November 2025

THE INTERSECTION OF EVIDENCE-BASED SCIENCE AND PRACTICAL D-I-Y INJURY

TREATMENT AND ROUTINE STRENGTHENING

At this stage of my physical therapy career, it is rare that I encounter really new and exciting evidence-based treatment strategies for injury rehab that also correlates with non-injury fitness and strengthening. In my quest to rehab myself from a hip tendon tear, I very recently came across research and treatment/strengthening protocols that should dramatically modify rehab measures for joint and soft tissue injuries including post-surgical rehab. I must avoid getting into the weeds and will try my best to make it as clear and concise as possible. This month’s offering explains the process and then applies it to Pickleball Elbow (No tennis!). Subsequent newsletters will include other common injuries. For clarity, an isometric exercise is one where you activate muscle activity while remaining stationary. For example, if you perform a standing squat and hold the squat then you are performing an isometric exercise to those muscles.

Research involving elite rock climbers, renowned for their exceptional finger flexor strength needed for gripping and supporting body weight, examined various strengthening methods using laboratory measurements of tension, compression and shear forces on muscles, joints and soft tissues (tendons, fascia). Researchers studied these rock climbers by dividing them up into 4 groups. Each group underwent grip and pinch strength measurements prior to intervention. Group 1(Control): No intervention for 30 days; Group 2: Isometric finger flexion at sub-maximal (40%) effort for 10 seconds followed by 50 seconds rest. This sequence was repeated 3 additional times for a total of 4 minutes. After 6 hours, they repeated this same 4 repetition cycle. Over 30 days, this twice daily sequence was repeated daily. Group 3: Traditional gripping and pinching strengthening exercises utilizing brief 10-12 repetitions over 3-5 sets that also included other upper extremity strengthening exercises over 30 days. Group 4: Combined strategies of Groups 2 & 3 over 30 days.

Results: Group 1 (Control): No change in grip or pinch strength; Group 2: Statistically significant improvement in grip and pinch strength. Group 3: Statistically significant improvement in grip and pinch strength but equal to that of Group 2; Group 4: Statistically significant increased grip and pinch strength than either Group 2 or Group 3 by themselves. So a cumulative effect.

Conclusion: Sustained sub-maximal (40%) 10 second isometric holds followed by a 50 second rest and then repeated 3 additional times over 4 minutes and repeated 6 hours later and performed daily over 30 days resulted in statistically significant improvements in grip and pinch strength in elite rock climbers. The improvement is due to the sustained

tension that is transmitted to the tendon resulting in tissue matrix remodeling, enhanced by hormonal release, that “thickens” and thus strengthens the cross-sectional area of the tendon. This study also investigated injured tendons like you find with rotator cuff tears (RCT); Pickleball Elbow; Golfer’s Elbow; tendon tears and strains in the hip, knee, ankle and spine. The modification of the protocol for these injuries was that the sub-maximal isometric (40%) lasted 30 seconds followed by a 2 minute rest and then repeated 3 additional times (total time 10 minutes) with a 6 hour rest before a 2nd set later in the day. This was repeated daily for 30 days. Pain during the sub-maximal isometric was not to exceed 2/10 on a visual analog scale (VAS). This protocol resulted in statistically significant improvement in strength and less pain.

D-I-Y isometric treatment protocol for Pickleball Elbow a.k.a Tennis Elbow for a dwindling number of players. Please note that the isometric time and the rest time are tested and crucial for the success of the protocol. Use your phone’s stopwatch feature. You can also estimate 40-60% of maximum weight/resistance intensity.

ISOMETRIC WRIST EXTENSION WITH WEIGHT: Do not follow any directions on the video. The amount of weight you hold should be somewhere between 30-50% of what you could very briefly hold. For example, if you can briefly hold a 10 pound weight, then hold a 4 pound weight for 30 seconds and rest 2 minutes. Repeat 3 additional times for a total of 10 minutes. Repeat this cycle at least 6 hours later. It is possible to space this exercise 3 times during the day. This is repeated daily for a minimum of 30 days. Keep any pain at 2/10 or less.

https://share.google/images/YTuKzg0O1IZ94qVGv

ISOMETRIC WRIST SUPINATION WITH WEIGHT: Again, do not follow the instructions from the video. Follow the instructions I provided you for isometric wrist extension.

https://youtu.be/6G-PomeThok?si=WV8PWdZIyhSjQTw0

As always, contact me by text or email but also in person on the courts.

Mike Darnell PT

Text/Call: (706) 455-4857

Email: mdpt@tds.net