Posted on July 30, 2015 by Jenny Cromack
Plyometrics’ Place in Rehabilitation!
The traditional interpretation of plyometrics is that they are explosive exercises that involve a stretch-shortening cycle of the muscles. This phenomena utilises the reactive ability of the muscles. Repeated bouts of jumping, or reactive drop jumps are examples of traditional plyometric exercises. The muscles go through a phase of stretch before almost immediately going into a phase of reactive shortening which is where the explosive element comes in. The stretch-shortening cycles of contraction stimulates two main physiological components. These are proprioceptive reflexes (neural side) and elastic properties of muscle (muscular side). This is highly beneficial when the aim is to rehabilitate yourself to return to a high intensity or power based activities. Many people will only use plyometrics as part of their ‘normal’ training when injury free but plyometrics and rehabilitation work well together.
Effects of Plyometrics on Rehabilitation…
Plyometric based exercises can be a major part of rehabilitation and the use of plyometrics has huge benefits. It can play a huge role in determining an effective and safe return to sport and minimising re-injury (Swanik et al., 2002; Chimera et al., 2004; Zebis et al., 2008). Neuromuscular adaptations appear to form a major part of the effectiveness of plyometrics in rehabilitation by optimising and regaining co-ordination and control of the joints and muscles.
The repetitive length and tension changes during plyometrics may stimulate receptors in the muscles that are sensitive to stretching and tension changes within the muscles. Information about muscle length and tension is sent between these structures and the central nervous system. This can then help make individuals more aware of their joint position and state of their muscles, this may help them co-ordinate themselves to alter joint and muscle positions on their return to sport, thus reducing the risk of re-injury.
There is some suggestion that plyometric style training helps improve power output and therefore helpful when trying to regain sport based power.
Does it Work?…
Using plyometric based exercises for treating shoulder injuries have been shown to help improve joint position sense and joint awareness. This shows that the neural adaptations associated with plyometrics may actually be beneficial in rehabilitation of upper body injuries. The neuromuscular adaptations specifically alter muscle coordination and increases the recruitment of motor units within the muscle. The pre-activation and control of the muscles when performing high intensity, explosive movements is improved as a result.
Increasing muscle activity has been shown to occur as a result of plyometric style training. Alterations in the activity of areas of the hamstring, hip adductors and abductors was shown to occur and reduce the bowing in of the knees during dynamic movements (Chimer et al., 2004; Zebis et al,. 2008). This highlights that by utilising plyometric based activities can help alter muscle activity and help correct any compensatory or dysfunctional joint movements.
Plyometrics and the Return to Sport…
Basically by improving the connection between the brain and muscle through the neural adaptations helps increase the awareness of limb and joint position the individuals will be able to detect any incorrect or injury prone postures and limb positions. Through the changes in muscle activity, recruitment, and co-ordination, along with the joint position sense, the individual will be more effective at altering any injury prone limb positions. The improvements in muscle activities helps improve muscle pre-activation and the co-activation of muscle groups. This means that musces will be more prepared for explosive activities and groups of muscles will also be much more effective at working together. This helps with restraint and control of muscles and joints, as well as the alteration in joint positions during dynamic movements. All of these adaptations will help reduce the likelihood of re-injury through preventing injury prone limb and joint positions, and improving the ability to control the joints during dynamic movements and thus increasing the stability of the joint.
Return to Sport Considerations…
The ultimate goal for rehabilitation is to get back playing sport or training as soon as possible. This return however also has to be safe, in that the individual should be fit to return both in an injury sense and a general conditioning sense. There are several criteria that should be considered before returning to sport or training:
- Physiological healing process – has the injury had enough healing time?
- Pain status – Has pain significantly reduced? Is it likely to hurt during sport/training??
- Swelling – Is there still swelling? Is the swelling likely to reoccur?
- Range of motion – Do they have enough ROM to perform sport or training movements effectively?
- Strength – Are they strong enough for the sporting/training demands?
- Neuromuscular control – What is their bodily awareness and control like?
- Cardiovascular fitness – Are they conditioned enough for the demands of sport or training?
- Sport specific demands – Are their sport/training specific skills good enough to return?
The above considerations are all part of the whole rehabilitation process not just plyometrics. However without plyometric inclusion the individuals may not possess the improved neural control or power production required to ensure their safe return to sport.
Plyometrics are generally used later on in rehabilitation, but the progression of plyometric exercises can be included earlier on as long as the healing process and pain allows. Power based athletes such as rugby players or those involved in power based training will need to retrain these power and control elements before returning to their activities, therefore plyometrics based rehabilitation activities will be of great importance to these individuals. These activities also need to replicate the movements and activities associated with their sport or training. This means that when they return to these activities their body has been allowed to progressively adapt to these movements.
This highlights that a successful rehabilitation program needs to fully prepare the individual for the return to sport considering the demands of the sport and any player specific roles. Creativity can be used when designing exercises and doesn’t have to simply follow generic exercise suggestions.