Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials

Clifford C, et al. · BMJ Open Sport & Exercise Medicine

Ten randomised trials, three of good and seven of poor overall quality, covering patellar (4), rotator cuff (2), lateral elbow (2), Achilles (1) and gluteal (1) tendinopathy. On limited (level 3) evidence isometric exercise was not superior to isotonic exercise for chronic tendinopathy on any outcome, either immediately after a session or through 12 weeks, and for acute rotator cuff tendinopathy it was no more effective than ice. Two results run the other way, both level 3: immediately after a session isometric work left greater strength and less cortical inhibition, and adding isometrics to an isotonic programme reduced short-term pain more than isotonic work alone. Immediate pain relief was rated no different overall because the three patellar trials disagree, two reporting large advantages for isometrics and the third none.

Population

10 RCTs across patellar, rotator cuff, lateral elbow, Achilles and gluteal tendinopathy

Intervention

Isometric exercise

Comparator

Isotonic exercise or other treatments

Limitations

Seven of the ten trials were of poor overall quality and every conclusion rests on limited (level 3) evidence. The populations are tendons rather than joints; no cartilage or joint-pain population is represented.