How Often Should You Do Isometrics?

: On today's episode, how often should you do isometrics? course, bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series, and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. Welcome back everyone, thanks for joining me on this episode. It's sort of answering a very specific question and not sure how long this episode will go, but I hear this constantly. It's always popping up in Facebook groups and people always personally asking me with a bit of confusion. So I thought I would do a episode just highlighting the specifics around this particular exercise so that if someone is confused in the future, I've got an episode to point them towards. and it is all about how often should you do isometrics amongst your rehab. And yeah, I thought I would start off by highlighting or explaining what an isometric is to start with. So you've got two types of exercises, you've got isometrics and then you've got isotonics. So isometrics is just straining your body while holding a certain position. So we're not going in and out of movement and your isotonics are through movement and those isotonic can be split up into concentric and eccentrics, but for the breadth that we're going to cover in this topic, let's just focus on the isometric and isotonic. As an example, most people who have been rehabbing their PHT would be familiar with a bridge, a glute bridge, a double leg bridge, whatever you want to call it. The isotonic variation would be moving in and out, like doing the bridge with weight, without thrusting up to the ceiling, then coming back down, thrusting up, coming back down and like moving and maybe doing three sets of ten just as a vague example. The isometric would be to thrust up towards the ceiling, hold it, hold it for the desired period of time, might be 15 to 30 seconds, and then come back down. And it's the act of holding that position is what makes it the isometric, sort of straining the body while holding that still position. Some exercises, like I say, a double leg bridge would be a good type of exercise. A single leg bridge would be a variation of that isometric so you can hold that position with a single leg. A long lever bridge, people might have heard me talk about on the podcast, which you still do the bridge exactly the same, but your feet are further away from your body. further away from your head so that it creates a longer lever. But, so people may be familiar with those, but there are others. We can do exercises into compression. So like with a little bit more hip flexion, that would be a classic example of that type of exercise would be a deadlift, where you have to hinge at your hips and compress and stretch the tendons that way. But you can do this as an isometric, doesn't have to be through movement. I don't really prescribe it too much as a isometric, but you could take a bar or take weights at the top position, so you standing up nice and tall, and then you hinge down to maybe half range of movement. Maybe the weights go and stop just above your knees, and then you just hold that position, and you can hold that for 10, 15 seconds, and then come back up, and that is an isometric deadlift. We can also do it with a hip dip. Most people know that I like this exercise. It's similar to your Nordic drop where your ankles have to be clamped or secure underneath a piece of furniture or a T-bar or whatever you have access to. But I like doing ones, a variation where you dip forward at the hip. So again, you're hinging at the hips while those ankles are sort of strapped in. But you can do this as an isometric. You can dip forward, maybe like a quarter range of movement. wouldn't, it'd be a bit too strenuous if you had to go the whole way and sort of bend 90 degrees at your hips and try and hold that. But we can do this as a good exercise. A heel press would be another one. We actually do this as a diagnostic tool. Sometimes in clinics, we have someone lying down on their back and their hips are bent at 90 degrees. Their leg is bent at 90 degrees. So it makes this 90-90 angle. and their heel, sometimes it's on the therapist's shoulder, sometimes it's on like a plyo box or something. And then you dig your heel down into that box, don't come up into a bridge, but just press your heel down into the box. And if that triggers pain in the high hamstring region, we can start to suspect that it might be PHT, but we can do this in isometric as well. You can lie down on the floor and pop your leg up onto a chair. okay, if it's probably preferred if it's a bit firmer, but then you press your heel down into that chair, and you can hold that for 10, 15 seconds, and that's an isometric hamstring exercise. Typically, we're looking at three sets, three to four sets of 15 to 30 seconds. We wanna try to activate that area, but we don't wanna really take it too much to fatigue. There is good research on the benefits of isometrics for tendons, mainly done around the patella tendons, but we can sort of extrapolate away towards the hamstring. And we know that we don't want to contribute to shaking tremors, like fatigue type of shaking, because tendons don't really respond well to that. So we're looking for a duration of time, like I say, sometimes between 15 to 30 seconds where it's engaging that tendon, it's sort of warming up that tendon. putting it through load, but not holding it long enough that you start to get some shakes in the muscle and the tendon. And then you just add load that is appropriate. So these isometrics definitely don't need to be body weight. You can do deadlifts with weight. You could do bridges with weight. You can do your heel press with weight. You can do hip dips with a weight at your chest. Whatever's really challenging for you to get that sweet spot of between under load and overload. Why do we do isometrics? That's the big question. I can only think of two reasons why you do isometrics. The first reason would be it's just a level one exercise. And if you are at the point of your rehab where you are quite deconditioned, the injury is quite sensitive, we can't really tolerate a lot, we would start from the ground up and the ground being isometrics. So we try to prescribe certain type of exercises, certain type of dosage, certain frequency throughout the week, so that it starts to foster this, starts to attempt the getting stronger, the tendon tolerating more and more load. So one reason is it's a level one exercise. It's a baseline exercise that we assign people. And the isometric tends to avoid, it's our best attempt to avoid irritation in most exercises. So if I give someone a calf raise and it's an isometric calf raise, I have the justification to do the isometric because maybe going through movement up and down into that calf raise might irritate the injury. So an isometric is a nice way to still load the tendon. while trying to balance out some elements or variations of that exercise that might cause irritation. So baseline exercise, the second reason I would give someone an isometric is to create an analgesic effect, which is just a fancy term that dampens people's pain levels. Sometimes people can be sitting and walking around and doing stairs and their hamstring is like a two or three out of 10 discomfort. and then they do their isometric exercises and that pain is down to a one or even symptom free. I've mentioned this on the podcast before, but I have a very good analgesic effect to load. I think it's based on all the clients I've worked with and the people that I've talked to, I think my analgesic effect is a little bit more enhanced than others, I don't know why, but I've had. Achilles issues in the past. I've had a battala tendon issue in the past and I've also obviously had high hamstring tendinopathy in the past and when I load up those When I load up With exercises to load the tendon if it's irritated on that day It might be a three when I load it but by the second set that goes down to a one and so I increase the weight again and It might still be a one for the second or third set But by the end of that third set, I am pain free. And I feel really good for hours afterwards. And that is a perfect example. I'll go back to sitting, I'll go back to doing stairs and I don't have any pain. And that's an extreme example. And your response might be somewhat a mild case of that, but that's what we're aiming for when it comes to using these exercises as analgesics. Isometrics. Um, it doesn't have to be isometrics that create that analgesic effect. If I, because I could do dead lifts through range and I still get that analgesic effect, but isometrics, like I mentioned, are a way of low load, not a lot of movement to irritate the, um, injury, but can produce that analgesic effect. Okay. How often? should we do this? So there's only two reasons why I'd get you to do this. It's a level one exercise and to serve as an analgesic if that's your individual response, if you get that analgesic response. So how often should we do it? This question or the answer to this question will depend on why you're doing those isometrics, one of those two reasons. So let's go with that first reason and say that we are doing your isometrics because it is a level one foundation exercise and you can't do anything more challenging because of the rehab scenario that you're in. So if that were the case, I would perhaps do this type of isometric exercise maybe one to three times a day, one or maybe two times for most, two times a day, depending on your symptoms. And I say depending on your symptoms because it's always gonna refer back, symptoms are always gonna dictate how often we do these, but as a vague sort of thing, rule, we will say twice per day. And that's only because it's such a low loaded exercise. Like I say, this is a level one baseline exercise that shouldn't really irritate, but offers some nice healthy load. And because it's so, because you can't tolerate anything higher or anything more strenuous or more challenging, It doesn't require a lot of recovery. Therefore, why not do it a couple of times a day? People often ask me, oh, if I do my deadlifts, how often should I do them? I sort of have to lay out this scenario. So we assign the frequency of exercises based on how much your body can tolerate or how much your injury can tolerate. We start you off with deadlifts. How much can you tolerate? it's gonna, the starting point is gonna be so different for everyone. Some people can only start with five pounds, half range of movement, three sets of five. But someone can start off with 80 pounds, three sets of six. The frequency that we do these exercises at will vary very differently. Scenario number one, can only tolerate five pounds. Let's do that three times a day. The person can tolerate 60, 80, 100 pounds. let's do that maybe twice a week, because you need the recovery to back, to, you need the recovery on the backend to offer that right balance between load and recovery. And somewhere along the way for that one person who starts off at five pounds, they progress and progress and progress to 10, 20, 30, 50 pounds. And eventually that frequency will have to start tapering off so that it matches that second scenario. So we may start off twice a day, but eventually we'll get to twice a week. So when someone asks me how often, how frequently should I do these exercises, I say it depends, it depends on how much your starting point is or how much you're currently lifting. And that might fluctuate here and there, like we might get really technical with someone and say do a high day, an easy day, a medium day, and then a rest day. So you are doing heavy 100 pound deadlifts twice a week, but you might also be doing 40 pound deadlifts another two times per week, if we wanna just continue offering some sort of load for that analgesic effect. Okay. So how often are we doing these exercises for these isometrics? It depends, it might start off with twice per day, if you're doing it for a level one exercise, can't do anything else. But then we wanna quickly progress. In that scenario, we do want to quickly progress to weighted exercises, modified deadlifts, hamstring curls, weighted step ups, those sorts of things. So we're quickly moving out of the isometric phase once you're tolerating it. So that is scenario number one or reason number one of why you would be doing isometrics. But remember, there was a second reason why we're doing isometrics, and that was for the analgesic effect. If this is the reason why you're doing it, then how often we do it will depend. How often we do it is almost like we treat it like a painkiller. Like if you take a painkiller tablet, we do that when you're in pain and that's pretty much the only reason. So in a flare up state, and if you have a good response to isometric exercises, when you're flared up, hey, let's do it every two or three hours, very low load, but very frequently. similar to what you would with pain medication. You take a Neurofen or you take some Panadol or something, you know, two to three times a day. And once you're getting better, we wean off the pain medication and then we get back into the heavier stuff which contributes to the long-term gains. So, you know, when flare-ups we wanna... We want to resume the isometrics at a high frequency until it's settled, essentially. You might find that after a, sometimes throughout the week, like I say, if you're doing a complicated high day or a heavy day, then an easy day, then a moderate day, then a rest and, you know, fluctuating through that. On that easy day, there might be some isometrics in there. just because it offers a little bit of load and helps you feel better throughout the day. But that's what I would prescribe. But in both of those scenarios, whether you're doing it for a level one exercise or whether you're doing it for the painkiller effect, we're quickly transitioning out of isometrics. And I say this because a lot of people get really hung up with doing isometrics because they feel that benefit and they just latch onto it and continue doing it. but it doesn't really get you anywhere in the long term. It only just serves as a, like if you were, if you had a headache and you took Panadol and it made you a bit better, you wouldn't continue taking that Panadol after having that headache. Or if you had that headache, you know, continue for six months, you wouldn't continue taking that Panadol for a little bit of relief. You'd be like, okay, there's probably something else I could do to get rid of this headache. There's probably something that I'm missing here. So we should do the same. And it kind of, this is where it differs in the research because a lot of people find that paper that has the three stages of PHT rehab. Um, I'm going a bit off my script here. So I'm deviating away from my script, but, um, there's those three levels and yes, I'm, um, guilty of giving people this, this information because it was one of the earlier episodes on my podcast talking through the three stages of rehab. I'm sort of defining it a little bit differently these days because some people do level one exercises, which is the isometrics, which is what the paper prescribes. And then they say level two exercises, ah, weighted bridges or getting into, you know, like rollouts and like exercises that have a little bit more eccentric, a little bit more concentric. And people do those and it increases their pain or they're scared to transition into that because they feel like they're not ready. and then they just do isometrics for a long period of time. And how my opinion has changed over the years is I give people deadlifts straight away. I almost bypass the level one, I bypass the isometric phase if they can tolerate something heavier. We just need to find what that is because I start people on deadlifts day one straight away, but just trying to find out what. deadlift they can tolerate. Like I said earlier, some people five pounds, half range of movement, three sets of five, once a day. That could tolerate, like most people could tolerate that. And then we just progress from there. So we're almost diving straight into stage two of what is in that paper, those three stages and bypassing stage phase one essentially. Just so we can get your confidence, get that load, eventually progress to foster that environment that tendons love rather than just being really stuck in that isometric phase and afraid to progress beyond it. Okay, I want to make sure I've covered everything here. So every two, three hours, we talked about the flare ups, we talked about once you're, if you have a flare up and you're doing your isometrics, once it's getting better, we wean off those isometrics and get back into the heavier stuff. I thought I'd finish off with some misconceptions. Some misconceptions, isometrics rarely move the needle. They help in the short term, but they very rarely help for the long term. And as our goal for all rehab is to come up with long-term effects, long-term benefits. And that comes with the slow heavy stuff, which we need to progress through. We need to phase out of the isometrics. So rarely does it move the needle for the longterm. The other thing, they shouldn't continue three times a day. If you shouldn't be doing the isometric three times a day, if it settles your symptoms for too long, like we wanna move away. We don't wanna be loading the tendon small amounts very frequently for two months, three months straight. have the confidence to wean off that and transition into something that might be heavier, that might be less frequent. Um, and they don't need to be done when you're lifting heavy. They don't have to be, um, they don't have to be a warmup exercise. They don't have to be an analgesic. You can just try and figure out what works for you. So hopefully we've cleared up a few of those things, but just as a general summary. two reasons why you should be doing isometrics. Either one, your condition, your injury is really sensitive and so, I guess, deconditioned or weak that you have to do these isometrics as a level one foundation exercise to start up some strength. Or you are really strong, but you're going through a particularly rough patch at the moment with a flare-up, and we need to just do some analgesics as a painkiller to make you feel better. Both of those scenarios were quickly transitioning away from isometrics when you're ready to get into the heavier stuff that is the long term, what the tendons love, what the tendons enjoy. So, hopefully I've cleared this up. Hopefully I've created this resource to help you maybe spark a little bit of ideas of how you want to change your rehab. But if you have any questions, reach out to me. Let me know. I'm glad this episode is now out here. Hopefully it's clear enough. Hopefully it makes sense. And I can point people to this episode in the future. So good luck with your rehab this week and we'll catch you in the next episode. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format, then go ahead and check out the Run Smarter podcast. Hosted by me. I'll include the link along with all the other links mentioned today in the show notes. So open up your device. Click on the show description and all the links will be there waiting for you. Congratulations on paving your way forward towards an empowering, pain-free future. And remember, knowledge is power.