Isometric Tendon Exercise & The Role it Plays
Isometric Tendon Exercise & The Role it Plays
At POGO Physio we frequently get asked ‘what exercises do I need to do to help get my tendon pain under control?’.
This blog post will answer this question as it is going to explore the use of isometric exercises in the treatment of tendon pain.
Tendon Injuries
Tendons are the structures in the human body that connect muscles to bone. There job is to transfer the energy produced by muscular contractions onto the body’s skeleton. In effect producing movement of the body.
There are number of things that can cause tendon pain (for example poor running form, sudden increases in exercise, prolonged overuse). When a tendon injury is sustained it unfortunately can be quite a slow process to resolve. For a better understanding of tendon pain and tendinopathy click HERE.
What are Isometric Exercises?
Isometric exercises, put simply are muscular contractions without movement of the joint. This means that the tendon is both elongating and retracting. Conversely, a contraction with joint movement is called and isotonic exercise.
At what point during my rehabilitation do I use isometric exercises?
Many people view isometric exercises as a ‘rite of passage’. That is they use isometric exercises as an indicator as to when they can progress to other exercises. While this may be useful to an extent; it is important to note that the starting point varies depending on your response to exercise.
|
Presentation |
Load intervention |
| Reacts for days to high load eg running | Isometric load for pain |
| Reacts <2days to high load Minimal pain with low load activity eg calf raises |
Commence isotonic |
| <20% strength deficit No reaction to power/energy store rehab e.g. hop |
Commence power & energy storage (functional) |
FIG: Source: Complete Sports Care.
Are there any exceptions to this rehabilitation chart?
Although this table is a good guide, there a number of instances where the above chart needs to be manipulated a bit to help attain the best rehabilitation outcome.
If there is a significant compressive load on the affected tendon, then it is wise not to progress onto isotonic heavy load but rather straight onto more functional movements. For example, the insertion point of the Achilles tendon can be put under quite a lot of compression by the heel bone during heavy load isotonic exercises (such as calf raises). If you click HERE you can view our POGO Guru, Brad, demonstrating a terrific isometric exercise for your Achilles tendon.
Additionally, if the muscle has a big role to play in the stability of a joint, isometric exercises are favoured over isotonic exercises. This is because isometric exercises have been shown to be good in increasing body awareness in the affected tendon and muscle, hence making the joint more stable. A good example of this would be the peroneal tendons, a group of muscles that are involved heavily in stabilising the foot.
A note for people with stiff joints & osetoarthritis
A final example is people with stiff joints. People with stiff joints (for example, people with arthritic joints), also benefit greatly from isometric exercises because it helps increase the tolerance load in a tendon even when the joint it acts upon has compromised range. Furthermore, people with joint stiffness from arthritis tend to be an older population and will benefit from isometric exercises as opposed to isotonic/functional exercises as it is easier to perform.
So in conclusion, never commence an exercise program for tendon pain without the advice of a physiotherapist as you may be causing more harm than good!
Alister Cran (APAM)
Physiotherapist
References
1. Rio E, Kidgell D, Moseley L, et al: Exercise to reduce tendon pain: A comparison of isometric and isotonic muscle contractions and effects on pain, cortical inhibition, and muscle strength. Journal of Science and Medicine in Sport. 2013, e28
2. Drew BT, Smith TO, Littlewood C, Sturrock B: Do structural changes (eg, collagen/matrix) explain the response to therapeutic exercises in tendinopathy: a systematic review. British Journal of Sports Medicine. 2012:bjsports-2012-091285
3.Source: Complete Sports Care. http://us7.campaign-archive1.com/?u=319344e547bb6e454fb1290f0&id=60e479fb01&e=13677e14c6. Accessed: 09/04/2015
