35 reported that only 30% of patients completed a plyometric program prior to RTS after ACLR. 28–32 In particular, plyometric training has been reported to be superior to more traditional resistance training for development of explosive lower limb performance (power/RFD), 30,31,33 as well as effective at eliciting gains in maximal strength, 32 and sports performance variables, such as linear 34 and multiple directional 29 movement speeds.Įbert et al. 27 Plyometric training has long been used to optimize explosive sporting performance (e.g., speed, jump height) of athletes and is regarded as an excellent training method, due to the wide ranging neuromuscular and motor control benefits. 8 Plyometric exercises involve a stretch-shortening cycle, which is a commonly observed phenomenon involving a rapid lengthening of a muscle tendon unit, immediately followed by a rapid shortening (for a review see Davies et al.). One highly valued element of rehabilitation after ACLR is the use of plyometric training. 17 Furthermore, patients often RTS with movement asymmetries during an array of functional tasks 18–23 thought to predispose them to increased risk of injury. 8–11 Following ACLR, at the time of RTS, patients often present with deficits in knee extensor maximal strength 12–14 and rate of force development (RFD), 15,16 as well as lower limb/closed chain strength 15 and power. 8,9 Key areas suggested in need of improvement are the restoration of neuromuscular performance (e.g., strength and power) and movement quality of patients prior to RTS after ACLR. 7 Current opinion is that in order to improve athlete outcomes after ACLR, there is a need to optimize the processes and practices of rehabilitation. 1–4 Those who RTS, do so often at much elevated risk of re-injury, with typically around nearly one in three young athletes experiencing a knee re-injury, 5,6 generally within the first two years after RTS. It appears that many patients fail to return-to-sport (RTS) and/or previous sporting performance levels after anterior cruciate ligament reconstruction (ACLR). Level of evidenceĪ key goal within sports medicine is to improve the outcomes of patients after major injury.
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The aim of this paper is to provide recommendations to clinicians on how to design and implement plyometric training programs for the ACLR patient, as part of the functional recovery process. There should be a gradual increase in task intensity and specificity throughout the program, with all tasks used for both neuromuscular and motor control re-conditioning. Furthermore, how the person technically performs the task will influence joint loading.
Plyometric intensity is based on the intensity of efforts, the vertical and/or horizontal momentum prior to ground contact, the ground contact time and the surface or environment on which they are performed on/in. To do this, it is important to understand the relative intensity of plyometrics tasks, align these tasks to the ACL functional recovery process and monitor the athlete as part of criterion based rehabilitation. In designing a plyometric program, it is important to match the specific plyometric tasks to the functional recovery status of the ACLR patient. To truly impact individual patients, a stronger focus on research implementation is needed from researchers to translate efficacious interventions into practice. However, few patients undertake or complete a plyometric program prior to return-to-sport. Plyometric training, as a component of the ACL functional recovery process, can aid in restoring function and supporting timely return to sport.
Effective use of plyometrics can support enhancements in explosive sporting performance, movement quality and lower risk of injury. Plyometric training is an important component for neuromuscular and movement re-conditioning after ACLR.
After ACLR, the patient experiences alterations of joint mobility, gait and movement patterns, neuromuscular function and general physical fitness. This paper presents a four-stage plyometric program to be undertaken as part of criterion-based rehabilitation for athletes with anterior cruciate ligament reconstruction (ACLR).
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