Tendinopathies, the artist formally known as tendinitis, are common orthopedic and sports medicine conditions affecting both athletes and the general population.  Repetitive overload (overuse) of these structures creates a reactive followed by degenerative process in the affected tendon.  These injured tissues have not been shown to have significant numbers of inflammatory cells but rather show an in growth of blood vessels and nerves as the injured tendon cells are replaced by immature new cells.  This process of remodeling has been shown to be positively impacted by load management strategies (gradual return of activity) and strength training exercises.  Conversely, complete rest has been shown to slow remodeling and prolong a patient’s recovery.  The process of tendon healing is long and can take up to 12 months secondary to the lack of blood supply in a tendon compared to the adjacent muscles.  The key is early, slow, progressive loading of the injured tendon cells. 

Isometric exercise has recently come into the research due to its’ ability to produce significant pain relief in patients with tendon pain.  In addition, these exercises provide an excellent starting point for patients with tendon pain due to their control, safety, and low energy costs relative to their strength training exercise counterparts.  The research has shown benefits in both short and long duration isometric holds but the intensity of the exercise should be high.  Systematic reviews have documented a force of at least 70% of maximum voluntary contraction (MVIC) is required to improve tendon structure (remodeling) and function (Oranchhuk et al. Scandinavian J Med Sci Sport. 2019). 

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