Chronic Tendon Injury and the Role of Isometric ExercisesPete Kissel
Tendon injuries from repetitive forceful loading in sport, weight training or some occupations can be debilitating. For example high volume jumping in volleyball or basketball, or frequent forceful use of tools in a worker, can lead to a slow deterioration of a tendon, which is generally called tendinopathy.
Common symptoms for tendinopathy include pain, stiffness and loss of strength all of which have the potential to force time away from work or sport.
For the last decade the prevailing rehabilitation strategy to address tendinopathy injuries has been an eccentric exercise protocol (sometimes called the negative phase of an exercise repetition). We have experimented with eccentric exercises for our patients for many years, but have found one key limitation…it hurts! Understandably, compliance for this protocol can be challenging, especially for those looking to continue their work or sport.
Recent research has shown isometric exercise can help minimize pain and improve strength immediately and lasting (at least) 45 minutes via a complex mechanism of tricking the nervous system. Read here for a more scientific explanation.
By persuading the nervous system to function in a “less injured” state tendon loading demands are then more tolerable and efficient in the short term. We recommend patients suffering from tendinopathy consider isometric exercises as part of their warm up (either before practice, competition, weight training session or before their eccentric or heavy slow rehabilitation program). Try 3-5 repetitions of 30-45 second holds at an intensity just below the threshold for pain. See this brief video to show some positions we use in our clinic for patellar tendinopathy (jumpers knee). The position prescribed will vary based on the clinical presentation.
To summarize, Isometric exercises can be helpful in the short term, for example in-season or used as a warm up for a comprehensive rehabilitation strategy (which we will discuss in part 2).
As an aside: Manual therapy, electro-acupuncture, Class 4 laser, technique/activity modification are also considerations for a well-designed plan of management for tendinopathy concerns. Rarely do we use Isometrics only to address this problem. For an individualized rehabilitation program to address your tendon concerns contact The Proactive Athlete.