Isometric exercises do not provide immediate pain relief in Achilles tendinopathy: A quasi‐randomized clinical trial

Abstract

Background Isometric exercises may provide an immediate analgesic effect in patients with lower‐limb tendinopathy and have been proposed as initial treatment and for immediate pain relief. Current evidence is conflicting, and previous studies were small. Objective To study whether isometric exercises result in an immediate analgesic effect in patients with chronic midportion Achilles tendinopathy. Methods Patients with clinically diagnosed chronic midportion Achilles tendinopathy were quasi‐randomized to one of four arms: isometric calf‐muscle exercises (tiptoes), isometric calf‐muscle exercises (dorsiflexed ankle position), isotonic calf‐muscle exercises, or rest. The primary outcome was pain measured on a visual analogue scale (VAS) score (0‐100) during a functional task (10 unilateral hops) both before and after the intervention. Between‐group differences were analyzed using a generalized estimation equations model. Results We included 91 patients. There was no significant reduction in pain on the 10 hop test after performing any of the four interventions: isometric (tiptoes) group 0.2, 95%CI −11.2 to 11.5; isometric (dorsiflexed) group −1.9, 95%CI −13.6 to 9.7; isotonic group 1.4, 95%CI −8.3 to 11.1; and rest group 7.2, 95%CI −2.4 to 16.7. There were also no between‐group differences after the interventions. Conclusion The isometric exercises investigated in this study did not result in immediate analgesic benefit in patients with chronic midportion Achilles tendinopathy. We do not recommend isometric exercises if the aim is providing immediate pain relief. Future research should focus on the use of isometric or isotonic exercise therapy as initial treatment as all exercise protocols used in this study were well‐tolerated.

Management of recent onset tendon‐related pain in a primary contact setting: A survey of practice

“…Isometric exercises were the most popular for both scenarios, despite the limited evidence of effectiveness (Mitham et al., 2021; Vlist et al., 2020). Both eccentric and heavy slow resisted exercises were preferred for Achilles scenario, despite current research suggesting no superiority between exercises (Head et al., 2019; Vlist et al., 2020; Van Der Vlist et al, 2020). This is particularly interesting given the majority of respondents recommended a follow up visit with a healthcare professional for both scenarios.…”

“…Tendon‐related pain affects a wide range of people and affects both function and quality of life (Grimaldi et al., 2015; Malliaras et al., 2015). A wide range of treatments are used to treat people with tendon‐related pain, including exercise therapy, injection therapy, shockwave therapy and acupuncture (Mitham et al., 2021; Vlist, et al., 2020).…”

An Overview of Achilles Tendinopathy Management

“…In general, it appears that tendons have a better response to high loads with longer duration than undergoing low loads with reduced duration [39]. Isometric exercise was recently proposed in the early stages of AT treatment [40], but there is no evidence of its superiority over any other exercise modality [41] and does not seem to have immediate effects in reducing pain in patients with chronic AT [42].…”

“…Isometric exercise was recently proposed in the early stages of AT treatment [40], but there is no evidence of its superiority over any other exercise modality [41] and does not seem to have immediate effects in reducing pain in patients with chronic AT [42].…”

Mitochondrial transfer from bone mesenchymal stem cells protects against tendinopathy both in vitro and in vivo

“…Achilles tendinopathy (AT) is a highly prevalent condition, with an overall incidence rate of 2.35 per 1000 registered adults patients (mean age: 43.4 yeas) [ 3 ]. The underlying histopathology of tendinopathy involves an increased tenocyte response and a localized disorganization of the tendon structure [ 4 ]. Fortunately, stem cells-based therapy for various diseases has led to breakthroughs in the treatment of tendinopathy [ 5 – 9 ].…”