[Music]
Hi guys!
This video is about plyometric exercises
and how you can actually use them
as part of your Achilles rehab to get
your tendon
to fully recover. Now, for those of you
who don't know me, my name is Maryke. I'm
one of the physiotherapists from
treatmyachilles.com, where you can get
online physiotherapy assessment
as well as treatment for your Achilles
injuries. Have a look at the description
of this video if you want the link to our
website.
Okay, so plyometrics: what are they? They're
any activity where you jump and hop,
those type of things are plyometrics. And
it may sound a bit weird that I'm saying
you can use it
for Achilles rehab, because anybody who's
had Achilles tendinopathy
and an Achilles flare-up will tell you
that any
jumping, hopping, running type activities
really can flare the tendon up.
But that's why it's important to add it
in at the right
stage, and I'll get to that in a minute.
So, let's first look at why would you
want to put that into the program
if we've spoken so much about
heavy resistance is the way to go with
exercise, to get it
to strengthen the Achilles tendon up and
get you back to running and stuff.
Well, because the research shows that for
some people,
heavy resistance training alone is not
enough to restore the full function of
the Achilles tendon.
So, you've got to remember that that the Achilles
works like a spring.
It gets stretched and then it
stores energy and then it releases that
energy as it shortens again,
and it propels you forward. Now, they can
test how well
your calf and Achilles complex works at
the stretch
shortening cycle... I can never say
properly stretch shorting cycle, yes, I
had to write it down...
through doing a series of hop tests
and things. And what the researchers have
found is
that, lo and behold, there's a discrepancy
between your uninjured leg and your
injured leg when you have Achilles
tendinopathy.
And that makes sense, because when we've
got a tendinopathy we know that the
tendon becomes a little bit
softer, it's not as stiff as before, so it
can't return the energy as well.
But now, interestingly as well, there's
another study that came out a while back
- actually quite a while back, 2007 I think
already - which showed that
even when people have gone successfully
through a rehab program, they have no
symptoms and they're back
to their full sport, when they retest how
well that
calf tendon complex works, not everybody
has regained full function of that
stretch shortening cycle. So it's not...
that Achilles is not yet working as
effectively
as the other side. They're not quite sure
what causes that, so that can be a
control issue, but it can also be the
tendon properties and things that
affect it, so we've got to keep that in
mind.
Also, we can't say that that applies to
everyone with Achilles tendinopathy,
because it wasn't everybody in the study
that showed that.
And it was rather a small study, so it's
still got to be
reproduced on a larger scale for us to
really tell us
more about that. But, what it does mean
is that if you're not recovering as well
as you want
or should and you've got high volumes of
running in there,
you've got your strength training up to
a really decent level,
but it still remains niggly, then maybe
it's time to start adding in some
plyometric training.
And with that in mind, a group of
researchers has done
a very small study at this point because
they just wanted to see the feasibility
about the study,
and is not a randomized controlled trial,
so we can't say
that the plyometrics was more effective
than anything else.
But what they did was they wanted to
see if they do plyometric training
as part of Achilles rehab: One, is it
effective?
Can... are the patients happy to do
it?
Two, do they see any adverse effects? And
some of the other things they were
looking at was, does it actually restore
how well the Achilles functions with the
calf complex?
And what they found is really
encouraging that, in that
first, it was very safe because people
are often scared
to jump and hop on an injured Achilles
tendon, because
I mean, we all tell you that it's not
that strong, but you know what? It's
pretty robust if you've gone through the
steps
to get it to the point where you're
ready for the hopping program, and that's
the key.
So they didn't really have any
adverse effects in that group,
again, remember, small group, though. The
adverse effects came from people who did
stuff they weren't supposed to do, like
went back to football
matches and things before they were
ready and tore calf muscles, so,
not related to the training.
What they also saw was yes, it restored
the function there,
and the patients improved through 12
weeks of doing the program.
So it shows that it is effective
and that it is safe to do, but we don't...
we can't say that it's more effective
than any other program, okay.
But, how did they implement this? So
yes, if you've got an acutely painful
Achilles tendon
and you start a hopping program when
it's not ready for it,
you will make your pain worse. So the
first step
is to make sure that the Achilles is
robust enough and calmed down enough
to actually handle the hops. So they used
some tests, but in their study they
wanted people to be able to do
double leg hops, and... 20 double leg hops,
10 single leg hops without pain.
And then they started the hopping
program,
but it was dovetailed with the strength
training program. So they didn't do just
the hopping program, they still had
strength training in there as well.
The second thing is that you can't just
jump in and do really high load of
jumping.
You've got to ease into it, and that's
also important because
different people's exercise history
would be different or varied. So you'd
come with a different
strength in your Achilles tendon already.
That tendon needs to get used to this
load, so it needs to
slowly - like you built your strength
training up - needs to build the hops and
the jumps and things up. And you can do
that through a variety of ways: You can
make them
double leg hops at the beginning, double
leg hops where the knees bend a little
bit,
so it's not just the Achilles working,
migrating to
ones where the knees are actually kept
really still so you're isolating to the
Achilles, so
now it's working harder. And then of
course going on to single leg hops.
And also going forwards or backwards or
things like that. So, there are plenty of
ways
to play with that. What was the other
thing? Oh yes!
Remember, any plyometric exercise
is a lot higher force than...
that it creates, than any strength
training exercises do. Even if you're
doing
heavy load, slow resistance strength
training,
the load and the force is different when
you do
plyometrics. So you can't do it every
single day.
And you shouldn't do it on the same day
as you do your strength training, because
otherwise you may overload things.
So usually we add it in once, maybe twice,
but mostly as one session in the week so
that there's enough
recovery time. And especially if you're
gonna, at that point, also be busy with a
running program at the same time. So
we've got strength training, we've got
running,
and now we're adding in plyometrics.
You've got to really think about where
you structure in the week, that you
don't cause overload through that.
What was the other thing I wanted to say
about that now? Came in and out of my
head...
Oh yes! I wouldn't add it in for
everybody, and I haven't added it in for
all my patients in the past.
There are definitely a vast majority of
my runners
get back to running through just heavy
slow resistance training
and a slow return to running program, and
that's enough for them; they do perfectly
well.
The higher level guys are the guys who
are doing high volumes of training
and their strength training to high
volumes and that Achilles remains niggly
and is just not reacting;
they are the guys that we definitely
will add in plyometric training for.
And then of course if your sport
involves a lot of plyometrics like
you're doing basketball, or you're doing
anything where you have to jump, or you
have to be explosive,
then you have to retrain that bit. So
they will always get
hopping and jumping programs in theirs as
well.
Okay, so I hope that's given you a few
ideas,
but the take-home message is: hopping and
jumping is absolutely fine
if you put it in at the right stage of
your treatment program.
It could really help guys who are stuck
with a rehab that's just not moving
forwards.
But you have to tick the boxes of, are
you actually doing the heavy resistance
and things properly as well?
And then thirdly, not everybody needs it.
Not everybody
will benefit from it, so it needs to be
right for you.
Now, let me know if you've got any
questions, and if you need more help with
your injury, you can
always consult one of us via video call.
The link to the website is in the
description of this video.
Take care!