Today’s blog was recently shared as a newsletter for our Cutting Edge Clinicians mailing list. It proved really popular so I’ve adapted it into an article for you below.
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Back in 2015, a new paper hit the headlines when it reported a HUGE reduction in tendon pain with the use of isometric exercises (Rio et al. 2015). The study participants’ pain dropped from an average of 7 out of 10 (during a single leg decline squat) down to an average of 0 (yes, ZERO!).
Research results like this aren’t common so the news spread quickly and isometrics were soon widely adopted for reducing pain in tendinopathy. It’s one of those studies though where we should delve beneath the headline. When you do so you see this is a small study of just 6 men with no control group.
Several research groups have examined the effects of isometrics since this key paper and their findings have been far more mixed (as we’ve summarised in the infographic below).
These mixed findings needn’t mean we consign isometrics to the scrapheap, it just might be time for us to review their role. One new study you might spot in the graphic above is from Chris Clifford and colleagues and suggests isometrics may be another option for progressive loading over time, rather than just for an immediate change in pain (Clifford et al. 2019). Check out the infographic below for details and our upcoming review for the Physio Network.
The more I work with people with tendinopathy, the more I think it’s less about a specific approach or strict protocol and more about finding a progressive loading program that suits each individual.
Below we have some recommendations for you to bring this new evidence into your practice.
Clinical Recommendations for Isometrics and Tendinopathy
- Isometrics may be a good loading option for your patient if they are better tolerated than other forms of loading or they do create an immediate reduction in pain.
- We can progress isometric exercises by gradually adding load as we would do with other approaches such as heavy, slow resistance training.
- Shorter duration isometrics can be an option too, especially in those unable to sustain a longer contraction due to pain/ weakness.
- In irritable cases try a slow ‘ramp up’ with the isometric contraction by asking the patient to slowly increase the tension rather than perform a rapid, hard squeeze.
- It may be useful to include a variety of contraction types within rehab (isometric, isotonic and plyometric) to promote adaptation and prepare for the demands of goal activities.
If you’d like to learn more about exercise selection, tendinopathy and running injury then join us on our Running Repairs Course. We’ve just announced 5 new course dates for 2020, click here to find out more and book your place.