Isometric Exercise Above but not Below an Individual’s Pain Threshold Influences Pain Perception in People With Lateral Epicondylalgia

Coombes, Brooke K.; Wiebusch, Matheus; Heales, Luke; Stephenson, Aoife; Vicenzino, Bill

doi:10.1097/ajp.0000000000000365

Cited by 26 publications

(32 citation statements)

References 23 publications

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“…This indicates a chronic state, although symptom duration was not reported in the study by Rio et al Patients with chronic pain often demonstrate lesser response to exercise than healthy individuals . Participants responded variably to the isometric exercise similar to what has been demonstrated in patients with lateral epicondyalgia . This highlights the need for research to determine which patient groups will benefit from isometric exercise, as findings in one type of tendinopathy may not necessarily be generalizable to others.…”

Section: Discussionmentioning

confidence: 83%

The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial

Riel

Vicenzino

Jensen

et al. 2018

Scandinavian Med Sci Sports

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Isometric exercise is commonly recommended for immediate pain relief in individuals suffering from lower limb tendinopathies, despite the limited evidence supporting its analgesic effect. Due to the similarities between plantar fasciopathy and tendinopathies, the aim of this trial was to investigate the acute effect of isometric exercise on pain, compared to isotonic exercise, or walking, in individuals with plantar fasciopathy. We recruited 20 individuals with plantar fasciopathy for this prospectively-registered, participant-blinded, randomized, superiority crossover trial (ClinicalTrials.gov: NCT03264729). Participants attended three exercise sessions (isometric, isotonic, or walking) in a randomized order, within a 2-week period. Both isometric and isotonic exercises were performed standing with the forefoot on a step bench, while walking was performed barefoot. The primary outcome was pain (measured on a 0-100-mm VAS) during a pain-aggravating activity. Secondary outcomes included pressure pain threshold (PPT) under the heel, and plantar fascia thickness (PFT). All outcomes were measured before and after each exercise session. There were no significant differences between the three exercises on pain (P = 0.753), PPTs (P = 0.837), or PFT (P = 0.718). Further, there was no change in pain from before to after any of the exercises (isometric exercise 2.7 mm [95% CI: -12.2; 6.8], isotonic exercise -3.4 mm [95% CI: -5.0; 11.8], or walking 1.6 mm [95% CI: -16.1; 12.9]). Contrary to expectations, isometric exercise was no better than isotonic exercise or walking at reducing pain in individuals with plantar fasciopathy. None of the exercises induced any systematic analgesic effect.

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Section: Discussionmentioning

confidence: 83%

The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial

Riel

Vicenzino

Jensen

et al. 2018

Scandinavian Med Sci Sports

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“…In chronic musculoskeletal pain, only 1 study examined dynamic resistance exercise 45 and no studies examined aerobic exercise. Only 2 studies (both in chronic musculoskeletal pain) reported on the presence/absence of adverse events 5,41 ; no adverse events were reported in these studies.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

“…illustrates the summary effects of EIH with correlation set at .9. Isometric exercise did not cause EIH with high heterogeneity (3 studies,5,41,45 114 participants; g = À.41 [À1.08, .25], I 2 = 95%). This remained true when the correlation was reduced to .5 (g = À.44 [À1.13, .24], I 2 = 87%; supplementary Fig 5) or 0 (g = À.47 [À1.18, .24], I 2 = 80%; supplementary…”

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confidence: 99%

Exercise-Induced Hypoalgesia in Healthy Individuals and People With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis

Wewege

Jones

2021

The Journal of Pain

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“…Comparable results with no meaningful change were also found in patients with lateral elbow tendinopathy, plantar fasciopathy, and a recent second study in patellar tendinopathy. 19,29,31 We also demonstrated no meaningful change in pain score after the To determine whether participants were active or sedentary we used the ankle-activity score. If the score was ≥ 4 points, the participant was considered to be active (starting from heavy physical work).…”

Section: Discussionmentioning

confidence: 97%

Isometric exercises do not provide immediate pain relief in Achilles tendinopathy: A quasi‐randomized clinical trial

Vlist

Veldhoven

Oosterom

et al. 2020

Scandinavian Med Sci Sports

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Background Isometric exercises may provide an immediate analgesic effect in patients with lower‐limb tendinopathy and have been proposed as initial treatment and for immediate pain relief. Current evidence is conflicting, and previous studies were small. Objective To study whether isometric exercises result in an immediate analgesic effect in patients with chronic midportion Achilles tendinopathy. Methods Patients with clinically diagnosed chronic midportion Achilles tendinopathy were quasi‐randomized to one of four arms: isometric calf‐muscle exercises (tiptoes), isometric calf‐muscle exercises (dorsiflexed ankle position), isotonic calf‐muscle exercises, or rest. The primary outcome was pain measured on a visual analogue scale (VAS) score (0‐100) during a functional task (10 unilateral hops) both before and after the intervention. Between‐group differences were analyzed using a generalized estimation equations model. Results We included 91 patients. There was no significant reduction in pain on the 10 hop test after performing any of the four interventions: isometric (tiptoes) group 0.2, 95%CI −11.2 to 11.5; isometric (dorsiflexed) group −1.9, 95%CI −13.6 to 9.7; isotonic group 1.4, 95%CI −8.3 to 11.1; and rest group 7.2, 95%CI −2.4 to 16.7. There were also no between‐group differences after the interventions. Conclusion The isometric exercises investigated in this study did not result in immediate analgesic benefit in patients with chronic midportion Achilles tendinopathy. We do not recommend isometric exercises if the aim is providing immediate pain relief. Future research should focus on the use of isometric or isotonic exercise therapy as initial treatment as all exercise protocols used in this study were well‐tolerated.

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Isometric Exercise Above but not Below an Individual’s Pain Threshold Influences Pain Perception in People With Lateral Epicondylalgia

Cited by 26 publications

References 23 publications

The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial

The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial

Exercise-Induced Hypoalgesia in Healthy Individuals and People With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis

Isometric exercises do not provide immediate pain relief in Achilles tendinopathy: A quasi‐randomized clinical trial

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