Are isometric exercises a good treatment for tendinopathy ?

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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.

To learn more about the treatment of tendinopathy complete the ‘Tendinopathy’ module in the FIFA Diploma in Football Medicine.

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

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Jahad Eljojo
13 June 2019 21:01

Yes I think isometric exercises and taping and padding can help to treat tendinopathy and reduction of weight bearing can speed up the healing.

14 June 2019 4:14

After 35 years of working on or with the best to least active sports player it shows you how out of touch researchers are with clinicians in sport injury. Owners of teams want the best and they do not share their ways of care with the outside world. We all in the care of our athletes have confidentiality agreements once we achieve a professional standard. And our skills will never be published ever because of this. For the best of the best players attract the best of the best practitioners from tape strapper to needle person from pusher to puller… Read more »

Greg Mirt
16 June 2019 14:48
Reply to  stevengriffith

Proper badass response🙂

27 June 2019 13:34
Reply to  stevengriffith

For years I’m working on research on how to eliminate swelling in sports injuries. Finally, I’m there with all is needed youngster DR to implement. Problem. If the hematoma is resolved in one day with a few hours of treatment and no more visitation, no big money, no big income? What injures a person wants, to be healthy today or in a month? I understand you. Help that youngster to back to normal soon is posable. You are not helping him any other way.

03 July 2019 0:49

L isometrie est un ensemble d exercices qui déclenchent une contraction MUSCULAIRE sans forcer sur les tendons et les articulations.Si l exercice isométrique est devenu un traitement plus ou moins utilisé dans la gestion des tendinopathies.Les zones de tendinopathies les lus exposées sont
1 Les tendinopathies Achilliennes
2Les tendinopathies Rotuliennes
Les exercices isotoniques et isométriques sont alors un traitement adjuvent mais pas de traitement de première intention.
Une tendinite entraîne
Une douleur et une inflammation dont un traitement à base d ANTALGIQUE et anti inflammatoire.

Karthick k
11 June 2020 12:51

Very informative. Yes Agreed Thank you. Yes I think isometric exercises and taping and padding can help to treat tendinopathy and reduction of weight bearing can speed up the healing.

Rosemary Cassell
18 October 2020 0:42

This disorder seemingly gets worse with movement and overuse therefore rest seems to be a better option.