Whenever we have an injury, we look to establish our new baseline capabilities such as movement availability, strength, and tolerance to stress. We also will tend to have compensatory movement patterns existing as we try not to move into painful positions.
Our nervous system is responsible for creating the motor programs and movement patterns that we execute, all from a subconscious manner. You can think of throwing an object as an example of this. You initially need to learn the skill by breaking down the components of a throw before putting it all together in one smooth and coordinative movement. After prolonged practice and exposure, you can line all the joints up and generate the right amount of force without even thinking about it. That’s your nervous system at play, providing the blueprint for your movement without you having to consciously think about each step. Stepping down from a stair is the same thing at a lower skill requirement. You need to be able to place the foot in the right spot, absorb the landing, and control your body mass as you transition to the other foot. All of this is taken for granted because we have an ingrained motor memory for how to do this.
The things described above are both a form of a plyometric activity. Despite the level of complexity between the two, they both require a coordination of multiple joints and an ability to transfer force at varying rates to create motion. Obviously throwing a ball is more explosive than stepping down from a stair, but the concepts remain the same.
When it comes to rehab, we need to reestablish motor patterns to reduce the rate of injury and increase our ability to tolerate stress. This is where the use of utilizing plyometrics in the early stages of a rehab program can become so important.
We aren’t talking about high level jumping or sprinting either. What we want to be able to do is jumpstart our motor learning abilities at a low level to coincide with the rest of our program. This would involve the use of force absorption and control to accelerate the healing process and allow us to regain coordination so when things are ready to be loaded quickly, you won’t have to start at ground zero.
For context, let’s use the example of an Achilles tendinopathy in an athlete that requires frequent takeoffs such as a sprinter or a basketball player.
This particular injury is a chronic condition and requires time to heal. One of the biggest things missing in this scenario, is the athlete may have been overloading the tendon and had a poor ability to absorb force to then effectively transfer it. Since this can be a painful condition to run, jump, or in some cases, walk on, we will want to reduce the overloading strategies first. This will help ensure movement compensations will not hinder progress and comprise the athlete further down the road.
So where will these plyomterics fit?
First we want to gain control of the joints in static positions and learn to move under loads in a stable manner. For this scenario, single-leg RDL’s with an upper extremity support may be a useful option, along with single-leg glute-bridges.
The plyometric portion plays an important role here because we can start to learn how to absorb forces and improve our landing coordination at a low level so it can transfer to the higher levels of sprinting or jumping as the athlete progresses, all in an unconscious manner. A good starting point would be to utilize step & stick walks where you land and hold on a single leg for a second before advancing to the next one. This would progress to a hop & stick which is just a bigger step then the previous exercise with a small hop component. Both of these activities give the athlete exposure to ground contacts to learn how to absorb forces from the ground up and coordinate their foot landing, along with how to center their body weight in a controlled manner.
As strength and stability are regained, you can further the loading with depth drops from progressively increasing heights (usually 4”-10”) and pogo jumps to build up the elastic strength and recoil ability of the tissues.
Having these progressive plyometric coincide with the rehab process allows the athlete to have multiple repetitions and practice in controlled manners in various components of the jump or sprint that they will have ingrained a subconscious movement pattern as they progress to their desired activity. If these things waited weeks down the road, you would not have had enough accumulation of stress to the area, nor the movement competency to be ready to perform, causing a further delay in return to sport.
Utilizing plyometrics in the rehab process can help accelerate the healing process, but it should not be taken for granted. Intelligent planning and understanding of an injury is vital to creating a proper protocol to reduce injuries, rather than create new ones. You should always seek the guidance of a skilled professional for the rehabilitation of an injury to ensure proper guidelines are set forth for your maximum benefit.
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Dr. Peter Dionisopoulos is the owner and founder of Dynamic Performance & Rehab. He has worked with many high-level athletes and military personnel, but his true passion is to help active adults maintain their lifestyle by providing information and potential solutions to their aches and pains so they can continue with the activities they love.