Traditionally, the treatment of choice for tendons has been to do eccentric exercises (working the muscle while it is lengthening). When these type of exercises are performed during an athlete’s season however, no benefit, or even a more painful tendon has resulted. Obviously this is not an acceptable result. Luckily there are other types of muscle contractions that can be performed and have been scientifically evaluated for their effectiveness in reducing tendon pain.
These forms of contractions are isometric and isotonic. Isometric contractions are when the muscle performs work but there is no movement (think of trying to push a bus full of people just after they have had Christmas lunch). Isotonic is when the muscle is able to move the load causing first a shortening then a lengthening movement (think bicep curls).
The effect on tendon pain of these two types of contractions was compared in a recent study performed on six volleyball players with painful patella tendons. It showed that isometric contractions immediately reduced the tendon pain by 87%! The same volleyballers were tested again 45 minutes later and the tendon pain was still reduced by the same amount (have you started pushing a bus yet?). This compares to a 42% reduction of pain with the isotonic contractions which did not last 45 minutes. So not only do the isometric contractions reduce pain dramatically, the effect lasts for at least 45 minutes.
While the isometric contraction is beneficial for the patient in terms of pain, it can also be very helpful for the physiotherapist. It can sometimes be quite difficult to differentiate between patella tendinopathy and patellofemoral pain syndrome (PFPS; an extremely common cause of anterior knee pain). In the case of PFPS it is very likely that due to the compression of the patellofemoral joint caused by a single leg squat hold that the pain will become worse or at least stay the same. This contrasts drastically to what has been demonstrated for someone suffering from patella tendinopathy. Therefore, a patient’s response to this exercise could form a part of the physiotherapist’s differential diagnosis.
An additional interesting finding of this study was that the isometric contractions also increased the isometric strength of the leg immediately after performing the exercises and this effect also lasted for at least 45 minutes. What a combination for motivation. Do some isometrics as a warm-up exercise, it will reduce your pain and has the potential to increase the strength of your muscle when you play your sport!
Some nice examples of isometric exercises that you can do for tendon pain are as follows:
- Patella or quadriceps tendon: single leg squats on a decline board or with your heel slightly elevated
- Achilles tendon: single leg heel raise holds just 1cm off the ground
- Proximal hamstring tendon: straight leg single or double leg bridge holds
- Gluteus medius tendon: clam holds (ideally with your hip flexed to the angle which best reproduces your tendon pain)
The study used a dosage of five repetitions of 45 seconds each. Importantly there was a 2-minute wait between each repetition to make sure the muscle did not fatigue too much. This can be done multiple times per day to ensure ongoing pain reduction. Give these a try for some short term pain relief, but if they don’t work or you continue to struggle with pain, go and see a sports physio to get your tendon under control.
Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G., Pearce, A., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal Of Sports Medicine, 49(19), 1277-1283. http://dx.doi.org/10.1136/bjsports-2014-094386