Isometrics for Tendinopathy

[Jeff Dausch]

Ive been struggling with bilateral patellar tendinopathy/PFPS for years now. It’s gotten better with training and managing training load and volume. I’m able to train through it, it just feels like hell the rest of the time. I’ve read about isometrics having a positive effect on these issues, but haven’t been able to find details on it. How would one go about incorporating this into a training regimen. Isometric leg extensions post workout, wall sits on days off, etc?

Any advice or insight would be appreciated.

Thanks.

[Michael Ray]

Ive been struggling with bilateral patellar tendinopathy/PFPS for years now. It’s gotten better with training and managing training load and volume. I’m able to train through it, it just feels like hell the rest of the time. I’ve read about isometrics having a positive effect on these issues, but haven’t been able to find details on it. How would one go about incorporating this into a training regimen. Isometric leg extensions post workout, wall sits on days off, etc?

Any advice or insight would be appreciated.

Thanks.

How old are you? Are you experiencing symptoms while training? If you are feeling like hell the majority of the time, then load is likely not being optimized. Tendinopathy is typically a question of appropriate loading and allowing time for adaptations.

[Jeff Dausch]

Hi Doctor Ray. I’m 45. I stopped squatting for a couple years because of it, which of course had no effect. After 8-10 empty bar warm ups, I can get into position and start my warm up sets and squat relatively pain free. The pain and tightness comes in immediately after my work sets though. I’m still trying to find my optimal training load (volume and intensity).

I’m going on 5 years with this issue.

Thanks for the response.

[Michael Ray]

Hi Doctor Ray. I’m 45. I stopped squatting for a couple years because of it, which of course had no effect. After 8-10 empty bar warm ups, I can get into position and start my warm up sets and squat relatively pain free. The pain and tightness comes in immediately after my work sets though. I’m still trying to find my optimal training load (volume and intensity).

I’m going on 5 years with this issue.

Thanks for the response.

Gotcha. The usual heuristic with tendinopathies is it's ok to experience symptoms while training but these symptoms shouldn't leave you feeling debilitated afterwards and shouldn't be increased above usual baseline for 24 hours. If either of those are occurring, then there's a good chance you are not tolerating loading well. What's training typically look like for you each week?

[Jeff Dausch]

I ran the NLP after being away from squats for so long. I was not recovering towards the end even with all recovery variables in check. I started The Bridge, but shortly in to that, I realized the paused squats, heavier tempo work and increasing volume was not going to fly either. I have a 2 week layoff coming up due to a minor unrelated procedure I have to have done. Once I return I was going to give a H/L/M system a try with a much lighter starting point to see if I can find that sweet spot then titrate slowly from there. If 3x/week is still too much at the lighter intensities, I’ll have to find a 4/week program squatting twice weekly.

Ive also been working with a great PT I found on Clinical Athlete. Things had been feeling better, especially with ROM, but I feel like I’m going backwards over the last few weeks. Pain is much worse now than it’s been. Not sure if the Extra PT work twice a week is making it worse either (split squats, lunges, goblets).

Thats is the current/foreseeable plan.

Thanks again for your time.

EDIT: There was a period during LP where everything was feeling better, in and out of the gym (low to mid 200’s). Things got sore again as I pushed towards 300 (stopped at 295 @ 3x5).

[Michael Ray]

I ran the NLP after being away from squats for so long. I was not recovering towards the end even with all recovery variables in check. I started The Bridge, but shortly in to that, I realized the paused squats, heavier tempo work and increasing volume was not going to fly either. I have a 2 week layoff coming up due to a minor unrelated procedure I have to have done. Once I return I was going to give a H/L/M system a try with a much lighter starting point to see if I can find that sweet spot then titrate slowly from there. If 3x/week is still too much at the lighter intensities, I’ll have to find a 4/week program squatting twice weekly.

Ive also been working with a great PT I found on Clinical Athlete. Things had been feeling better, especially with ROM, but I feel like I’m going backwards over the last few weeks. Pain is much worse now than it’s been. Not sure if the Extra PT work twice a week is making it worse either (split squats, lunges, goblets).

Thats is the current/foreseeable plan.

Thanks again for your time.

EDIT: There was a period during LP where everything was feeling better, in and out of the gym (low to mid 200’s). Things got sore again as I pushed towards 300 (stopped at 295 @ 3x5).

Gotcha. Have you discussed your pain experience with your treating PT?

[Jeff Dausch]

Gotcha. Have you discussed your pain experience with your treating PT?

Yes sir, ad nauseum.

[Michael Ray]

Yes sir, ad nauseum.

What did he/she have to say?

[Jeff Dausch]

He and I both agree that I need to find that tolerable load again and work up slowly from there. For the prescribed rehab exercises (goblets, lunges, split squat, isometrics) I only work to a point just above the pain threshold. I would use those exercises as a subjective gauge to assess if I’m tolerating training load well.

I guess after this 1-2 week layoff I have coming up, I’ll ease back into it again slower and see how things go.

Let me know if you have any other suggestions.

Thanks again for your time.

[Michael Ray]

He and I both agree that I need to find that tolerable load again and work up slowly from there. For the prescribed rehab exercises (goblets, lunges, split squat, isometrics) I only work to a point just above the pain threshold. I would use those exercises as a subjective gauge to assess if I’m tolerating training load well.

I guess after this 1-2 week layoff I have coming up, I’ll ease back into it again slower and see how things go.

Let me know if you have any other suggestions.

Thanks again for your time.

Sounds like you are on the right track. The tough part is embracing the process and being patient. Exacerbation is usually par for the course when dealing with tendinopathies.

[Jeff Dausch]

One final thought (I promise). Ill probably go with a heavy/light 4 day split. I’m planning on starting with 2 light days/week for squat (70% 3x5). Then slowly increase one of the days that hopefully will become a heavy(ish) day as things progress. The other 3 lifts would follow the standard H/L programming.

Any suggestions with this plan? I think I’m on the right track.

Thanks.

[Michael Ray]

One final thought (I promise). Ill probably go with a heavy/light 4 day split. I’m planning on starting with 2 light days/week for squat (70% 3x5). Then slowly increase one of the days that hopefully will become a heavy(ish) day as things progress. The other 3 lifts would follow the standard H/L programming.

Any suggestions with this plan? I think I’m on the right track.

Thanks.

You can certainly attempt that program and see how you respond. I usually recommend LP that starts with high volume and low intensity at tempo (3.0.3) for sensitized movements.

[Jeff Dausch]

What would you consider high volume in this case, 5x8-10? 5x5? Or should I be looking at a certain number of total reps per session?

Hoping to be back at it next week sometime. I have 4 wisdom teeth coming out tomorrow morning.

Thanks.

[Michael Ray]

What would you consider high volume in this case, 5x8-10? 5x5? Or should I be looking at a certain number of total reps per session?

Hoping to be back at it next week sometime. I have 4 wisdom teeth coming out tomorrow morning.

Thanks.

For the provocative lifts, I typically start out at 3 x 15.

[Jeff Dausch]

Dr. Ray, thanks so much for taking this time to consider my situation. Between our conversation and the ongoing thread with Jungle Dave, including the rep scheme you laid out for him, I’ve got a solid plan nailed down.

Your time and advice are greatly appreciated to say the very least.

Thank you again, and I’ll post up an update as I get further along...and better!