Tendinopathy Explained: Why Your Physio Talks About Isometrics

If you’ve been hearing the term tendinopathy but aren’t entirely sure what it means—or why your physiotherapist keeps talking about isometric exercises—this post is for you. Let’s unpack what’s really going on with tendons, why rest alone won’t fix the problem, and how isometric training can help.

What Is Tendinopathy?

Tendinopathy (sometimes also called tendinitis or tendinosis) is a condition that affects the tendons—the strong cords connecting muscles to bones.

Unlike tendinitis, which suggests inflammation, tendinopathy usually involves degeneration and disorganisation of tendon fibres, rather than just swelling or irritation.

It often develops gradually due to:

• Repetitive use

• Overloading the tendon

• Poor recovery between activities

Common symptoms include:

• Localised pain and tenderness

• Pain during activity

• Stiffness, sometimes with swelling

Commonly affected tendons:

• Achilles (ankle)

• Patellar (knee)

• Rotator cuff (shoulder)

• Lateral elbow (tennis elbow)

• Gluteal tendons (hip)

The condition is very common, making up a large portion of musculoskeletal pain seen in clinics. The encouraging part? With proper rehabilitation, about 80% of people improve within a few months.

Why Rest Isn’t the Answer

It might feel logical to rest an injured tendon, and in the short term it can help reduce pain. But tendons don’t regain health and resilience through rest alone.

Instead, they require progressive loading—structured exercise that gradually increases the tendon’s ability to handle stress. This strengthens the tendon, restores its structure, and reduces the chance of reinjury.

Isometric Exercises: A Key Rehab Tool

What are isometric exercises?They involve contracting a muscle without changing its length—for example, holding a static position or pressing against an immovable object.

Why they’re useful:

• Immediate pain relief: Research has shown that isometrics can provide rapid pain reduction, particularly for patellar tendinopathy. In some cases, pain scores dropped from 7/10 to nearly zero, with relief lasting up to 45 minutes.

• Early rehab strategy: Many physiotherapy protocols include isometric holds (45–60 seconds, 5 reps, 2–3 times per day at 40–70% of maximal effort) as a way to manage pain before moving into heavier loading.

👉 Here’s a practical example: Watch this YouTube demo of an isometric exercise for patellar tendinopathy.

The limitations:

• Evidence is mixed: A 2020 review found that isometrics aren’t always better than isotonic (movement-based) exercises.

• Tendon-specific: They appear to work particularly well for patellar tendinopathy, but results vary for Achilles, shoulder, or elbow tendons.

• Individual response: Some people get great relief, others very little.

The Bigger Picture: Balanced Rehab

So, are isometrics the “king” of tendon rehab? Not exactly.

Here’s the take-home message:

• ✅ Tendinopathy is degenerative, not just inflammatory.

• ✅ Exercise—not rest—is the cornerstone of treatment.

• ✅ Isometric exercises can provide short-term pain relief, especially in patellar tendinopathy.

• ❌ They’re not a standalone cure—evidence shows no consistent advantage over other strengthening methods.

• 💡 A successful rehab plan combines isometrics, eccentric loading, and progressive strengthening to fully restore tendon health.

Final Thoughts

If you’re dealing with tendon pain, don’t rely on rest alone. Work with your physiotherapist to design a structured program that starts with pain-relieving strategies like isometrics, and gradually builds strength and resilience through progressive loading.

With the right plan, you’ll not only reduce pain—you’ll rebuild tendon capacity so you can get back to moving with confidence.