Plyometrics for Achilles tendinopathy may seem like a strange idea – hopping and jumping about on an injured tendon. But the research has shown that plyometrics can be useful for Achilles tendon rehab in some cases and that it is safe when introduced and done in the right way. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.
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Are plyometrics useful and safe for Achilles tendon rehab?
Plyometrics (for the Achilles tendon) refer to exercises where you hop or jump.
Therefore, it may sound a bit weird to mention “plyometrics” and “Achilles tendon rehab” in the same sentence, because many people who have had Achilles tendinopathy and a painful Achilles tendon will tell you that any jumping or hopping activity can really flare up that injury.
However, plyometrics are useful and safe for Achilles rehab, as long as it’s added to your programme at the right stage and in the right way.
Why do plyometrics for Achilles rehab?
The research is clear that a rehab programme consisting of slow, heavy weight training is the best way to get an injured Achilles tendon to recover back to its former strength to enable the patient to return to their normal daily activities and their sport. So, why would plyometrics, which consists of fast, light movements, add something to the healing process?
There is also research that shows that, for some people, heavy resistance training alone is not enough to restore the full function of their Achilles tendon.
The Achilles works like a spring. When you walk, run, or jump, it gets stretched as your foot lands, and then it stores that energy and releases it as it shortens again to propel you forwards or upwards.
What the research is saying
When researchers tested people with an Achilles injury, they found that the stretch-shortening cycle of the injured leg was not as efficient as that of the uninjured leg. No surprises there, because we know that a tendon with a tendinopathy is a little bit softer and not as stiff as a healthy tendon, so it can’t return that energy as efficiently.
However, when they then did the same test on people who had gone through a seemingly successful Achilles rehab programme, had no pain anymore, and had gone back to participating fully in their sport, they found that not everybody had regained the full function of their stretch-shortening cycle. So, their formerly injured Achilles tendon was still not working as effectively as the other one.
They're not sure why this is; it might be inhibited neural control of the calf muscle on the formerly injured side, but it could also have something to do with the properties of the healed tendon itself.
Also, this was not the case for everybody in the study, just some of the participants.
But what it does mean is that if your Achilles tendon is still feeling a bit iffy despite the fact that you’ve done your rehab training to a decent level and are able to run normally, it may make sense to add in some plyometric training.
Are plyometric exercises for Achilles tendon rehab safe?
With the above research results in mind, another group of researchers did a study about the feasibility of plyometrics for Achilles rehab.
It was not a randomised controlled trial where they had a group who did plyometrics and another group who did other types of rehab and then compared the results, so we can't say that the plyometrics were more effective or less effective than anything else. They just wanted to test whether it was effective as such for Achilles rehab and they wanted to know whether it had any adverse effects.
First, they found that some patients had improved after 12 weeks of doing the plyometrics programme.
They also found that it did not cause any adverse effects for patients who followed the programme correctly. Some patients who did things they weren’t supposed to do, like playing a football match, had adverse effects, e.g. straining a calf muscle, but this wasn’t connected to the plyometrics.
How to add plyometrics to your Achilles rehab programme
First, get your Achilles strong and pain-free
Obviously, if you have an acutely painful Achilles tendon and you start a hopping programme when it's not yet ready for it, you will make your pain worse. So, the first step is to make sure that the Achilles is robust enough and that the pain has calmed down enough to handle the hops. The way to do this is to follow the classic Achilles rehab plan of strength training for your tendon.
We only add plyometric training into a rehab plan when we are sure that the tendon is ready to handle it. We use a combination of factors to inform this decision, e.g. for how long the person has been doing heavy strength training, whether they have been doing other tendon loading activities, and whether they have taken any medication.
And then, we’ll also test it with a small set of hops to check the 24-hour pain response before issuing a full programme, e.g. hop 20 times on two legs and then 10 times on the injured leg only. If you can do this without pain and without experiencing a worsening of your symptoms in the 24 hours after the hop test, you should be ready to add plyometrics to your rehab programme.
Start easy and then increase the difficulty
Please don’t go crazy with the plyometrics right off the bat. Like with the strength training, you should get your tendon used to what is expected of it by starting easy and then gradually increasing the difficulty. Be guided by whether you experience any pain during the exercises or within the 24 hours afterwards. If you don’t, you’re ready to turn things up just a notch in the next session.
There are several ways you can do that.
You could start with double-leg hops with the knees slightly bent so that it’s not just the Achilles tendon that’s working, and then progress to double-leg hops with stiff knees to isolate the Achilles so that it’s working a little bit harder.
And then, of course, at some stage you would progress to single-leg hops that you eventually make more difficult in the same way as above.
Later on, you could start adding in jumping forwards and backwards as well as sideways or onto and off boxes. Your physio will be able to advise on what is best for you by assessing your current ability and what is needed for your sport.
Stagger the plyometrics with your running and strength training
Research has shown that hopping and jumping exercises can create forces of more than seven times your bodyweight in the Achilles tendon. So, your tendon will have to deal with much higher forces during plyometrics than it has to contend with during strength training.
Therefore, you shouldn’t do plyometrics every day – your tendon needs time to recover between sessions. Also, don’t do it on the same day as your strength training, because you may overload your tendon. The same goes for heavy running sessions.
Depending on the specific case, we ask our patients to do one or maximum two plyometric sessions per week, and we help them to structure their rehab throughout the week, so that the tendon gets enough recovery time between the various types of session.
Who should use plyometrics?
Like I said above, plyometrics aren’t essential for everyone’s Achilles rehab, and we certainly don’t prescribe it for all our patients.
For people who just want to be able to walk their dogs again, we would not prescribe plyometrics. However, for some runners, and for high-level sportspeople we would prescribe it, especially if proper, high-volume strength training did not help their tendon to recover 100%.
And then, of course, if your sport involves a lot of jumping or explosive leg movements, like basketball, we would prescribe a plyometrics programme that should eventually progress to mimicking the type of movements that are specific to that sport.
How we can help
Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
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Igor Sancho, Dylan Morrissey, Richard W. Willy, Christian Barton, Peter Malliaras, Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: A single cohort feasibility study. Physical Therapy in Sport, Volume 40, 2019, Pages 107-116. https://doi.org/10.1016/j.ptsp.2019.08.007
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