Physio Edge podcast with David Pope18 Helmi

175. Tendinopathy treatment: Your guide to isometrics, isotonics & plyometrics with Dr Ebonie Rio

Should you prescribe isometric or isotonic exercises for your patient's lower limb tendinopathy?

When is it safe to add plyometric loading, and how do you progress running or jumping without flaring your patients tendon pain?

Why do some "tricky tendons" refuse to respond to your best loading programs?

Dr Ebonie Rio (Post-Doctoral Senior Research Fellow, La Trobe University) reveals the evidence-based answers as she guides you through the clinical reasoning and practical strategies for managing patellar, achilles, and other lower limb tendinopathies.

In this conversation, you'll follow clinical examples and unpack the latest research to help you feel confident with tendinopathy assessment and treatment.

Inside this podcast you'll explore:

Tendon pathology explained: What's happening inside tendinopathic tendons, how to explain tendinopathy and ultrasound scan results to patients
The role of isometrics: Whether isometrics actually change tendon structure, when to use isometrics to improve pain, optimal dosage, and whether isometrics are all your tendinopathy patients need
Safe loading from day one: When are both isometrics AND isotonics safe to start immediately, and how to choose isometric positions and loads.
The 24-hour emoji rule: How to teach patients to monitor their response after running or loading using the emoji system
What NOT to do: Exercises, manual therapy and supplements that won't help tendon pain and may stir it up
Differential diagnosis mastery: How to distinguish patellar tendinopathy from patellofemoral pain, mid-portion achilles tendinopathy from peritendinitis, and when you've got the diagnosis wrong
Stairs as a progression exercise: The quasi-isometric stair protocol that works for everyone from sedentary patients to elite sprinters—and how to use tempo to control tendon load
Criteria-based progressions: Moving beyond time-based rehab to functional milestones
When loading programs fail: What to do when your patient is worse with your exercises

You'll walk away with:

Clear clinical reasoning to differentiate true tendinopathy from other conditions
Practical loading frameworks that progress your isometrics, isotonics and plyometrics based on patient response
Patient education scripts that use imaging findings to build confidence rather than fear
Simple monitoring tools (the emoji system) to empower patients to self-manage their load progression

Dr Ebonie Rio is a post doc researcher at La Trobe University and has completed her PhD in tendon pain, Masters Sports Phys, B. Phys (Hons) and B. App Sci. Her clinical career has included the Australian Institute of Sport, Australian Ballet Company, Australian Ballet School, Melbourne Heart Football Club, Alphington Sports Medicine Centre, Victorian Institute of Sport, 2006 Commonwealth Games, 2010 Vancouver Winter Olympics, 2010 Singapore Youth Olympics, 2012 London Paralympics, 18 months travelling with Disney's The Lion King stage show (Melbourne and Shanghai tour).

Get free access to the "Tricky tendons" infographic series

Unlock the secrets of successful tendinopathy assessment and treatment with this free infographic series for therapists.

Links

Chapters:

00:02:57 - How isometrics emerged as a tendinopathy treatment
00:07:00 - How loading helps a tendon
00:07:38 - Tendon structure & how to describe tendinopathy to patients
00:12:27 - When and why tendinopathy develops
00:15:17 - Tendon imaging
00:17:38 - Differential diagnosis - Achilles peritendinitis vs mid-portion tendinopathy
00:19:35 - Does treatment change tendon structure?
00:21:27 - Can we load disorganised areas of tendon?
00:22:46 - Do supplements help?
00:24:44 - Avoid these in your tendinopathy treatment
00:26:47 - Finding the right level of running or load
00:28:40 - What causes tendinopathy to develop
00:31:52 - When and how to include isometrics in treatment
00:36:42 - When isometrics are likely to help or not help
00:38:51 - Choosing the starting position for isometrics
00:39:38 - How to describe isometrics to patients
00:40:23 - How to choose the load for isometrics
00:42:53 - When to include isotonics in treatment
00:44:03 - Plyometric & Stair loading
00:46:49 - How long should isometric holds be?
00:47:26 - Patient advice & discussion

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