Plyometric Exercises

Plyometric exercise involves a rapid

eccentric action immediately followed
by rapid concentric action.
This quick transition from the eccentric to the
concentric portion of the movement is known as
the stretch–shortening cycle.
Plyometric training (PLY) is a popular training modality
aiming to improve physical performance.
Most often, PLY is performed as unloaded jumping
exercises with high‐speed execution that involve a
stretch‐shortening cycle, a rapid stretch of the
muscle‐tendon complex immediately followed by muscle
shortening.
Potential energy is stored in the muscle‐tendon complex
during the stretch phase and is utilized during the
shortening phase.
The elastic components act like a spring, where the
energy release will be greater with higher forces.
 Furthermore, the rapid transition from stretch to shortening
activates the stretch reflex by stimulating stretch‐sensitive
receptors (muscle spindles) within the muscle detecting
changes in both muscle length and velocity.
 Activated muscle spindles excite motor neurons in the spinal
cord, which in turn excite the muscle fibers they innervate.
 This way the stretch reflex potentiates agonist muscle activity.
In combination, these processes result in an increased
force development and speed of shortening when
compared to similar movements without a prior stretch
phase.
Consequently, PLY is a promising exercise modality for
maximizing muscle strength and speed.
Most pieces of equipment used for resistance training,
such as free weights, weight machines or weight-pulley
systems, are designed for developing advanced levels of
strength but not power in that they provide substantial
resistance but typically are used by performing slow,
controlled movements.
However, reactive bursts of force in functional
movement patterns are often necessary if a
patient is to return to high-demand occupational,
recreational, or sport-related activities.
A program of high-intensity, high-velocity exercises,
known as plyometric training, not only improves muscle
strength but also develops power output, quick
neuromuscular reactions, and coordination.
This form of exercise also is recommended to improve
athletic performance and reduce the risk of
musculoskeletal injury.
Plyometric training typically is integrated into the
advanced phase of rehabilitation as a mechanism to
train the neuromuscular system to react quickly in order to
prepare for activities that require rapid starting and
stopping movements or quick changes of direction.
This form of training is appropriate only for carefully
selected patients who wish to return to high-demand
functional activities and sports.
 Plyometric training is defined as a system of high-velocity resistance
training characterized by a rapid, resisted, eccentric (lengthening)
contraction during which the muscle elongates, immediately
followed by a rapid reversal of movement with a resisted
concentric (shortening) contraction of the same muscle.
The rapid eccentric loading phase is the stretch cycle,
and the concentric phase is the shortening cycle.
The period of time between the stretch and shortening
cycles is known as the amortization phase.
It is important that the amortization phase be kept very
brief by a rapid reversal of movements to capitalize on
the increased tension in the muscle.
Neurological and Biomechanical
Influences

 Plyometric training is thought to utilize the series-elastic properties of

connective tissues and the stretch reflex of the neuromuscular unit.
 The spring-like properties of the series-elastic components of
muscle-tendon units create elastic energy during the initial phase
(the stretch cycle) as the muscle contracts eccentrically and
lengthens while loaded.
 This energy is stored briefly and then retrieved for use during the
concentric contraction (shortening cycle) that follows immediately.
 The storage and release of this elastic energy augments the force
production of the concentric muscle contraction.
Furthermore, the stretch-shortening cycle is thought to
stimulate the proprioceptors of muscles, tendons,
ligaments, and joints; increase the excitability of the
neuromuscular receptors; and improve the reactivity of
the neuromuscular system.
Therefore, the term reactive neuromuscular training also
has been used to describe this approach to exercise.
More specifically, the loaded, eccentric
contraction (stretch cycle) is thought to prepare
the contractile elements of the muscle for a
concentric contraction (shortening cycle) by
stimulation and activation of the monosynaptic
stretch reflex.
 Muscle spindles, the receptors that lie in parallel with muscle fibers,
sense the length of a muscle and the velocity of stretch applied to
a muscle and transmit this information to the CNS via afferent
pathways.
 Impulses are then sent back to the muscle from the CNS, which
reflexively facilitates activation of a shortening contraction of the
stretched muscle (the shortening cycle).
 Therefore, the more rapid the eccentric muscle contraction (the
stretch), the more likely it is that the stretch reflex will be activated.
Effects of Plyometric Training

 The evidence to support the effectiveness of plyometric training for

developing muscle strength and power is substantial.
 There is also evidence indicating that plyometric training is
associated with an increase in a muscle’s ability to resist stretch,
which may enhance the muscle’s dynamic restraint capabilities.
 In addition, there is promising, but limited, evidence to suggest that
plyometric training may enhance physical performance and may
decrease the incidence of lower extremity injury.
Application and Progression of Plyometric
Exercises

Preparation for plyometrics

Prior to initiation of plyometric training, a patient should
have an adequate base of muscle strength and
endurance, as well as flexibility of the muscles to be
exercised.
Criteria

Should be met to begin plyometric training usually include

an 80% to 85% level of strength of the involved muscle
groups (compared to the contralateral extremity)
90% to 95% pain-free ROM of the moving joints.
Sufficient strength and stability of proximal regions of the
body (trunk and limb) for balance and postural control
are necessary prerequisites as well.
Progression and parameters

 When planning and implementing a plyometric training program,

exercises should be sequenced from easy to difficult and
progressed gradually.
 Programs also should be individually designed to meet each
patient’s needs and goals.
 Note that prior to initiating each session of plyometric activities, a
series of warm-up exercises should be performed in order to reduce
the risk of injury to the contracting muscle groups.
The following parameters should be considered
when progressing a plyometric program

■ Speed of drills;
Drills should be performed rapidly but safely.
The rate of stretch of the contracting muscle is more important than the
length of the stretch.
Emphasis should be placed on decreasing the reversal time when
transitioning from an eccentric to a concentric contraction (decreasing the
amortization phase).
This trains the muscle to generate tension in the shortest time possible. If a
jumping activity is performed, for example, progression of the plyometric
activity should center on reducing the time on the ground between each
jump.
■ Intensity

Resistance should be increased gradually so as not to slow down the

activity.
Methods for increasing external resistance include using a weight belt
or vest, heavier weighted balls, or heavier grade elastic resistance;
progressing from double-leg to single-leg activities; and increasing the
height of platforms for jumping and hopping activities.
Intensity also may be increased by progressing from simple to
complex movements.
■ Repetitions, frequency, and duration
The number of repetitions of an activity should be increased as long
as proper form (technique) is maintained.
The number of plyometric exercises in a single session also is increased
gradually, working up to perhaps six different activities.
The optimal frequency of plyometric sessions is two sessions per week,
which allows a 48- to 72-hour recovery period between sessions.
Maximum training benefits typically occur within an 8- to 10-week
duration.
Precautions for Plyometric Training

Because of the emphasis on eccentric loading and rapid

reversal to concentric muscle contractions, the potential
for tissue damage is increased with plyometric activities.
As with other forms of high-intensity resistance training,
special precautions must be followed to ensure patient
safety.
 If high-stress, shock-absorbing activities are not permissible, do not
incorporate plyometric training into a patient’s rehabilitation
program.
 If a decision is made to include plyometric activities in a
rehabilitation program for children or elderly patients, select only
beginning-level stretch-shortening drills against light resistance. Do
not include high-impact, heavy-load activities—such as drop jumps
or weighted jumps—that could place excessive stress on joints.
Be sure the patient has adequate flexibility and strength
before initiating plyometric exercises.
Wear shoes that provide support for lower extremity
plyometrics.
Always warm-up prior to plyometric training with a series
of active, dynamic trunk and extremity exercises.
During jumping activities, emphasize learning techniques
for a safe landing before progressing to rebounding.
Progress repetitions of an exercise before increasing the
level of resistance used or the height or length of jumps.
For high-level athletes who progress to high-intensity
plyometric drills, increase the rest intervals between sets
and decrease the frequency of drills as the intensity of the
drills increases.
Allow adequate time for recovery with 48 to 72
hours between sessions of plyometric activities.
Stop an exercise if a patient can no longer
perform the plyometric activity with good form
and landing technique because of fatigue.
Plyometric Activities for the Upper and
Lower Extremities

Upper Extremities
■ Catching and throwing a weighted ball with a partner or
against a wall, bilaterally then unilaterally
■ Stretch-shortening drills with elastic tubing using
anatomical and diagonal motions
■ Swinging a weighted object (weighted ball, golf club,
bat)
Plyometric Activities for the Upper and
Lower Extremities

Upper Extremities
■ Dribbling a ball on the floor or against a wall
■ Push-offs from a wall or countertop while standing
■ Drop push-ups from a low platform to the floor and back
onto the platform
■ Clap push-ups
Plyometric Activities for the Upper and
Lower Extremities

Lower Extremities
■Repetitive jumping on the floor: in place;
forward/backward; side-to-side; diagonally to four corners;
jump with rotation; zigzag jumping; later, jump on foam
■ Vertical jumps and reaches and proper landing
■ Multiple jumps across a floor (bounding)
■ Box jumps: initially off and freeze, then off and back on
box, increasing speed and height
Plyometric Activities for the Upper and
Lower Extremities

Lower Extremities
■ Side-to-side jumps (box to floor to box)
■ Jumping over objects on the floor
■ Hopping activities: in place, across a surface, over objects
on the floor
■ Depth jumps (advanced): jumping from a box, squatting
to absorb the shock, and then jumping and reaching as
high as possible
Sample Plyometric Sequence for the
Upper Extremities

Warm-Up Activities
■ Trunk exercises holding lightweight ball: rotation,
sidebending
■ Upper extremity exercises in anatomical and diagonal
planes of motion with light-grade elastic tubing
■ Prone push-ups
 For each of the following plyometric activities, perform a quick reversal
between the eccentric and concentric phases.
■ Bilateral throwing motions with a weighted ball to and from an exercise
partner: bilateral chest press; bilateral overhead throw; bilateral side throw
■ ER/IR against elastic tubing (first with the arm positioned slightly away from
the side of the trunk in some shoulder abduction and then in the 90/90
position of shoulder and elbow)
■ Diagonal patterns against elastic resistance
■ Unilateral catching/throwing motions with a weighted ball: side throws →
overhead throws → baseball throws
Additional Exercises
■ Trunk exercises holding weighted ball: abdominal curl-ups,
back extension, sit-up and bilateral throw, long sitting throws
■ Push-offs from a wall or countertop while in a standing
position
■ Clap push-ups
■ Drop push-ups: prone push-ups from platform to floor and
back to platform
Plyometric Exercises: Upper Extremities

 Plyometric exercises for the upper extremities can be performed in

a variety of nonweight-bearing and weight-bearing positions, using
anatomical motions that target a key muscle group or using
combined movement patterns that involve multiple muscle groups
throughout the entire upper extremity.
 Many combined patterns used in plyometric activities incorporate
trunk stability and balance into the movement sequence and often
simulate desired functional motor skills that occur during work or
recreational activities.
Bilateral Diagonal Upper Extremity
Movements

 Patient position and procedure: While holding a weighted ball with

both hands, have the patient perform diagonal patterns (D1 or D2)
with a quick transition from the flexion to extension patterns.
Incorporate trunk rotation into the movement patterns. These
exercises also develop dynamic stability of the trunk rotators and
lower extremities.
 Bilateral Chest Press and Throw: Supine

 Patient position and procedure: Supine

with both hands reaching toward the
ceiling. Have the patient catch a weighted
ball dropped from above by the therapist,
control and lower it to the chest (eccentric
phase), and then quickly throw it vertically
back to the therapist. As the ball moves
toward the chest, shoulder flexors and
elbow extensors are loaded eccentrically.
Bilateral Chest Press and Throw: Standing

 Patient position and procedure:

While standing and with feet
placed in a stride position for
balance, have the patient catch a
weighted ball with both hands,
bringing it to the chest (eccentric
phase), and then throw it back to
the therapist or onto a rebounder
(concentric phase).
Bilateral Overhead Catch and Throw

 Patient position and procedure: While

standing and with feet placed in a stride
position for balance, have the patient use
both hands to catch a weighted ball
thrown over the head, controlling the
momentum of the ball with shoulder and
elbow musculature (eccentric phase),
and then throw the ball back quickly to
the therapist or onto a rebounder
(concentric phase). This exercise targets
the shoulder and elbow extensors.
Bilateral Horizontal Side Throw and Catch

 Patient position and procedure: While standing with one side of the
body about 10 feet away from a rebounder, have the patient hold
a weighted ball in both hands with arms positioned across the chest
and then throw the ball toward the rebounder by rotating the trunk
and moving the arms across the chest in the transverse plane. The
patient then catches the ball as it bounces back from the
rebounder, controlling the momentum of the ball by allowing the
arms to move back across the chest and rotating the trunk
(eccentric phase).
Bilateral Horizontal Side Throw and Catch

 The patient then throws the ball

back to the rebounder by reversing
the movements of the arms and
trunk (concentric phase). This
exercise targets the horizontal
abductors and adductors of the
shoulder and trunk rotators. If a
rebounder is not available, the
exercise can be performed with a
therapist or exercise partner.
Hand-to-Hand Overhead Catch and
Throw

 Patient position and procedure: While standing

or kneeling with both upper extremities elevated
to about 120° (aligned just anterior to the frontal
plane of the trunk), elbows extended, and
forearms supinated (palms facing upward), have
the patient throw a bean bag or weighted ball
over the head with one upper extremity and
catch it with the opposite hand, controlling the
weight of the ball with that shoulder (eccentric
phase). Then throw the ball back to the other
hand by abducting the shoulder (concentric
phase). Repeat the sequence as if juggling the
ball overhead. This exercises targets the shoulder
abductors.
Unilateral Plyometric Shoulder Exercises
Using Elastic Resistance

Plyometric activities using elastic resistance can be

set up to target individual or multiple muscle
groups depending on the patient’s position, the
line of pull of the elastic, and which joints are
moving during the exercise.
 Patient position and procedure: To target the external rotators of
the shoulder, have the patient stand facing a wall or door frame
and grasp one end of a length of elastic tubing or band attached
to the wall at eye level. Begin with the shoulder and elbow in the
90/90 position (shoulder abducted 90° and in full external rotation
and the elbow flexed 90°).
 Have the patient release the
externally rotated position, controlling
movement into internal rotation
(eccentric phase), and then quickly
reverse the motion by moving the
shoulder into external rotation
(concentric phase). The elastic should
remain taut throughout the exercise.
 Patient position and procedure: To target the internal rotators of the
shoulder, have the patient stand facing away from the doorframe
or wall to which the elastic resistance is attached. Begin with
tension on the elastic while the shoulder is in 90° abduction and full
internal rotation, and control movement of the shoulder into
external rotation (eccentric phase), then quickly return to internal
rotation (concentric phase).
Bounce a Weighted Ball: Prone-Lying

Patient position and procedure: While lying prone

on a table with the scapula retracted and the
upper arm (humerus) supported on the table,
position the shoulder in 90° abduction and
external rotation and the elbow in 90° flexion.
 Have the patient bounce a weighted
ball on the floor by internally rotating
the shoulder; catch it, moving the
shoulder back into external rotation
under control (eccentric phase); and
quickly bounce it again by internally
rotating the shoulder (concentric
phase). This exercise targets the
shoulder internal rotators
Unilateral Side Catch and Throw

 These exercises target the internal rotators of

shoulder.
■ Patient position and procedure: While standing in
the stride position and with the shoulder positioned in
some degree of abduction (upper arm slightly away
from the trunk), have the patient face the therapist,
catch a weighted ball thrown to one side by the
therapist, allowing the shoulder to externally rotate to
control the momentum of the ball (eccentric phase),
and return the ball using primarily shoulder internal
rotation (concentric phase). If a rebounder is
available, the patient can perform the exercise
independently.
Unilateral Side Catch and Throw

 These exercises target the internal rotators

of shoulder.
■Patient position and procedure: While
standing in the stride position and with the
shoulder abducted and externally rotated
and the elbow flexed, have the patient
catch and throw a weighted ball using
shoulder rotation (a simulated baseball
throw). Incorporate trunk rotation in the
backward and forward motion of the
shoulder.
Unilateral Reverse Catch and Throw

 This exercise primarily targets the external rotators of shoulder in the

end-range.
Patient position and procedure: Have the patient assume a half-
kneeling position, facing away from the therapist, with the involved
shoulder abducted 90° and externally rotated, the elbow flexed to
90°, and the forearm pronated (palm facing therapist). Instruct the
patient to look at the hand and catch a soft, lightweight object (ball
or bean bag) thrown toward the hand by the therapist; control the
momentum of the object by allowing the shoulder to move into
internal rotation; and then quickly throw the object back to the
therapist by externally rotating the shoulder.
Throw and Catch with Elbow Action

 Patient position and procedure: While in

a standing position and with the arm
positioned along the side of the trunk,
have the patient throw a weighted ball
into the air with one hand, using primarily
elbow flexion; catch it, allowing the
elbow to extend with control (eccentric
phase); and then quickly throw it into the
air again (concentric phase). This
exercise targets the elbow flexors.
Unilateral Throw and Catch with Wrist
Action

 Patient position and procedure: While

seated, have the patient stabilize the
elbow on the thigh in about 90° flexion,
and with the forearm supinated, toss a
weighted ball or bean bag into the air
using primarily wrist flexion; catch it,
allowing the wrist to extend under control
(eccentric phases); and then quickly toss
it into the air again (concentric phase).
This exercise targets the wrist flexors.
Simulated Sport Activities

Dribble a weighted ball or

basketball against a wall or on
the floor using either elbow or
wrist actions. This activity targets
either the elbow extensors or
wrist flexors.
 Bounce a tennis ball or racquetball into
the air or onto the floor (forearm
supinated or pronated, respectively) with
a short-handled racquet, progressing to
a long-handled racquet. These activities
emphasize the wrist flexors. In contrast,
bouncing a ball into the air with the
forearm pronated emphasizes the wrist
extensors.
 Swing a weighted golf club or
baseball bat. The backward
motion followed by a rapid
reversal forward provides the
plyometric stimulus.
Upper Extremity Weight-Bearing
Movements on a Slide Board

Use of a slide board, such as a ProFitterTM, provides an

unstable, moving surface for performing movements of
the shoulders that require quick changes of direction
combined with weight bearing through the upper
extremities.
 Patient position and procedure: Have the patient
place both hands on a spring-loaded slide board
while kneeling along one side of the equipment.
Shift the arms side-to-side from the shoulders ,
gradually increasing the speed of the shoulder
movements and changes of direction.
 Patient position and procedure: Have the patient
kneel at one end of the slide board and move the
arms forward and backward from the shoulders.
■ Progression: Perform the same movements while
kneeling and bearing weight on one hand.
Push-Offs from a Wall

 Patient position and procedure: While the patient is standing

several feet away from a wall (or countertop), gently push the
patient directly forward toward the wall. Instruct the patient to
catch himself/herself with equal weight on both hands, allowing the
elbows to flex under control (eccentric phase) as the trunk moves
toward the wall. Then have the patient quickly push away from the
wall with both hands (concentric phase), catch the patient as
he/she falls backward, and then push the patient forward again to
repeat the sequence.
Side-to-Side Push-Offs from a Waist-Level
Surface

 Patient position and procedure: While standing

and maintaining both feet approximately 3 feet
away from a waist height, stable surface
(countertop, heavy table), have the patient fall
forward and slightly to the right of midline and
catch self with hands on the edge of the
countertop or table; push off and shift arms and
trunk to the left; catch self with both hands; and
push off again, moving arms and trunk back to
the right, past midline. This exercise alternately
places greater weight on the right and then the
left upper extremity.
 Drop push-ups: Have the patient perform a prone pushup
from knees or feet with hands on platforms positioned a
shoulder width apart. Drop both hands and the chest to
the floor, controlling the descent of the trunk (eccentric
phase); quickly perform another push-up (concentric
phase); and return both hands to the platforms
Plyometric Exercises: Lower Extremities

 Most plyometric exercises for the lower extremities are performed

while standing and require eccentric and concentric control of the
hip and knee extensors and ankle plantarflexors against body
weight.
 These exercises require postural stability and balance because of
the quick changes of direction involved.
 Plyometric activities can be progressed by adding an external load
(a weighted belt, vest, or backpack) to augment body weight or
by first performing the exercises in bilateral stance (jumping) and
then in unilateral stance (hopping).
Sit-to-Stand from a Ball

 Patient position and procedure: While in sitting,

have the patient bounce on a therapy ball
(stabilized by the therapist), come to a partial
standing position, and then sit back down on
the ball and quickly come to a partial standing
position again. Progress the exercise by
eventually coming to a full standing position.
This activity requires contraction of the hip and
knee extensors against the resistance of body
weight. To be effective, rapid reversals must
occur between the lowering (eccentric) and
standing-up (concentric) phases.
Bilateral Heel Raises on a Mini-Trampoline

Patient position and procedure: In bilateral stance,

have the patient bounce on a mini-trampoline by
performing repeated heel raises and lowering. This
activity targets the gastrocnemius-soleus muscle
groups.
Side-to-Side Shuffle

Patient position and procedure: Have the patient

take several quick side steps to the right and then
back to the left, and repeat. This exercise requires
rapid contractions of the hip abductors and
adductors against body weight during each
change of direction.
Side-to-Side Movements on a Slide Board

 Patient position and procedure:

While standing on a slide board,
such as a Pro-Fitter®, have the
patient shift body weight side-to-
side, gradually increasing the speed
of the directional changes as skill
and coordination improve.
 Squat Jumps

 Patient position and procedure: Have

the patient move quickly from a
standing position into a squat position
(eccentric phase), quickly transition to
a vertical jump (concentric phase),
return to the squat position, and then
perform another vertical jump. When
landing and moving into the squat
position, be sure the patient keeps the
lower legs aligned as close to vertical
as possible.
Bounding

 Patient position and procedure: Have the patient start with the feet positioned
shoulder width apart, and take multiple jumps forward in a straight line across the
floor.
■ Progressions: Increase the speed at which the activity is performed, and then
increase the distance of each jump. When able, have the patient perform forward
hopping across the floor.
Four-Quadrant Jumps or Hops

Patient position and procedure: Using

two lines on the floor intersecting at
right angles as a guide, have the
patient jump forward, backward,
side-to-side, and diagonally from one
quadrant to another, using quick
directional changes.
Tuck Jumps

 Patient position and procedure: Have the

patient begin in standing position, quickly
lower the body into a squat position
(eccentric phase), perform a tuck jump as
high as possible, bringing the knees toward
the chest, and then land in proper
alignment and return to the squat position
to initiate the next tuck jump.
■ Progression: Perform a series of side-to-side
tuck jumps over a barrier.
Lunge Jumps

Patient position and procedure: Have the patient begin in

a symmetrical standing position, jump vertically, and land
in a forward lunge position (eccentric phase); then
quickly jump vertically (concentric phase) and again land
in a forward lunge position. Perform multiple repetitions by
landing with the same foot forward each time.
Lunge Jumps

 Alternative activity—Scissor-lunge jumps: Perform a sequence of

lunge-jumps, alternately bringing the right and then left foot
forward, as in a scissoring motion.

■ Progression: Increase the challenge by performing lunge jumps

while wearing a weighted vest or holding weights in both hands.
Zigzag Forward Jumping or Hopping

 Patient position and procedure: Have

the patient jump or hop across the floor
in a zigzag pattern marked on the floor.
Progress by increasing the speed of
jumping or hopping and the distance
between jumps or hops.
Hopping Over Objects

Patient position and

procedure: Have the patient
hop over objects of various
sizes placed on the floor like an
obstacle course.
Single Platform Jumping or Hopping

 Patient position and procedure:

Have the patient jump and
progress to hopping onto and off
of a single, low platform in
forward, backward, and lateral
directions, being certain to use
proper landing technique. To
progress, first increase the speed
and repetitions of the jumping or
hopping activity, then increase
the height of the platform.
Multiple Platform Jumping or Hopping

 Patient position and procedure: Have the patient jump (or hop) in a
forward direction off of a platform to the floor and then jump
forward again onto another platform . Progress by performing the
sequence more rapidly or by increasing the height of the platforms.
 https://youtu.be/dvggf9hPwtM