We all know now that the smartest way out of a chronic tendinopathy is painfree, progressive loading. We, as many others have found, that isometrics serve the initial process well because there is no movement through a painful arc, the isometrics can help reduce the neurologic pain loop, and we can more easily find positions where there is no pain in the tendon. This allows us to load the affected tendon, without adding insult to the tendon portion that is injured. It them prepares us for the weeks to months of eccentric and concentric loading that is often necessary to restore function. Keep in mind that some of the literature indicates that some tendons never fully heal, but we replace things with a better functioning of the remaining competent tendon.
This study found that there was an improvement in pain and function as early as 2 weeks. You might find this interesting because on imaging tendon structure does not change within 2 weeks and muscular hypertrophy is not seen for at least 4 weeks following inception of a loading protocol (Murphy). Thus, we all need to continue our education and understanding of central pain mechanisms. Meaning, that these initial early changes, are in part, and maybe a huge part, are neurologic.
Sports Med. 2018 May 15. doi: 10.1007/s40279-018-0932-2. [Epub ahead of print]
Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis.
Murphy M1,2,3, Travers M4,5, Gibson W4, Chivers P6,7, Debenham J4, Docking S8, Rio E8,9.