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Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain: An In-Season Randomized Clinical Trial

Rio, Ebonie BASc, BA Phys (Hons), PhD, MSp(Phys)*,†,¶; van Ark, Mathijs PhD, MSc; Docking, Sean PhD, BHSc(Hons)*,†,¶; Moseley, G. Lorimer BASc (Phty)(Hons), PhD, FACP§; Kidgell, Dawson PhD; Gaida, Jamie E. PhD*,‖; van den Akker-Scheek, Inge PhD; Zwerver, Johannes MD, PhD; Cook, Jill PhD*,†,¶

Clinical Journal of Sport Medicine: May 2017 - Volume 27 - Issue 3 - p 253–259
doi: 10.1097/JSM.0000000000000364
Original Research

Objective: This study aimed to compare the immediate analgesic effects of 2 resistance programs in in-season athletes with patellar tendinopathy (PT). Resistance training is noninvasive, a principle stimulus for corticospinal and neuromuscular adaptation, and may be analgesic.

Design: Within-season randomized clinical trial. Data analysis was conducted blinded to group.

Setting: Subelite volleyball and basketball competitions.

Participants: Twenty jumping athletes aged more than 16 years, participating in games/trainings 3 times per week with clinically diagnosed PT.

Interventions: Two quadriceps resistance protocols were compared; (1) isometric leg extension holds at 60 degrees knee flexion (80% of their maximal voluntary isometric contraction) or (2) isotonic leg extension (at 80% of their 8 repetition maximum) 4 times per week for 4 weeks. Time under load and rest between sets was matched between groups.

Main Outcome Measures: (1) Pain (0-10 numerical rating score) during single leg decline squat (SLDS), measured preintervention and postintervention sessions. (2) VISA-P, a questionnaire about tendon pain and function, completed at baseline and after 4 weeks.

Results: Twenty athletes with PT (18 men, mean 22.5 ± 4.7 years) participated (isotonic n = 10, isometric n = 10). Baseline median SLDS pain was 5/10 for both groups (isotonic range 1-8, isometric range 2-8). Isometric contractions produced significantly greater immediate analgesia (P < 0.002). Week one analgesic response positively correlated with improvements in VISA-P at 4 weeks (r2 = 0.64).

Conclusions: Both protocols appear efficacious for in-season athletes to reduce pain, however, isometric contractions demonstrated significantly greater immediate analgesia throughout the 4-week trial. Greater analgesia may increase the ability to load or perform.

*Department of Physiotherapy, Monash University, Victoria, Australia;

Australian Centre for Research into Injury in Sport and its Prevention, La Trobe University Bundoora, Victoria, Australia;

University of Groningen, University Medical Center Groningen, Groningen, Netherlands;

§University of South Australia and PainAdelaide;

College of Science, Health and Engineering, School of Allied Health, Department of Rehabilitation, Nutrition and Sport, La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; and

Faculty of Health, University of Canberra Research Institute for Sport and Exercise.

Corresponding Author: Ebonie Rio, PhD, MSp(Phys), Monash University, School of Primary Health Care, Peninsula Campus, PO Box 527, Frankston, Victoria 3199, Australia (

The authors report no conflicts of interest.

Received May 18, 2015

Accepted May 02, 2016

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