Difference between Isometric and Isotonic Exercises and Their Effects on Patients with Patellar Tendinopathy: A Critically Reviewed Study
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Abstract
Clinical Scenario
In basketball players patellar tendinopathy cases are common with studies reporting that 1in 3 college basketball players have reported patellar tendon issues.1 The most often type of treatment used currently is eccentric load training (ELT)1. A potential negative consequence to performing ELT is that it can be painful for patients to perform.2 Due to this, isometric exercises have recently been investigated to determine if they produce a comparable result or offer a benefit, while causing less pain. In isometric training, the joint itself is not moving which has been shown to reduce pain levels and still supply quality stress reactions in the tendons.3 The use of isotonic exercises has also been incorporated into rehabilitation programs for patellar tendinopathy. Isotonic exercise involves the use of eccentric training. By comparing these two types of training, isotonic vs isometric, we can determine which type of training should be implemented to decrease pain.
Clinical Question:
In patients with patellar tendinopathy, what are the effects of isometric vs isotonic exercise on pain levels during a single leg decline squat assessment?
Search Strategy:
The following terms were used during an online search: patients clinically diagnosed with patellar tendinopathy, Isometric exercise and isotonic exercise. Outcome measures searched for were pain scale rating of 1-10 during single leg decline squat. Inclusion criteria were human participants, clinically diagnosed chronic patellar tendinopathy, articles published after 2005, isometric exercise compared to isotonic exercise, and measured outcomes of SLDS pain scale rating. Exclusion criteria included animals, cadavers, acute injury, and published before 2005.
Quality Assessment:
PEDRO scales ranged from 5/10- 8/10. The Oxford scale for all articles were level 2. All studies were determined to have internal validity.
Summary of Search:
Research showed isometric exercise reduces pain during and 45 minutes post-exercise.However, multiple articles were retested from 7 to 52 weeks after the study and showed that pain level differences were insignificant. Therefore, our assessment from the appraisal of the research is that performing isometric vs isotonic exercise for pain control has no significant difference. Furthermore, it was noted that the analgesic effects of isometric exercise can be felt for 45 minutes post-completion of the exercise.
Clinical Bottom Line:
While there is short term pain relief performing isometric vs isotonic training that lasts up to 45 minutes after rehabilitation sessions, there was no data supporting long term pain relief past 8 weeks3,4,5. The SORT score for the body of evidence was A.
Implications
Isometric exercise was found to provide pain relief immediately post-exercise and 45 minutes post treatment but no significant differences in pain levels in the long term (>8 weeks)3,4,5. When treating future patients, isometric exercises may be beneficial in reducing pain levels during initial rehabilitation sessions and may potentially allow the practitioner to perform eccentric exercise with less pain.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Nora Kraemer, PhD, LAT, ATC, CSCS
Second Advisor/Mentor
Brian Zeller, PhD, LAT, ATC
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Transcript of the presentation
Difference between Isometric and Isotonic Exercises and Their Effects on Patients with Patellar Tendinopathy: A Critically Reviewed Study
Clinical Scenario
In basketball players patellar tendinopathy cases are common with studies reporting that 1in 3 college basketball players have reported patellar tendon issues.1 The most often type of treatment used currently is eccentric load training (ELT)1. A potential negative consequence to performing ELT is that it can be painful for patients to perform.2 Due to this, isometric exercises have recently been investigated to determine if they produce a comparable result or offer a benefit, while causing less pain. In isometric training, the joint itself is not moving which has been shown to reduce pain levels and still supply quality stress reactions in the tendons.3 The use of isotonic exercises has also been incorporated into rehabilitation programs for patellar tendinopathy. Isotonic exercise involves the use of eccentric training. By comparing these two types of training, isotonic vs isometric, we can determine which type of training should be implemented to decrease pain.
Clinical Question:
In patients with patellar tendinopathy, what are the effects of isometric vs isotonic exercise on pain levels during a single leg decline squat assessment?
Search Strategy:
The following terms were used during an online search: patients clinically diagnosed with patellar tendinopathy, Isometric exercise and isotonic exercise. Outcome measures searched for were pain scale rating of 1-10 during single leg decline squat. Inclusion criteria were human participants, clinically diagnosed chronic patellar tendinopathy, articles published after 2005, isometric exercise compared to isotonic exercise, and measured outcomes of SLDS pain scale rating. Exclusion criteria included animals, cadavers, acute injury, and published before 2005.
Quality Assessment:
PEDRO scales ranged from 5/10- 8/10. The Oxford scale for all articles were level 2. All studies were determined to have internal validity.
Summary of Search:
Research showed isometric exercise reduces pain during and 45 minutes post-exercise.However, multiple articles were retested from 7 to 52 weeks after the study and showed that pain level differences were insignificant. Therefore, our assessment from the appraisal of the research is that performing isometric vs isotonic exercise for pain control has no significant difference. Furthermore, it was noted that the analgesic effects of isometric exercise can be felt for 45 minutes post-completion of the exercise.
Clinical Bottom Line:
While there is short term pain relief performing isometric vs isotonic training that lasts up to 45 minutes after rehabilitation sessions, there was no data supporting long term pain relief past 8 weeks3,4,5. The SORT score for the body of evidence was A.
Implications
Isometric exercise was found to provide pain relief immediately post-exercise and 45 minutes post treatment but no significant differences in pain levels in the long term (>8 weeks)3,4,5. When treating future patients, isometric exercises may be beneficial in reducing pain levels during initial rehabilitation sessions and may potentially allow the practitioner to perform eccentric exercise with less pain.
