Push Or Hold?

I like to spend a few hours most days reading ‘stuff’. This means I usually read a blog or two, half a dozen abstracts, and normally at least one research paper in full. Most of the stuff I read I would rate as ok, kinda meh, however once in a while something really grabs my attention and gets me a little excited. Yesterday was one of those days!

I was going through my daily email notifications of keyword searches I have set up on various platforms, which I find an effective way to be alerted of new research I may be interested in, and this paper here stood out. First due to its title, but also it made me think more and more which is exactly what a good research paper should do.

As you can see its called Are there two forms of isometric muscle action’ by Laura Schaefer and Frank Bittman from Potsdam, Germany. Now on first reaction, you would think that’s stupid, isometrics are isometrics. But reading further they describe two ways that isometric exercises can be carried out that upon reflection is obvious but something I never even considered a big deal.

The first way isometrics can be done is pushing against an immovable object or surface. The other is holding a fixed resistance or load still. Holding isometrics are where the forces are resisted against, pushing isometrics is where the forces are pushed back against, both methods have no joint movement, hence both being isometric contractions.

Although both isometric exercises these pushing and holding differences appear to have different characteristics. Pushing isometrics, for example, have more ‘endurance’ being able to sustain significantly longer times under tension than the holding isometrics.

The authors wanted to investigate this further to see if there were any other objective differences such as peak forces, EMG amplitudes, and oscillations that could also distinguish pushing isometrics (PIMA) from holding isometrics (HIMA).

What they found was peak forces, EMG profiles and oscillations had no significant difference between either pushing or holding isometrics, but they did find again that pushing isometrics had significantly longer endurance times than holding isometrics

They theorise this may be due to differences in metabolic fatigue and neural control strategies, and holding isometrics being more akin to eccentric muscle actions and pushing isometrics more like concentric actions. This was also based on the subject’s feelings during the different isometrics and one I tend to agree with.

I don’t know about you but when I do maximum effort isometrics I feel much stronger/stable if I am pushing against something that I can’t move, rather than trying to hold a heavy force still. Think of trying to push a fixed wall over v’s trying to hold a falling wall up.

However, the BIG question I have is do these differences in pushing v holding isometrics help explain why we see such a wide and varied response with pain modulation when using isometrics for tendinopathy.

For example, in some lower limb tendinopathy research such as the patella we see isometrics work like a bloody miracle, with complete resolution of pain in some cases. However in the elbow we see the opposite with an increase in pain, and in the shoulder we see a kind of confusing ‘meh’ response showing neither significantly good nor bad effects.

Could this different response be due to how the isometrics are done? Or could it also be that the margin for error in pushing a body parts capacity beyond its threshold in the upper limb is much less than in the lower limb? Meaning upper limbs are much easier to piss off if they have pain or pathology with isometrics or any other exercise for that matter.

Think about how a lower limb often has to do things that require 100s if not 1000s of Newtons of force daily in tasks and functions. A pissy little 50 or 75 Newton isometric exercise is there nothing significant to it

However, the upper limb often experiences far less force in tasks and activities, meaning that the same extra 50 or 75 Newton isometric exercises have a much greater chance of pissing it off, especially if it has pain or pathology.

Anyway, I found this paper really interesting and it got me thinking about how there is no such thing as a standard isometric exercise. And there is most certainly no such thing as a standard response to any exercise.

As always thanks for reading


RehabPush Or Hold?



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  1. The only thing I can take from this is that extensors seem to have more endurance then flexors.
    The muscle is holding a constant length in both instances. The same mechanisms. Muscles can’t push they can only pull (within themselves – I’m not talking about the end product of actual movement). I know you have concentric/eccentric contraction. But neither of these generate a pushing force within the muscle. The isometric contraction is just an actin amd myosin over lap that is trying to be maintained. In the ‘pull’ the muscle starts in shortened position and fatigues quicker. In the ‘push’ the muscle starts in an elongated position and lasts longer.
    Anyway this is more a ramble from me then a coherent review of your blog!
    Keep up the good fight and try and drop the Australian accent on the podcasts ?!

  2. Interesting post Adam though quite how we would replicate the pneumatic forces used in the lab for upper and lower limb within the clinic setting will take some thinking about. I think any interventions that can help tendinopathies are worthy of pursuit however nerdy they might be. As an aside, I’d be interested on your thoughts on Occlusion Therapy…I think it might be entertaining ! Also, on a different tack, we’re looking for an S&C coach or a Physio with great S&C knowledge whom is well respected in both fields to review our current database and add, edit and delete where necessary. I’m based in Bedfordshire…can you recommend anyone ? Best regards, Gary.

  3. Reading this article made me think about using weight bearing as rehab tool for upper limb tendinopathies,
    where appropriate (more from my own experience of using yoga poses to help some of my ailments).
    Would you agree weight bearing through the upper limb is the same as pushing? Its not as easy to measure though. ( I usually allowing for 4-5/10 pain levels as a guide of how much weight to put through the joint, as per Jill Cook recommendation.)

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