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Isometric exercise as an initial treatment and in-season pain management for tendinopathies has become the latest trend, yet clear evidence in support of this approach is lacking. This new approach is based on a small cross-over study (n=6)1 and a small randomised control trial (n=20)2 comparing isometric and isotonic muscle contraction by Dr Ebonie Rio and colleagues. They reported substantial, acute effects of isometric exercise on pain in patients with patellar tendinopathy, which was greater than seen with isotonic exercise. While the pain relieving response of isometrics in the first trial1 was dramatic and homogenic, the pain relief response of the second trial2 was much more heterogenic. Based on these results an isometric management approach was quickly extrapolated to other tendons, as evinced in a popular recently updated sports medicine textbook.3 We contend that three important questions need to be answered before isometric exercise is widely adopted as standard valid first step in tendinopathy management.
Question 1. What is the strength of the evidence for adopting isometrics for tendinopathy?