VALD_Practitioners Guide to Isometrics

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<p>2 | Practitioner’s Guide to Isometrics</p><p>Some Words From the</p><p>Isometrics Experts</p><p>Catherine A. Logan</p><p>MD, MBA, MSPT.</p><p>Orthopaedic Surgeon, Sports</p><p>Medicine Team Physician, USA</p><p>Lacrosse Team Physician,</p><p>US Ski & Snowboard</p><p>Isometric testing is an integral component of</p><p>my patients' postoperative plan at each visit,</p><p>right through to the RTP testing protocol. In</p><p>our case, we use the ForceFrame because it is</p><p>a tool that I can easily implement into a busy</p><p>sports medicine practice.</p><p>The positive impact of obtaining objective data</p><p>for each post-operative visit is twofold: I can</p><p>gather insight into their progress over time and</p><p>make sure they are on track but I also find the</p><p>patient is more motivated and engaged</p><p>to stay the course of rehab, knowing</p><p>benchmarks and normalized data exist to use</p><p>in goal setting.</p><p>“</p><p>@cloganmd @cloganmd</p><p>Alex Natera</p><p>Performance Science Manager, NSW Institute of Sport and creator of</p><p>Run-Specific Isometric Strength Testing (RSIST)</p><p>Isometric training offers a powerful stimulus with both activation and force production levels found to be</p><p>greater than both concentric and eccentric training.</p><p>Isometric training can drive architectural, morphological, neurological and biomechanical adaptations that</p><p>can enhance both dynamic lifting and sport performance.</p><p>While the isometric training stimulus is a potent stimulus, the training time cost and the recovery dynamics</p><p>are both rapid, allowing for a time and energy-efficient training protocol for sports performance.</p><p>Isometric assessments are also time-efficient, low risk, devoid of technical requirements and a true</p><p>measure of a muscle/group of muscles' ability to generate force.</p><p>Unlike other forms of maximal strength assessments, isometric assessments can be performed regularly</p><p>throughout training blocks and through all stages of return-to-play (RTP) to really understand exactly where</p><p>athletes are at all stages of training and development.</p><p>“</p><p>@alex_natera @alex.natera</p><p>Nicol van Dyk</p><p>Ad Astra Fellow, School of Public</p><p>Health, Physiotherapy and Sport</p><p>Science.</p><p>University College Dublin</p><p>Isometric testing and training are nothing new.</p><p>Leveraging user-friendly technology such as</p><p>dynamometers and force plates can amplify the</p><p>effectiveness of isometric testing tenfold.</p><p>This advancement offers real-time feedback,</p><p>enhances the experience and understanding for</p><p>those being tested and optimizes decision-making</p><p>for rehabilitation and training. Understanding</p><p>isometric testing's role in strength assessment can</p><p>greatly benefit your practice.</p><p>“</p><p>@NicolvanDyk nicolvandyk</p><p>https://www.linkedin.com/in/catherine-logan-md-mba-mspt-19763952/</p><p>https://twitter.com/cloganmd</p><p>https://twitter.com/cloganmd</p><p>https://www.instagram.com/cloganmd/</p><p>https://www.instagram.com/cloganmd?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw==</p><p>https://www.sportsmith.co/courses/isometric-strength-training-online-course/</p><p>https://twitter.com/alex_natera</p><p>https://twitter.com/alex_natera</p><p>https://www.instagram.com/alex.natera/</p><p>https://www.instagram.com/alex.natera/</p><p>https://www.linkedin.com/in/nicolvandyk/</p><p>https://twitter.com/NicolvanDyk</p><p>https://twitter.com/NicolvanDyk</p><p>https://www.instagram.com/cloganmd/</p><p>https://www.instagram.com/nicolvandyk/</p><p>Practitioner’s Guide to Isometrics | 3</p><p>Ebonie Rio</p><p>Senior Clinical Research Fellow:</p><p>The Australian Ballet/La Trobe</p><p>University, Sports and Exercise</p><p>Physio: The Victorian Institute of</p><p>Sport</p><p>I use VALD technology for immediate feedback in</p><p>hitting the isometric target in my clinical practice.</p><p>This could be a long duration isometric contraction</p><p>for tendinopathy at a set force or a short duration</p><p>with a focus on performance.</p><p>The addition of features such as “Training Mode”</p><p>has made prescribing and monitoring these</p><p>dosages significantly easier and enhanced</p><p>biofeedback as well as the overall patient</p><p>experience.</p><p>“</p><p>Danny Lum</p><p>Head of Strength and Conditioning,</p><p>Sport Singapore</p><p>@dannylum</p><p>Isometric training provides individuals with the</p><p>opportunity to generate maximal force repeatedly</p><p>within a training session while posing low risk</p><p>to injury, thus, providing individuals the training</p><p>stimulus to fill in the gaps of other modes of</p><p>training.</p><p>This mode of training is also an ideal pre-game</p><p>priming activity as it requires a shorter recovery</p><p>time as compared to heavy resistance training.</p><p>With the availability of more affordable force plates</p><p>and strain gauges these days, practitioners can</p><p>easily monitor the effort that athletes put in when</p><p>performing isometric training.</p><p>“</p><p>@dannylum82 dannylum82</p><p>We're taking as much skill out of an</p><p>assessment as we can and get close to</p><p>the raw physical properties that we are</p><p>trying to quantify.</p><p>“</p><p>Connor White</p><p>High Performance Coordinator</p><p>Driveline, AZ</p><p>@cwhite23 connorwhite23</p><p>https://www.linkedin.com/in/ebonie-rio-436474224/</p><p>https://www.ksw.ch</p><p>https://www.youtube.com/@dannylum</p><p>https://www.youtube.com/@dannylum</p><p>https://www.linkedin.com/in/danny-lum-phd-cscs-asca-l2-14958544/</p><p>https://twitter.com/DannyLum82</p><p>https://twitter.com/DannyLum82</p><p>https://www.instagram.com/dannylum82/</p><p>https://www.instagram.com/dannylum82/</p><p>https://www.ksw.ch</p><p>https://www.linkedin.com/in/connor-w-9a5336b1/</p><p>https://twitter.com/cwhite23_</p><p>https://twitter.com/cwhite23_</p><p>https://www.instagram.com/connorwhite23/</p><p>https://www.instagram.com/connorwhite23/</p><p>4 | Practitioner’s Guide to Isometrics</p><p>Can isometrics apply to all</p><p>populations or just athletes?</p><p>Why should I</p><p>prescribe isometric training?</p><p>Why should I</p><p>use technology to</p><p>test isometrics?</p><p>High-Speed Running</p><p>by Alex Natera</p><p>Normative Data</p><p>for Common Isometric Tests</p><p>Hamstring Rehabilitation</p><p>by Nicol van Dyk Group Athlete Screening</p><p>ACL Reconstruction</p><p>How do I know I’m</p><p>testing for the right outcome?</p><p>What are the advantages</p><p>of isometric training with</p><p>technology?</p><p>When I test isometrics,</p><p>there are so many metrics.</p><p>Where do I start?</p><p>Tip: Click any heading to jump to section</p><p>In this document, we will cover a wide range of topics and</p><p>answer some common questions, including:</p><p>Isometric</p><p>Applications</p><p>Practitioner’s Guide to Isometrics | 5</p><p>Contents</p><p>Isometric Fundamentals ............................................................................. 7</p><p>Common Isometric Actions ........................................................................ 8</p><p>Isometric Testing, Training and Technology ................................................ 9</p><p>How Do I Choose the Right Isometric Test? ................................................14</p><p>6 Golden Rules of Isometric Testing ...........................................................15</p><p>Understanding the Metrics ........................................................................16</p><p>Types of Isometric Testing Technologies ...................................................17</p><p>Applications for Isometric Testing ............................................................ 30</p><p>Isometric Training ..................................................................................... 34</p><p>Applications for Isometric Training ........................................................... 37</p><p>Example Applications for Isometrics ......................................................... 40</p><p>Administration/Workflow Efficiency .......................................................... 55</p><p>What Next? ............................................................................................... 59</p><p>Normative Data for Common Isometric Tests ............................................ 60</p><p>6 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>What Makes Isometrics so Special?</p><p>Isometric exercises have long been used in training and rehabilitation but so have eccentric and concentric</p><p>movements, so what makes isometrics worthy of a dedicated resource like this?</p><p>Isometric exercises have maintained popularity over time for a few key reasons, including:</p><p>• Safety – they are often self-limiting and therefore present a low risk of</p><p>causing or exacerbating injuries.</p><p>the use of force</p><p>plates wherever possible when administering RSIST.</p><p>0-10°</p><p>Ankle</p><p>Plantar Flexion</p><p>135-145°</p><p>Knee</p><p>Flexion</p><p>135-145°</p><p>Knee</p><p>Flexion</p><p>36 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Training with Technology.</p><p>In addition to technology providing real-time feedback during training sessions, some technologies, such as</p><p>ForceFrame offer specialized “training modes.” This feature allows accurate prescription of:</p><p>• Loads;</p><p>• Sets;</p><p>• Reps; and</p><p>• Rest Periods.</p><p>These variables can be accurately prescribed, monitored and recorded with Training Mode, which also uses a</p><p>gamified interface to help engage patients and athletes in their exercise programs.</p><p>“When the iPad gets brought out and the threshold is set, the athletes get excited and stay engaged to</p><p>keep their force output within the threshold. It becomes a fun game that is a cornerstone of a quality</p><p>rehab session. Training Mode is a tool clinicians can use to keep their patients bought-in to their plan of</p><p>care and completing scheduled visits.” Matt Witt, Physical Therapist</p><p>Athlete performing a guided</p><p>isometric training session with</p><p>ForceFrame's Training Mode.</p><p>Custom programs allow for centralized programming</p><p>and self-guided exercise.</p><p>Pre-programmed exercises, sets, reps and target force ranges</p><p>allow for precisely controlled loading.</p><p>https://valdperformance.com/news/diamond-to-clinic-forceframe-training-impact</p><p>Practitioner’s Guide to Isometrics | 37</p><p>Back to Contents</p><p>Applications for Isometric Training</p><p>By now, it is probably clear that isometrics can be applied in a wide range of settings with almost any athlete or</p><p>patient. Some of the best times, situations and ways to use isometric training are:</p><p>• For Time-Efficient Workouts: Utilize isometric</p><p>exercises when time is limited, as they can be</p><p>effective in shorter durations.</p><p>• As a Supplement: Integrate isometric exercises</p><p>into existing strength training programs to</p><p>enhance muscle activation and overcome</p><p>strength plateaus.</p><p>• Incorporate Multi-Angle Isometrics: Perform</p><p>isometric exercises at different joint angles</p><p>to target muscles comprehensively, increase</p><p>strength in specific positions and potentially</p><p>enhance hypertrophy.</p><p>• For Pain Management: Isometrics have been</p><p>shown to modulate pain in various pathological</p><p>conditions.</p><p>• During Rehabilitation: Initially, isometrics were</p><p>popular in the early stages of rehabilitation</p><p>or when dynamic movements might be</p><p>contraindicated due to injury. However, they are</p><p>now commonplace throughout rehabilitation,</p><p>return to activity and beyond.</p><p>• With Ageing Patients: Isometrics are suitable</p><p>for all ages and abilities.</p><p>• In Congested Competition Periods: When</p><p>turnaround times between competitions and</p><p>recovery periods are short, isometrics can be a</p><p>safe, fast and effective way to maintain loading.</p><p>• For Microdosing: Increase the frequency of</p><p>strength and power stimuli.</p><p>In this section, we will unpack these applications and more.</p><p>Application of Isometrics Throughout</p><p>Rehabilitation and Performance</p><p>Early-Stage Return to Sport</p><p>Ongoing Monitoring</p><p>Checkpoints</p><p>Post-return to sport, athletes can use isometric training as a way to top up strength scores after games. These</p><p>doses are likely needed less frequently as the athlete continues to perform well in their sport.</p><p>38 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Time Efficiency and Safety</p><p>Isometric training can be very time-efficient, typically</p><p>requiring shorter training durations compared to</p><p>isotonic strength training. Not only are they more</p><p>efficient but also provide an overall greater training</p><p>impulse than traditional strength training (TST) in</p><p>that short time. Despite the greater training impulse,</p><p>there is also more rapid recovery.</p><p>Isometric exercises are also considered a safe</p><p>option due to their self-limiting nature and the lack of</p><p>movement through range.</p><p>Strength Gains</p><p>Isometrics can significantly increase muscular</p><p>strength and power, making them a necessary tool</p><p>in any practitioner's repertoire to improve athletic</p><p>and physical performance. Doses and intensities of</p><p>isometric strength testing will be dependent on the</p><p>client and their experiences with resistance training</p><p>and isometrics, however, higher relative intensities</p><p>(80-100% maximum voluntary contraction (MVC))</p><p>over shorter contraction periods (1-5s per repetition),</p><p>over multiple joint angles have shown to improve</p><p>muscle strength and RFD. It is also recognized that</p><p>these high-intensity actions will help improve tendon</p><p>morphology and overall musculotendinous strength.</p><p>Hypertrophy</p><p>When performed at multiple joint angles, specifically</p><p>at longer muscle lengths, isometrics can contribute</p><p>significantly to muscle hypertrophy. For example,</p><p>using Stretch Isometrics, HIMA and longer duration</p><p>isometric exercises can help to maximize the</p><p>hypertrophic response of a muscle to isometric</p><p>resistance training.</p><p>However, it should be noted that significant muscular</p><p>hypertrophy can occur with participation in isometric</p><p>training at both lower and higher exercise intensities.</p><p>“To increase muscle hypertrophy, isometric</p><p>strength testing should be performed at 70-</p><p>75% of MVC with sustained contraction of</p><p>3-30s per repetition and a total contraction</p><p>duration of >80-150s per session for >36</p><p>sessions. Performing isometric strength</p><p>testing in a ballistic manner can maximize the</p><p>improvement of RFD.”</p><p>Danny Lum</p><p>Rehabilitation</p><p>Isometrics are commonly used in rehabilitation due to their safety, self-limiting nature and controlled joint</p><p>positions. For example, low-intensity isometric exercise can be introduced relatively soon after surgery to</p><p>maintain stimulus and reduce atrophy. Additionally, given isometrics do not involve joint movement, in many</p><p>cases, they can be performed before the full ROM is restored in a joint.</p><p>• Build Strength: Either maximal or sub-maximal</p><p>isometrics help rebuild muscle strength, which</p><p>can be easily controlled as isometrics are</p><p>self-limiting and technology (such as</p><p>ForceFrame’s Training Mode) has made it easier</p><p>to control loading.</p><p>• Modulate Pain: In parallel with building</p><p>strength, isometric contractions have been</p><p>shown to be an effective method for reducing</p><p>pain in affected muscles or joints.</p><p>Isometrics can also reduce pain and muscle inhibition, making them a powerful tool for managing recovering</p><p>tissues and priming for dynamic exercises.</p><p>See Example Cases for Isometrics for an example of the role of isometrics in rehabilitating a hamstring injury.</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://link.springer.com/article/10.1007/s42978-023-00241-0</p><p>https://link.springer.com/article/10.1007/s42978-023-00241-0</p><p>https://pubmed.ncbi.nlm.nih.gov/30943568/</p><p>https://pubmed.ncbi.nlm.nih.gov/30943568/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://www.linkedin.com/authwall?trk=bf&trkInfo=AQGQ_dRUp4ukMAAAAY8MmyQIVqSEpa2wFlporG0TOqQwQmJt59JI-L3lv0rDAWqaLOsrX5I7aE6bumKdlFJjKq1D0vVy1kl-JHwx478jYKsN4kUvfbYfBX9OlyhDTaIp9Aw6YM8=&original_referer=&sessionRedirect=https%3A%2F%2Fwww.linkedin.com%2Fin%2Fdanny-lum-phd-cscs-asca-l2-14958544%2F</p><p>Practitioner’s Guide to Isometrics | 39</p><p>Back to Contents</p><p>Joint Stability</p><p>Injury Risk Management Programs</p><p>Whilst isometric testing plays a pivotal role in</p><p>assessing physical capacity to develop programs that</p><p>mitigate injury risk factors, isometric exercises also</p><p>play a role in the risk management program.</p><p>As previously mentioned, isometric exercises can</p><p>result in strength gains as well as have the ability to be</p><p>targeted, specific and require minimal technical skill.</p><p>Isometric testing is crucial for evaluating physical</p><p>capacity and crafting programs to address injury risk</p><p>factors.</p><p>Additionally, isometric exercises contribute</p><p>significantly to risk management</p><p>strategies. These</p><p>exercises not only enhance strength but also offer</p><p>targeted, specific benefits while demanding minimal</p><p>technical expertise.</p><p>The benefits of isometrics can be harnessed by</p><p>practitioners in a variety of settings – sporting,</p><p>workplace or in aging populations.</p><p>Isometric Training Tips</p><p>There are many ways to integrate isometric training into programs – the versatility of the exercises and the rapid</p><p>recovery seen by athletes allow practitioners many opportunities to integrate in their programming.</p><p>It is important to note that if an isometric or quasi-isometric action is occurring in the sporting task, then</p><p>including the application of isometric or quasi-isometrics in a training program is essential.</p><p>PIMAs seem to be less fatiguing than HIMAs. A PIMA</p><p>of equivalent intensity can be sustained for up to twice</p><p>as long as a HIMA, indicating metabolic fatigue of</p><p>the muscle fibers during HIMA.</p><p>This aspect is crucial to consider when determining</p><p>repetition durations for various isometric actions.</p><p>Studies indicate that failure tends to happen sooner in</p><p>HIMAs. Therefore, when setting repetition durations</p><p>at matched intensities, holding durations should be</p><p>adjusted to be shorter compared to pushing durations.</p><p>For more information about training principles such</p><p>as repetition duration, total volume, intensity and</p><p>rest times can be manipulated to develop different</p><p>physical qualities – check out this SportSmith lecture</p><p>by Alex Natera.</p><p>Isometrics can be effective in reducing osteoarthritic pain, improving function and joint stability. They can also</p><p>be performed at different joint angles to develop strength through range of movement without requiring large</p><p>dynamic movements.</p><p>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426061/</p><p>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426061/</p><p>https://www.sportsmith.co/wp-content/uploads/2022/09/1b-accompanying-PDF.pdf</p><p>https://pubmed.ncbi.nlm.nih.gov/34812331/</p><p>40 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Example Applications for Isometrics</p><p>This section will provide fictional yet practical examples of how isometric testing and training can be applied to</p><p>common conditions, situations and cohorts, ranging from rehabilitation to high performance, pre-employment</p><p>screening to aged care and more.</p><p>Examples include:</p><p>• High-Speed Running,</p><p>• Criteria-Based Hamstring Rehabilitation,</p><p>• Group Athlete Screening/Profiling,</p><p>• Anterior Cruciate Ligament Reconstruction,</p><p>• Recreational Athlete Strength Testing,</p><p>• Neck Strength Testing,</p><p>• Employee Screening and Assessment,</p><p>• Elderly Patient Functional Well-Being Assessment.</p><p>High-Speed Running</p><p>Guest Author</p><p>John Harris (26 years old)</p><p>Elite Football Athlete</p><p>John Harris presents at the club on the first Monday</p><p>of pre-season training after a solid off-season training</p><p>period where he has enjoyed the rest from footy and</p><p>the club and completed all prescribed training. The</p><p>off-season training consisted of resistance training</p><p>from a general strength perspective, where strength</p><p>training intensity in key strength and power lifts</p><p>incrementally increased throughout.</p><p>A specific tendon loading protocol for the patella and</p><p>Achilles’ tendons was also completed throughout</p><p>using moderate duration isometrics. Eccentric</p><p>adductor and posterior chain loading were also</p><p>performed throughout the off-season strength</p><p>training program.</p><p>John followed the running program “to a tee,” which</p><p>consisted of a gradual build in aerobic intensities and</p><p>volume, incremental speed exposures, incremental</p><p>acceleration exposures and incremental change</p><p>of direction exposures, all building in intensity and</p><p>volume throughout the off-season period.</p><p>As part of the squad’s pre-season training structure,</p><p>the first week upon returning to the club baseline</p><p>assessments are conducted throughout the first</p><p>training week. Everything from skinfold testing and</p><p>blood work to aerobic testing and force assessments</p><p>are performed.</p><p>For force assessments, the club chooses a more</p><p>nuanced assessment of force output that biases</p><p>the measurement of the force produced by muscles</p><p>surrounding specific lower limb joints used in running.</p><p>They have chosen this approach to be more precise</p><p>in the measurement of force output specifically for</p><p>running and to be able to diagnose and prescribe</p><p>more effectively for this purpose. Therefore, the Run-</p><p>Specific Isometric Assessments are the choice of</p><p>force assessment rather than the IMTP, for example.</p><p>Based on the layout of the week, with a lower-intensity</p><p>training day scheduled for Tuesday and a training-</p><p>free day scheduled for Thursday, the club chose to</p><p>measure:</p><p>• Knee Iso-Push assessment on Monday morning;</p><p>• Ankle Iso-Push assessment on Wednesday</p><p>morning; and</p><p>• Hip Iso-Push assessment on Friday morning.</p><p>Using this format, they can assess all 46 players</p><p>in their roster within two hours with a single set of</p><p>ForceDecks.</p><p>Practitioner’s Guide to Isometrics | 41</p><p>Back to Contents</p><p>Knee Iso-Push</p><p>PtekeFfont</p><p>Ankle Iso-Push</p><p>PtekeFfont</p><p>Hip Iso-Push</p><p>PtekeFfont</p><p>Personll Record</p><p>PotvifuseStesfa</p><p>Current Score</p><p>FofaeRtnta eAsstssata</p><p>Notes</p><p>Assess�en!</p><p>Rigt eLtg</p><p>4.25 ee fdbewtigt e(BW)</p><p>3.18eeeBW</p><p>2.25eeesbs taewtigt e(SW) 2.2GeeeBW</p><p>Sligt edtfni eaf tdewi tiaeafoaeles eadeodedtvie ifaserfoe</p><p>Jftaneiadine iagelfwe u e f ta ielenfantoaerfoedt oeiaiagefoe</p><p>re igutme</p><p>Sigaifnea edtfni ef stovtdenfa eotde feafoaeles eadeode</p><p>dtvie ifasmeTtiseiseeered flaenfantoanets tniellbeiaenfa te e</p><p>wi teJfta’sehistory of riaht cllf injuriesm</p><p>Sligt lbee fvteafoaelevelutsnetfwtvtonerfontee e100aseise</p><p>11�elfwtoe teaeusuelnewtinteisetafugte fe tenfasidtotdeee</p><p>red flaenfantoae be tte torfoaeante team</p><p>4.18 eeBW</p><p>3.03eeeBW</p><p>After John's assessments, the performance team</p><p>realizes John has a slight deficit in his Knee Iso-Push</p><p>peak force on his right leg (last season’s personal</p><p>record (PR) = 4.25xBW vs current score = 4.18xBW).</p><p>This deficit is deemed within normal standard</p><p>deviations for John but it is noted as a potential</p><p>concern.</p><p>However, John’s right Ankle Iso-Push peak force is</p><p>much lower than normal standard deviations (last</p><p>season’s PR = 3.18xBW vs. current score = 3.03xBW).</p><p>This is considered a red flag by the team, particularly</p><p>as John has had previous injuries to his right calf.</p><p>Although John's Hip Iso-Push peak force is slightly</p><p>above his normal values (last season’s PR = 2.25xSW</p><p>vs. current score = 2.27xSW) John's force at 100</p><p>milliseconds is 11% lower than the percent of peak</p><p>force he normally produces in 100 milliseconds. This</p><p>is also considered a red flag by the performance team.</p><p>Based on the pre-season screening results the</p><p>decision is made to target the return of peak force in</p><p>John’s Ankle Iso-Push and the return of rapid force in</p><p>John’s Hip Iso-Push.</p><p>As John has successfully completed all off-season</p><p>running exposures and the first week of pre-season</p><p>running with no issues, there is no change to his</p><p>running and team training program except for the</p><p>modification of additional speed training or “top-ups.”</p><p>The decision is made to constrain John’s “top-end”</p><p>speed exposure to efforts <85-90% until his Ankle Iso-</p><p>Push and Rapid Hip Iso-Push peak forces improve.</p><p>Over the next four weeks, a concerted effort is made</p><p>to improve these measures within and around John’s</p><p>2x lower body strength session per week.</p><p>Bilateral load share to</p><p>rapid release of one limb,</p><p>training unilateral RFD.</p><p>Volumes for both Iso-Hold variants are in concert with Iso-Push volume to ensure total volume of Iso-Push and Iso-Hold</p><p>work does not exceed 90s of total work in a single session.</p><p>Maintain heel height</p><p>and knee position</p><p>throughout contraction.</p><p>Ankle Iso-Hold</p><p>Emphasise ballistic force</p><p>generation to improve</p><p>hip extension RFD.</p><p>Same setup as</p><p>assessment, cue for</p><p>maximal effort.</p><p>100% effort required for</p><p>short bouts of maximal</p><p>intensity contractions.</p><p>100% Effort required for</p><p>short bouts of maximal</p><p>intensity contractions.</p><p>External</p><p>load equal to G0%X</p><p>Peak Force in Ankle Iso-</p><p>Push.</p><p>External load equal to</p><p>50% Peak Force in Ankle</p><p>Iso-Push.</p><p>2 Sets of 3 repetitions;</p><p>3s duration per rep:</p><p>2 x 3 x 3s</p><p>Exercise volume should not</p><p>exceed 40s of total</p><p>contraction time.</p><p>Exercise volume should not</p><p>exceed 30s of total</p><p>contraction time.</p><p>External load increases up</p><p>to 80% Peak Force, time</p><p>reduces to as low as 5s per</p><p>repetition.</p><p>External load increases up to</p><p>70% Peak Force, time</p><p>reduces to as low as 5s per</p><p>repetition.</p><p>Along with knee extension</p><p>force, can inform</p><p>readiness for ballistic or</p><p>plyometric activities.</p><p>Week</p><p>1</p><p>Session 1</p><p>Notes:</p><p>WeekIFession Exercise Comments Intensit^ Volume Progression</p><p>Ankle Iso-Push</p><p>3 Sets of 5 repetition;</p><p>1s duration per rep:</p><p>3 x 5 x 1s</p><p>2 Sets of 1 repetition;</p><p>20s duration per rep:</p><p>2 x 1 x 20s</p><p>Hip Iso-Push</p><p>Hip Iso-Hold</p><p>42 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>With the ability to dose isometrics in more frequently, (i.e., 2x per week), practitioners can use smaller doses of higher-</p><p>intensity exercises to improve strength, RFD and tolerance to training sessions.</p><p>Same setup as previous</p><p>exercise, but with focus</p><p>on maximum force.</p><p>Ballistic and rapid force</p><p>generation emphasis to</p><p>improve hip extension</p><p>RFD.</p><p>Exercise performed with</p><p>same set up as</p><p>assessment, cue for</p><p>maximal effort.</p><p>80% Effort cued based on</p><p>pre-season assessments.</p><p>100% Effort required for</p><p>short bouts of maximal</p><p>intensity contractions.</p><p>100% Effort required for</p><p>short bouts of maximal</p><p>intensity contractions.</p><p>1 Set of 3 repetitions;</p><p>each repetition is 2Ss in</p><p>duration:</p><p>1 x 3 x 20s</p><p>Exercise intensity will</p><p>increase to 100% with</p><p>contraction duration</p><p>reducing to 5s over time.</p><p>Exercise volume shou�d</p><p>not exceed 30s of total</p><p>contraction time.</p><p>Load increases up to 80%</p><p>Peak Force, time reduces</p><p>to as low as 5s per</p><p>repetition.</p><p>Week</p><p>1</p><p>Session 2</p><p>Notes:</p><p>Weekvression Exercise Comments Intensity Vo�ume Progression</p><p>Ankle Iso-Push</p><p>3 Sets of 3 repetition;</p><p>each repetition is 1s in</p><p>duration:</p><p>3 x 3 x 1s</p><p>2 Sets of 1 repetition;</p><p>each repetition is 5s in</p><p>duration:</p><p>2 x 1 x 5s</p><p>Hip Iso-Push</p><p>Hip Iso-Push</p><p>As ForceDecks are used to monitor John’s Ankle and</p><p>Hip force output throughout the four weeks, we can</p><p>see a return to last season’s force levels by week three</p><p>of the program.</p><p>As John continues this focus through pre-season, he</p><p>records a 17% improvement overall for his maximum.</p><p>The Ankle Iso-Push peak force from last season to</p><p>this season and an 8% improvement for force at 100</p><p>milliseconds in his Hip Iso-Push.</p><p>Run-Specific Isometrics Benchmark Results</p><p>Team Sport</p><p>Males</p><p>Hip Iso-Push Knee Iso-Push Ankle Iso-Push</p><p>Elite Track</p><p>Males</p><p>Team Sport</p><p>Females</p><p>2.2 - 2.5 x SW *</p><p>1.95 - 2.15 x SW</p><p>> 3 x SW</p><p>3.1 - 3.3 x BW</p><p>2.!5 - 2.9 x BW</p><p>> 4 x BW</p><p>4.2 - 4.4 x BW</p><p>3.15 - 4.2 x BW</p><p>> 5.5 x BW</p><p>*SW is the amount of body weight supported at the heel in the supine bridge type position.</p><p>Practitioner’s Guide to Isometrics | 43</p><p>Back to Contents</p><p>Criteria-Based Hamstring Rehabilitation</p><p>Guest Author</p><p>Mark Jones (24 years old)</p><p>Recreational Football Player</p><p>A 24-year-old Recreational Football Player suffered</p><p>a posterior thigh injury during a league game. The</p><p>injury occurred without contact in the 80th minute</p><p>while sprinting towards the ball with a slight change in</p><p>direction.</p><p>Unable to continue playing, the player felt immediate severe localized pain in his posterior thigh when walking.</p><p>Following a comprehensive assessment from the medical team, it is determined to be a Grade II biceps femoris</p><p>tear and no signs of neural involvement.</p><p>This article explores the role of isometric testing and training within the framework of a typical hamstring injury</p><p>rehabilitation process, as outlined in the following table (Reference: Aspetar Protocol).</p><p>zNoYCd��Y</p><p>�d��Y</p><p>lgMhMdY^jY�X�U�^�UT^Y�gXQ^M[d�h�X^XM�T�U�^MO^djY^�UoPgYT^d�eePb</p><p>L ZKWIH]I\G]fK\IBGGAH\@H:HJW/kH$IF</p><p>L SB$BkB?H\kAG]JH\fIKW/ER\f$@\/fB$D</p><p>�Y���U^OPXX^hPeCXY^OPUCd�M�</p><p>L �H~fB$\|AJJ\:WJA$IfKR\]W$IKWJ\W|\B$�AKH@\kAG]JHF</p><p>L �H~fB$\/fB$\|KHH\GIKH$~IE\|KWk\B$$HK\Kf$~HG\IW\JW$~HK\JH$~IEGF</p><p>L sH:HJW/\f//KW/KBfIH\]W$IKWJ\W|\IKA$r\f$@\/HJ:BG\qBIE\/KW~KHGGB$~\G/HH@\f$@\JWf@\W$\IEH\</p><p>EfkGIKB$~GF</p><p>L ZfB$\|KHH\KA$$B$~\A/\IW\kfpBkfJ\G/HH@\qBIE\]Ef$~B$~\@BKH]IBW$Gm\f$@\A$@HK\|fIB~AHD</p><p>�UdY�g�dY^OPXX^e[Mgde^e[YC�+C^[�gd�C�[�d�M�</p><p>L 0Rk/IWk&|KHH\@AKB$~\fJJ\f]IB:BIBHGF</p><p>L )Wk/JHIH\3\/KW~KHGGB:H\G/WKIG\G/H]B�]\GHGGBW$G\qBIE\$W\/fB$\�@AKB$~\WK\f|IHK\GHGGBW$	\</p><p>qBIE\|AJJ\H||WKID</p><p>Isometric testing and training have a role in each of</p><p>these stages of rehabilitation. Importantly, isometrics</p><p>help us track our progress through the rehabilitation</p><p>process. We use these results to determine increases</p><p>or changes to exercises and training programs.</p><p>Muscle injuries that involve tendon or more proximal</p><p>hamstring injuries often respond well to early</p><p>isometrics interventions, allowing us to load areas of</p><p>the injured muscle-tendon unit more specifically.</p><p>https://www.aspetar.com/en/professionals/aspetar-clinical-guidelines/aspetar-hamstring-protocol</p><p>44 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Early-Stage Isometric Testing</p><p>Testing Through Range</p><p>F JED�:/$GE/�E���$</p><p>F �I�i^�DGD�D�S$D�$</p><p>F t�/H$��</p><p>[PYWVTPR</p><p>[QXWOYQVTWZ</p><p>ONYMTYW[[OMLWYOPKUW</p><p>F kGq��mI/$ $</p><p>F e��/���D�I:$</p><p>F ]ED:I:$fH$</p><p>[PYWP�y PM~WYQV�z</p><p>PW[PKVTOrOPYQKVKVs</p><p>PM~WYQV�W</p><p>F kGq��mI/$</p><p>F �DGD�/$/DGD���$:IG��:/$��$</p><p>�Dq$k/�^�E/�</p><p>F JD�iII:f���$i��$</p><p>[PYWVTPyOQPO~MVTO~WVTPyZ</p><p>Y</p><p>V�[NW�K�</p><p>OOOOOOOK[MUWPYK�O</p><p>VW</p><p>YM�MTVKPKLWOPYQKVKVT</p><p>' & & % " � " &� % O � � " %&� �# 5 4 2 2 3 + � , 0-* + O . ) , +-* )( ?C) + , � , 0-* + O . ) , +-* )(</p><p>Initially, we would not expect much force to</p><p>be able to be produced in this position. Pain</p><p>may even prevent muscle contraction in this</p><p>position in the early stages of rehabilitation.</p><p>Isometric testing is important for rehabilitation</p><p>progression. Although initial pain may halt</p><p>the exercise, we generally see improvements</p><p>in strength as the pain settles.</p><p>Therefore, if a patient demonstrates pain and</p><p>a drop in strength, we will not progress their</p><p>in that session. Conversely, if both strength</p><p>increases and pain decreases, we typically</p><p>progress rehabilitation or increase the intensity.</p><p>Strength in the injured limb is usually assessed</p><p>as a percentage of the strength in the uninjured</p><p>limb, accepted as a proxy for expected strength</p><p>in the injured limb at the end of rehabilitation.</p><p>Early Isometric Training</p><p>We often use isometric exercises early on to achieve optimal loading while promoting tissue healing and scar</p><p>formation. A useful moniker at this stage is “a little a lot often.”</p><p>H e e l d i g s m i d d l e - r a n g e p u s h</p><p>B r i d g e i s o m e t r i c s</p><p>I N N E R - R A N G E h o l d s</p><p>( 3 s e t s o f 1 2 r e p s )   ( 3 s e t s o f H t o 1 2 r e p s )   ( 3 s e t s o f H t o 1 2 r e p s )   ( 3 s e t s o f 1 2 r e p s )</p><p>Practitioner’s Guide to Isometrics | 45</p><p>Back to Contents</p><p>Mid-Stage Isometric Testing</p><p>Usually, by this stage, we’ve dropped the inner range</p><p>iso testing as the pain would have settled and strength</p><p>has returned to levels comparable to the uninjured</p><p>side. However, it may continue to be useful for</p><p>hamstring injuries with tendon involvement.</p><p>We continue with mid-range and outer-range testing.</p><p>While we still monitor pain, we also use these tests</p><p>to determine the effectiveness of the rehabilitation</p><p>program. Increases in strength measures, ROM and</p><p>reduced or no pain are good indicators that we can</p><p>push harder. Once the program reaches a sufficient</p><p>intensity, we would expect slight decreases in either</p><p>strength or range if the testing happened within a</p><p>24-to-36-hour cycle.</p><p>This is a general indication of a training load response</p><p>and evidence that the exercise dosage and training</p><p>is sufficient. Clinicians must take all available</p><p>information into their clinical reasoning process.</p><p>If not already progressed, we would advance</p><p>from a</p><p>bridge test to a single-leg bridge test at this stage.</p><p>Mid-Stage Isometric Training</p><p>Bridge Progressions</p><p>B r i d g e i s o m e t r i c s b i l a t e r a l</p><p>B r i d g e i s o m e t r i c s</p><p>n i l a t e r a l E l e v a t e d u n i l a t e r a l b r i d g e i s o</p><p>Another recent development would be to utilize</p><p>the NordBord or Nordic hamstring exercise early in</p><p>rehabilitation.</p><p>Performing a bilateral isometric kneeling exercise is</p><p>often useful to help athletes overcome anxieties about</p><p>loading the injured muscle and it acts as preparation</p><p>for moving into eccentric exercises.</p><p>The biofeedback from NordBord can be useful to</p><p>assess how comfortable the athlete is to weight-</p><p>shift and distribute the load between the injured and</p><p>uninjured limbs.</p><p>46 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>End-Stage Isometric Testing</p><p>To determine progression and inform decision-making</p><p>around exercise programs and training, we continue</p><p>with mid- and outer-range testing.</p><p>We have seen discrepancies in the single limb HHD,</p><p>bilateral FFD and FPD. Players may show a significant</p><p>difference in unilateral testing and nothing in bilateral</p><p>testing. Regardless of the difference in testing</p><p>position, it also helps the practitioner understand</p><p>the mechanisms still responsible for the inhibition or</p><p>difference.</p><p>Isometric holds may indicate a muscle endurance or</p><p>fatigue issue at this stage, often seen in the impulse of</p><p>the strength curve.</p><p>By this stage, the player is underway toward running at high-speed, change in direction and sport-specific drills</p><p>incorporated into the rehab. We continue to consider where isometric exercises may be useful to add additional</p><p>loads or achieve specific muscle contraction and activation patterns.</p><p>Any of the options discussed are considered, with variation in weight, position, duration, bilateral versus unilateral</p><p>and intensity.</p><p>Whilst this case focuses on the role of isometrics, it</p><p>is also necessary to incorporate dynamic exercises</p><p>throughout rehabilitation.</p><p>End-Stage Loading Options</p><p>D Y N A M I C E X E R C I S E S H I P I s o - P u s h</p><p>E.g., Nordic Hamstring Curl</p><p>Practitioner’s Guide to Isometrics | 47</p><p>Back to Contents</p><p>Group Athlete Screening/Profiling</p><p>Lincoln Stars</p><p>Sub-Elite Ice Hockey Team</p><p>Last season, the Lincoln Stars had a high incidence of</p><p>a variety of adductor-related injuries. Typically, they did</p><p>not have a regimented preseason screening (largely</p><p>due to funding and access to equipment).</p><p>However, this season, the decision was made to invest</p><p>in a ForceFrame and ForceDecks with the specific</p><p>goal of assessing lower limb performance and</p><p>providing objective data for targeted interventions.</p><p>The strength and conditioning and medical team</p><p>created a screening battery that included hip</p><p>abduction and adduction isometric strength testing in</p><p>various positions.</p><p>Using available literature, a study of NHL players</p><p>found that a player “was 17 times more likely to</p><p>sustain an adductor muscle strain if his adductor</p><p>strength was less than 80% of his abductor strength.”</p><p>In addition, they also used the information available</p><p>in this article by Lassi Laakso, which states: “Our</p><p>interpretation of the ratio will depend on the relative</p><p>adduction strength value but healthy players typically</p><p>have values between 1-1.2.”</p><p>Using the ForceFrame the following tests were</p><p>performed on all athletes.</p><p>Supine Abduction</p><p>At Knee</p><p>Supine Adduction</p><p>At Knee</p><p>CMJ and IMTP</p><p>Peak Force</p><p>A]]e]]ment]</p><p>Sxstem Metrics Benchmarked DataAssessment</p><p>ForceFrame</p><p>ForceFrame</p><p>ForceDeck]</p><p>Peak: 416N</p><p>Asxmmetrx: 4.4�</p><p>Peak: 40�N</p><p>Asxmmetrx: ¯.��</p><p>Team Average: 0.61</p><p>Benchmark )'oa�(: 0.�*</p><p>Peak Force A]ymmetry</p><p>Peak Force A]ymmetry</p><p>Dynamic Strength Index</p><p>(DSI)</p><p>*Benchmarking decisions are always specific to team and individual goals. It is always recommended to determine what benchmark is most</p><p>appropriate for your team.</p><p>The results were then analyzed; athletes whose</p><p>adductor strength was less than 80% of their abductor</p><p>strength were flagged and provided with specific</p><p>intervention programs.</p><p>Post-season, the data scientist team will compare</p><p>injury statistics with testing data obtained throughout</p><p>the season. Any potential risk factors are identified</p><p>and are then used to develop injury risk management</p><p>plans for future seasons.</p><p>https://journals.sagepub.com/doi/10.1177/03635465010290020301</p><p>https://www.sportsmith.co/articles/reducing-hip-and-groin-injuries-in-ice-hockey/</p><p>48 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Anterior Cruciate Ligament (ACL) Reconstruction</p><p>Freya Jones (24 years old)</p><p>Sub-Elite Volleyball Athlete</p><p>Freya is six weeks post ACL reconstruction with a hamstring graft.</p><p>Example Early-Stage Isometric ACL Tests</p><p>DynaMo</p><p>ForceFrame</p><p>ForceFrame</p><p>Peak Force</p><p>Peak Force</p><p>Asymmetry</p><p>Peak Force</p><p>Peak Force</p><p>Asymmetry</p><p>Restoration of quadriceps</p><p>function, a key consideration</p><p>for ACw rehab progressions.</p><p>Isometric knee extensions</p><p>or Knee Iso-Push to</p><p>tolerance. 2-3 Times per</p><p>week.</p><p>High-intensity isometrics</p><p>(80% MVC) for short</p><p>durations to maintain</p><p>strength (FF Training Mode).</p><p>Baseline function of hip force</p><p>production to determine</p><p>accessory rehab</p><p>interventions.</p><p>Knee Extension</p><p>Hip Abduction/</p><p>Adduction (45°)</p><p>Test/Image Systems Metrics Interpretation Training bptions</p><p>These findings can then be used to set training thresholds and monitor over time. In conjunction with a</p><p>comprehensive training program, some example isometric exercises could be as follows:</p><p>Example Early-Stage Isometric ACL Training</p><p>¤ [E/$��¯��Å�º/E�</p><p>¤ :��EÅ$���$��</p><p>¤ :/�P��qE� ��º/��</p><p>�������|�</p><p>����}���{�~</p><p>�z��}�r��|f��</p><p>¤ £¯�Eq���</p><p>¤ ����Å��</p><p>¤ :/�P��q� �����qE�ºq/��</p><p>¹³°</p><p>·���}f��f©f®fzµ</p><p>ª�z{����}</p><p>¤ ½ÏqÍ� �$��Ê$º/��E/º�¯q��¯���</p><p>¤ �/¯$º$/E$�P�Í$�Ï�</p><p>¤ Â$q����Ê/ż��qE�</p><p>������®��</p><p>®��®f�{}ªz�f®fz�~</p><p>����z|z{�f®f��}®��f�f�{</p><p>¤ £¯�Eq����qº�E/�Å���q����Å�$q�/º��q�$�$q�.</p><p>¤ [E/$��</p><p>¤ £��Eq��Å��</p><p>���|�7��}�������|�</p><p>�®���{®�}�r��|f���</p><p>O N M L J K H D J K G } I D J K O S Y X S T I } D Z V J X S Y D T Z O N M L J K H D J K G } ] ^ J K y N w T S D V w K G } D Z V J X S Y D T Z</p><p>Freya progressed well through early-stage rehabilitation and is now ready to continue progress to mid-stage</p><p>rehabilitation.</p><p>Practitioner’s Guide to Isometrics | 49</p><p>Back to Contents</p><p>Example Mid-Stage Isometric ACL Tests</p><p>RFD 200ms</p><p>Asymmetry</p><p>Peak Force</p><p>RFD 200ms</p><p>Asymmetry</p><p>DynaMo</p><p>ForceFrame</p><p>NordBord</p><p>ForceDecks</p><p>ForceDecks</p><p>Peak Force</p><p>AsymmetrÏ</p><p>Impulse 200ms</p><p>Asymmetry</p><p>Peak Force</p><p>Peak Force</p><p>Asymmetry</p><p>Restoration of ðuadriceps</p><p>function, a key consideration</p><p>for ACâ rehab progressions.</p><p>Knee Extension Iso-Hold or</p><p>Knee Iso-Hold for ðuasi-</p><p>eccentric isometric force</p><p>capacity.</p><p>Progressions from ISO 50*</p><p>to ISO Prone and ultimately</p><p>assisted Nordic Hamstring</p><p>curls.</p><p>Progressions from self-</p><p>selected PIMAs to HIMA</p><p>with set loads and durations</p><p>for muscular endurance.</p><p>Along with knee extension</p><p>force, can inform readiness</p><p>for ballistic or plyometric</p><p>actiYities.</p><p>Restoration of isometric</p><p>hamstring function, a key</p><p>consideration for ACâ rehab</p><p>progressions.</p><p>Combined hip extension</p><p>abilities zhamstring and</p><p>glutes). Insights into lower</p><p>extremity compound function.</p><p>Combined lower extremity</p><p>extension capabilities. âower</p><p>limb strategy during high-</p><p>intensity tasks.</p><p>Knee Extension</p><p>ISO 30°</p><p>Hip Iso-Push</p><p>IMTP/ISO Squat</p><p>Test/Image Systems Metrics Interpretation Training Options</p><p>Example Mid-Stage Isometric ACL Training</p><p>E r:³[/$�É�:¾f¨¾��[�</p><p>E P�[���</p><p>E q/���/[�</p><p>���������</p><p>������������</p><p>�����������}����</p><p>E r:³[/$��</p><p>E ¥�[��[�£�q��/[�</p><p>E P�f���/� �£�q�/[��/�É�</p><p>��}¼�����¯���������¬�¶</p><p>�����¬�µ�����±}«�º</p><p>°�}¬�����</p><p>E r:³[/$�� �f�[����Å</p><p>E r:³[/$��f�[����Ä����</p><p>E Ñ/��[/���É�f��:¾�¾f��/[�</p><p>������������}������</p><p>�°}����°���</p><p>�����¬��</p><p>µ�¬µ�¼}����������¬</p><p>E r:³[/$��</p><p>E '[�����¾³³/[��$��</p><p>E £�¨/�É���/��</p><p>��=������¬�¶</p><p>�����¼������������</p><p>��¬¼�����������</p><p>M V Q � I S N J K H V R K � L V D G � B � O U C F b N `</p><p>J N Z L � V H R D J N ` V Z H o l F b U � U b h C I n � U c b F Z Z J H H R ` y � Q V D G</p><p>Freya is now in her final rehabilitation phase, progressing to return to play.</p><p>50 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Example Late-Stage Isometric ACL Tests</p><p>Peak Force</p><p>Asymmetry</p><p>Peak Forc�</p><p>RFD 200ms</p><p>Asymmetry</p><p>DynaMo</p><p>ForceFrame</p><p>ForceDecks</p><p>ForceDecks</p><p>ForceDecks</p><p>Peak Force</p><p>Asymmetr­</p><p>Start time to 80%</p><p>Peak Force</p><p>Max RFD</p><p>Peak Force</p><p>Asymmetry</p><p>Restoration of Üuadriceps</p><p>peak force and RFD, key</p><p>metrics when returning to</p><p>cutting, plyometrics and</p><p>agility.</p><p>Knee Extension Iso-Push or</p><p>Knee Iso-Push to tolerance.</p><p>2-3 Times per week.</p><p>Informs loading progression</p><p>for Knee Iso-Switches,</p><p>Quasi-Eccentric and</p><p>Functional Isometrics.</p><p>Informs next steps to</p><p>progress to Üuasi-</p><p>isometrics like Hip Iso-Hold</p><p>Switches or PIMAs.</p><p>Can inform readiness for</p><p>ballistic ankle switches</p><p>(PIMA or HIMA).</p><p>Restoration of vertical, weight-</p><p>bearing Üuadriceps function,</p><p>assessed in common knee</p><p>lfexion angle of ACL injury. (145°)</p><p>Combined hip extension</p><p>abilities (hamstring and</p><p>glutes). Insights into lower</p><p>extremity strength and RFD.</p><p>Peak force output for calf</p><p>musculature; has similar</p><p>activation time as Üuadriceps,</p><p>aids in deceleration capacity.</p><p>Knee Extension</p><p>Knee Iso-Push</p><p>Hip Iso-Push</p><p>Ankle Iso-Push</p><p>Test/Image Systems Metrics Interpretation Training ,ptions</p><p>Example Late-Stage Isometric ACL Training</p><p>� fPÎ/$[$E��}âE</p><p>� r�q�¸:P�¢E</p><p>� �/­P:¢}P­E E</p><p>������</p><p>������������</p><p>�������� ��������</p><p>� ±$¯}�©¢E</p><p>� ¥¢q[âE</p><p>� rP°�E:�E �¥�fE�}E­�Pq�</p><p>�Æ��¼�Ä�����������µ</p><p>²��´�����¾����Á</p><p>���������</p><p>� ±$¯}�©¢E E°:}¢��:ÒE�E¥	Ð</p><p>� ±$¯}�©¢EÃ�$¯�[�qE°:}¢��:Ñ</p><p>� ���:}�­­¢qE°:/$[­[°E��}E</p><p>�������¼� ¼</p><p>�����!��´���������</p><p>� 6�PqE:�</p><p>� �[°:�$/(¢E</p><p>� �P�E��$&/�¢E4/:ÒE</p><p>����������¼� ¼�´�Ä��´L</p><p>�����������������������</p><p>���Ä����´�</p><p>Ä���¾�!�¼����Ä����¼�</p><p>X U S � XWX � O N VWX S � O R N O N VSV^ O R � O N VWX S � O R N � t^ � N o X R O � O R � O N VWX S � O R N � ��~� z w� | { � x zv | u � zv |</p><p>Practitioner’s Guide to Isometrics | 51</p><p>Back to Contents</p><p>Recreational Athlete Strength Testing</p><p>Ben Smithers (42 years old)</p><p>Social Football Athlete</p><p>Ben signs up with Sarah, a trainer at his local gym,</p><p>to improve his strength and conditioning, which he</p><p>hopes will help both with performance and injury</p><p>prevention.</p><p>He is skeptical as he has seen trainers in the past and</p><p>not only did he not find a lot of value in the sessions,</p><p>he also injured his back doing heavy squats under the</p><p>instruction of a previous trainer.</p><p>Since that incident, he has had a history of recurrent</p><p>back flares – particularly when he has done heavy</p><p>squats, some occasional groin pain late in the season,</p><p>as well as hamstring tightness with high running</p><p>volumes.</p><p>Sarah needs to perform a comprehensive assessment</p><p>of Ben’s physical capacity but also needs to</p><p>demonstrate the value of her plan so he commits to</p><p>the program.</p><p>As part of her assessment, she performs an isometric</p><p>squat push on ForceDecks to ascertain Ben’s strength</p><p>to benchmark these against the general population</p><p>and sports-specific normative data.</p><p>Not only is this less likely to aggravate Ben’s back pain</p><p>but it is also more time efficient (less than five mins</p><p>compared with 15-20 minutes to perform typical 1RM</p><p>testing).</p><p>Additionally, Sarah has read some recent research</p><p>that has found there to be correlations between</p><p>1RM testing and peak force from isometric tests. As</p><p>such, there is also the possibility of using this test to</p><p>prescribe training loads.</p><p>Example tests that are included in Sarah’s assessment:</p><p>Iso Squat Push</p><p>Run-Specifcc</p><p>Isometrics</p><p>Hip Adduction/</p><p>Abduction</p><p>Iso Prone Hamstrin¬</p><p>Systems Metrics RationaÊeTest Type</p><p>ForceDecks</p><p>Peak Force (Bilateral)</p><p>Peak Force Asymmetr</p><p>Start Time to 80% Peak Force</p><p>so Squat Push will be more time efcientn less likely</p><p>to aggravate Ben’s back and will allow more specifc</p><p>assessment than a rep max squat assessment.</p><p>Run-Specifc sometrics will provide nuanced data to</p><p>show Ben what muscle groups he may need to</p><p>develop more to reduce injury risk on the football feld.</p><p>ForceFrame AbductionbAdduction test is quickn simple</p><p>and provides with quickly comparable ratio metrics to</p><p>inform Matt which areas he needs to work on.</p><p>This assessment will provide quality data specifc to</p><p>hamstring strength and total impulse in a short time</p><p>frame. Helpful data for his recurrent hamstring pain.</p><p>Peak Force (Unilateral)</p><p>Peak Force Asymmetr</p><p>Max RFD</p><p>Peak Force Abductio</p><p>n</p><p>Peak Force Adductio</p><p>n</p><p>Abduction: Adduction Ratio</p><p>Peak Forc</p><p>e</p><p>Peak Force Asymmetr</p><p>mpulse at 200ms</p><p>ForceDecks</p><p>ForceFrame</p><p>NordBord</p><p>Using Normative Data Reports available in VALD Hub for Men’s Football (Soccer), it is noted that Ben has scored</p><p>the following:</p><p>• Iso Prone Peak Force – 25th percentile</p><p>• Hip Adduction Peak Force – 75th percentile</p><p>• Hip Abduction Peak Force – 50th percentile</p><p>• Hip Adduction: Abduction Ratio – 25th</p><p>percentile and less than 1.0</p><p>Using these findings, Sarah can clearly show Ben</p><p>where he sits relative to other football players who</p><p>have similar goals to him. She can also link these</p><p>objective results with injury risk mitigation and</p><p>performance standards.</p><p>Ben commits to the program and Sarah performs a</p><p>re-testing session every four to six weeks. They can</p><p>see the progress being made and can therefore target</p><p>the program, based on the new results.</p><p>Hip Ad/Ab - Supine (Ankle)</p><p>Max Force - Left & Right Side Hip Ad/Ab.</p><p>https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-1103-2173</p><p>52 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Neck Strength Testing</p><p>Greg Bruce (17 years old)</p><p>High School Rugby Union Athlete</p><p>Greg’s high school rugby team is undergoing pre-</p><p>season screening to establish their baselines but also</p><p>to identify any modifiable injury risk factors.</p><p>Last season, Greg sustained a concussion while</p><p>playing rugby, so the medical team is particularly</p><p>interested in his neck strength.</p><p>From recent research, it is known that higher neck</p><p>extension strength is associated with lower</p><p>concussion rates in male rugby players. This study</p><p>also showed that a 10% increase in neck extension</p><p>was associated with a 13% reduction in concussion</p><p>rate.</p><p>It was decided to test his neck strength using the</p><p>reliable method described in this study using the</p><p>ForceFrame.</p><p>Quadruped Neck</p><p>Extension</p><p>Quadruped Neck</p><p>Flexion</p><p>Quadruped Neck</p><p>Lateral Flexion</p><p>Systems</p><p>Metrics</p><p>Rationale</p><p>Test Type</p><p>ForceFrame</p><p>Peak Force</p><p>Neck strength and performance has been</p><p>shown to demonstrate a protective effect</p><p>against concussion risk and is a simple,</p><p>time-effective assessment procedure.</p><p>Provides �ualit� information about</p><p>individual and team performance for pre-</p><p>season screens.</p><p>Peak Force</p><p>Peak Forc3</p><p>Peak Force 's�mmetr�</p><p>ForceFrame</p><p>ForceFrame</p><p>The ratio of cervical flexor-to-extensor muscles is</p><p>also examined as there is research to suggest that</p><p>those less than 60% are associated with an increased</p><p>prevalence and incidence of concussion.</p><p>Furthermore, a flexion-extension strength ratio of</p><p>close to one correlates with lower head acceleration</p><p>during impact.</p><p>Greg’s findings show that he is below the team’s</p><p>benchmark for neck extension strength and his</p><p>cervical flexion-to-extension ratio is less than 0.8. He</p><p>is flagged by the medical team and provided a series</p><p>of neck strengthening exercises, including isometric</p><p>training using Training Mode with ForceFrame.</p><p>For six weeks, Greg’s neck strength is monitored</p><p>weekly and his flexion-to-extension ratio reaches</p><p>approximately 0.9 and his extension strength is now in</p><p>line with his peers.</p><p>Due to his history, he is then monitored monthly</p><p>over the season to ensure he maintains his muscle</p><p>strength and ratio of flexion-to-extension strength.</p><p>https://pubmed.ncbi.nlm.nih.gov/35197247/</p><p>https://pubmed.ncbi.nlm.nih.gov/35197247/</p><p>https://pubmed.ncbi.nlm.nih.gov/35197247/</p><p>https://valdperformance.com/news/research-summary-is-there-a-correlation-between-neck-strength-and-concussion</p><p>https://valdperformance.com/news/research-summary-is-there-a-correlation-between-neck-strength-and-concussion</p><p>https://valdperformance.com/news/research-summary-is-there-a-correlation-between-neck-strength-and-concussion</p><p>https://www.mdpi.com/2075-4663/11/1/2</p><p>https://www.mdpi.com/2075-4663/11/1/2</p><p>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102493/</p><p>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102493/</p><p>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102493/</p><p>Practitioner’s Guide to Isometrics | 53</p><p>Back to Contents</p><p>Employee Screening and Assessment</p><p>Just Logistics</p><p>Warehousing and Logistics Business</p><p>Over the last three years, Just Logistics has noticed</p><p>their top three workplace-related injuries were:</p><p>• Shoulder Injuries: Commonly from overhead</p><p>activities.</p><p>• Lower Back Injuries: Most commonly, post</p><p>workers lifting objects that they reported were</p><p>“very heavy.”</p><p>• Ankle Injuries: Mostly from overbalancing when</p><p>stepping down from a height.</p><p>These injuries led to significant costs to the</p><p>organization in terms of medical expenses and time</p><p>off work.</p><p>They enlisted the help of an occupational health</p><p>contractor to assist in developing risk mitigation</p><p>strategies aimed at reducing the incidence of injuries</p><p>to the workers and the associated costs.</p><p>After a thorough review, in addition to making multi-</p><p>modal recommendations about improving certain</p><p>environmental factors in the workplace and worker</p><p>education, the occupational health consultant</p><p>recommended physical capacity assessments of the</p><p>workers.</p><p>This includes baseline testing of current employees</p><p>and pre-employment screenings. Similar to a sports</p><p>team setting, this information can then be used to</p><p>inform:</p><p>• Intervention plans for those deemed to have</p><p>higher risk factors.</p><p>• Ongoing periodic monitoring.</p><p>• Matching workers to roles that are appropriate</p><p>for their physical capacity.</p><p>• Benchmarking for rehabilitation.</p><p>In addition to a number of other tests, some example assessments include:</p><p>Isometric Mid Thigh</p><p>Pull (IMTP)</p><p>Single Leg Land and</p><p>Hold (S§§A¸)</p><p>Shoulder ÉRÅIR at¼</p><p>90° Abduction</p><p>Grip Strength</p><p>Systems Metrics</p><p>Rationale</p><p>Test Type</p><p>ForceDecks</p><p>Peak Force (	ilateral�</p><p>Peak Force Asymmetrô</p><p>Start Time to 80% Peak Force</p><p>Provides an indication of systemic neuromuscular force</p><p>generating capacity. Especially useful when comparing</p><p>to Norms.</p><p>Indication of ability to stabilize  when landing on a single</p><p>limb. Impaired control can lead to longer time to obtain</p><p>stabilization.</p><p>Assessment of IR/ER shoulder strength in a compromised</p><p>position. Provides insights into overall shoulder function for</p><p>someone who freMuently lifts and reaches overhead.</p><p>Grip strength is reported to have a strong correlation with</p><p>rotator cuff strength. Can be used as a proxy measure if</p><p>shoulder pain is limiting.</p><p>Time to Stabilization</p><p>Peak Force External Rotatio�</p><p>Peak Force Internal Rotatio�</p><p>Max RFD for ER and IR</p><p>Peak Forc</p><p>e</p><p>Peak Force Asymmetry</p><p>ForceDecks</p><p>ForceFrame</p><p>DynaMo Plus</p><p>These results can then be benchmarked against:</p><p>• Available literature</p><p>• Cohort results</p><p>• Normative data, such as VALD’s Norms</p><p>2500</p><p>3000</p><p>2000</p><p>IMTP</p><p>Max Peak Vertical Force - Bilateral Total</p><p>9.7%</p><p>Asym. 1.9% Right</p><p>39th pct.</p><p>2547N</p><p>54 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Elderly Patient Functional Well-Being Assessment</p><p>Debora Jackson (68 years old)</p><p>Functional Well-Being Assessment</p><p>It has been three years since Debora’s total hip</p><p>replacement (THR) and although she completed a</p><p>full rehabilitation program, she reports that she hasn’t</p><p>maintained her general physical well-being.</p><p>She isn’t in any pain and feels she made a full recovery</p><p>from her hip replacement. However, she has sought</p><p>out a physical therapist's help to achieve certain goals,</p><p>including:</p><p>• To improve overall physical health and well-being.</p><p>• To increase her ability to lift heavy objects around</p><p>the home – including her grandchildren.</p><p>• To get back into recreational tennis with her</p><p>friends (which she was able to do post-surgery</p><p>but stopped due to increased commitments with</p><p>her grandchildren).</p><p>Her practitioner decides to conduct baseline testing to provide insights as to where she sits relative to her peers</p><p>but also to help develop your program. In addition to other fitness and dynamic assessments, you decide to</p><p>include some isometric tests such as:</p><p>IMTP</p><p>Double Leg Land and</p><p>Hold (DLLAH)</p><p>Hip Abduction�¨</p><p>Adduction</p><p>Grip Strength</p><p>Systems</p><p>Metrics</p><p>Rationale</p><p>Test Type</p><p>ForceDecks</p><p>Peak Force (áilateralÞ</p><p>Peak Force Asymmetrê</p><p>Start Time to 80% Peak Force</p><p>Provides a safe and ob�ective indication of</p><p>full body strength. Especially useful when</p><p>comparing to Norms.</p><p>Indication of ability to accept load upon</p><p>landing. High peak landing forces or</p><p>signifcant asymmetry may indicate</p><p>stiffness or compensation strategies.</p><p>Assessment of hip adductors and abductor</p><p>due to history of THR and goal to return-to-</p><p>sport re;uiring lateral movement.</p><p>Grip strength is reported to have a strong</p><p>correlation with rotator cuff strength._\an be</p><p>used as a proxy measure if shoulder pain is</p><p>limiting.</p><p>Time to Stabilization</p><p>Peak Landing Force Asymmetry</p><p>Peak Force Abduction</p><p>Peak Force Adduction</p><p>Peak Force Asymmetry Ad�Ab</p><p>Peak Forc</p><p>e</p><p>Peak Force Asymmetry</p><p>ForceDecks</p><p>ForceFrame</p><p>DynaMo Plus</p><p>The results of the tests can be used to benchmark against VALD’s Norms and to track progress longitudinally</p><p>over time.</p><p>Hip Ad/Ab - Seated</p><p>Max Force - Left & Right Side Hip Ad/Ab.</p><p>0.96Ns 0.**Ns</p><p>Practitioner’s Guide to Isometrics | 55</p><p>Back to Contents</p><p>Administration/Workflow Efficiency</p><p>While isometrics primarily serve as a tool for practitioners to test and improve their patients’ and athletes’ health</p><p>and performance, implementing isometrics effectively – particularly when used in conjunction with the right</p><p>technology — can significantly increase efficiency and reduce administrative overheads.</p><p>Clinical Notes, Reports and Programming</p><p>One of the most time-consuming – and at times</p><p>unrewarding – parts of a practitioner’s daily</p><p>workflow can be clinical note-taking, report</p><p>writing and programming.</p><p>With the help of technology, isometric testing</p><p>and training can reduce this workload and</p><p>improve the quality of practitioners’ notes,</p><p>reports and exercise programs.</p><p>With the help of technology, isometric testing and training can</p><p>reduce this workload and improve the quality of practitioners’</p><p>notes, reports and exercise programs.</p><p>When isometrics are tested or trained using</p><p>technology, data is uploaded and appears</p><p>automatically in the patient’s profile.</p><p>With NordBord, ForceFrame, ForceDecks and</p><p>DynaMo, for example, you can use VALD Hub to</p><p>generate reports for clinical notes or letters</p><p>with a single click.</p><p>VALD</p><p>115 Breakfast Creek Rd Newstead, QLD 4006</p><p>ph: 234 456 7890</p><p>Pro le: John Davis</p><p>Report By: Dr. Jenny Smith</p><p>Report Date: 21 May 2024</p><p>Isometric Tests</p><p>Age: 24 (01 Jan 2000)</p><p>Left</p><p>1136N</p><p>Right</p><p>1184N</p><p>4.1%</p><p>Asymmetry</p><p>Single Leg Standing Iso Calf R...</p><p>Max Peak Vertical Force</p><p>8.3% 12.4%</p><p>2547N</p><p>1.9%</p><p>Asymmetry</p><p>IMTP</p><p>Max Peak Vertical Force - Bilateral Tota...</p><p>9.7%</p><p>Left</p><p>693N</p><p>Right</p><p>697N</p><p>0.5%</p><p>Asymmetry</p><p>Knee Extension Seated</p><p>Max Force Left and Right Side</p><p>9.2% 4.8%</p><p>Left</p><p>356N</p><p>Right</p><p>334N</p><p>6.1%</p><p>Asymmetry</p><p>Hip Add/Abd - Supine (Ankle)</p><p>Max Force - Left & Right Side Hip Add</p><p>3.8% 8.0%</p><p>Left</p><p>428N</p><p>Right</p><p>403N</p><p>5.8%</p><p>Asymmetry</p><p>Hamstring Iso - 60°</p><p>Max Force - Left & Right Side</p><p>4.4% 0.4%</p><p>Left</p><p>431N</p><p>Right</p><p>421N</p><p>2.3%</p><p>Asymmetry</p><p>Nordic</p><p>Max Force - Left & Right Side</p><p>6.5% 0.5%</p><p>powered by</p><p>Printable reports from VALD Hub</p><p>56 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Personalized Dashboards</p><p>Most modern isometric testing and training</p><p>technology systems, such as VALD Hub, allow you to</p><p>configure dashboards to show the exact test results</p><p>and metrics all on one screen.</p><p>Setting up such a dashboard can take a little bit of</p><p>extra time at the beginning of a training or treatment</p><p>journey but can save hours in the long run.</p><p>Plus,</p><p>once your dashboard is set up, you can share it</p><p>with your athlete, patient, coach, parent or referrer, as</p><p>well as print it or monitor it at a glance with minimal</p><p>effort.</p><p>Doing this can have an extremely positive effect on</p><p>engagement, satisfaction and outcomes without</p><p>taking up much time.</p><p>…once your dashboard is set up, you can share it with your</p><p>athlete, patient, coach, parent or referrer, as well as print it</p><p>or monitor it at a glance with minimal effort.</p><p>This is particularly valuable if you can visualize more</p><p>than simply isometric data on your dashboard.</p><p>For example, VALD Hub allows users to create</p><p>dashboards with data from any VALD system and</p><p>metric, allowing users to visualize a patient or</p><p>athlete’s data from many systems on one screen –</p><p>from isometric testing, to exercise, education and</p><p>outcomes.</p><p>Practitioner’s Guide to Isometrics | 57</p><p>Back to Contents</p><p>Groups, Categories and Tags</p><p>If you work with groups of individuals regularly, for example, local sporting clubs or you treat many patients with</p><p>the same or similar pathologies, it can be difficult to sift through all the data you have to see just the subset of</p><p>individuals you are interested in.</p><p>…technologies like VALD Hub offer a range of data</p><p>categorization tools – much like folders or file tags on your</p><p>computer or inbox – designed to help make data easy to find.</p><p>To help with this, technologies like VALD Hub offer a</p><p>range of data categorization tools – much like folders</p><p>and file tags on your computer or inbox – designed to</p><p>help make data easy to find.</p><p>Below is an example of how VALD Hub “Groups” and</p><p>“Categories” functions can be used to organize your</p><p>patients, athletes, staff, locations and more.</p><p>Categories and Groups</p><p>Example VALD User Categories Groups</p><p>Active Performance</p><p>Performance facility catering</p><p>to the active population and</p><p>local sporting clubs.</p><p>Coac� A</p><p>Coac� �</p><p>Coac� C</p><p>Men’s</p><p>Women’s</p><p>Aca¤em¡</p><p>Performance Training</p><p>P�¡sical T�erap¡</p><p>Movement Screening</p><p>G¡m Site</p><p>Sporting Club Name</p><p>Service</p><p>Categories and Groups</p><p>58 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Normative Data</p><p>VALD Hub also includes normative data in two forms:</p><p>• Normative Data Reports: For a range of</p><p>cohorts, isometric tests and metrics.</p><p>• Norms: Integrated ForceDecks normative data</p><p>overlaid directly onto patients’ and athletes’</p><p>results (other product Norms coming soon).</p><p>Normative data gives you and your athletes or patients</p><p>a contextually accurate, immediate reference point</p><p>when reviewing their results, glancing at a dashboard</p><p>or sharing a report.</p><p>Normative data gives you and your athletes or patients a</p><p>contextually accurate, immediate reference point when</p><p>reviewing their results, glancing at a dashboard or</p><p>sharing a report.</p><p>125</p><p>15�</p><p>1��</p><p>75</p><p>Isometric Mid-Thigh Pull</p><p>Peak Vertical Force</p><p>14.2%</p><p>Asym. 5.2% Left</p><p>76th pct.</p><p>2223 N</p><p>NORMS</p><p>If you have many profiles with demographic data</p><p>requiring updating, updating them one by one may be</p><p>very time-consuming. However, depending on which</p><p>system you use, it may be possible to do this in bulk,</p><p>as is the case in VALD Hub.</p><p>Tip: If you are struggling to update your patients’</p><p>demographics, VALD’s Client Success Managers are</p><p>here to help – simply email clientsuccess@vald.com</p><p>and the team will help solve your challenges.</p><p>mailto:clientsuccess@vald.com</p><p>Practitioner’s Guide to Isometrics | 59</p><p>Back to Contents</p><p>Alex Natera</p><p>Isometric Strength Training</p><p>Online Course</p><p>Danny Lum</p><p>Manipulating Isometric</p><p>Training Variables to get</p><p>Sport-Specific</p><p>Danny Lum</p><p>Effects of Isometric</p><p>Strength Training on</p><p>Strength and Dynamic</p><p>Performance</p><p>Dustin</p><p>Oranchuk</p><p>Isometric Training and</p><p>Long-Term Adaptations</p><p>Jo Clubb</p><p>Global Performance</p><p>Insights</p><p>Ryan Mc Laughlin</p><p>Sports Scientist and VALD</p><p>Business Development Manager</p><p>Frazer Findlay</p><p>Implementing Isometric Strength Training</p><p>During a Premier League Season</p><p>Alex Natera</p><p>Optimizing Isometric</p><p>Testing and Training</p><p>Danny Lum</p><p>Combining Plyometrics</p><p>and Isometric Training</p><p>Alex Natera</p><p>All Isometric Training is</p><p>Not the Same</p><p>Alex Natera</p><p>Isometric Training;</p><p>Assessments, Progressions</p><p>and Regressions.</p><p>What Next?</p><p>While isometrics are not a “silver bullet” and will always have a place alongside dynamic exercises, they have</p><p>risen in popularity in recent years, thanks at least in part to the democratization of isometric testing and training</p><p>technology. This document has touched on the broad range of applications for isometric testing and isometric</p><p>training, which at times can overlap but this is just the beginning.</p><p>…with ever-improving technology making them easier to</p><p>perform and providing more data and insights, [isometrics]</p><p>are bound to become more and more popular…</p><p>Isometrics are supported by decades of research and practice, and with ever-improving technology making them</p><p>easier to perform and providing more data and insights, they are bound to become more and more popular in</p><p>clinical practice and performance settings alike.</p><p>We have included several helpful sources below to help you in continuing your isometrics learning journey.</p><p>At VALD, we strive to help you on this journey. Born from university research, education is in our DNA. We have</p><p>our own in-house Client Success team, made up of over 20 (and growing) experienced physical therapists,</p><p>physiotherapists, exercise physiologists, performance specialists and beyond. These team members around the</p><p>globe are dedicated to helping you succeed in implementing technology into your practice.</p><p>If you ever want to discuss isometrics, implementing technology into your practice or anything else covered in</p><p>this guide and beyond, get in touch with us at info@vald.com.</p><p>Other great isometrics resources</p><p>https://www.sportsmith.co/courses/isometric-strength-training-online-course/</p><p>https://www.sportsmith.co/articles/manipulating-isometric-training-variables-to-get-sport-specific/</p><p>https://www.sportsmith.co/articles/manipulating-isometric-training-variables-to-get-sport-specific/</p><p>https://www.sportsmith.co/articles/manipulating-isometric-training-variables-to-get-sport-specific/</p><p>https://www.sportsmith.co/articles/manipulating-isometric-training-variables-to-get-sport-specific/</p><p>https://pubmed.ncbi.nlm.nih.gov/30943568/</p><p>https://pubmed.ncbi.nlm.nih.gov/30943568/</p><p>https://pubmed.ncbi.nlm.nih.gov/30943568/</p><p>https://pubmed.ncbi.nlm.nih.gov/30943568/</p><p>https://pubmed.ncbi.nlm.nih.gov/30943568/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://www.linkedin.com/in/dustin-oranchuk-phd-40a99188/</p><p>https://www.linkedin.com/in/dustin-oranchuk-phd-40a99188/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://www.youtube.com/playlist?list=PLhcuhC0uO5QmPbOgyz2Nh8KIuFW78FM5T</p><p>https://www.linkedin.com/in/jo-clubb-89a285210/</p><p>https://www.youtube.com/playlist?list=PLhcuhC0uO5QmPbOgyz2Nh8KIuFW78FM5T</p><p>https://www.youtube.com/playlist?list=PLhcuhC0uO5QmPbOgyz2Nh8KIuFW78FM5T</p><p>https://www.linkedin.com/in/ryan-mc-laughlin/</p><p>https://www.linkedin.com/in/ryan-mc-laughlin/</p><p>https://www.sportsmith.co/articles/implementing-isometric-strength-training-during-a-premier-league/</p><p>https://www.sportsmith.co/articles/implementing-isometric-strength-training-during-a-premier-league/</p><p>https://www.sportsmith.co/articles/implementing-isometric-strength-training-during-a-premier-league/</p><p>https://www.sportsmith.co/articles/optimising-isometric-testing-and-training/</p><p>https://www.sportsmith.co/articles/optimising-isometric-testing-and-training/</p><p>https://www.sportsmith.co/articles/optimising-isometric-testing-and-training/</p><p>https://www.sportsmith.co/articles/combining-plyometrics-and-isometric-training-to-improve-tendon-stiffness-and-performance/</p><p>https://www.sportsmith.co/articles/combining-plyometrics-and-isometric-training-to-improve-tendon-stiffness-and-performance/</p><p>https://www.sportsmith.co/articles/combining-plyometrics-and-isometric-training-to-improve-tendon-stiffness-and-performance/</p><p>https://www.sportsmith.co/articles/all-isometric-training-is-not-the-same-differences-in-the-execution-prescription-and-use-of-pushing-and-holding-isometrics/</p><p>https://www.sportsmith.co/articles/all-isometric-training-is-not-the-same-differences-in-the-execution-prescription-and-use-of-pushing-and-holding-isometrics/</p><p>https://www.sportsmith.co/articles/all-isometric-training-is-not-the-same-differences-in-the-execution-prescription-and-use-of-pushing-and-holding-isometrics/</p><p>https://www.sportsmith.co/listen/isometric-training-assessments-progressions-and-regressions-and-programming-for-different-populations/</p><p>mailto:info@vald.com</p><p>60 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Normative Data for</p><p>Common Isometric Tests</p><p>Normative Data</p><p>Hip Adduction</p><p>Femalemale</p><p>Hip Adduction</p><p>Hip A�duction Hip A�duction</p><p>AgeAge</p><p>AgeAge</p><p>Practitioner’s Guide to Isometrics | 61</p><p>Back to Contents</p><p>Normative Data</p><p>Hip Ad/Ab 60°</p><p>60°</p><p>Hip Abduction Hip Abduction</p><p>Hip AdductionHip Adduction</p><p>AgeAge</p><p>Age Age</p><p>Femalemale</p><p>62 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Normative Data</p><p>Hip Adduction</p><p>Femalemale</p><p>Hip Adduction</p><p>AgeAge</p><p>Age Age</p><p>Hip A�ductionHip A�duction</p><p>Practitioner’s Guide to Isometrics | 63</p><p>Back to Contents</p><p>Normative Data</p><p>Hip Adduction</p><p>Femalemale</p><p>Hip Adduction</p><p>Hip A�ductionHip A�duction</p><p>AgeAge</p><p>AgeAge</p><p>64 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Normative Data</p><p>Supine Hip Ad/Ab 0° at Knee</p><p>Hip Adduction</p><p>Femalemale</p><p>Hip Adduction</p><p>Hip A�ductionHip A�duction</p><p>AgeAge</p><p>AgeAge</p><p>Practitioner’s Guide to Isometrics | 65</p><p>Back to Contents</p><p>Normative Data</p><p>Supine Shoulder ER/IR 90°</p><p>Shoulder Internal Rotation</p><p>Femalemale</p><p>Shoulder Internal Rotation</p><p>Shoulder ��ternal RotationShoulder ��ternal Rotation</p><p>Age Age</p><p>AgeAge</p><p>66 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Normative Data</p><p>Isometric Mid-Thigh Pull (IMTP)</p><p>IMTP</p><p>Femalemale</p><p>IMTP</p><p>Age Age</p><p>Isometric Squat (ISO-SQT)</p><p>ISO-SQT</p><p>Femalemale</p><p>ISO-SQT</p><p>Age Age</p><p>Practitioner’s Guide to Isometrics | 67</p><p>Back to Contents</p><p>Normative Data</p><p>iSO I iSO Y iSO T</p><p>Athletic Shoulder</p><p>ISO I/Y/T</p><p>ASH - iSO I</p><p>Femalemale</p><p>ASH - iSO I</p><p>A�e A�e</p><p>ASH - iSO �</p><p>Femalemale</p><p>ASH - iSO �</p><p>A�e</p><p>A�e</p><p>ASH - iSO �</p><p>Femalemale</p><p>ASH - iSO �</p><p>A�e A�e</p><p>68 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Normative Data</p><p>ISO Prone ISO 30 ISO 60</p><p>30° 60°</p><p>ISO Prone</p><p>Femalemale</p><p>ISO Prone</p><p>Age Age</p><p>ISO ��</p><p>Femalemale</p><p>ISO ��</p><p>AgeAge</p><p>ISO ��</p><p>Femalemale</p><p>ISO ��</p><p>AgeAge</p><p>Practitioner’s Guide to Isometrics | 69</p><p>Back to Contents</p><p>Grip in Neutral</p><p>Grip - Neutral</p><p>Femalemale</p><p>Grip - Neutral</p><p>Age Age</p><p>Grip Elbow at 90°</p><p>Grip - Elbow 90</p><p>Femalemale</p><p>Grip - Elbow 90</p><p>Age Age</p><p>Normative Data</p><p>70 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Normative Data</p><p>Sidelying Hip Abduction</p><p>Hip Abduction - Sidelying</p><p>Femalemale</p><p>Hip Abduction - Sidelying</p><p>Age Age</p><p>Hip flexion</p><p>Hip Flexion</p><p>Femalemale</p><p>Hip Flexion</p><p>Age Age</p><p>Practitioner’s Guide to Isometrics | 71</p><p>Back to Contents</p><p>Normative Data</p><p>Seated Knee Extension</p><p>Knee Extension - Seated</p><p>Femalemale</p><p>Knee Extension - Seated</p><p>Age Age</p><p>Prone Knee Flexion</p><p>Knee Flexion - Prone</p><p>Femalemale</p><p>Knee Flexion - Prone</p><p>Age Age</p><p>• Simplicity – they require minimal technical ability or instruction to perform.</p><p>• Effectiveness – they are capable of training muscles at high intensity in</p><p>specific ranges that can be tightly controlled.</p><p>Isometric strength has been tested by practitioners for centuries, however, historically</p><p>strength could only be assessed subjectively – and typically by hand – commonly</p><p>known as manual muscle testing (MMT). MMT remains commonly used today,</p><p>however the democratization of technology in recent years has allowed practitioners to</p><p>objectively measure and guide the prescription of isometrics.</p><p>With technology such as handheld dynamometers (HHDs)</p><p>and force plates, isometrics have become measurable.</p><p>With technology such as handheld dynamometers</p><p>(HHDs), fixed-point dynamometers (FPDs) and force</p><p>plates now accessible to practitioners, isometrics</p><p>have become measurable.</p><p>Where concentric and eccentric exercises have long</p><p>been quantifiable simply by recording the amount of</p><p>weight that was able to be lifted or lowered, isometrics</p><p>were previously inherently unmeasurable. This would</p><p>mean practitioners previously could not be confident</p><p>if a person was exerting their maximal effort.</p><p>Now, with technology that can precisely measure</p><p>force, torque, asymmetry and other strength-related</p><p>metrics, isometrics can be effectively measured,</p><p>monitored and improved.</p><p>Subsequently, isometric testing has become a</p><p>fundamental pillar in health and performance settings,</p><p>as perhaps the most popular method of quantifying</p><p>musculoskeletal (MSK) health and performance in</p><p>patients and athletes.</p><p>“…But isometrics aren’t functional!”</p><p>Despite their popularity, many practitioners avoid</p><p>isometric exercises because they are not “functional”</p><p>or “dynamic.” While isometrics are indeed almost</p><p>completely static, this can often overlook their place in</p><p>a program that involves a range of contraction modes</p><p>and exercise types.</p><p>Isometrics’ advantage is in their ability to assess</p><p>and train force application in almost any position –</p><p>typically only limited by a practitioner’s imagination</p><p>or patient contextual constraints. Most humans will</p><p>also generate significantly higher forces in isometric</p><p>contractions than can be lifted with traditional weights</p><p>as the technical requirements are removed from</p><p>the exercise, allowing them to train muscles more</p><p>intensively.</p><p>As such, isometrics can be used in a variety of</p><p>settings, from pain modulation to rehabilitation and</p><p>high-performance programs.</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>https://pubmed.ncbi.nlm.nih.gov/30580468/</p><p>Practitioner’s Guide to Isometrics | 7</p><p>Back to Contents</p><p>Isometric Fundamentals</p><p>Isometric exercise, in its many forms, has been around for a long, long time. During this time there have been</p><p>notable peaks and troughs in the popularity of isometric strength testing.</p><p>Not only is it a safe and time-efficient mode of resistance training but if applied appropriately, isometrics can be</p><p>an effective stimulus in driving morphological and architectural adaptations of tendon and muscle respectively.</p><p>Not only is it a safe and time-efficient mode of</p><p>resistance training but… can be an effective stimulus</p><p>in driving morphological and architectural adaptations…</p><p>Compared with traditional resistance training,</p><p>isometrics are more efficient – with not only shorter</p><p>contraction times but also greater overall training</p><p>impulse.</p><p>Also, despite the greater training impulse, there is</p><p>more rapid recovery. Furthermore, when the joint is at</p><p>an optimum angle, the muscle can produce higher</p><p>force during isometric than concentric and eccentric</p><p>contractions.</p><p>Isometric strength training is a method of exercise</p><p>that is well and truly in vogue, for good reason. With</p><p>new technology accessible to practitioners in almost</p><p>any setting isometrics can be measured, monitored</p><p>and prescribed more effectively than ever before,</p><p>opening up their range of applications and enhancing</p><p>their popularity.</p><p>What is Isometric Training and Testing?</p><p>Isometric adjective</p><p>Of, relating to, involving or being muscular</p><p>contraction (as in isometrics) against resistance,</p><p>without significant shortening of muscle fibers and</p><p>with a marked increase in muscle tone.</p><p>Isometric training is a type of strength training</p><p>method in which the joint angle does not change</p><p>during contraction.</p><p>It involves relatively static muscle contractions against</p><p>an immovable object or a fixed position.</p><p>For most beginners performing isometrics, it is</p><p>commonly assumed that there is no length change of</p><p>muscle tissue during isometric contractions.</p><p>However, for more advanced populations, there is</p><p>technically muscle shortening due to tendon creep</p><p>(slow elongation of the tendon under load).</p><p>This may be one of the reasons why there is a transfer</p><p>to dynamic performance.</p><p>…in more advanced populations there is technically muscle</p><p>shortening during isometrics due to tendon creep… This may</p><p>be a reason why there is a transfer to dynamic performance.</p><p>https://link.springer.com/article/10.1007/s42978-023-00241-0</p><p>https://www.sportsmith.co/fundamental/what-is-isometric-training/</p><p>https://www.sportsmith.co/fundamental/what-is-isometric-training/</p><p>https://www.sportsmith.co/articles/all-isometric-training-is-not-the-same-differences-in-the-execution-prescription-and-use-of-pushing-and-holding-isometrics/</p><p>https://www.sportsmith.co/articles/all-isometric-training-is-not-the-same-differences-in-the-execution-prescription-and-use-of-pushing-and-holding-isometrics/</p><p>https://www.merriam-webster.com/dictionary/isometrics</p><p>8 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Common Isometric Actions</p><p>There are several common isometric “actions” that most isometric exercises and tests can be categorized by:</p><p>• Isometric Pushing (e.g., isometric squat, run-</p><p>specific isometrics, isometric calf raise)</p><p>• Isometric Pulling (e.g., isometric mid-thigh</p><p>pull (IMTP)), tension HHD actions such as knee</p><p>extension)</p><p>• Isometric Holding (e.g., isometric posterior</p><p>chain, isometric prone hamstring holds)</p><p>• Isometric Squeezing (e.g., hip adduction, grip</p><p>strength)</p><p>I S O P U S H I S O H O � �</p><p>I S O P U � � I S O S � U � � � �</p><p>I S O P U S H I S O H O � �</p><p>I S O P U � � I S O S � U � � � �</p><p>I S O P U S H I S O H O � �</p><p>I S O P U � � I S O S � U � � � �</p><p>I S O P U S H I S O H O � �</p><p>I S O P U � � I S O S � U � � � �Isometric strength testing applies the same principles as isometric training but the individual simply contracts</p><p>against force sensors on their system of choice, which allows the force to be measured and analyzed.</p><p>This type of testing provides information about the</p><p>isometric strength of a particular muscle or muscle</p><p>group in a specific position, as well as – depending</p><p>on the technology being used – a raft of other metrics</p><p>including asymmetry, rate of force development (RFD),</p><p>time to peak force and more.</p><p>The Benefits of Isometrics</p><p>The musculoskeletal benefits of isometrics include:</p><p>• Assessing muscular function;</p><p>• Monitoring strength over time;</p><p>• Enhancing muscular function;</p><p>• Athletic performance improvement;</p><p>• Managing loading in rehabilitation; and</p><p>• Pain relief and cortical disinhibition in conditions</p><p>such as tendon pathologies and osteoarthritis.</p><p>Due to their safety, simplicity and ease, isometric</p><p>testing and training serves a range of purposes across</p><p>MSK health and fitness, rehabilitation and sports</p><p>performance.</p><p>In addition to safety and ease, other key benefits</p><p>of isometric testing include the minimal technical</p><p>abilities required to perform the task as well as</p><p>reducing the impact of favorable anthropometrics</p><p>influencing results.</p><p>Similarly, isometric training has a range of tangible benefits including those</p><p>listed in this article by Danny Lum:</p><p>• Isometrics induce less fatigue and result in</p><p>superior joint angle-specific strength than</p><p>dynamic strength training.</p><p>• They may be included in the athletes’ training</p><p>regime to avoid getting overly fatigued while still</p><p>acquiring</p><p>positive neuromuscular adaptations.</p><p>• They improve the strength at a biomechanically</p><p>disadvantaged joint position of a specific</p><p>movement.</p><p>• They help improve sports-specific movements</p><p>that require mainly isometric contraction.</p><p>• They are beneficial when athletes have limited</p><p>mobility due to injuries.</p><p>https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-0863-4539</p><p>https://www.linkedin.com/in/danny-lum-phd-cscs-asca-l2-14958544/</p><p>https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-0863-4539</p><p>Practitioner’s Guide to Isometrics | 9</p><p>Back to Contents</p><p>Isometric Testing, Training</p><p>and Technology</p><p>While strength tests and strength exercises serve different purposes, the advent of technology has blended the</p><p>best of both worlds. Historically, the protocol and equipment for isometric testing may have been different (and</p><p>often much less accessible) than that of isometric training but today’s technology allows testing and training to</p><p>become one and the same.</p><p>Historically… isometric testing may have been different than</p><p>isometric training but today's technology allows them to</p><p>become one and the same.</p><p>Technology has added value to isometric testing and training in a wide range of dimensions, including:</p><p>• Objective Data – technology can enable</p><p>isometric forces to be quantified, something</p><p>that was not possible with traditional resistance</p><p>equipment and manual assessment tools.</p><p>• New Insights – in addition to providing objective</p><p>force data, technology can also provide valuable</p><p>insights, such as how the force was generated</p><p>(e.g., Rate of Force Development (RFD)).</p><p>• Biofeedback – some technology, such as</p><p>VALD systems, can provide isometric strength</p><p>readouts in real-time so you can provide</p><p>immediate feedback to patients and athletes, as</p><p>well as longitudinal comparisons.</p><p>• Accurate Asymmetries – not possible with</p><p>traditional training methods (even in dynamic</p><p>movements), technology such as dual force</p><p>plates (e.g., ForceDecks) enables precise</p><p>measurement of strength asymmetries, a key</p><p>factor in understanding strength and movement</p><p>deficiencies.</p><p>• Normative Data – technology can unlock</p><p>access to large normative datasets, such as</p><p>VALD’s integrated Norms, which give invaluable</p><p>context as to how an individual compares with</p><p>results from others within the same age and sex</p><p>demographics.</p><p>• Monitoring – using systems such as VALD Hub,</p><p>practitioners can automatically centralize and</p><p>collate athletes’ and patients’ results, making it</p><p>easy to monitor individuals or groups over time.</p><p>Practitioners can easily track trends in health</p><p>and performance and make data-informed</p><p>decisions.</p><p>• Criteria-Based Progression – now that</p><p>isometrics have been made measurable with</p><p>technology, practitioners can use data to</p><p>objectively determine whether rehabilitation</p><p>programs are achieving the desired results and</p><p>appropriately progress (or regress) through</p><p>rehab.</p><p>• Training Dosages – the same technology that</p><p>can accurately assess isometrics can be used</p><p>for precise training dosages. This enables the</p><p>practitioner to confidently ensure the prescribed</p><p>force intensity and duration are being adhered</p><p>to.</p><p>Subsequently, practitioners in nearly any setting can</p><p>test and train isometrics with a level of precision never</p><p>before possible.</p><p>https://valdperformance.com/news/introducing-vald-norms</p><p>10 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Spotlight: Run-Specific Isometric Test Battery</p><p>What is it?</p><p>The Run-Specific Isometric assessment battery tests lower body strength in three positions that are key to running.</p><p>Why was it developed?</p><p>“Despite being effective general force assessments, the IMTP and</p><p>isometric squat assessment lack the specificity to identify force-generating</p><p>capabilities of specific muscle groups at the specific muscle lengths used</p><p>in high-speed running (HSR).</p><p>Assessing positions and postures resembling HSR positions whilst more effectively</p><p>isolating key muscle groups around the ankle, knee and hip are becoming more popular</p><p>in high performance settings. In doing so, we can collect more information to make more</p><p>informed decisions around whether and when players are in fact, “strong enough to run fast.”</p><p>Alex Natera</p><p>Performance Science</p><p>Manager, NSWIS and</p><p>creator RSIST</p><p>What are the testing positions?</p><p>What normative data is available?</p><p>The following are established reference benchmarks for each of the Run-Specific Isometric tests.</p><p>0-10°</p><p>Ankle</p><p>Plantar Flexion</p><p>135-145°</p><p>Knee</p><p>Flexion</p><p>135-145°</p><p>Knee</p><p>Flexion</p><p>Team Sport</p><p>Males</p><p>Elite Track</p><p>Males</p><p>Team Sport</p><p>Females</p><p>2.2 - 2.5 x SW*</p><p>1.95 - 2.15 x SW</p><p>> 3 x SW</p><p>Hip Iso-Push</p><p>* System Weight (SW) is the portion of bodyweight applied to the force plates.</p><p>In this case, it is the weight supported at the heel in the supine bridge position.</p><p>Team Sport</p><p>Males</p><p>Elite Track</p><p>Males</p><p>Team Sport</p><p>Females</p><p>4.2 - 4.4 x BW</p><p>3.85 - 4.2 x BW</p><p>> 5.5 x BW</p><p>Knee Iso-Push</p><p>Team Sport</p><p>Males</p><p>Elite Track</p><p>Males</p><p>Team Sport</p><p>Females</p><p>3.1 - 3.3 x BW</p><p>2.75 - 2.9 x BW</p><p>> 4 x BW</p><p>Ankle Iso-Push</p><p>* System Weight (SW) is the portion of body weight applied to the force plates. In this case, it is the weight supported at the heel in the supine bridge position.</p><p>Supine position, pushing into</p><p>supramaximally-loaded barbell</p><p>across hips. Emphasis on</p><p>hip extensors.</p><p>Standing position, knee slightly</p><p>flexed, pushing into a fixed bar</p><p>across shoulders. Emphasis on</p><p>knee extensors.</p><p>Standing position, heel raised,</p><p>pushing into a fixed bar across</p><p>shoulders. Emphasis on</p><p>ankle plantar flexors.</p><p>https://www.athleticshoulder.com</p><p>https://www.sportsmith.co/courses/isometric-strength-training-online-course/</p><p>Practitioner’s Guide to Isometrics | 11</p><p>Back to Contents</p><p>Spotlight: Athletic Shoulder (ASH) Test</p><p>What is it?</p><p>The ASH Test is a battery of three long-lever test positions, designed to test the shoulder in a range of positions</p><p>to expose strengths, deficiencies and asymmetries.</p><p>Why was it developed?</p><p>“The ASH test was created to solve the problem of quantifying long-</p><p>lever force transfer and rate of force development.</p><p>We needed a valid, reliable and sensitive field-based test to quantify an athlete’s</p><p>ability to transfer high-forces fast in vulnerable long-lever positions. The ASH test</p><p>does that, with rate of force data correlating with overhead athlete velocity and peak</p><p>force data correlating with athletes who have a history of upper quadrant injury or</p><p>surgery.”</p><p>Ben Ashworth</p><p>Director</p><p>Athletic Shoulder</p><p>What are the testing positions?</p><p>What normative data is available?</p><p>In addition to VALD's Norms, Ben has also published a range of normative scores for each of the ASH Test</p><p>positions, as seen in the tables below and elaborated on in the ASH Test Normative Data at the appendix.</p><p>Poor</p><p>Excellent</p><p>Good</p><p>Gradin! Absolute Relative</p><p>< 125 N < 1.25 NBJA</p><p>> 1.U NBJA</p><p>> 1.\U NBJA</p><p>> 155 N</p><p>> 1\e N</p><p>ASH Test Y</p><p>ASH Test x</p><p>Poor</p><p>Gradin! Absolute Relative</p><p>Excellent</p><p>Good</p><p>< 15e N < 1.�\ NBJA</p><p>> 1.�5 NBJA</p><p>> 2.1 NBJA</p><p>> 1�e N</p><p>> 2ee N</p><p>Poor</p><p>Excellent</p><p>Good</p><p>Gradin! Absolute Relative</p><p>< 115 N < 1.15 NBJA</p><p>> 1.� NBJA</p><p>> 1.5� NBJA</p><p>> 1�5 N</p><p>> 15e N</p><p>ASH Test T</p><p>full abduction in line</p><p>with the body</p><p>135° abduction 90° abduction</p><p>https://www.athleticshoulder.com</p><p>12 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Knee sometrii Strength</p><p>Knee Extension</p><p>Strength</p><p>Knee Flexioä</p><p>Strength</p><p>Knee-Dominanü</p><p>Compound Strength</p><p>FFD - PF, Asym</p><p>Knee Extension Assessment 60° Test</p><p>Force Plates - PF, RFD, Asym</p><p>Run-Speiifi Knee so-Push Test</p><p>HHD - PF, Asym</p><p>Prone Knee Flexion 60° Test</p><p>MMT Grade 1-5</p><p>Knee Extension 60° Test</p><p>MMT Grade 1-5</p><p>Prone Knee Flexion 60° Test</p><p>3 RM / Subjective Rating of Form</p><p>Front Squat Test</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Hand sometrii Strength</p><p>Grip Strength</p><p>Hand Pinch</p><p>Strength</p><p>HHD - PF, Asym</p><p>Grip Squeeze Test</p><p>HHD - PF, Asym</p><p>Pinih Grip Test</p><p>MMT Grade 1-5</p><p>Grip Squeeze Test</p><p>MMT Grade 1-5</p><p>Pinih Grip Test</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Neck sometrii Strength</p><p>Neck Extension</p><p>Strength</p><p>Neck Side-Bendin</p><p>g</p><p>Strength</p><p>Neck Flexion</p><p>Endurance</p><p>FFD - PF, RF</p><p>D</p><p>Quadruped Neik Extension Test</p><p>FFD - PF, T吀�</p><p>T</p><p>Supine Neik Flexion Test</p><p>HHD - PF, RFD, Asym</p><p>Prone Neik Lateral Flexion Test</p><p>MMT Grade 1-5</p><p>Neik Extension Test</p><p>MMT Grade 1-5</p><p>Neik Lateral Flexion Test</p><p>Timed MM</p><p>T</p><p>Neik Flexion Enduranie Test</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Ankle sometrii Strength</p><p>Plantar Flexion</p><p>Strength</p><p>Plantar Flexioä</p><p>RFD</p><p>Dorsilfexioä</p><p>Strength</p><p>FFD - PF, Asym</p><p>Seated Plantar Flexion Test</p><p>HHD - PF, Asym</p><p>Supine Ankle Dorsilfexion Test</p><p>Force Plates - RFD, TTPF, Asym</p><p>Run-Speiifi Ankle so-Push Test</p><p>MMT Grade 1-5</p><p>Supine Ankle Plantar Flexion Test</p><p>MMT Grade 1-5</p><p>Supine Ankle Dorsilfexion Test</p><p>Subjective Rating of Form</p><p>Single Leg Pogo Tes</p><p>t</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Full Body sometrii Strength</p><p>Full Body</p><p>Strength</p><p>Lower Extremit</p><p>y</p><p>Strength</p><p>吀�pper Extremit</p><p>y</p><p>Strength</p><p>Force Plates - PF, RFD, Asym</p><p>sometrii Mid-Thigh Pull Test</p><p>Force Plates - PF, Asym</p><p>sometrii Push-Up Test</p><p>Force Plates - PF, RFD, Asym</p><p>sometrii Squat Test</p><p>1-5 Repetition Maximum</p><p>Barbell Deadlift Test</p><p>1-5 Repetition Maximum</p><p>Barbell Benih Press Test</p><p>1-5 Repetition Maximum</p><p>Barbell Baik Squat Test</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Shoulder sometrii Strength</p><p>Shoulder External</p><p>Rotation (ER)</p><p>Strength</p><p>吀�pper Extremity</p><p>RFD</p><p>吀�pper Extremit</p><p>y</p><p>Push Strength</p><p>FFD - PF, Asym</p><p>Seated Shoulder ER Test</p><p>Force Plates - PF, RFD, Asym</p><p>ASH so Y Test</p><p>Force Plates - PF, Asym</p><p>sometrii Push-Up Test</p><p>MMT Grade 1-5</p><p>Seated Neutral ER Test</p><p>Distance Measuremenü</p><p>Seated Shot-Put Test</p><p>Repetitions to Fatigu</p><p>e</p><p>Benih Press Tes</p><p>t</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Hip sometrii Strength</p><p>Hip Abduction (Ab)</p><p>Strength</p><p>Hip Adduction (Ad)</p><p>Endurance</p><p>Lower Extremit</p><p>y</p><p>Push Strength</p><p>FFD - PF, Asym</p><p>Supine Ab 45° Test</p><p>FFD - PF, Asym, T吀�</p><p>T</p><p>Supine Ad 0° (Ankle) Test</p><p>Force Plate - PF, RFD, Asym, TTP</p><p>F</p><p>sometrii Squat Test</p><p>MMT Grade 1-5</p><p>Sidelying Ab Test</p><p>Timed Endurance Tesü</p><p>Copenhagen Side Plank Tes</p><p>t</p><p>Timed Endurance Tesü</p><p>Wall Sit Tes</p><p>t</p><p>MMT Manual Musile Test PF Peak Forie</p><p>TTPF Time to Peak ForieFFD Fixed-Frame Dynamometer</p><p>RFD Rate of Forie Development RM Repetition MaximumHHD Handheld Dynamometer</p><p>Asym Forie Asymmetry</p><p>T吀�T Time Under TensionKe</p><p>y</p><p>MMT Manual Musile Test PF Peak Forie</p><p>TTPF Time to Peak ForieFFD Fixed-Frame Dynamometer</p><p>RFD Rate of Forie Development RM Repetition MaximumHHD Handheld Dynamometer</p><p>Asym Forie Asymmetry</p><p>T吀�T Time Under TensionKe</p><p>y</p><p>Technology-Enabled Isometric Tests</p><p>Technology has had a significant influence on isometric testing. Not only does it allow new insights</p><p>to be derived but also paved the way for a range of entirely new tests.</p><p>Here, we highlight some of the most common traditional musculoskeletal tests across the body</p><p>and compare them to their modern, technology-enabled isometric equivalents, as well as the new</p><p>types of metrics these technologies enable.</p><p>Practitioner’s Guide to Isometrics | 13</p><p>Back to Contents</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Knee sometrii Strength</p><p>Knee Extension</p><p>Strength</p><p>Knee Flexioä</p><p>Strength</p><p>Knee-Dominanü</p><p>Compound Strength</p><p>FFD - PF, Asym</p><p>Knee Extension Assessment 60° Test</p><p>Force Plates - PF, RFD, Asym</p><p>Run-Speiifi Knee so-Push Test</p><p>HHD - PF, Asym</p><p>Prone Knee Flexion 60° Test</p><p>MMT Grade 1-5</p><p>Knee Extension 60° Test</p><p>MMT Grade 1-5</p><p>Prone Knee Flexion 60° Test</p><p>3 RM / Subjective Rating of Form</p><p>Front Squat Test</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Hand sometrii Strength</p><p>Grip Strength</p><p>Hand Pinch</p><p>Strength</p><p>HHD - PF, Asym</p><p>Grip Squeeze Test</p><p>HHD - PF, Asym</p><p>Pinih Grip Test</p><p>MMT Grade 1-5</p><p>Grip Squeeze Test</p><p>MMT Grade 1-5</p><p>Pinih Grip Test</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Neck sometrii Strength</p><p>Neck Extension</p><p>Strength</p><p>Neck Side-Bendin</p><p>g</p><p>Strength</p><p>Neck Flexion</p><p>Endurance</p><p>FFD - PF, RF</p><p>D</p><p>Quadruped Neik Extension Test</p><p>FFD - PF, T吀�</p><p>T</p><p>Supine Neik Flexion Test</p><p>HHD - PF, RFD, Asym</p><p>Prone Neik Lateral Flexion Test</p><p>MMT Grade 1-5</p><p>Neik Extension Test</p><p>MMT Grade 1-5</p><p>Neik Lateral Flexion Test</p><p>Timed MM</p><p>T</p><p>Neik Flexion Enduranie Test</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Ankle sometrii Strength</p><p>Plantar Flexion</p><p>Strength</p><p>Plantar Flexioä</p><p>RFD</p><p>Dorsilfexioä</p><p>Strength</p><p>FFD - PF, Asym</p><p>Seated Plantar Flexion Test</p><p>HHD - PF, Asym</p><p>Supine Ankle Dorsilfexion Test</p><p>Force Plates - RFD, TTPF, Asym</p><p>Run-Speiifi Ankle so-Push Test</p><p>MMT Grade 1-5</p><p>Supine Ankle Plantar Flexion Test</p><p>MMT Grade 1-5</p><p>Supine Ankle Dorsilfexion Test</p><p>Subjective Rating of Form</p><p>Single Leg Pogo Tes</p><p>t</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Full Body sometrii Strength</p><p>Full Body</p><p>Strength</p><p>Lower Extremit</p><p>y</p><p>Strength</p><p>吀�pper Extremit</p><p>y</p><p>Strength</p><p>Force Plates - PF, RFD, Asym</p><p>sometrii Mid-Thigh Pull Test</p><p>Force Plates - PF, Asym</p><p>sometrii Push-Up Test</p><p>Force Plates - PF, RFD, Asym</p><p>sometrii Squat Test</p><p>1-5 Repetition Maximum</p><p>Barbell Deadlift Test</p><p>1-5 Repetition Maximum</p><p>Barbell Benih Press Test</p><p>1-5 Repetition Maximum</p><p>Barbell Baik Squat Test</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Shoulder sometrii Strength</p><p>Shoulder External</p><p>Rotation (ER)</p><p>Strength</p><p>吀�pper Extremity</p><p>RFD</p><p>吀�pper Extremit</p><p>y</p><p>Push Strength</p><p>FFD - PF, Asym</p><p>Seated Shoulder ER Test</p><p>Force Plates - PF, RFD, Asym</p><p>ASH so Y Test</p><p>Force Plates - PF, Asym</p><p>sometrii Push-Up Test</p><p>MMT Grade 1-5</p><p>Seated Neutral ER Test</p><p>Distance Measuremenü</p><p>Seated Shot-Put Test</p><p>Repetitions to Fatigu</p><p>e</p><p>Benih Press Tes</p><p>t</p><p>Test Non-Technology Method</p><p>Technology-Enabled Method</p><p>Hip sometrii Strength</p><p>Hip Abduction (Ab)</p><p>Strength</p><p>Hip Adduction (Ad)</p><p>Endurance</p><p>Lower Extremit</p><p>y</p><p>Push Strength</p><p>FFD - PF, Asym</p><p>Supine Ab 45° Test</p><p>FFD - PF, Asym, T吀�</p><p>T</p><p>Supine Ad 0° (Ankle) Test</p><p>Force Plate - PF, RFD, Asym, TTP</p><p>F</p><p>sometrii Squat Test</p><p>MMT Grade 1-5</p><p>Sidelying Ab Test</p><p>Timed Endurance Tesü</p><p>Copenhagen Side Plank Tes</p><p>t</p><p>Timed Endurance Tesü</p><p>Wall Sit Tes</p><p>t</p><p>MMT Manual Musile Test PF Peak Forie</p><p>TTPF Time to Peak ForieFFD Fixed-Frame Dynamometer</p><p>RFD Rate of Forie Development RM Repetition MaximumHHD Handheld Dynamometer</p><p>Asym Forie Asymmetry</p><p>T吀�T Time Under TensionKe</p><p>y</p><p>MMT Manual Musile Test PF Peak Forie</p><p>TTPF Time to Peak ForieFFD Fixed-Frame Dynamometer</p><p>RFD Rate of Forie Development RM Repetition MaximumHHD Handheld Dynamometer</p><p>Asym Forie Asymmetry</p><p>T吀�T Time Under TensionKe</p><p>y</p><p>Download Print-Ready Version</p><p>https://qrco.de/bf507U</p><p>14 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>How Do I Choose the</p><p>Right Isometric Test?</p><p>This is a common question, particularly when using isometric testing technology, which can – at times – be</p><p>overwhelming in the number of testing options available to users.</p><p>For many practitioners, you will already know what you want</p><p>to achieve and are likely doing a version of isometric testing</p><p>already. So, start there!</p><p>Instead, it is best to approach your testing design with the end in mind:</p><p>1. What outcome are you trying to achieve?</p><p>First, understand what physical attributes</p><p>make up the end goal. What physical</p><p>attribute? What muscle group(s)?</p><p>What position(s)?</p><p>2. Is there readily available information on best</p><p>practices and common protocols?</p><p>Don’t reinvent the wheel if you don’t need to.</p><p>The growing popularity of isometrics has led</p><p>to many quality resources for best practices.</p><p>3. Select the appropriate test:</p><p>Once you know your desired outcome and</p><p>best practices, you can select the best test (or</p><p>tests) to achieve that goal much more easily.</p><p>For many practitioners, you will already know what</p><p>you want to achieve and are likely doing a version of</p><p>isometric testing already.</p><p>Marrying the two becomes much easier when a</p><p>framework has been set in place. Here, you can</p><p>guide your isometric</p><p>training decisions based on the</p><p>outcome of interest.</p><p>Important questions to ask</p><p>3</p><p>How are you able to</p><p>control for noise or error?</p><p>Set-up</p><p>cueing</p><p>familiarity</p><p>fre°uency</p><p>4</p><p>How will you Áenc¿¾ar»</p><p>your results?</p><p>Research</p><p>NORMS</p><p>Limb</p><p>Symmetry</p><p>Index</p><p>Historical</p><p>data</p><p>What qualities are</p><p>required in their sport?</p><p>Strength</p><p>Power</p><p>Speed</p><p>S6ill</p><p>What qualitF are you</p><p>trying to assess?</p><p>2</p><p>StrengtW</p><p>(PF)</p><p>efficiency</p><p>(aaPF)</p><p>enduranc~</p><p>(�e�eated Pea� uorne</p><p>measures)</p><p>speed</p><p>(�F�)</p><p>1</p><p>Practitioner’s Guide to Isometrics | 15</p><p>Back to Contents</p><p>6 Golden Rules of Isometric Testing</p><p>While HHDs, FFDs and force plates have many differences, one of the advantages of isometric testing is that</p><p>most key principles for collecting good data apply regardless of the isometric testing technology being used.</p><p>Keep each of these in mind whenever you perform isometric tests to ensure you get the best possible results:</p><p>1. Accuracy: Choose an isometric testing</p><p>technology that is accurate and trustworthy,</p><p>such as VALD systems which are relied upon by</p><p>thousands of organizations around the world.</p><p>2. Zeroing: Before commencing a test, ensure the</p><p>device is zeroed (or tared) before any force is</p><p>applied.</p><p>3. Protocols: Use best practice protocols wherever</p><p>possible. The VALD Knowledge Base includes</p><p>effective and easy-to-understand protocols for</p><p>hundreds of isometric tests.</p><p>4. Cues: Use consistent, simple, easy-to-</p><p>understand cues, like “push as hard and as fast</p><p>as you can” and keeping your tone consistent –</p><p>typically positive and firm – to drive intent.</p><p>5. Pre-Tension: Ensure that the subject applies</p><p>slight "pre-tension" to the device before the start</p><p>of each repetition. Pre-tension removes slack</p><p>and prevents false peaks from “shock loading."</p><p>6. RFD Testing: Ensure there is no</p><p>“countermovement” or relaxation before the</p><p>repetition starts. Go directly from pre-tension to</p><p>maximal contraction.</p><p>Below are examples of both good and poor isometric force traces, highlighting how incorrect protocols or</p><p>mistakes can be identified easily from a force trace alone.</p><p>System Weight</p><p>Time</p><p>Start og TesP</p><p>Smooth but quick initiation</p><p>of isometric effort.</p><p>Pretension</p><p>Participant sets up and removes</p><p>“slack” from system.</p><p>Quality Data</p><p>Proper e�ecution provides</p><p>reliable insights into RFD and</p><p>other highly sensitive metrics.</p><p>Normal Peak Force</p><p>A reasonable peak force</p><p>achieved within the test duration.</p><p>Adequate Test Duration</p><p>Isometric tests should have</p><p>efforts between 3-5 seconds.</p><p>Good Isometric Force Trace</p><p>System Weight</p><p>Time</p><p>Countermovement</p><p>Force dip just before Start of</p><p>Movement indicates a counter-</p><p>movement to initiate isometric action,</p><p>creating excess momentum.</p><p>No Pretension</p><p>A lack of pretension leaves slack</p><p>in the system and often results</p><p>in a double peak deformity seen</p><p>in this trace.</p><p>Double Peak</p><p>A double peak occurs when the subject</p><p>begins the isometric assessment with</p><p>momentum, this can be seen when a</p><p>client “yanks” the bar at the beginning</p><p>of an IMTP.</p><p>Sho'-(1oading Peak</p><p>A falsely high peak force may register</p><p>from “collision” force when slack in</p><p>system is taken up. Such a peak may</p><p>not be indicative of actual strength.</p><p>Inadequate Test Duration</p><p>Tests less than 3 seconds or</p><p>greater than 5 seconds should</p><p>be screened for Xuality data.</p><p>Poor Isometric Force Trace</p><p>https://support.vald.com/</p><p>16 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Understanding the Metrics</p><p>Previously, when simple analog and early digital HHDs were the only isometric strength testing technologies</p><p>available to practitioners, results were equally simple.</p><p>For many years, peak force was the only metric reported by</p><p>HHDs. Now... a broad range of metrics are available.</p><p>For many years, peak force (reported in pounds, kilograms or Newtons) was the only metric reported by HHDs.</p><p>Now, with advancements in sensors, electronics, software and algorithms, a broad range of metrics is available.</p><p>Below is an overview of modern isometric strength testing metrics and how they can be interpreted by</p><p>practitioners to guide their decision-making.</p><p>Metric Description Interpretation</p><p>Peak Force</p><p>Asymmetry</p><p>Percentage asymmetry between</p><p>peak force of the left and right limbs.</p><p>Difference in total force output when comparing</p><p>unilateral assessments shows compensation</p><p>strategies with bilateral assessments.</p><p>Rate of Force</p><p>Development</p><p>(RFD)</p><p>Slope of the force-time curve</p><p>between two points; represents the</p><p>rate at which force can be produced.</p><p>Gives insight into contractile speed and muscle</p><p>performance, a key component for many athletic</p><p>characteristics.</p><p>Force at</p><p>200ms</p><p>Similar to RFD, force at 200ms</p><p>describes how much force can be</p><p>produced in a short, fixed time frame.</p><p>Provides insight into force production strategy.</p><p>Can inform performance and rehabilitation</p><p>progressions.</p><p>Start Time to</p><p>Peak Force</p><p>Time required for the athlete to reach</p><p>peak force.</p><p>Gives insight into how quickly maximal force</p><p>expression can be achieved. Rarely used to</p><p>dictate readiness or performance training with</p><p>biofeedback.</p><p>Start Time</p><p>To 80%</p><p>Peak Force</p><p>More reliable metric than Time to</p><p>Peak Force, as the last 20% can take</p><p>a variable amount of time to reach.</p><p>Assesses time to 80% Net Peak Force, which</p><p>removes body weight from accounting for force</p><p>production, allows for assessment consistency.</p><p>These metrics can be used by practitioners to guide</p><p>exercise programming, criteria-based rehabilitation</p><p>decisions and return-to-play/sport/function/work</p><p>decisions.</p><p>While these metrics add extra context to patients’ and</p><p>athletes’ data, they can be confusing to interpret –</p><p>particularly for novice users.</p><p>Therefore, some modern isometric strength testing</p><p>technologies provide even greater context by providing</p><p>users with contextual normative data (such as VALD’s</p><p>integrated Norms) to enable practitioners to compare</p><p>patients and athletes to large cohorts of individuals</p><p>from similar demographics.</p><p>https://valdperformance.com/news/introducing-vald-norms</p><p>Practitioner’s Guide to Isometrics | 17</p><p>Back to Contents</p><p>Types of Isometric Testing</p><p>Technologies</p><p>Isometric testing is already commonplace in clinics, hospitals and gyms around the world. Even in the absence</p><p>of technology, many practitioners still use MMT to assess patients’ strength (albeit with limited accuracy).</p><p>Isometric testing technology can be grouped into three main categories:</p><p>• Handheld dynamometers (e.g., DynaMo);</p><p>• Fixed-frame dynamometers (e.g., ForceFrame and NordBord); and</p><p>• Force plates (e.g., ForceDecks).</p><p>Each of these technologies has their place and can be</p><p>integrated into clinical and performance practice relatively</p><p>easily for most practitioners.</p><p>Handheld</p><p>Dynamometers (HHDs)</p><p>e.g., DynaMo</p><p>Fixed-Frame</p><p>Dynamometers (FFDs)</p><p>e.g., 5o320o32, 8o3-e83a/e</p><p>ForGe =lates></p><p>e.g., 8o3-eDe-JI</p><p>https://pubmed.ncbi.nlm.nih.gov/27476066/</p><p>https://valdperformance.com/products/dynamo</p><p>https://valdperformance.com/products/forceframe</p><p>https://valdperformance.com/products/nordbord</p><p>https://valdperformance.com/products/forcedecks</p><p>18 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Handheld Dynamometers (HHDs)</p><p>Smedley Grip</p><p>Dynamometer</p><p>Duchenne de</p><p>Boulogne Handheld</p><p>Dynamometer</p><p>Lafayette Digital</p><p>Dynamometer</p><p>VALD</p><p>Dyna/o</p><p>1856</p><p>2022</p><p>1@01 200@</p><p>1@8B</p><p>Hoggan FET</p><p>Dynamometer</p><p>[HHDs’] isometric testing protocols closely mirror many</p><p>traditional MMT protocols, making them familiar and easy to</p><p>implement for practitioners.</p><p>Of all isometric testing technologies, HHDs are</p><p>perhaps the most common, given their isometric</p><p>testing protocols closely mirror many traditional</p><p>MMT protocols, making them familiar and easy to</p><p>implement for most practitioners.</p><p>HHDs are also typically the most affordable of all</p><p>isometric testing technologies. HHDs also offer the</p><p>widest range of possible tests of any isometric testing</p><p>technology, with some models capable of hundreds of</p><p>different tests across every major joint in the body.</p><p>The range of tests that a HHD can perform is dictated</p><p>by a combination of their sensors’ capabilities and the</p><p>features of their design.</p><p>The most common types of HHD tests are:</p><p>• Handheld compression tests;</p><p>• Fixed-point compression tests;</p><p>• Fixed-point tension tests; and</p><p>• Grip tests.</p><p>It is rare for HHDs to perform more than one of the above functions, so practitioners would historically have</p><p>required separate devices to perform a comprehensive range of tests. However, DynaMo – released in 2022 –</p><p>amalgamates all of these functions into a single device and even includes an inertial sensor to measure ROM.</p><p>HHDs have long been the tool of choice for physical therapists, strength and conditioning coaches</p><p>and other MSK health professionals. HHDs have existed for over a century, starting as analog tools</p><p>and evolving into the digital, app-enabled embodiments we see today, such as DynaMo.</p><p>https://valdperformance.com/products/dynamo</p><p>Practitioner’s Guide to Isometrics | 19</p><p>Back to Contents</p><p>…practitioners would historically have required three</p><p>separate devices… DynaMo amalgamates all of these</p><p>functions into a single device…</p><p>Beyond simply testing different body parts, HHDs are commonly used for more than one type of isometric test.</p><p>These are commonly referred to as “make” tests and “break” tests:</p><p>• Make Tests: These are the most common type of isometric test, where the individual contracts maximally</p><p>against the HHD, which is held or mounted in a fixed position. This is comparable to the HIMA principle or</p><p>yielding, to isometric force.</p><p>• Break Tests: These can be considered a supra-maximal test, as the subject contracts as forcefully as</p><p>possible against the HHD but rather than holding stationary, the practitioner overcomes the subject’s</p><p>strength often, resulting in a higher peak force reading. This is comparable to the PIMA or overcoming</p><p>isometric force.</p><p>Handheld Compression Tests</p><p>Prone Shoulder Internal RotationSidelying Hip AbductionProne Hip Extension</p><p>Important Considerations for Handheld Testing</p><p>• Positioning of the patient – to ensure the targeted muscle group(s) are appropriately isolated.</p><p>• Positioning of HHD – to ensure comfort and direct force application.</p><p>• Position of practitioner – to ensure appropriate bracing and eliminate any movement.</p><p>Handheld tests are the most commonly used test mode for HHDs and can be performed on almost all body</p><p>parts. They are most useful for performing multiple tests in quick succession, allowing freedom of positioning</p><p>around the patient, which is particularly important for those with compromised mobility.</p><p>However, accuracy can be limited by the ability of the assessor to control the test position and protocol. As such,</p><p>handheld compression tests are considered to be the least reliable type of HHD tests.</p><p>In order to get the most reliable information from performing handheld tests, whenever possible, it is important</p><p>to control the following key factors:</p><p>20 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Fixed-Point Compression Tests</p><p>Seated Shoulder ExtensionProne Y (ASH)S ��ne Plantar Flexion</p><p>Important considerations for fixed-point compression testing</p><p>Whenever possible, it is important to control the following key factors:</p><p>• Positioning of the subject – to ensure the targeted muscle group(s) are appropriately isolated.</p><p>• Positioning of HHD – to ensure comfort for the patient and stability of the HHD to minimize movement.</p><p>Fixed-Point Tension Tests</p><p>Fixed-point tension tests are considered the most</p><p>reliable type of HHD test. Similar to fixed-point</p><p>compression tests, they remove the requirement of</p><p>the practitioner to resist the movement but also allow</p><p>the HHD to naturally align with the direction of applied</p><p>force.</p><p>In addition to increased reliability, they are best placed</p><p>for high-force tests, such as when assessing very</p><p>strong athletes or muscle groups that can generate</p><p>high-forces. The trade-off of fixed-point tension tests</p><p>is the additional time required to set up and perform a</p><p>test compared with other methods.</p><p>Standing Shoulder External RotationSeated Knee ExtensionProne Knee Flexion</p><p>Important considerations for fixed-point tension testing</p><p>• Positioning of the subject – to ensure the targeted muscle group(s) are appropriately isolated and the line</p><p>of pull is in-line with the HHD.</p><p>• Positioning of HHD – to ensure comfort for the patient and stability of the anchor points.</p><p>Whenever possible, it is important to control the following key factors:</p><p>Fixed-point compression tests improve on the reliability and accuracy of handheld tests by removing the</p><p>requirement for the partitioner to resist the movement. They are most useful for pushing movements, where a</p><p>fixed-point tension configuration is not practical.</p><p>Whilst fixed-point compression tests offer more reliability than handheld tests, they are typically not as</p><p>reliable as fixed-point tension tests as it is more difficult to align the application of force with the HHD’s axis of</p><p>measurement.</p><p>Practitioner’s Guide to Isometrics | 21</p><p>Back to Contents</p><p>Grip Tests</p><p>Seated Hand</p><p>(Elbow at 90°)</p><p>Grip Squeeze Stand%n" Hand</p><p>(Elbow at 90°)</p><p>Grip Squeeze</p><p>Seated ;%n53</p><p>(Elbow at 90°)</p><p>Grip Squeeze</p><p>Important considerations for grip testing</p><p>Whenever possible, it is important to control the following key factors:</p><p>• Positioning of the subject – to ensure that the wrist, elbow and shoulder joints are positioned</p><p>appropriately for the test type but are also consistent between testing sessions.</p><p>• Positioning of HHD and grip attachments – to ensure comfort for the patient as well as ensuring the</p><p>opportunity to generate maximal gripping force.</p><p>Wherever possible, choose fixed-point tension HHD tests,</p><p>as these are typically easiest to control and produce the</p><p>most repeatable results.</p><p>Want to know more about HHDs? Check out our blog:</p><p>Grip testing is the most common form of handheld tests and is considered highly reliable. It is simple to perform</p><p>but requires specific attachments (or an entirely different HHD in some cases).</p><p>There is evidence that grip strength is a marker of general health and conditions such as sarcopenia.</p><p>https://valdhealth.com/news/handheld-dynamometers-101-century-old-technology-for-the-modern-practitioner</p><p>22 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Pros and Cons of HHDs</p><p>Pros</p><p>On the Move</p><p>Whmerne vmlienr(msns,r n-hosmrnem nsmenrtmttioet,r w yrn smtrwinhrtpoenienrnm st)r</p><p>edrwhmerl enmerdmvicmtrc e’nrbmrm tilyrne etpoenmds</p><p>Whmer rwidmre enmrofrnmtntrsutnrbmrpmefoesmdrier rthoenrpmeiodrofrnismrbyr rtienlmr</p><p>pe cninioemer(msns,ruppmermxnemsiny,rlowmermxnemsiny,re enmrofrsonioer(ROM)r edrsoem)s</p><p>Efeieney</p><p>HHDtr emrbmtnrtuinmdrfoertienlm-joienrnmtnt,rwhmemrfoecmtr emrnypic llyrlowmer edr</p><p>potinioetrc erbmrm tilyrcoeneollmd,rminhmerierfxmd-poienroerh edhmldrcoefnue nioets</p><p>Single-Joint Testing</p><p>Whmernhmrp nimenrsutnrbmrnmtnmdroer rnem nsmenrbmdrdumrnorcospeositmdrsobilinyr</p><p>oertuenic lremcovmeys</p><p>Bed-Based Testing</p><p>Whmernhmrnmtnryourwithrnorpmefoesrc eeonrm tilyrbmrcoeducnmdrwinhronhmeritosmneicr</p><p>nmtnienrnmcheolonimt,rtuchr trneiprtnemennh,rpiechr edrfenmer ttmttsments</p><p>Adaptability</p><p>HHDtr emrnypic llyrnhmrsotnr ffoed blmritosmneicrnmtnienrnmcheolonimts</p><p>B2dget 6onst-aints</p><p>Cons</p><p>Ma ycHHDsciav co-w fcsp osc( tht,cmax mcmcoapao eyca ecsampo hcfae )ceia c</p><p>FFDsc-fcF-fo cPoae s,cwi oicmaycmak cei mco sscaoocfae c cs-m ce sest</p><p>Accuracy</p><p>HHDscgcpafe ocoafoycwi ccs ech-fcia ei oece sescgcaf c-he co m e ecbycass ss-fc</p><p>sef hei,cm a hc ecoa cb cm-f ce focoece-co-oo oecaoocfae ceaeac ci high-fo ce sest</p><p>High Force Tests</p><p>Practitioner’s Guide to Isometrics | 23</p><p>Back to Contents</p><p>Fixed-Frame Dynamometers (FFDs)</p><p>FFDs use similar sensors to those of HHDs (typically load cell sensors) but feature purpose-designed frames,</p><p>adjustment systems and other mechanical features to tightly control the positioning and anchoring of the</p><p>sensors.</p><p>This means that FFDs produce more reliable</p><p>results than those of handheld tests, as the "human factor" is</p><p>largely removed from the test protocol.</p><p>Some examples of FFDs are:</p><p>• NordBord • ForceFrame Fold • ForceFrame Max</p><p>FFDs…feature purpose-designed frames, adjustment systems</p><p>and other mechanical features…</p><p>…this allows FFDs to produce more reliable results than those</p><p>of handheld tests, as the "human factors" can be largely</p><p>removed from the test protocol.</p><p>In many ways, FFDs are the modern, field-based</p><p>equivalents of isokinetic dynamometers (IKDs).</p><p>IKDs have long resided in university laboratories and</p><p>hospitals but remained out of reach for most sporting</p><p>teams, clinics and gyms.</p><p>FFDs such as the NordBord and ForceFrame have</p><p>changed that, translating much of the modular</p><p>functionality from IKDs into accessible, easy-to-use</p><p>systems.</p><p>While FFDs are typically significantly more portable</p><p>than IKDs, they are still larger than HHDs and force</p><p>plates to accommodate their adjustment and</p><p>mounting features.</p><p>This means they are typically more difficult to</p><p>transport, although FFDs such as ForceFrame Fold</p><p>offer optional travel cases to assist with portability.</p><p>https://valdperformance.com/products/nordbord</p><p>https://valdperformance.com/products/forceframe</p><p>https://valdperformance.com/products/forceframe</p><p>24 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Common FFD Tests</p><p>Some FFDs can differ significantly in functionality, offering the ability to perform dozens of tests on every major</p><p>body part (such as the ForceFrame) or highly specific tests on one or a small number of body parts (such as the</p><p>NordBord).</p><p>What all FFDs share is some variant of a fixed frame in order to tightly control positions and enhance reliability.</p><p>Some examples of the types of tests FFDs offer include:</p><p>S H O R T L E V E R T E S T L O N G L E V E R T E S T N E C K S T R E N G T H T E S T</p><p>U N I L A T E R A L T E S T B I L A T E R A L T E S T U 2 2 E R E / T R E 5 I T 3 T E S T</p><p>Considerations for FFD Testing</p><p>FFDs – by their nature – are designed to enable</p><p>more accurate and repeatable testing, reducing the</p><p>skill required to operate them and produce accurate</p><p>results. However, as with any technology, they are</p><p>never truly fool-proof and it is worthwhile keeping</p><p>some key considerations in mind:</p><p>• Consistent Device Setup: Ensure the device is</p><p>set up in a consistent position each time. For</p><p>example, use features such as ForceFrame’s</p><p>bar position or NordBord’s knee position setting</p><p>– each of which can be saved against a patient</p><p>or athlete’s profile – to ensure a consistent</p><p>configuration each time.</p><p>• Consistent Subject Position: Similarly, ensure</p><p>the patient or athlete is in a similar position each</p><p>time. Also, consider the parts of the subject’s</p><p>body that are not in contact with the device</p><p>– for example, where appropriate it may be</p><p>beneficial to have the subject cross their arms</p><p>to remove any influence.</p><p>Practitioner’s Guide to Isometrics | 25</p><p>Back to Contents</p><p>Pros and Cons of FFDs</p><p>Pros</p><p>FFDs are especially useful for comparing agonist and antagonist muscle group</p><p>strength ratios quickly (e.g., hip adductors and hip abductors) in a single test.</p><p>Testing Agonists and Antagonists</p><p>With modular designs, FFDs such as ForceFrame feature incremental adjustability</p><p>for sensors positions, heights, widths, rotation and more, so practitioners can</p><p>ensure repeatability in their tests.</p><p>Repeatable Positioning</p><p>Some FFDs such as ForceFrame feature a “Training Mode” that allows practitioners</p><p>to set repetition numbers, thresholds and durations of isometric exercises to guide</p><p>and elicit a proper training dose.</p><p>Guided Isometric Exercise</p><p>Stability</p><p>When working with athletes or strong patients, it may be di4cult to manually resist</p><p>the subjects, strength. To achieve reliable and repeatable results, FFDs provide greater</p><p>stability and improve test quality.</p><p>FFDs such as ForceFrame provide multiple high-capacity sensors that are modular,</p><p>allowing for assessment of asymmetry in a range of unilateral and bilateral tests.</p><p>Asymmetry</p><p>FFDs typically feature high capacities to allow for a range of tests. ForceFrame</p><p>sensors are rated to ���lb (j��kg) capacity, making them suitable for strong athletes</p><p>and high force tests such as ankle plantar pexion and knee extension.</p><p>High Force Tests</p><p>FFDs allow any practitioner to test any person. Once the set up is complete, the</p><p>practitioner simply monitors the test - no manual intervention required.</p><p>Removes Tester Skill</p><p>Cons</p><p>Accessibility</p><p>Despite having dozens or hundreds of testing positions, FFDs still require the person</p><p>being tested to be able to get into the appropriate testing position, such as lling</p><p>positions. This can be a limiting factor for people with compromised mobilitl.</p><p>Whilst some models are portable, FFDs are tlpicalll signifcantll larger and heavier</p><p>than HHDs (and even force plates), making them less convenient to transport.</p><p>On the Move</p><p>26 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Force Plates</p><p>Force plates are not a new technology in performance,</p><p>academic or health settings, having been used in</p><p>some research laboratories, hospitals and other</p><p>advanced settings for decades to assess both</p><p>dynamic and isometric strength. Force plates were</p><p>largely confined to these settings due to their cost,</p><p>size and the complexity of analyzing the data they</p><p>generated.</p><p>…modern force plates such as ForceDecks can now</p><p>automatically analyze a range of different tests, eliminating</p><p>the complex and time-consuming data analysis…</p><p>However, with the advent of newer models of force</p><p>plates such as ForceDecks which are more affordable,</p><p>more portable, easier to use and feature a range of</p><p>practitioner-friendly features, force plates’ capabilities</p><p>for isometric testing and training have broadened</p><p>significantly in recent years. Most significantly,</p><p>modern force plates such as ForceDecks can now</p><p>automatically analyze a range of different tests,</p><p>eliminating the complex and time-consuming data</p><p>analysis of traditional systems.</p><p>AutoDetect:</p><p>Automatically recognizes,</p><p>tracks and analyzes 15+</p><p>different force plate</p><p>assessments.</p><p>More than Jumps and IMTP</p><p>Force plates were traditionally only used for jump</p><p>tests and full-body isometric strength tests, such as</p><p>the IMTP, isometric squat and isometric belt squat.</p><p>Such tests typically yielded a maximum force result</p><p>and, in some cases, a force asymmetry result.</p><p>Now, force plates can provide many more results</p><p>analyzing an isometric test and are used for a much</p><p>wider range of both single and multi-joint isometric</p><p>tests, including:</p><p>• Isometric ankle plantar flexion strength</p><p>(standing or seated)</p><p>• Isometric hamstring strength (multiple</p><p>positions)</p><p>• Isometric push-up</p><p>Practitioner’s Guide to Isometrics | 27</p><p>Back to Contents</p><p>Example Isometric Force Plate Test:</p><p>Ankle Iso-Push</p><p>Force Plate Ankle Strength TestTraditional Ankle Strength Test</p><p>Test ®¬tions</p><p>Metric</p><p>What it Means</p><p>Heel Raise</p><p>Endurance Test</p><p>Manualä</p><p>Muscle Test</p><p>Supine Plantarfeeion</p><p>Repetitions</p><p>to Failure</p><p>With or Without Load</p><p>Peak Vertical</p><p>Force</p><p>Grades 1-5</p><p>TiRe toT</p><p>80% Peak Force</p><p>Hoj xuicklu close</p><p>to peak force can</p><p>be achieved</p><p>Hoj Ruch vertical</p><p>force can be</p><p>generated</p><p>Test ®utcoRes</p><p>Ankle Iso Push</p><p>Syste猀� Weight</p><p>Ti猀�e</p><p>Start of Move猀�ent</p><p>Peak Force</p><p>Highest force registered</p><p>during test.</p><p>Pretensio£</p><p>Participant sets up and removes</p><p>“slack” from system.</p><p>Max Rate of Force Develop猀�ent</p><p>(RFD)</p><p>Steepest positive curve in</p><p>the force-time analysis.</p><p>Force at 200猀�</p><p>�</p><p>Amount of force</p><p>produced 200ms after</p><p>the start of movement.</p><p>Start Ti猀�e to J0G Peak Force</p><p>Amount of time until m0l peak</p><p>force was achieved. Often</p><p>more reliable than Time to</p><p>Peak Xorce.</p><p>Common Isometric Force Plate Tests</p><p>Isometric Mid-Thigh Pull ASH Iso Y Seated Iso ($l% $is!Hip Iso Push</p><p>28 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Considerations for Force Plate Testing</p><p>Strg ,es h nyephgwrnebhfrgh</p><p>hs</p><p>ehxhco wrud</p><p>Phgwrnebh hhues g erfecru g c wru</p><p>unehunerfecru g c wrud</p><p>D e sshssmhu efrgeqo ew y</p><p>une ppewc wrud</p><p>BeforeeThs</p><p>CohewueAne uch</p><p>Ceh g,ecrucwshecohseoshnewu</p><p>ne uche ghemrs ehffhc wehd</p><p>QowckeQo ew yeCthck</p><p>Rhewh egh e- wmhen e rehusogheyro’ge</p><p>t ppye w te the teh h’sehxhco wrud</p><p>Dh hgmwuheyroge u eyswsepgrchss</p><p>unes wcke rew d</p><p>S wcke w te thePe u</p><p>Eqo eeCrmp gwsrus</p><p>Lrrke e thebw hgecru hx</p><p>(hd d,ef w oh)e rem khesogheyroge</p><p>crmp gwsruse ghef wgd</p><p>S yeLhss</p><p>Dru’ e ekergenwsgop e theqowh ept sh\</p><p>thuecohebhfrghemrehmhu d</p><p>Crusws hu ePgr rcres</p><p>Pgrewnwu e thes mhewus goc wrusefrge</p><p>h cte hs e une g wuwu eshsswruehusoghse</p><p>ccog hecrmp gwsrud</p><p>DuringeThs AftereThs</p><p>S yeS wee</p><p>Aes weee hw twu ept shewsekhyefrg</p><p>ccog hewufrgm wrud</p><p>Zhgre thePe hs</p><p>C ewbg heyroge�rgchDhcks</p><p>bhfrghe thecewhu es hpserud</p><p>Lhehee the�hh</p><p>Eusoghe the hs wu esogf chew¥</p><p>f e uneehehee w te the ground</p><p>Force plates – despite using similar sensors to those of HHDs and FFDs – are arguably the least similar, as they</p><p>use multiple sensors (typically four per plate) at once to provide a summarized reading, making them extremely</p><p>accurate. However, there are still environmental and human factors that can significantly affect their results:</p><p>1. Environment: Force plates should always be</p><p>used on a firm, flat surface, such as concrete. If</p><p>they are used on soft surfaces such as carpet,</p><p>grass or sprung floors, your readings are likely</p><p>to be inaccurate.</p><p>ForceDecks feature adjustable feet for this</p><p>purpose – to ensure the plates are completely</p><p>flat and stable every time, every test.</p><p>2. Body weight: Unlike HHDs and FFDs, many</p><p>force plate tests require body weight to be</p><p>measured before recording in order to calculate</p><p>metrics relative to body mass (e.g., Peak Power/</p><p>Body Mass). Accordingly, recording an accurate</p><p>body weight is of critical importance.</p><p>Ensure your athlete or patient stands completely</p><p>still while being weighed until the software</p><p>confirms their weight is accepted.</p><p>3. Quiet Periods: Force plates rely on a “quiet</p><p>period” – a period of very stable force readings</p><p>– to determine the start of movement (and as a</p><p>result, many of the metrics that follow) for each</p><p>rep in a test.</p><p>If the subject is moving – e.g., turning their</p><p>head, speaking or weight-shifting between limbs</p><p>– when a rep begins, the start of movement</p><p>may not be detected accurately.</p><p>The patient or athlete can adjust between reps</p><p>but ensure they are completely still before the</p><p>next rep starts.</p><p>Practitioner’s Guide to Isometrics | 29</p><p>Back to Contents</p><p>If you are interested in diving into more detail about force plates, check out our Practitioner’s Guide to Force</p><p>Plates or for a short introduction, check out this Force Plates 101 article from Jo Clubb.</p><p>Pros and Cons of Force Plates</p><p>Pros</p><p>Force plates are known for their accuracy and reliability and in many ways are</p><p>functionally very similar to FFDs.</p><p>Reliability and Accuracy</p><p>While many HHDs and FFDs feature relatively high sampling rates, force plates</p><p>typically sample even faster (e.g., 1,000Hz for ForceDecks), making them well-suited</p><p>for assessing ~FD.</p><p>Rate o° Force ¶evelo¦«ent ¥RF¶¤</p><p>Force plates feature higher capacities than HHDs and FFDs, as loads are spread</p><p>across four sensors in each plate. For example, ForceDecks are rated up to 4,400lb</p><p>(2,000kg) capacity per plate.</p><p>High Force Tests</p><p>Multi-Joint Tests</p><p>Force plates allow athletes and patients to be assessed in a comfortable position</p><p>— standing as they normally would in common exercises. This makes force plates</p><p>well suited for multi-joint assessments.</p><p>Typically smaller than FFDs, some force plate brands such as ForceDecks are</p><p>designed to be portable and offer accessories that make them easy to transport.</p><p>On the Move</p><p>Cons</p><p>Single Joint Tests</p><p>Itn snmorcne facptnton sopltcns igpcneo itsnorns ca fanmcsapcnal la tyntcstsnw thnforacn</p><p>pltcsntcstsnaom lrcenw thnHHDsnlienFFDse</p><p>Foracn pltcsnlrcnty alppynpcssnaoivci citntontrlvcpnw thnthlinHHDsnliensomcnbrliesn</p><p>lienmoecpsnofnforacn pltcsnlrcncvcinecs gicentonbcn crmlicitpynficen in place</p><p>On the Move</p><p>Practitioner's</p><p>Guide to</p><p>Force Plates</p><p>https://resources.valdhealth.com/practitioners-guide-to-force-plates</p><p>https://resources.valdhealth.com/practitioners-guide-to-force-plates</p><p>https://valdperformance.com/news/force-plates-101-what-are-they-and-why-are-they-used</p><p>https://www.youtube.com/@globalperformanceinsights</p><p>https://resources.valdhealth.com/practitioners-guide-to-force-plates</p><p>https://valdperformance.com/news/force-plates-101-what-are-they-and-why-are-they-used</p><p>https://resources.valdhealth.com/practitioners-guide-to-force-plates</p><p>30 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Applications for Isometric Testing</p><p>Along with blurring the lines between isometric testing and isometric training, technology has also widened the</p><p>range of applications for isometrics.</p><p>While most research and practitioners agree exercise programs should emphasize dynamic movements first</p><p>and foremost, isometrics have proven to be effective in almost any clinical or performance setting.</p><p>Rehabilitation</p><p>Isometrics are nothing new in rehabilitation, having long been</p><p>used as a safe, easy-to-perform exercise modality…</p><p>Isometrics are used in two main ways in rehabilitation:</p><p>• Monitor Progress: When incorporating</p><p>technology into isometrics in rehabilitation,</p><p>strength gains can be easily monitored</p><p>as tissues heal, which can be a powerful</p><p>communication tool between practitioners and</p><p>their patients or athletes.</p><p>• Return-to-Activity Assessments: Isometric</p><p>testing is one of the most commonly used</p><p>methods for establishing return-to-activity/play/</p><p>work goals and for measuring if the patient or</p><p>athlete has regained enough strength to safely</p><p>perform their day-to-day activities.</p><p>Task-Specific Assessments</p><p>Along with a range of dynamic assessments like jumping, squatting and lifting (commonly assessed with the</p><p>same technology as isometrics, such as ForceDecks), isometrics are regularly used to perform functional</p><p>assessments to determine if patients or athletes of any age or ability have deficiencies or weaknesses that may</p><p>be targeted by an exercise program.</p><p>As isometrics can be performed on almost any body part or position, they can easily be tailored to the patient,</p><p>their stage of life and their day-to-day activities. For example:</p><p>• Grip Strength: As a screening tool for</p><p>sarcopenia or as part of an athletic screening</p><p>battery.</p><p>• IMTP: Overall strength or lifting capacity.</p><p>• Shoulder Internal/External Rotation Strength:</p><p>Screening and monitoring of throwing athletes.</p><p>• Neck Flexion, Extension and Lateral Flexion:</p><p>Screening neck strength for concussion and</p><p>neck injury risk in collision sports such as rugby</p><p>or combat sports.</p><p>• 1st Toe Flexion Strength: Ballet dancers.</p><p>Isometrics are nothing new in rehabilitation, having long been used as a safe, easy-to-perform exercise modality</p><p>and – particularly in the early stages of acute injuries or surgery – are often the only contraction mode that can</p><p>be satisfactorily controlled and tolerated.</p><p>https://link.springer.com/article/10.1007/s40520-023-02539-z#:~:text=In%20conclusion%2C%20our%20study%20demonstrates,to%20those%20with%20symmetric%20HGS.</p><p>https://link.springer.com/article/10.1007/s40520-023-02539-z#:~:text=In%20conclusion%2C%20our%20study%20demonstrates,to%20those%20with%20symmetric%20HGS.</p><p>https://valdperformance.com/news/research-summary-is-there-a-correlation-between-neck-strength-and-concussion</p><p>https://pubmed.ncbi.nlm.nih.gov/35763910/</p><p>Practitioner’s Guide to Isometrics | 31</p><p>Back to Contents</p><p>…practitioners can simply determine the specific functions</p><p>that are most important, then tailor isometric assessments to</p><p>test those functions.</p><p>In order to implement isometrics into functional</p><p>assessments, practitioners can simply determine the</p><p>specific functions that are most important, then tailor</p><p>isometric assessments to test those functions.</p><p>For</p><p>common sports, pathologies and activities, there</p><p>are also countless studies recommending specific</p><p>protocols for specific patient or athlete requirements.</p><p>As technology becomes more and more accessible</p><p>to practitioners in widely varied settings, we see</p><p>many great examples of creative, effective, easy-to-</p><p>implement functional testing batteries created by</p><p>VALD users.</p><p>Below is one example of how isometric testing</p><p>technology is incorporated into senior health and</p><p>wellness programs.</p><p>Patient performing hip flexion strength assessment as part of LiveWell Health’s Test Battery to understand holistic function in senior care assessments.</p><p>“Historically, only labs with expensive equipment could conduct precise</p><p>measurements. However, VALD has brought this capability to clinical settings.”</p><p>“Your father is quite weak in this area,” doesn’t quite cut it anymore. Now we can provide</p><p>meaningful data insights to say: “When you compare your father with others in this cohort</p><p>you can see he generates 1.04 Newtons of force per kilogram of body weight, the average</p><p>among skilled nursing residents is 1.26N/kg.”</p><p>Andrew Sokolowski</p><p>Founder</p><p>Livewell Health</p><p>32 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Baseline Screening</p><p>Most applications for isometric testing are made</p><p>more effective when a baseline has been established.</p><p>Without such a baseline, practitioners would typically rely on one of two reference points:</p><p>• Limb Symmetry Index (LSI): Can be effectively</p><p>used to target between-limb deficiencies but</p><p>can easily overlook global or chronic issues</p><p>affecting the “healthy” limb as well.</p><p>• Normative Data: Traditionally required</p><p>practitioners to scour research publications</p><p>to find comparative pathologies and cohorts</p><p>to those of their patients, then rely on those</p><p>results, which are often published on very small</p><p>numbers of subjects. With modern systems</p><p>such as VALD’s Norms – integrated normative</p><p>data in VALD Hub – practitioners have easy</p><p>access to much larger datasets, making</p><p>normative data significantly more accessible.</p><p>125</p><p>15�</p><p>1��</p><p>75</p><p>Shoulder Internal Rotation</p><p>Peak Force</p><p>Pre-Injury</p><p>P(&'-Injury</p><p>21.2%</p><p>Asym. 13.2% Right</p><p>76th pct.</p><p>132 N</p><p>While both reference points can be effective, they</p><p>lack complete context without pre-injury baseline</p><p>data. Therefore, baseline screening can allow</p><p>practitioners to use all three reference points to</p><p>guide their rehabilitation strategy.</p><p>Similarly, for athletes embarking on a program to build</p><p>strength or enhance performance, baseline screening</p><p>can provide a reference point to gauge progress</p><p>against and, in some cases, can alert practitioners</p><p>to areas of potential injury risk or deficits, which can</p><p>guide programming decisions.</p><p>Most applications for isometric testing are made more effective when a baseline has been established. For</p><p>example, when a patient presents with an injury, a pre-injury baseline is considered the most effective reference</p><p>point to use as a return-to-activity goal.</p><p>Practitioner’s Guide to Isometrics | 33</p><p>Back to Contents</p><p>Group Testing</p><p>Isometrics testing’s safety, simplicity and speed –</p><p>typically taking less than one minute to perform –</p><p>make them particularly well-suited to group testing,</p><p>where a large number of individuals typically need to</p><p>be tested in a short period of time.</p><p>Isometrics testing’s safety, simplicity and speed – typically</p><p>taking less than one minute to perform – make them</p><p>particularly well-suited to group testing…</p><p>As such, isometric testing is popular in a range of</p><p>group settings, such as:</p><p>• Elite sports</p><p>• Physical education and school sports programs</p><p>• Military recruitment</p><p>• Workforce screening</p><p>Some systems even allow more than one individual</p><p>to be tested at a time (for example, using the</p><p>ForceDecks Jump app) and feature other workflow</p><p>automation (such as ForceDecks’ AutoDetect and</p><p>AutoAnalysis functions), significantly reducing</p><p>testing time and enabling tests to be performed more</p><p>regularly, enhancing data granularity.</p><p>Flags:</p><p>VALD Hub compares each</p><p>individual’s assessment to their</p><p>personal averages, highlighting</p><p>those who may be fatigued or at</p><p>increased in�ury risW.</p><p>Customizable Dashboard:</p><p>Monitor the groups that</p><p>matter to you, while</p><p>customizing the tests and</p><p>metrics that matter most.</p><p>Immediate Comparisons:</p><p>Identify who is above,</p><p>below and meeting group</p><p>averages at a glance.</p><p>An example of a group monitoring</p><p>dashboard in VALD Hub, showing</p><p>a range of isometric testing</p><p>technology results. These group</p><p>reports make it easy to visualize</p><p>large groups of data with a click.</p><p>https://www.youtube.com/watch?v=qVrMJEFpIoY&t=142s</p><p>34 | Practitioner’s Guide to Isometrics</p><p>Back to Contents</p><p>Isometric Training</p><p>Despite the democratization of isometric testing</p><p>technology in recent years, most isometric training is</p><p>still done without technology.</p><p>The most common types of resistance for isometrics</p><p>are typically body weight (e.g., single-leg isometric</p><p>plantar flexion) or an immovable object (e.g., isometric</p><p>squat against a fixed bar). However, there are a</p><p>range of variations to isometric exercise (or pseudo-</p><p>isometric exercise) developed and popularized by</p><p>practitioners.</p><p>“Pseudo-isometrics subdivides into quasi-isometrics,</p><p>eccentric quasi-isometrics, oscillatory isometrics</p><p>and isotonic isometrics, to name a few distinct</p><p>methods. Many of these methods have not been</p><p>thoroughly researched and instead appear mostly in</p><p>coaching manuals, textbooks and online resources.”</p><p>Alex Natera</p><p>Types of Isometric Training</p><p>https://www.sportsmith.co/articles/pseudo-isometrics/</p><p>Practitioner’s Guide to Isometrics | 35</p><p>Back to Contents</p><p>Due to their nature – namely involving minimal or no movement – it is difficult or impossible to quantify</p><p>isometric exercise performance without technology.</p><p>…due to…involving minimal or no movement – it is difficult</p><p>or impossible to quantify isometric exercise performance</p><p>without technology.</p><p>Without being quantifiable, it can be difficult to drive</p><p>intent, measure progress and make programming and</p><p>rehabilitation decisions based on isometric training.</p><p>Introducing technology into isometric training can</p><p>yield a range of benefits:</p><p>• Biofeedback: Patients or athletes who can</p><p>visualize their strength data as they perform</p><p>isometric exercise are more likely to generate</p><p>higher forces and can respond to the data – for</p><p>example, correcting for asymmetries.</p><p>• Dosage: Practitioners can more accurately</p><p>prescribe exercise dosages, as loads can be</p><p>expressed precisely. For example, ForceFrame</p><p>offers the ability to prescribe isometric training</p><p>at percentages of maximal effort or fixed loads,</p><p>with set contraction and rest periods.</p><p>• Recording Progress: Isometric training and</p><p>testing can be merged such that maximal effort</p><p>training can also be recorded and tracked.</p><p>…RSIST protocols… blend testing and training with the goal of</p><p>assessing and improving running-specific strength.</p><p>An excellent example of how technology can be</p><p>incorporated into isometrics is Alex Natera’s RSIST</p><p>protocols, which blend testing and training with the</p><p>goal of assessing and improving running-specific</p><p>strength.</p><p>“These assessments are similar to the joint positions</p><p>found in mid-stance of the high-speed running stride.</p><p>Importantly, the Run-Specific Isometric assessments</p><p>are multi-joint assessments, despite each individual</p><p>assessment’s name. The Run-Specific Isometric</p><p>assessments are designed to bias a joint and this is</p><p>where we infer the force-generating capabilities of</p><p>the muscles surrounding the target joint.” Alex Natera</p><p>RSIST involves three related yet distinct protocols,</p><p>emphasizing ankle, knee and hip strength respectively</p><p>to provide a comprehensive profile and stimulus to the</p><p>joints most responsible for running speed, at specific</p><p>joint angles mimicking running positions. While these</p><p>positions can be trained in the absence of technology,</p><p>Natera emphasizes the importance of biofeedback</p><p>in driving intent, so he encourages</p>