What type of exercise works for treating Achilles tendinopathy and why? - Isometric exercises

Updated: Dec 18, 2019

Achilles Tendinopathy Exercise Series:

There are many different types of exercises that can be used for Achilles tendinopathy treatment and rehabilitation. The aim of this exercise blog series is to understand what type of exercise does what and how that can help your tendon, according to the latest research.


In this article we discuss how isometric exercises (a contraction held for a while without movement) can help kick-start the rehabilitation process, especially if your tendon is very irritable.



In this article:

  • What are isometric exercises?

  • What they do

  • When to use isometric exercises for Achilles tendinopathy / tendonitis

Ali also discusses isometric exercises in this video:



What are isometric exercises?


Isometric exercises mean a hold or a static contraction (no movement). As you are reading this squeeze your bottom cheeks as hard as you can – this is an isometric contraction. Your muscles contract but your body does not physically move.


Typically these are the first type of exercises in a rehabilitation programme as they are unlikely to aggravate anything and can be repeated multiple times a day. The aim in the tendinopathy-based research is to hold for between 40-60 seconds and repeat them 4-5 times in a row.


What they do


Well the jury is out on this one.


There is a piece of research that got everyone thinking and it seemed to prove that if people did isometric exercises for the muscles related to their tendinopathy, then this can cause pain relief. This research was specifically done on the knee for patellar tendinopathy. How helpful is that?


Recently researchers have tried to replicate this study and have looked at isometrics for pain relief for a variety of tendon problems all over the body, including the Achilles. The outcome from all of these studies showed that Isometrics exercises are no better than exercise with movement (isotonics) for reducing pain in tendinopathy. Not so helpful after all.



When to use isometric exercises for Achilles tendinopathy / tendonitis


There is now a change in focus in Achilles rehabilitation. Research has found that pain is not detrimental for recovery and it may even be beneficial to feel a small amount (niggle level) whilst doing rehabilitation exercises for tendinopathies.


The key is to start your exercises at a starting point that is right for you and progress your exercises by making them more and more challenging over weeks to months as your tendon symptoms improve and function returns.


When we assess your Achilles tendon at TreatMyAchilles.com we look at your tendon's capacity i.e. what you can do and how that feels when you do it. We all have different starting points due to our fitness levels, other health issues, and goals and aspirations.


Therefore, doing isometric exercises is the right starting point for you if:

  • you found isometric exercises challenging,

  • they were at an acceptable level of pain for you,

  • and you could not progress to more challenging exercises.

If isometric exercises are too easy and you can progress, then you do not need to start here.


The key is to remember that this is a longstanding condition that takes a few months to resolve and this is just a starting block. For Achilles tendinopathy, rehabilitation success should not be measured in immediate pain reduction – it will come with time and perseverance.


Let me know if you have any questions. Need more help with your Achilles injury? You can consult us online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes

Alison

About the Author:

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram or Twitter.



References:

  1. Silbernagel, K.G., Vicenzino, B.T., Rathleff, M.S. and Thorborg, K., 2019. Isometric exercise for acute pain relief: is it relevant in tendinopathy management?.

  2. Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G.L., Pearce, A.J. and Cook, J., 2015. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med, 49(19), pp.1277-1283.

  3. O’Neill, S., Radia, J., Bird, K., Rathleff, M.S., Bandholm, T., Jorgensen, M. and Thorborg, K., 2019. Acute sensory and motor response to 45-S heavy isometric holds for the plantar flexors in patients with Achilles tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy, 27(9), pp.2765-2773.

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