Isometric Exercise to Reduce Pain in Patellar Tendinopathy In-Season: Is It Effective “on the Road”?

Rio, Ebonie; Purdam, Craig; Girdwood, Michael; Cook, Jill

doi:10.1097/jsm.0000000000000549

Cited by 23 publications

(31 citation statements)

References 15 publications

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“…Moreover, differences in the clinical outcome concerning insertional and midportion tendinopathy could not be analyzed separately due to a limited cohort size. A further limitation of this study is that the patients did not receive feedback by a metronome, as described in previous studies, while conducting ISOs, 18,19 which might have influenced the outcome. Moreover, general outcome of the individuals might have been influenced positively by absence of hypoechogenity in some individuals of our study, as focal changes in echogenity might be associated with a worse outcome potential.…”

Section: Limitationsmentioning

confidence: 99%

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Eccentric and Isometric Exercises in Achilles Tendinopathy Evaluated by the VISA-A Score and Shear Wave Elastography

et al. 2020

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Background: Apart from eccentric exercises (EE), isometric exercises (ISO) might be a treatment option for Achilles tendinopathy. Shear wave elastography (SWE) provides information for diagnosis and for monitoring tissue elasticity, which is altered in symptomatic tendons. Hypothesis: Isometric exercises will have a beneficial effect on patients’ outcome scores. Based on SWE, insertional and midportion tendon parts will differ in their elastic properties according to current symptoms. Study Design: Randomized clinical trial. Level of Evidence: Level 2. Methods: Group 1 (EE; n = 20; 12 males, 8 females; mean age, 52 ± 8.98 years) and group 2 (EE + ISO; n = 22; 15 males, 7 females; mean age, 47 ± 15.11 years) performed exercises for 3 months. Measurement points were before exercises were initiated as well as after 1 and 3 months using the Victorian Institute of Sports Assessment–Achilles (VISA-A) score, American Orthopaedic Foot & Ankle Society score, and SWE (insertion and midportion). Results: Both groups improved significantly, but there were no significant interindividual differences (VISA-A; P = 0.362) between group 1 (n = 15; +15 VISA-A) and group 2 (n = 15; +15 VISA-A). The symptomatic insertion (symptomatic, 136.89 kPa; asymptomatic, 174.68 kPa; P = 0.045) and the symptomatic midportion of the Achilles tendon (symptomatic, 184.40 kPa; asymptomatic, 215.41 kPa; P = 0.039) had significantly lower Young modulus compared with the asymptomatic tendons. The midportion location had significantly higher Young modulus than the insertional part of the tendon ( P = 0.005). Conclusion: Isometric exercises do not have additional benefit when combined with eccentric exercises, as assessed over a 3-month intervention period. SWE is able to distinguish between insertional and midportion tendon parts in a symptomatic and asymptomatic state. Clinical Relevance: The present study shows no additional effect of ISO when added to baseline EE in treating Achilles tendinopathy. Different elastic properties of the insertional and midportion tendon have to be taken into consideration when rating a tendon as pathologic.

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Section: Limitationsmentioning

confidence: 99%

“…Clinical studies on patellar tendinopathy showed good results with ISOs, with reduced pain intensity after 4 weeks without a mandatory reduction of load. 18,19 So far, effects of isometric training have not been studied in AT.…”

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confidence: 99%

Eccentric and Isometric Exercises in Achilles Tendinopathy Evaluated by the VISA-A Score and Shear Wave Elastography

et al. 2020

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“…The ISO protocol was self-designed aiming to be simple and easily applicable without using technical aid in order to increase compliance. Therefore, a metronome as described in studies by Rio et al has not been used (5,6). Table I as well as figure 1 and figure 2 give an overview about the different treatment regimes.…”

Section: Eccentric and Isometric Exercisesmentioning

confidence: 99%

“…Moreover, in active athletes reduced plantarflexor strength is considered as the primary modifiable risk factor for AT requiring M. Gatz, M. Betsch, M. tinGart, r. Michalik, F. MiGliorini, t. Dirrichs, c. kuhl, V. Quack a specific training for the muscle and not only the tendon (4). In patellar tendinopathy clinical studies showed good results with ISO, reducing pain intensity after four weeks without a mandatory reduction of load (5,6). In comparison to ISO, EE have a higher level of gene expression, upregulation of muscle cell activity and anabolic pathways as well as a greater increase in muscle strength (7).…”

Section: Introductionmentioning

confidence: 99%

Effect of a 12-week Eccentric and Isometric Training in Achilles Tendinopathy on the Gastrocnemius Muscle: an Ultrasound Shear Wave Elastography Study

Gatz

Betsch

Tingart

et al. 2020

Muscle Ligaments and Tendons J

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Background. Eccentric exercises (EE) and isometric exercises (ISO) are standard treatment options for Achilles tendinopathy, but still their exact effect remains uncertain. Shear Wave Elastography (SWE) was used to examine the influence of these exercises on the elastic properties of Mm. gastrocnemii medialis and lateralis in a 12-week training program. Methods. Prospective study with patients suffering from Achilles tendinopathy, which were randomised into 2 groups and conducted exercises for 12 weeks on the symptomatic limb: EE (n=15, 9 male, 55a ± 6.5) and EE+ISO (n=15, 10 male, 47a ± 16.1). Shear Wave Elastography of the gastrocnemius medialis (MG) and lateralis (ML) was made before exercises (T0), after 4 (T1) and 12 weeks (T2) using an established protocol. Results. Muscles of asymptomatic and symptomatic legs did not differ at baseline neither for EE (p=0.139) nor for EE+ISO (p=0.778). SWE values of MG and ML of symptomatic limbs showed no significant alterations neither for EE and EE+ISO nor for the whole population (p=0.567-0.746) without any difference between EE vs. EE+ISO for the whole study period (T0: p=0.247, T1: p=0.990, T2: p=0.516). Contrary, MG and ML of the asymptomatic untrained limb showed increased SWE values over the course for the EE-group (p=0.041) and the whole population (p=0.003) with a significant difference of the symptomatic and asymptomatic limb at T2 for the EE group (p=0.01) and the whole population (p=0.03). MG and ML of asymptomatic limbs differed significantly between EE vs. EE+ISO at T2 (p=0.03), showing higher SWE values for EE. Conclusions. Using Shear Wave Elastography there was no measurable effect neither for EE nor for EE+ISO on MG and ML of symptomatic limbs over a 12-week intervention period. Contrary, in the asymptomatic untrained limb elastic properties increased in the EE group which might be based on the cross-education effect.

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“…Recommendations for altering recreational physical activity have ranged from complete cessation of sports participation (5)(6)(7) to continued activity at the pre-injury level. (8)(9)(10) Other studies have used a more individualized approach where pain-levels are used to guide activity modi cation. (11,12) Each of these approaches have yielded positive results, however, the impact of activity modi cation on clinical outcomes have not been directly investigated nor compared.…”

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confidence: 99%

Pain-Guided Activity Modification During Treatment for Patellar Tendinopathy: A Feasibility and Pilot Randomized Clinical Trial

Sprague

Couppé

Pohlig

et al. 2020

Preprint

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Background: Activity modification is a key component of patellar tendinopathy treatment but there is a lack of evidence guiding activity modification prescription. Use of activity modification in treatment studies has varied widely and the impact of those recommendations has not been directly investigated or compared. The purpose of this study was to assess 1) the feasibility of using pain-guided activity modification during treatment for patellar tendinopathy and 2) if our outcome measures are responsive to changes in tendon health over the course of treatment.Methods: This was an unblinded, randomized two-arm pilot and feasibility study randomized clinical trial with parallel assignment, conducted in Newark, DE. Individuals between the ages of 16 and 40 years old with patellar tendinopathy were included. Participants were randomly assigned to a pain-guided activity (PGA) or pain-free activity (PFA) group using a spreadsheet-based randomization scheme. All participants received standardized treatment using a modified version of the heavy-slow resistance protocol 3x/week for 12-weeks. For the first six weeks, the PGA group used the Pain-Monitoring Model to guide activity outside of treatment and the PFA group was restricted from running, jumping, or activities that provoked their patellar tendon pain. Feasibility outcomes included recruitment, enrollment, randomization, compliance, and retention percentages. Clinical evaluations were conducted at baseline, 6- and 12-weeks to assess symptom severity, psychological factors, tendon morphology and mechanical properties, lower extremity function and quadriceps muscle performance. Results: In a ~13 month period, 108 individuals were screened, 47/108 (43.5%) were eligible for participation, and 15/47 (32.0%) of those were enrolled (9 PGA, 6 PFA). The recruitment rate was 1.15 participants/month. The mean±SD compliance with treatment was PGA: 86.1±13.0% and PFA: 67.1±30.7%. There was one missed evaluation session and two adverse events, which were not due to study interventions. Changes exceeding the smallest detectable change were observed for at least one outcome in each domain of tendon health.Conclusions: Use of pain-guided activity modification during exercise therapy for patellar tendinopathy was found to be feasible, and the proposed outcome measures appropriate. Computer-based allocation concealment, blinding of evaluators, and greater recruitment of high-level athletes should be implemented in future trials. Trial Registration: ClinicalTrials.gov identifier: NCT03694730. Registered 3rd of October, 2018. https://clinicaltrials.gov/ct2/show/NCT03694730

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Isometric Exercise to Reduce Pain in Patellar Tendinopathy In-Season: Is It Effective “on the Road”?

Abstract: This pragmatic study suggests that a portable isometric squat reduced pain in-season for athletes with PT. This form of treatment may be effective, but clinical trials with a control group are needed to confirm the results.

Cited by 23 publications

References 15 publications

Eccentric and Isometric Exercises in Achilles Tendinopathy Evaluated by the VISA-A Score and Shear Wave Elastography

Eccentric and Isometric Exercises in Achilles Tendinopathy Evaluated by the VISA-A Score and Shear Wave Elastography

Effect of a 12-week Eccentric and Isometric Training in Achilles Tendinopathy on the Gastrocnemius Muscle: an Ultrasound Shear Wave Elastography Study

Pain-Guided Activity Modification During Treatment for Patellar Tendinopathy: A Feasibility and Pilot Randomized Clinical Trial

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