Tendon pain is the most common gradual-onset, overloading injury. Mechanotherapy / exercise is the most beneficial treatment option.
Eccentric exercises have been commonly prescribed over the last decade, following the pain-provoking Alfredson programme of 3 x 15 reps, twice/day. It sometimes works very well.
The last few years I’ve favoured isometric exercise as an initial treatment - partly because of personal experience with Achilles, patellar, and lateral elbow tendon issues, & recommendation from Jill Cook & Craig Purdham at the AIS.
New research adds some support to isometric exercise as a treatment for tendinopathy, concluding it reduces tendon pain and improves strength. The authors delve in to all the “hows” & “whys” of how it works in their discussion, and to be honest it’s a bit technical for my understanding.
The research protocol uses 5 reps of a 45 second contraction, at a 70% effort. I prefer a more gentle contraction of 50% effort, but a longer hold of at least a minute, and I like a larger total volume of at least 10 minutes/day. Obviously it’s hard to define what the perfect dosage is for exercise, & volume could be adjusted depending on results.
I like isometrics because: