‘Pushing’ versus ‘holding’ isometric muscle actions; what we know and where to go: A scoping and systematic review with meta-analyses

Background

Pushing isometric muscle actions (PIMA) are utilized to evaluate strength, fatigue, and neuromechanical aspects. Holding isometric muscle actions (HIMA) are largely unknown, although practitioners prescribe them in rehabilitation and performance contexts. The lack of knowledge and consensus on the distinction between two isometric types combined with limited scientific backing makes appropriate application difficult.

Objective

To gather research directly comparing PIMA and HIMA, and summarize and synthesize findings. We also aimed to identify potential practical applications for both tasks. Lastly, we highlight existing gaps in the literature and propose directions for future research.

Methods

CINAHL, Embase, MEDLINE, PubMed and Web of Science databases were searched for peer-reviewed articles comparing PIMA and HIMA in humans. Risk-of-bias and study quality were assessed via established assessments for quasi-experimental studies and funnel plots. Findings were synthesized where possible, with meta-analyses and meta-regressions performed on time-to-task-failure (TTF), ratings of perceived exertion (RPE), heart rate (HR), and mean arterial pressure (MAP).

Results

Fifty-four studies (publication year 2012.9±6.9; 1995-2024) were identified (N=919 participants; ∼29.8±10.7 years). Thirty-five included performance parameters (e.g., TTF), 45 examined neurological outputs (e.g., electromyography (EMG), electroencephalography (EEG)), and 14 explored cardiovascular or metabolic variables (e.g., glucose uptake, oxygenation). Meta-analysis of 23 studies revealed consistently longer TTF for PIMA vs HIMA at the same absolute intensity (n=407; g =−0.74, p <0.001), except for two studies examining axial muscles ( g =1.78-3.59, p <0.001). Meta-analyses of 6-11 studies detected no absolute differences in HR, MAP, or RPE (n=136-194; g =−0.11-0.18, p =0.07-0.96), except for RPE at 50% of TTF being greater during PIMA (n=164; g =−0.31, p =0.01). PIMA mostly showed higher force fluctuations, discharge rates, D1-inhibition and peak torque, while HIMA indicated higher heteronymous facilitation, EMG burst rates, interspike interval variation, muscular glucose uptake, and faster increases in force/position fluctuations, EMG amplitude, RPE, HR, and MAP. Findings on muscle activation were mixed and mostly insignificant. Brain activity differed partly between both types, with unclear directions.

Conclusions

Evidence suggests distinguishing two types of isometric muscle action indicating more complex control strategies for HIMA than PIMA. Findings revealed similarities to anisometric actions, suggesting that the control strategies of HIMA and PIMA resemble the ones for muscle lengthening and shortening, respectively. HIMAs could provide novel diagnostics and injury prevention strategies, and time-efficient muscular, neural, and cardiovascular adaptations in rehabilitation. PIMA may be beneficial for prolonged activation and agonist neuromuscular adaptations. Methods varied widely across studies, making additional meta-analyses impossible. More consistent methodology and data reporting are recommended. Randomized controlled trials are required to confirm the use of PIMA vs HIMA in clinical or performance contexts. The knowledge of both isometric types should be implemented in research and education.

Registration

The original protocol was prospectively registered at the National Institute of Health Research PROSPERO (CRD42024530386).

Key Points

• The two distinct isometric muscle actions are not regularly recognized, although sports medicine practitioners increasingly distinguish and use pushing (PIMA) and holding (HIMA) isometric muscle actions in rehabilitation and sports performance; yet, limited evidence supports their differentiated use.

• The reduced time-to-task-failure in appendicular muscles under HIMA is presumably reasoned by specific alterations regarding neuromuscular and metabolic parameters suggesting more complex neuromuscular control strategies.

• While randomized control trials are needed, HIMA appears beneficial for diagnostics, injury prevention and time-efficient muscular, neural and cardiovascular rehabilitation, while PIMA appears more suitable for agonist neuromuscular adaptations.