Today’s guest post comes from Kevin Valcke, a physiotherapist working at the Allan McGavin Sports Medicine Clinic at the University of British Columbia (Vancouver, BC). Kevin is one of my favourite up and coming physiotherapists as he possesses a unique ability to blend strength and conditioning and rehabilitation protocols that can be applied across a very broad spectrum of clientele. He has hands-on experience working with elite athletic clientele, including Canadian Field Hockey and Basketball teams, UBC Men’s Basketball Team, and with BC Rugby. This is the third blog Kevin has written for the site (see Rehab and Training sections).
How do Isometrics Fit in with “Modern” Exercise and Rehab?
Let’s be honest, isometrics are sort of boring. They don’t get you the glory beach muscles or Instagram fame and you certainly don’t see many gym rats skipping chest day to do rotator cuff iso holds. So what is their purpose? How have they stood the test of time in a world cluttered with “functional” exercise? Well, they work.
1) Early-phase acute rehabilitation – This is nothing new. You talk to any PT and they will tell you that these are the basics of retraining a muscle/tendon. What they probably won’t tell you is how they are a back shelf exercise that rarely gets used anymore in their practice. Personally, I love them. Isometrics are a great tool to begin loading a muscle/tendon before large joint movements are safe. The client is in complete control of the duration and intensity, can monitor their own symptoms, and the exercises are super easy to progress. These are some of the key challenges with managing an acute injury and isometrics check all of the boxes.
Many tend to think of simply pushing your elbow or wrist into a wall to load the rotator cuff, but there are many other great rehab uses for isometrics in tendinopathy/acute injury: static achilles, open/closed kinetic chain quads, hip flexion holds, glute/ham push, wrist flexion/extension, etc. Think of any muscle/tendon and give it progressive static loading – just don’t forget the word progressive.
2) Chronic tendon injuries – For as long as I have been a PT, eccentric loading has been the gold standard for chronic tendinopathies. These can be quite effective; however, can also be quite painful for some. Athletes are often hesitant and need reassurance of the benefit of painful eccentric loading on an already upset tendon. I have found that supplementing isometrics for a chronic tendon injury can be a great addition. The client can begin to train a muscle/tendon to accept load in a pain-free fashion, which can help to de-threaten and desensitize the injured tissue. This should then allow the client to trust their injured structure to once again bear load as you begin to reintroduce heavier, concentric and eccentric patterns back into the mix!
3) Game time – About two years ago, work came out that looked at the analgesic (pain-relieving) effects of isometrics on an angry tendon – specifically the patellar tendon. Although a very small sample size, it shed light that isometrics might be used as a natural painkiller. It is a newer area of research, but I have used these techniques in practice with various teams and athletes (especially with patellar tendons in jumping athletes, i.e. basketball and volleyball) with decent success. The research indicated that pre-participation isometrics could decrease one’s subjective pain through cortical pathways, and improve ones pain-free max voluntary isometric contraction for up to 45 minutes. This was performed using isometric knee extensions in an open kinetic chain form repeated in 30-45 second submaximal holds. I tend to use a manual therapy belt/seat belt in the clinic or courtside attached to the bottom leg of a treatment table. This allows for an unbreakable resistance that can be tightened or loosened to change the knee extension angle for the contraction. The parameters are still to be played with and should likely be individualized as there is not enough evidence to support a specific approach to this.
4) Manual/perturbation isometrics –Let’s be honest here, in a rehab setting, people like manual therapy. For all the slack it gets lately, keep in mind that manual therapy is just an umbrella term for really any treatment provided with our hands. I like to use manual isometrics in various positions to get a similar muscular effect to self-directed isometrics, while also giving support and manual touch to the client. Here you can manually resist a muscle force, have an idea of their strength, and easily progress to muscular breaking points if required. You can also position the client into the exact joint angles that you’d like in gravity or non-gravity positions, and if you’re lucky, you can get the pain modulation that can sometimes come with manual therapy.
Many do not associate perturbation training with being isometric in nature, but when you think about it, it absolutely is. If one is holding a stable contraction in a given position with external perturbations, they are holding an isometric contraction of one or more muscle groups. The difference is they are often reactionary and not as simple and conscious as pushing into a wall. I love isometric perturbations as it can get great muscular firing, it is more engaging to the client, it promotes stability in different positions, and it is a reactionary task, which is far more suited towards athletics. Similar to the manual isometrics, this can be performed in weight bearing or non-weight bearing, and can also be regressed/lateralized to include anti-gravity positions.
5) Isometrics with movement – Lastly, don’t solely think of isometrics being a hold of only one muscle with no joint movement. Why can’t you have an isometric hold of one muscle group while moving others? This can increase a target tissue’s time-under-tension while you move through a certain range of motion. I like to think of this style of exercise as much of what is currently used for abdominal training where one holds stiff through the midsection while performing a movement with an extremity (ex. stir the pot or lunge stance chops). Other forms of these exercises can be shoulder-based: external rotation holds with wall slide elevation, or shoulder abduction with an anterior-based resistance band attempting to pull the arm out of the frontal plane. Both of these shoulder exercises represent great posterior rotator cuff isometric firing, while the glenohumeral joint moves through a range of motion. Sure, this form might not be the truest form of isometric exercise (muscle/tendon length will slightly change and so will tension) but I still consider it to be one.
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- (Rio E, Kidgell D, Purdam C, Gaida J, Moseley L, Pearce A, Cook J, (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. BJSM; 49(19):1277-1283)