Understanding the Difference: Pushing vs. Yielding Isometrics in Clinical Practice
As a physical therapist, you’re no stranger to isometric exercises. They’re staples in rehab protocols thanks to their safety, control, and versatility. But did you know that not all isometrics are created equal?
In the world of strength and rehab, there’s a critical distinction between two types of isometrics: pushing (overcoming) and holding (yielding). Understanding how and when to use each can significantly elevate your clinical outcomes—whether you’re working with post-op patients or elite athletes.
Let’s break it all down so you can confidently integrate both into your practice.
What Are Isometric Contractions, Really?
The Basics
Isometric contractions involve producing force without changing muscle length. They sit between concentric and eccentric actions, creating tension without visible movement.
But here’s the nuance: how that force is produced matters.
The Two Faces of Isometric Training
Pushing Isometrics (PIMA)
Also known as overcoming isometrics, these involve exerting maximal force against an immovable object—think pushing against a locked-down barbell or a wall.
Clinical example: A patient performing a maximal isometric quad contraction by pushing into a static resistance pad at 90 degrees knee flexion.
- Effort: Maximal or near-maximal (70–100% MVC)
- Duration: 1 to 10 seconds per contraction
- Total Load: ~30 seconds of cumulative effort per session
Holding Isometrics (HIMA)
Also referred to as yielding isometrics, these involve maintaining a joint position under submaximal load for time. Picture a classic wall sit or a plank hold.
Clinical example: A patient with shoulder instability holding a 90-degree scaption position against gravity with light dumbbells.
- Effort: Submaximal, moderate intensity
- Duration: 5 seconds to several minutes
- Focus: Time under tension and motor control
Why This Distinction Matters in Rehab
Different Stimuli, Different Adaptations
PIMA and HIMA offer unique physiological benefits:
Pushing Isometrics:
- Recruit high-threshold motor units
- Improve neural drive
- Increase tendon stiffness
- Great for strength plateaus and ballistic carryover
Holding Isometrics:
- Improve muscular endurance
- Reinforce joint angles and posture
- Enhance motor control and joint stability
- Excellent for early-stage rehab and joint positioning
Knowing which tool to reach for can make or break a treatment plan.
When to Use Each Type in Your Practice
Pushing Isometrics (PIMA)
Best For:
- Improving max strength in specific joint angles
- Postural re-education when high force is safe
- Reintegrating athletes into high-output patterns
Sample Application:
- Post-ACL reconstruction: Perform a seated isometric knee extension at 60 degrees using a dynamometer or manual resistance.
- Performance Phase: Contrast training—e.g., isometric mid-thigh pull (5s max effort) followed by a vertical jump.
Holding Isometrics (HIMA)
Best For:
- Stabilizing vulnerable joints
- Low-load rehab settings (e.g., early post-op)
- Postural and endurance retraining
Sample Application:
- Rotator cuff rehab: Have the patient hold 30-45 degrees shoulder external rotation with a resistance band for 30 seconds.
- Knee pain management: Wall sits to reinforce VMO activation without knee travel.
Programming Guidelines for Clinical Use
Pushing Isometrics
- Intensity: 70–100% of maximal effort
- Duration: 3–10 seconds per contraction
- Rest: 30–60 seconds between efforts
- Total Volume: Aim for at least 30 seconds cumulative work per session
Holding Isometrics
- Intensity: 30–70% of perceived exertion
- Duration: 10 seconds to several minutes
- Rest: As needed based on fatigue and symptom provocation
- Volume: 3–5 sets depending on goal and tolerance
Combining Both for Maximum Benefit
You don’t have to pick one over the other. In fact, alternating between PIMA and HIMA can create powerful neuromuscular synergy.
Example Contrast Pairing
- Step 1: Max effort isometric lunge (PIMA) for 5 seconds
- Step 2: Forward jump lunge (dynamic)
- Goal: Improve explosive strength and joint stiffness
Example Stability Sequence
- Step 1: 30-second wall sit (HIMA)
- Step 2: Single-leg balance with band resistance
- Goal: Build endurance and proprioception for return to sport
Final Thoughts: Choosing the Right Isometric
Whether you’re trying to get a patient back on the field or just up the stairs without pain, understanding the intent behind isometric training is key.
- Use pushing isometrics when you want strength, stiffness, and neural drive.
- Use holding isometrics when you need control, stability, and endurance.
By tailoring your approach based on these principles, you’ll make your isometric prescriptions more purposeful—and more powerful.
So next time you cue a static hold or resistance push, ask yourself: “Am I pushing or holding?” The answer could shape your patient’s outcome.
Reference:
Natera, A. (n.d.). All isometrics are not the same: Differences in the execution, prescription, and use of pushing and holding isometrics. Retrieved from https://nateraps.com/all-isometrics-are-not-the-same-differences-in-the-execution-prescription-and-use-of-pushing-and-holding-isometrics/
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