In my opinion, including plyometric exercises that are specific to a patient’s needs for recreational activities, sport or even just walking, are an important component of their rehabilitation and conditioning program. But I have found it hard to know what the most appropriate training guidelines are. This blog will go through evidence based plyometric training guidelines and exercises for the upper and lower limbs.
Plyometrics refers to exercises that are designed to enhance neuromuscular performance. They are also known as stretch-shorten cycle (SSC) exercises. These exercises start with a rapid stretch of a muscle (eccentric phase) with a very brief pause (amortization phase) followed immediately by a rapid shortening of the same muscle (concentric phase) and are recorded as repetitions or contacts. The energy stored in the elastic elements of tendon-muscular structures during the stretching phase enhances mechanical output during the subsequent concentric phase (Cavagna et al, 1968; Herzog and Leonard, 2002), in addition to improving the economy of muscle performance (Anderson and Pandy, 1993). SSC is a natural characteristic of many human movements, and is observed during numerous occasions in sports and daily activity including walking, running, jumping and even darts! Plyometric exercises are implemented primarily to improve muscular power. In sports requiring tasks that involve the lower extremities, athletes who have higher playing ability seem to have higher power capacity during jumping. Baker (2002) reported professional rugby league players exhibited significantly higher power output than high school players. Young et al. (2005) reported that starting players exhibited higher power output than non-starting players in professional Australian Rules football players. A meta analysis showed that plyometrics significantly improves vertical jump height (Markovic, 2007). A further more recent meta-analysis also showed that it is an effective training method for increasing strength (Effect Size = 0.97 plyometric group) (De-Villareal et al, 2010).
Evidence for Lower Limb Plyometric Training
De Villareal et al (2008) looked at the effects of 7 weeks of 3 different plyometric training frequencies (e.g., 1 day per week, 2 days per week, 4 days per week) with a total of 60 Drop Jumps per session (2 series of 10 jumps from a box of 20 cm, 2 series of 10 jumps from a box of 40 cm, and 2 series of 10 jumps from a box of 60 cm) with 1 min rest between sets. They found that the moderate training (2 x week and 840 drop jump total) group significantly improved isometric maximal strength, leg press 1RM, 20m sprint time, counter movement jump and drop jump height.
Ramirez- Campillo et al (2013) examined the effects of different volume and training surfaces during a short-term plyometric training program on maximum strength (5 maximum repetitions [5RMs]), drop jumps (DJs) of varying heights (20, 40, and 60 cm), squat and counter movement jumps (SJ and CMJ, respectively), timed 20-m sprint and agility in 29 young males. They found that plyometric training on a hard training surface (high impact reaction force) using a moderate training volume (60 jumps each session) induced the greatest increase in DJ, squat jump, illinois agility test, maximal dynamic strength and training efficiency.
A more recent study by Ramirez-Campillo et al (2014) also performed 60 contact Plyometric drill sessions on a grass soccer field in 121 soccer athletes over 7 weeks in season. They found this volume of training significantly improved CMJ, Illinois agility test and 2.4-km time trial in these elite athletes.
Rubley et al (2011) measured the effects of 80 contact plyometric training on vertical jump (VJ) and kicking distance in 16 female adolescent soccer players. They showed the plyometric training group increased kicking distance 21.5% and VJ 18.6%, whereas the control group actually declined in kicking distance performance as the season progressed.
A meta analysis suggests that using additional weights during lower limb plyometric training does not cause significant gains in jump height compared to bodyweight alone (De Villarreal et al, 2009).
Evidence Based Upper Limb Training Guidelines
There is less research performed on the upper limb but Vossen et al, (2000) compared dynamic pushup and plyometric push-up’s. Thirty-five healthy women completed 18 training sessions (3 x week) over a 6-week period, with training time and repetitions matched. The volume increased from 90 – 132 repetitions / contacts each week over the training period. The plyometric group displayed a significant increase in their medicine ball throwing distance (p < 0.03), but no other differences were found.
Carter et al (2007) examined the effects of an 8-week course of high volume upper extremity plyometric training in 24 intercollegiate baseball players. The plyometric group performed the ‘ballistic 6’ exercises (2 x week) with the volume progression shown below:
Their results showed the plyometric group significantly increased throwing velocity and shoulder internal rotation isokinetic strength. Swanik et al (2002) studied the effect of plyometric training in 24 female swimmers after 6 weeks of training. The training consisted of 2 sessions a week, 3 sets of 15 reps each session with a trampoline, weighted balls and elastic tubing. They showed plyometrics to significantly improve proprioception, time to peak torque and a reduced amortization phase.
Ample rest between sets should be used in order to avoid turning these speed and power enhancing exercises into endurance training. As a general rule, rest at least five times longer than it takes you to perform the set of plyometrics. Research indicates work to rest ratios during plyometric training of at least 1:5 (Potach and Chu, 2008) and that there is no advantage in jump performance with more than 15 seconds rest between single repetitions (Read and Cisar, 2001). Read and Cisar (2001) studied the effects of 15, 30, and 60-second rest on depth jump performance over 3 sets of 10-depth jumps; results showed that a 15-second rest interval is sufficient for recovery during the performance of depth jumps.
Tapering Volume Prior to Competition
Ebben et al (2010) evaluated the effectiveness of a mesocycle of periodized plyometric training and the influence of the duration of the post training recovery period. The plyometric program was periodized and the volume was reduced by 40 percent from a high of 100 foot contacts early in the program to 60 foot contacts near the end of the program, as supported by a meta-analysis (Bosquet et al., 2007). Their results showed significant improvements in vertical jump height and peak power that was optimal within 2 days of plyometric training and performance adaptations were sustained for at least 10 days after training.
Evidence Based Plyometric Training Guidelines
Plyometric Exercise Progressions
- double limb to single limb exercises
- single to multiple repetitions before resting
- reduce amortization phase
- the height jumped up or down increases intensity for the lower limbs
- aiming for a challenging target (eg basketball rim etc) increases intensity
Upper Limb Pyometric Exercises
Lower Limb Plyometric Exercises
Exercise Intensities of Lower Limb Exercises
Struminger et al (2013) found that sagittal plane single and double leg hurdle hops and split squat jumps produce greater gluteal and hamstring muscle activation (EMG) than frontal plane hops and 180 degree turns.
Van Lieshout et al (2014) quantified the intensity of seven plyometric movements commonly used in lower-extremity rehabilitation by joint-specific peak power absorption and the sum of the peak power on the hip, knee and ankle.
The data from these two studies will provide guidance for exercise prescription whether its early or late stage rehabilitation and also depending on the affected area and the patient’s specific goals.
Plyometric training has been shown to increase muscular power, speed, agility and strength. It is also an important component of rehabilitation and conditioning programs because SSC actions that constitute plyometric exercises are a natural characteristic of human movements from activities of daily living to elite level sporting actions. This blog has sought to provide guidance by using selective research to aid health care professionals in designing training programs for rehabilitating different conditions or just to improve performance. All comments and feedback are welcome relating to their own experience and exercise recommendations that they have used.
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