Train and Sustain: A Combination of Plyometrics Individualized Sport-Specific Training and Appropriate Bracing Can Help Athletes Get Back in the Game
By Jim Lundy, MPT, CSCS, and Ron Higa, ATC

As PT’s and ATCs, most of us have had the experience of treating former athletes.  For example, we treated John, a former college football player who was invited to play flag football against several former professional football players.  He trained with running and lifting weights for several months prior to the game.  As game time approached, he noticed slight but nonrestrictive knee pain.  He felt in good shape otherwise with good running endurance, strength, and agility.  Eventually, he played only 5 minutes before his knee pain became too severe too continue.  Five minutes of glory after months of training!  As he stated, “I felt like I was in good shape – just not in football shape!”

John’s situation is not unique.  We see these injuries in non-athletes and athletes alike.  As we progress these patients, we often need to find advanced ways to optimize knee function.  This is especially true when knee strength, as in John’s case, is more than appropriate.  From a patient-care standpoint, we can discharge them with no pain, full range of motion (ROM), and ample low-level function.  However, their level of conditioning will not often match their high athletic goals.  As clinicians, we have just run the proverbial 25 miles, but did not complete the marathon.

There are several advanced techniques that can supplement your knee rehabilitation programs and help your patients go the extra mile.  These are essential for any athlete, whether he participates in team sports (football, soccer, basketball) or individual sports (skiing, ice skating, running).  Inherent in all of these sports are explosive knee actions.  To train more explosively, plyometrics, individualized training programs, and appropriate bracing can be invaluable.

What are Plyometrics?

Plyometrics training is simply a stretch reflex to increase a muscle’s contraction.  This technique is not new, however it is has often been traditionally reserved for athletes.  And rightly so since it is effective at increasing jumping height and performance in basketball players, soccer players, volleyball players, and runners.  And just as plyometric training is effective in athletes, untrained people can use it to decrease muscle fatigue and jump higher.  Therefore, anyone can benefit from “plyos,” as they are often called.  We recommend that most knee rehabilitation programs implement some level of plyometrics training prior to discharge.  No is the time to use this well-researched technique for higher level patients, especially those with functional tasks involving jumping.

How then does it work and how do you apply it?  When you jump up in the air and start to descend, you are building potential energy.  As your foot hits the ground, the eccentric motion of the landing is building the kinetic energy in your quadriceps muscles and ligaments.  All that energy is stretching muscles and muscle spindles.  This continues until your knee stops all eccentric or lowering motion.  At this point there is a brief pause.  During this time, the muscle spindles send a signal to your spine triggering a reflexive signal back to your quadriceps.  This signal is used to increase quadriceps muscle firing.  After the brief pause – and it must be brief to work- the concentric contraction starts.  You begin to jump as high as you can go, and you go higher than you expected.  The combining of the stored energy (in the muscles) and the reflex firing makes the muscle work harder and faster.  The quadriceps (and all lower extremity muscles) is simply tricked into working faster.  The result is faster muscle contractions and higher jumps.

While this technique sounds pretty basic and straightforward, there are some prerequisites.  Appropriate patients have higher-level goals as well as normal strength, good balance, and reasonable symptom control.  Also, proper knee alignment is essential to avoid large varus and valgus stresses placed on the knees by the high ground reaction forces and body weight multiples.  Finally, due to the demanding nature of this training technique, ensure that patients are well rested and perform the jumps early in the treatment session.