This edition of the FastFact highlights an editorial, rather than original research, which has prompted an interesting online argument (look for the @BJSM_BMJ Twitter account) about a common clinical problem1. The editorial highlights that while isometric exercise has become a very popular treatment for the management of acute tendinopathy, the evidence for this approach is not overwhelming.
This article provides a brief review of (and commentary on) the literature relating to the use of isometric exercise for the treatment of tendinopathy. The authors highlight that while isometric exercise, as an initial treatment and for in-season pain management, has become the “latest trend” they believe that there is limited evidence to support this approach. They show that this treatment strategy is largely based on a small cross-over study (n=6) and a small randomised control trial (n=20) comparing isometric and isotonic muscle exercises. These papers reported substantial, acute effects of isometric exercise on pain in patients with patellar tendinopathy, which was greater than seen with isotonic exercise. Unfortunately, the results of these papers are in contrast with a subsequent study, using the same methods and outcome measures, while studies in plantar fasciopathy and lateral elbow tendinopathy have not shown any difference between isometric and isotonic exercise.
The take-home message from this editorial is that a progressive strengthening programme is desirable. At this stage clinicians should feel confident to prescribe any form of exercise, whether it is isometric, isotonic or eccentric, and they should tailor this to the individual player’s needs. More evidence is needed to help confirm the optimal treatment regime and to justify the opinion that isometric exercises are superior to other types of training for pain relief and in-season management.
1Silbernagel K G, Vicenzino BT, Rathleff MS, et al Isometric exercise for acute pain relief: is it relevant in tendinopathy management? British Journal of Sports Medicine Published Online First: 10 May 2019. doi: 10.1136/bjsports-2019-100591