The Effectiveness of Isometric Contractions Compared With Isotonic Contractions in Reducing Pain For In-Season Athletes With Patellar Tendinopathy

in Journal of Sport Rehabilitation
View More View Less
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

Clinical Scenario: Patellar tendinopathy is a common musculoskeletal disorder affecting the lower-extremities and a difficult condition to manage for athletes that are in season. To facilitate improvement in function and to decrease pain, initial treatment for patellar tendinopathy is typically conservative. Traditional interventions may include eccentric training, cryotherapy, patellar counterforce straps, oral anti-inflammatories, injectable agents, phonophoresis, iontophoresis, orthotics, therapeutic ultrasound, and extracorporeal shockwave. In addition, recent literature suggests that implementing isometric and isotonic contractions may be effective in reducing patellar tendon pain. Focused Clinical Question: How effective are isometric contractions compared with isotonic contractions in reducing pain for in-season athletes with patellar tendinopathy? Summary of Key Findings: Implementation of isometric and isotonic exercises statistically reduced pain levels in the short term of 4 weeks for in-season athletes; however, isometric contractions provided statistically greater pain relief immediately for up to 45 minutes postintervention compared with isotonic contractions. Clinical Bottom Line: Current evidence supports the use of isometric and isotonic contractions to reduce pain for in-season athletes with patellar tendinopathy. Based on the reviewed literature, clinicians should consider utilizing heavy loaded isometrics or progressive heavy loaded isotonic exercises, which showed reduction in pain levels immediately after intervention and at 4-week follow-up for both intervention groups. Isometric contractions appear to provide greater pain relief immediately after intervention. Strength of Recommendation: There is Grade B evidence from 2 level 2 randomized controlled trials and 1 level 3 randomized crossover study supporting the use of isometric and isotonic contractions to reduce patellar tendon pain for in-season athletes.

Vang is with Twin Cities Orthopedics, Eagan, MN, USA. Niznik is with Twin Cities Orthopedics, Burnsville, MN, USA.

Vang (cheevang24@gmail.com) is corresponding author.
  • 1.

    Rio E, Kidgell D, Purdam C, et al. Isometric exercises induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):12771283. PubMed ID: 25979840 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Rio E, Purdam C, Girdwood M, Cook JL. Isometric exercise to reduce pain in patellar tendinopathy in-season; is it effective on the road? Clin J Sport Med. 2017;29(3):188192. PubMed ID: 31033611 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Van Ark M, Cook JL, Docking SI, et al. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. J Sci Med Sport. 2015;19(9):702706. PubMed ID: 26707957 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Purdam CR, Johnsson P, Alfredson H, Lorentzon R, Cook JL, Khan KM. A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy. Br J Sports Med. 2004;38(4):395397. PubMed ID: 15273169 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Zwerver J, Bredeweg SW, Hof AL. Biomechanical analysis of the single-leg decline squat. Br J Sports Med. 2007;41(4):264268. PubMed ID: 17224441 doi:

  • 6.

    Reinking MF. Current concepts in the treatment of patellar tendinopathy. Int J Sports Phys Ther. 2016;11(6):854866. PubMed ID: 27904789

  • 7.

    Scott A, Backman LJ, Speed C. Tendinopathy: update on pathophysiology. J Orthop Sports Phys. 2015;45(11):833841. PubMed ID: 26390273 doi:

  • 8.

    Van Wilgen CP, Konopka KH, Keizer D, Zwerver J, Dekker R. Do patients with chronic patellar tendinopathy have an altered somatosensory profile? A quantitative sensory testing (QST) study. Scand J Med Sci Sports. 2013;23(2):149155. PubMed ID: 22092832 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Jayaseelan DJ, Weber MJ, Jonely J. Potential nervous system sensitization in patients with persistent lower extremity tendinopathies: 3 case reports. J Orthop Sports Phys. 2019;49(4):272279. PubMed ID: 30759356 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 495 495 230
Full Text Views 21 21 13
PDF Downloads 17 17 8