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Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials
  1. Christopher Clifford1,2,
  2. Dimitris Challoumas3,
  3. Lorna Paul4,
  4. Grant Syme5,
  5. Neal L Millar2
  1. 1Department of Physiotherapy, NHS Greater Glasgow and Clyde, Glasgow, UK
  2. 2Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  3. 3Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
  4. 4School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
  5. 5Department of Physiotherapy, NHS Fife, Kirkcaldy, Fife, UK
  1. Correspondence to Dr Neal L Millar; neal.millar{at}


Objective To systematically review and critically appraise the literature on the effectiveness of isometric exercise in comparison with other treatment strategies or no treatment in tendinopathy.

Design A systematic review and meta-analysis of randomised controlled trials.

Data sources Electronic searches of Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE and Cochrane were undertaken from inception to May 2020.

Methods Overall quality of each study was determined based on a combined assessment of internal validity, external validity and precision. For each outcome measure, level of evidence was rated based on the system by van Tulder et al.

Results Ten studies were identified and included in the review, including participants with patellar (n=4), rotator cuff (n=2), lateral elbow (n=2), Achilles (n=1) and gluteal (n=1) tendinopathies. Three were of good and seven were of poor overall quality. Based on limited evidence (level 3), isometric exercise was not superior to isotonic exercise for chronic tendinopathy either immediately following treatment or in the short term (≤12 weeks) for any of the investigated outcome measures. Additionally, for acute rotator cuff tendinopathy, isometric exercise appears to be no more effective than ice therapy in the short term (limited evidence; level 3).

Summary Isometric exercise does not appear to be superior to isotonic exercise in the management of chronic tendinopathy. The response to isometric exercise is variable both within and across tendinopathy populations. Isometric exercise can be used as part of a progressive loading programme as it may be beneficial for selected individuals.

PROSPERO registration number CRD42019147179.

  • tendinopathy
  • tendon
  • physiotherapy

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  • Twitter @11chrisclifford, @tendonglasgow

  • Contributors CC, DC and NLM conceived and designed the study. DC, NLM and CC performed the analysis. LP and GS provided expert advice. All authors analysed the data. All authors wrote the paper.

  • Funding This work was funded by grants from the Medical Research Council UK (MR/R020515/1).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.