Isometrics and Pain Reduction in Patellar Tendinopathy

Key Takeaways:

Isometric exercise induces analgesia (pain relief) and reduces inhibition in patellar tendinopathy (PMID: 25979840).

One isometric bout of exercise has been shown to reduce pain for at least 45 minute post intervention.

• Maximum voluntary isometric contraction (MVIC) was also increased.

• The pain reduction was paralleled by a reduction in cortical inhibition - neurophysiological process where y-aminobutyric acid (GABA) attenuates the activity of other neurons in the cortex.

  The standard commonly cited in research is 5 sets of 45s isometrics on the involved leg. However, it seems the total duration may be more important than individual set differences (PMID: 30095504)

  How we progress this with Unilateral SL squat on slant board

  • 3x45s at roughly 60-90° angle from knee to hip

  • 60° may be more applicable for quad tendinopathy (pain above the knee cap)

  • 90° may be more applicable for patellar tendinopathy (pain on the inferior pole of the patellar tendon, right below the knee)

  • 3x30s Loaded

  • Build load to 3x45s

  • Repeat 3x30s with heavier load

    This above study, albeit small (6 athletes) notes that athletes went from a median pain score of 7/10, to 0.17/10.

    Having used this consistently, we find that many of our athletes experience a significant pain reduction and the ability to get into full range of motion resistance training.

    We often use tempo work at 5.0.1 or 6.0.1 for 6 reps on a variation of split squats to start. This seems to allow the athlete to slowly move through pain without altering the primary motor pattern desired. This moderate to heavy-slow resistance training also seems to improve pain perception and joint function when done consistently

    (PMID: 35084703)