Tendinopathy rehabilitation reference page 1 - isometrics

Update November 2016 - more on isometrics on reference page 2 here

Welcome to our page on isometric exercises for tendinopathies.

Isometric exercises are a relatively new addition to tendon rehabilitation, brought to the fore by excellent research from Australian physiotherapists including Ebonie Rio, Jill Cook and Craig Purdham. Ebonie in fact is almost finished her PhD on tendon pain!

How do isometrics work?

  • They are one of the most effective ways of quickly reducing tendon pain (more here from the above mentioned authors and others).  The way they reduce pain is still being worked out - it's a tricky area!  There are thoughts that these exercises decrease the brain's perception of 'threat' from a tendon injury, therefore making the perception of tendon pain.
  • They build muscle strength
  • They are very 'non-provocative' for tendon pain.  Generally, 'fast' (high energy storage and release) activities such as running, jumping etc can aggravate a tendon is performed too much.  Slow, heavy exercises such as isometrics are very safe to perform even in high amounts

So, what do I do?

  • There isn't a recipe for any tendinopathy - it's important to watch the response to the tendon after the isometric exercise. If the pain is no better, or worse, the dosage probably isn't quite right!
  • We often start with a dosage of around 4-5 repetitions, of 40-50 seconds each, with a 1-2 minute recovery in between each repetition.  You should feel the 'burn' in the muscles, it's important to do heavy enough to get very tired in the muscles around the affected tendon.  However, don't go so heavy that the muscle starts 'shaking' - tendons don't like this!  (I'll credit the dosages and advice regarding 'no shaking' to Ebonie and Jill - this is not my invention!)
  • Isometrics can be performed between one and four times per day depending on the specific type of tendon problem.
  • Often tendon exercises (generally heavy, slow exercises to start with) are progressed to add speed of movement after an initial phase of isometrics.

Which tendonopathies can I use isometrics with?

  • We use these exercises for most tendon injuries, including achilles, patella, quadriceps, 'tennis elbow', rotator cuff tendinopathy, and even gluteal and abdominal tendinopathies!  I'll note here that the evidence and research is not yet here on using isometrics for other tendinopathies apart from patella, we are applying principles from patella research to other areas. 

See the videos below for examples of isometric exercises we prescribe for different tendinopathies

Aidan Rich is an APA Sports Physiotherapist at Advance Healthcare in Boronia. He has a particular interest in Sports Medicine conditions, especially hip, groin and tendon pathologies.  The clinic serves the local area including Bayswater, Ringwood East and Ferntree Gully with Sports Physiotherapy Services