There is some great new evidence to suggest that Isometrics can give good pain relief in PATELLA tendon.  Isometrics are superior to isotonics and can reduce the pain significantly allowing the patient to perform better- could be used to improve loading and allow return to play or increase performance in . Time under load were matched, and note the angle that these are performed in – at 60 degrees and at 80% of a 1RM- so load is key.

Thanks Jill Cook and Group for a great clinical paper.

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
Published Ahead-of-Print
Collapse BoxAbstract
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.

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