Practical Guide: Isometric Exercises for Tendon Healing

Daehan Kim. M.Sc., NASM-CES, CSEP-CEP., NSCA-CSCS
Oct 3
5 min read

Updated: 2 days ago

If you’ve landed here, you may have been directed by a handout from the 2025 Canadian Association of Orthopaedic Medicine conference or arrived from my first blog post on tendon rehab, where I explained why isometric loading is effective for stubborn tendon pain.

That said, this post is designed to be practical. But don't worry if you have come across this page independently and don't have background information yet. The "Isometric Loading 101" section in this post will cover everything you need to know before delving into practical application.

Here, you’ll find:

✅ A quick recap of the essentials, so you can follow along even if you haven’t read the first blog
📋 Isometric Loading 101: The Essentials for Tendon Isometrics
📝 A PDF handout (last update: November 5th, 2025) with written instructions and photos for exercises, exercise progression, protocol details, and nutrition integration
🎥 Video demonstrations for the exercises that may not be perfectly clear from photos alone — so you can see the correct technique in action

Quick Recap – Why Isometrics Matter

Tendons heal slowly and often flare up with small movements.
Isometric loading (gentle, sustained holds) helps stimulate weaker tendon fibers, encouraging repair and long-term resilience.
Done consistently, isometrics reduce pain, support tendon remodeling, and help prevent flare-ups.

Isometric loading 101

1️⃣ What is Isometric Exercise and Why is it Effective for Tendon Rehab?

Unlike typical strengthening, isometric loading involves holding a muscle contraction without movement. But not all isometrics are the same. We emphasize a specific type that helps bypass a challenge called stress-shielding, where stronger tendon fibers absorb most of the load while weaker, injured fibers get left out. With the right protocol, even the weaker fibers can be stimulated to adapt and heal.

Here is the video presentation for those who want to understand the science behind it.

2️⃣ Key Protocols for Isometric Exercise and Science Behind Them

This is the foundation you’ll return to throughout your tendon rehab journey:

Exercise: 4 cycles of 30-second holds
Rest: 2 minutes between holds
Effort level: Moderate pressure (~50% of max effort) is enough — you should feel tension in the tendon without straining
Pain guidelines: Mild discomfort (1–2 out of 10) may be okay, but avoid sharp or stabbing pain
Avoid “jerk”: Always push or pull gradually — sudden movements don’t load tendons evenly and raise injury risk
Frequency: 1–2 sessions daily (each session = 4 cycles), with at least 6–8 hours between sessions

Here is the video presentation for those who want to understand the key protocol more in detail.

3️⃣ Two Types of Isometric Exercises

Isometrics can be applied in two slightly different ways. Both promote tendon healing, but each has a unique purpose.

Push & Hold: Gradually press against an immovable object without movement.
Hold & Resist: Maintain a position while resisting an external force.

A table that compares the "push and hold" with "hold and resist" isometrics

4️⃣ The 4-Level Progression System

To make tendon rehab safe and effective, isometrics are arranged in a 4-level progression. This ensures you start at the right intensity and gradually challenge the tendon as it heals.

A picture describing 4-level progression system for isometric tendon exercises

Download the printable PDF Handouts (Last update: November 5th, 2025)

📥 Handouts are grouped by topic—choose the ones that fit your needs

Basic Principles and Key Guidelines

Nutrition integration guidelines

Patellar Tendon isometric exercise examples and progression strategies

Achilles Tendon isometric exercise examples and progression strategies

Upper Hamstring Tendon isometric exercise examples and progression strategies

Lower Hamstring Tendon isometric exercise examples and progression strategies

Exercise progression models for post-orthobiologic injection rehab (e.g., PRP, prolotherapy)

References to the scientific foundation of this approach

⚠️ While the basic protocol is designed for safe, independent use at home, nutrition and post-injection programs are supplemental and should always be integrated under the guidance of your physician. We gratefully acknowledge Dr. Pam Squire, who initiated this project and helped shape its overall purpose. She also provided valuable feedback and guidance to ensure the handout meets the standards and expectations of the physician community.

Video Demonstrations for Upper Hamstring Tendon

Level 1: Bridge without lift