Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain: An In-Season Randomized Clinical Trial
Two articles on PainSci cite Rio 2017: 1. Tennis Elbow Guide 2. Achilles Tendinitis Treatment Science
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: This study aimed to compare the immediate analgesic effects of 2 resistance programs in in-season athletes with patellar tendinopathy (PT). Resistance training is noninvasive, a principle stimulus for corticospinal and neuromuscular adaptation, and may be analgesic.
DESIGN: Within-season randomized clinical trial. Data analysis was conducted blinded to group.
SETTING: Subelite volleyball and basketball competitions.
PARTICIPANTS: Twenty jumping athletes aged more than 16 years, participating in games/trainings 3 times per week with clinically diagnosed PT.
INTERVENTIONS: Two quadriceps resistance protocols were compared; (1) isometric leg extension holds at 60 degrees knee flexion (80% of their maximal voluntary isometric contraction) or (2) isotonic leg extension (at 80% of their 8 repetition maximum) 4 times per week for 4 weeks. Time under load and rest between sets was matched between groups.
MAIN OUTCOME MEASURES: (1) Pain (0-10 numerical rating score) during single leg decline squat (SLDS), measured preintervention and postintervention sessions. (2) VISA-P, a questionnaire about tendon pain and function, completed at baseline and after 4 weeks.
RESULTS: Twenty athletes with PT (18 men, mean 22.5 ± 4.7 years) participated (isotonic n = 10, isometric n = 10). Baseline median SLDS pain was 5/10 for both groups (isotonic range 1-8, isometric range 2-8). Isometric contractions produced significantly greater immediate analgesia (P < 0.002). Week one analgesic response positively correlated with improvements in VISA-P at 4 weeks (r = 0.64).
CONCLUSIONS: Both protocols appear efficacious for in-season athletes to reduce pain, however, isometric contractions demonstrated significantly greater immediate analgesia throughout the 4-week trial. Greater analgesia may increase the ability to load or perform.
related content
- “The pain of tendinopathy: physiological or pathophysiological?,” Ebonie Rio, Lorimer Moseley, Craig Purdam, Tom Samiric, Dawson Kidgell, Alan J Pearce, Shapour Jaberzadeh, and Jill Cook, Sports Medicine, 2014.
- “Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy,” Ebonie Rio, Dawson Kidgell, Craig Purdam, Jamie Gaida, G Lorimer Moseley, Alan J Pearce, and Jill Cook, British Journal of Sports Medicine, 2015.
- “Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial,” Mathijs van Ark, Jill L Cook, Sean I Docking, Johannes Zwerver, James E Gaida, Inge van den Akker-Scheek, and Ebonie Rio, Journal of Science & Medicine in Sport, 2016.
- “The Acute Effect of Isometric Versus Isotonic Resistance Exercise in Patients With Patellar Tendinopathy—does contraction type matter? A randomised crossover trial,” S Holden, K Lyng, and T Graven-Nielsen, {Presented at the Scandinavian Sports Medicine Conference, Copenhagen, Denmark, 2019}, 2019.
Specifically regarding Rio 2017:
- “Isometric exercise for acute pain relief: is it relevant in tendinopathy management?,” Karin Gravare Silbernagel, Bill T Vicenzino, Michael Skovdal Rathleff, and Kristian Thorborg, British Journal of Sports Medicine, 2019.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.
- Sudden amnesia resulting in pain relief: the relationship between memory and pain. Choi 2007 Pain.
- Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.