do they play in tendinopathy rehab? First of all, isometrics are a great option to start exercising if everything else is too painful – and this is not only limited to tendinopathy but other conditions as well. Be aware that they must progress to isotonic exercises because you want to recover muscle function over the full range of motion instead of just 1 angle. So move on as soon as a patient is able to tolerate isotonic loads.
What can be derived from all of those studies is that isometrics do seem to work really well in some subjects and can actually make things worse in other subjects. To keep it simple, give them a try with the patient in front of you and if they respond favorably, keep doing them, if they don’t move on.
While 45 minutes of pain relief might not be a goal that is important in the average patient, this might be useful for athletes as a warm-up to decrease pain during the ensuing exercise session or competition. Isometrics are also less tiring for athletes in-season compared to isotonic exercises. One can surely argue if it is desirable to achieve short-term pain reduction in order to load a painful tendon during sporting activities and if this might actually lead to detrimental effects.
Alright, this was our blog on isometrics for tendinopathy. If you were surprised by the results, you will love our blog on 7 facts about tendinopathy you didn’t know! Thanks so much for reading.
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Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. Journal of Hand Therapy. 2017 Jan 1;30(1):13-9.