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Plyometric Progression for Rehabilitation

Original Editor - Ewa Jaraczewska based on the course by Josh Chung

Top Contributors - Ewa Jaraczewska and Jess Bell  

Introduction

Early rehabilitation typically incorporates low-load, low-velocity exercises appropriate for tissue healing and initial recovery. However, sport demands explosive power, rapid force development, and reactive movements (i.e., high-force, high-velocity activities like cutting, jumping, landing, and sprinting). An athlete who has regained full range of motion and restored their peak force after injury may still lack the neuromuscular capacity to safely perform these movements. Since physiological adaptations are specific to imposed demands, rehabilitation must bridge the gap between early low-load work and sport-specific demands.

Definitions and Key Concepts

True Plyometrics Versus Jump Training

"(......) plyometrics are not typically seen as just exercises or drills, but more as complex ‘movement skills’ due to their high complexity."[1]

A true plyometric exercise requires three specific criteria: a landing component, where the athlete impacts the ground or surface; a take-off component, where the athlete leaves the ground or surface; and a ground contact time shorter than 0.25 seconds.

The forces generated during true plyometric exercises can exceed seven times body weight. This places extraordinary demand on healing tissues and neuromuscular control systems. Psychological readiness must also be considered.[2]

True plyometric exercises are inappropriate for early and mid-stage rehabilitation because of their high intensity and demanding nature. However, jump training and plyometric-adjacent tasks can help athletes post-injury progressively develop the explosive qualities necessary for sport.[3][4]

Throughout this article, the term "plyometrics" is used in its broader sense to include exercises that utilise elements of the stretch-shortening cycle (see below), even when they do not meet all three criteria of a true plyometric exercise.

Stretch-Shortening Cycle

The stretch-shortening cycle (SSC) "describes an eccentric phase or stretch followed by an isometric transitional period (amortisation phase), leading into an explosive concentric action."[5]

The stretch-shortening cycle consists of three phases: the eccentric phase, where muscle-tendon units are rapidly stretched, the amortisation phase, where the direction of movement changes, and the concentric phase, where the stored elastic energy is released.[5] Exercises can emphasise different portions of this cycle.

Peak Force

Peak force is the maximum force an individual can generate during a test or movement.[6]

Peak force, often referred to as "strength", is measured through various testing protocols, including one-repetition maximum lifts, maximum voluntary isometric contractions, and isokinetic peak torque.[6] These measurements quantify the highest force output a person can achieve, regardless of the time required to reach that peak.

Muscle atrophy, arthrogenic muscle inhibition, and altered motor patterns following injury can result in significant peak force deficits. In rehabilitation settings, standard resistance training protocols can effectively restore peak force capacity. Restored peak force capacity is demonstrated by improved limb symmetry on strength testing.

Example: the Aspetar clinical practice guidelines for anterior cruciate ligament reconstruction recommend that athletes achieve 100% symmetry in isokinetic quadriceps and hamstring peak torque at 60 degrees per second before they return to high-demand pivoting sports.[7]

However, simply achieving symmetry in peak force does not guarantee an athlete is ready to return to the reactive, high-velocity demands of sport.[7]

Rate of Force Development

Rate of force development (RFD) describes how quickly a force can be produced.[8][9]

Rate of force development depends on the intrinsic contractile properties of muscle fibres, the rate of neural discharge, and motor unit synchronisation.[8] It is calculated as the change in force divided by the change in time, and is expressed in Newtons per second. It can also be expressed as the percentage of peak force achieved within specific time windows, such as the first 100 milliseconds or 200 milliseconds of a contraction.[10] Research consistently demonstrates that deficits in rate of force development persist after lower extremity injuries, even after peak force has been restored to normal levels.[11]

Power and Repeat Power Ability

Power represents the rate at which mechanical work is performed. It is calculated as the product of force and velocity and is expressed in watts.

Different sporting activities have different power requirements along the force-velocity continuum.[12] Initially, rehabilitation exercises focus predominantly on the force end of the spectrum to restore strength and tissue capacity. As rehabilitation progresses, velocity must be systematically increased while force demands are manipulated.

Repeat power ability (or power endurance) refers to the capacity to maintain power output despite accumulating fatigue.[12]

In rehabilitation, repeat power ability should be trained once single-effort power has been well-established. Training repeat power ability prematurely places athletes at higher injury risk because fatigue lowers movement quality.

Reactive Strength Index

The Reactive Strength Index (RSI) measures an athlete's explosive capability and efficiency in utilising the stretch-shortening cycle.[13]

The RSI is calculated using the formula: jump height divided by ground contact time. A higher RSI indicates an athlete can produce greater jump height while maintaining shorter ground contact times. RSI can be trained and improved through plyometric training.[14]

Example: the Aspetar clinical practice guidelines for anterior cruciate ligament reconstruction include RSI as a key component of return-to-sport criteria. These guidelines propose minimum RSI values greater than 1.3 for double-leg jumps and greater than 0.5 for single-leg jumps in field sport athletes.[7]

Extensive Versus Intensive Plyometrics

Plyometric exercises can be categorised into extensive and intensive exercises based on the intensity of effort, the duration and volume of the training session, and the primary training objectives.[15]

Extensive plyometrics are lower- to moderate-intensity exercises performed for a longer duration/higher volume.[16]

These exercises typically involve longer ground contact times and lower reactive strength demands. Examples include submaximal repeated jumps, pogos with moderate effort, low-height depth jumps, and continuous hopping patterns. Extensive plyometrics are useful at the very start of a session as a "primer" or a "warmup" all along the rehabilittaion process. In the EARLY stages of introducing plyometrics, clinicians can fit them in as pairings because the athlete cannot really tolerate intensive based work yet. Another option may be at the END of a session as a "finisher" or as a way to build work capacity or conditioning.[17][16]

Intensive plyometrics are high-intensity, low-volume exercises with complete recovery between efforts.[16]

These exercises emphasise very short ground contact times, maximal reactive strength, and peak power output. Examples include depth jumps from high boxes, single-leg maximum effort jumps, and sport-specific plyometric drills at competition intensity. Intensive plyometrics are great paired, or can be introduced at the start of the session.[17][16]

Clinical Indications for Plyometric Training

Determining Readiness

Objective criteria, including physical capacity (full range of motion and sufficient strength, endurance, and neuromuscular control[18]), movement quality, psychological preparedness, injury-specific considerations and surgical restrictions, should guide the decision to introduce plyometric exercises into a rehabilitation programme.[19]

Range of motion: Adequate range of motion is an important prerequisite for plyometrics. The Aspetar guidelines for ACL rehabilitation recommend that athletes achieve 95 percent knee flexion range of motion as a prerequisite for return to running. This typically precedes or coincides with introducing plyometrics.[7]

Force production: Athletes must be able to generate sufficient force without pain prior to commencing plyometrics.[20] Limb symmetry provides quantifiable benchmarks for progression.[21] A threshold of 80 percent limb symmetry for quadriceps strength represents a reasonable minimum for initiating extensive plyometrics in lower extremity rehabilitation. As intensity increases and athletes progress towards intensive plyometrics, they should be aiming for a threshold of 90 percent limb symmetry or higher.[22]

Psychological readiness: Fear of reinjury, kinesiophobia, and lack of confidence can lead to guarding patterns, movement avoidance, or hesitancy during dynamic activities.[23] These factors can impair performance and alter movement biomechanics in ways that increase injury risk. Addressing psychological readiness begins with education and graded exposure to progressively challenging activities. Drop-and-catch exercises can be beneficial as they introduce the neuromuscular demands of deceleration while removing the psychological barrier of actual landing.[16]

Contraindications to Plyometrics and Risk Mitigation

Absolute contraindications to plyometrics include acute inflammation or significant joint effusion, uncontrolled pain during loading activities, inadequate range of motion for exercise execution, and surgical restrictions.[17]

Relative contraindications include significant strength deficits (limb symmetry indices below 70 percent), poor movement quality that cannot be corrected through cueing, ongoing psychological barriers, and cardiovascular contraindications to high-intensity exercise.[24]

Risk mitigation strategies optimise safety. Strategies include: incorporating an appropriate warm-up; selecting exercises that match current capacity; influencing impact forces through the landing surface; providing technical coaching and real-time feedback on movement quality, volume and frequency; and monitoring systems that track athlete-reported outcomes and objective performance measures.[25]

Plyometric Progressions

Plyometric progression in rehabilitation

It is important to progressively increase plyometric load, respecting tissue healing, building neuromuscular capacity, and progressively challenging the stretch-shortening cycle.[16]

In the preparation phase, the aim is to address muscle guarding and movement apprehension. Example exercises include a drop-and-catch for the lower body and a medicine ball drop-and-catch for the upper body. This stage introduces rapid deceleration forces while eliminating the mental stress of landing or an explosive push-off.

Stage 1 introduces the eccentric component of plyometric exercises (i.e., the landing or decelerative portion). Example exercises include: depth drops for the lower body and plyometric push-up depth drops for the upper body.

Stage 2 focuses on the concentric/acceleration component of a plyometric without the landing component. For example, a box jump incorporates a take-off, but eliminates the landing component as the athlete lands on an elevated surface. Ballistic medicine ball chest presses for the upper body isolate the acceleration phase.

Stage 3 incorporates a full stretch-shortening cycle by combining the acceleration and deceleration components. Exercises include a landing component followed immediately by a concentric component (e.g., depth jump). Initially, exercises can be performed with a lower reactive strength index/longer ground contact time before progressing to a higher reactive strength index/shorter ground contact time.

In stage 4, true plyometrics can be introduced, with a focus on repetitions and multi-directional movements. Example exercises include: tuck jumps, repeated pogo jumps, multi-directional hops, and sport-specific sequences. Training parameters match sport-specific intensity and competition demands.[16]

Vertical Versus Horizontal Force Vectors

Athletic movements require force production in multiple planes and directions. While the preparation and eccentric stages are similar for both vectors, the concentric stage (Stage 2 onwards) is where vertical versus horizontal force vectors become most relevant in exercise programming. These vectors demand different neuromuscular strategies and produce specific mechanical loads on joints and tissues.

Plyometrics with a vertical force vector focus on upward movements. Exercise progressions include box jumps, depth jumps with vertical rebound, tuck jumps, and repeated vertical jumps progressing from bilateral to unilateral.

Plyometrics with a horizontal force vector propel an individual forward, backward, or sideways. They require greater anterior-posterior ground reaction forces with higher hamstring, gluteal, and anterior-posterior stability demands. Horizontal exercises include broad jumps and depth broad jumps.[16]

Programming Considerations

It is important to consider the timing or placement of plyometrics in a rehabilitation programme or exercise session. Timing differs based on plyometric type. Extensive plyometrics can be done after strength work and can be paired with primary lifts or as a conditioning component. Intensive plyometrics are ideally performed at the beginning of a session after a dynamic warm-up when the individual is neurologically fresh, as maximum power output is required.[16]

Plyometrics can be incorporated into a rehabilitation programme using contrast pairing, where a heavy strength lift is followed by an explosive plyometric exercise. For example, a lower body lift like a squat or split squat might be paired with a vertical or horizontal jump, while an upper body press could be paired with a plyometric press-up. This pairing primes the neuromuscular system for the explosive movement whilst building efficiency into the training session.[16] Another pairing strategy is efficiency pairing, where complementary movements that work different muscle groups are introduced. This allows for shorter rest periods and higher volumes.

Progressing to the next stage requires good movement technique, no pain during or after exercise, minimal swelling, and confident, controlled movement. Regression is necessary when movement quality decreases, pain develops, hesitation returns, or excessive fatigue occurs.[26][27][28]

Ground Contact Time

As mentioned, a ground contact time of less than 0.25 seconds distinguishes true plyometrics from plyometric-adjacent exercises. To effectively utilise the stretch-shortening cycle for enhanced performance, it is important to minimise contact time.[4][29]

Ground contact times exceeding 0.4 seconds rely primarily on muscular force production rather than elastic energy. At this duration of ground contact, the movement depends predominantly on concentric muscle action. This is appropriate earlier in the rehabilitation continuum, where the focus is on controlled force production.[4][29]

Ground contact times between 0.25 and 0.4 seconds indicate a shift from strength-based jumping to more reactive movements. This is appropriate for mid-stage rehabilitation, where athletes begin utilising the stretch-shortening cycle but still have a significant muscular contribution to force production. They are learning to coordinate the timing of the eccentric-to-concentric transition while building the tendon stiffness necessary for efficient elastic energy return.[4][29]

A ground contact time of less than 0.25 seconds requires optimal tendon stiffness and reflex potentiation. Movements become largely reflexive with minimal time for volitional control or correction. This level of reactive ability should be reserved for late-stage rehabilitation and return-to-sport preparation.[4][29]

Conclusion

Plyometric training helps bridge the gap between early rehabilitation and return to sport. Structured progressions that respect tissue healing and balance extensive versus intensive training can improve strength, power, and functional performance. The continuum framework outlined in this article provides a systematic approach for integrating plyometrics from early rehabilitation through to return to sport.

Resources

References

  1. ↑ Walker O. Plyometric training. Available from https://www.scienceforsport.com/plyometric-training-2/?srsltid=AfmBOoq5-bkoEel0wfqFKWLZ2093IGi_ZzCnZDL1X1o-woi4Bh7oVwnA [last accessed 24.10.2025]
  2. ↑ Bastholm M, Olsen G. The Role of Plyometric Training in Improving Explosive Power in Sprinters: A Qualitative Analysis. International Journal of Sport Studies for Health. 2024 Jul 1;7(3).
  3. ↑ Deng N, Soh KG, Abdullah BB, Huang D, Xu F, Bashir M, Zhang D. Effects of plyometric training on health-related physical fitness in untrained participants: a systematic review and meta-analysis. Scientific reports. 2024 May 17;14(1):11272.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Chmielewski TL, Myer GD, Kauffman D, Tillman SM. Plyometric exercise in the rehabilitation of athletes: physiological responses and clinical application. Journal of Orthopaedic & Sports Physical Therapy. 2006 May;36(5):308-19.
  5. ↑ 5.0 5.1 Turner AN, Jeffreys I. The stretch-shortening cycle: Proposed mechanisms and methods for enhancement. Strength & Conditioning Journal. 2010 Aug 1;32(4):87-99.
  6. ↑ 6.0 6.1 Kawamori N, Rossi SJ, Justice BD, Haff EE, Pistilli EE, O'BRYANT HS, Stone MH, Haff GG. Peak force and rate of force development during isometric and dynamic mid-thigh clean pulls performed at various intensities. The Journal of Strength & Conditioning Research. 2006 Aug 1;20(3):483-91.
  7. ↑ 7.0 7.1 7.2 7.3 Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British journal of sports medicine. 2023 May 1;57(9):500-14.
  8. ↑ 8.0 8.1 Maffiuletti NA, Aagaard P, Blazevich AJ, Folland J, Tillin N, Duchateau J. Rate of force development: physiological and methodological considerations. Eur J Appl Physiol. 2016 Jun;116(6):1091-116.
  9. ↑ Otley T, Myers H, Lau BC, Taylor DC. Return to sport after shoulder stabilisation procedures: a criteria-based testing continuum to guide rehabilitation and inform return-to-play decision making. Arthroscopy, sports medicine, and rehabilitation. 2022 Jan 1;4(1):e237-46.
  10. ↑ What is RFD, and how is it calculated? Available from https://quickstart.k-invent.com/what-is-rfd-and-how-is-it-calculated/#:~:text=Definition,%CE%94t=%20Time%20taken%20to%20decelerate. [last accessed 29.10.2025]
  11. ↑ Kasmi S, Zouhal H, Hammami R, Clark CCT, Hackney AC, Hammami A, Chtara M, Chortane SG, Salah FZB, Granacher U, Ounis OB. The Effects of Eccentric and Plyometric Training Programs and Their Combination on Stability and the Functional Performance in the Post-ACL-Surgical Rehabilitation Period of Elite Female Athletes. Front Physiol. 2021 Jul 2;12:688385.
  12. ↑ 12.0 12.1 Meixner B, Joyner MJ, Sperlich B. Durability, Fatigability, Repeatability and Resilience in Endurance Sports: Definitions, Distinctions, and Implications. Journal of Applied Physiology. 2025 Jul 1.
  13. ↑ Walker O. Reactive Strength Index. Available from https://www.scienceforsport.com/reactive-strength-index/?srsltid=AfmBOooPNzEw9vw8Kd330ZEbdmnhRJMMfiQvMDcBL_ANhwgGq_TG5X6E [last accessed 29.10.2025]
  14. ↑ Ramirez-Campillo R, Thapa RK, Afonso J, Perez-Castilla A, Bishop C, Byrne PJ, Granacher U. Effects of plyometric jump training on the reactive strength index in healthy individuals across the lifespan: A systematic review with meta-analysis. Sports Medicine. 2023 May;53(5):1029-53.
  15. ↑ Watkins CM, Storey AG, McGuigan MR, Gill ND. Implementation and efficacy of plyometric training: Bridging the gap between practice and research. The Journal of Strength & Conditioning Research. 2021 May 1;35(5):1244-55.
  16. ↑ 16.00 16.01 16.02 16.03 16.04 16.05 16.06 16.07 16.08 16.09 Chung J. Bridging the Gap Between Early and Late Stage Rehabilitation. Plus course 2025
  17. ↑ 17.0 17.1 17.2 Marrone W, Andrews R, Reynolds A, Vignona P, Patel S, O’Malley M. Rehabilitation and Return to Sports after Achilles Tendon Repair. International Journal of Sports Physical Therapy. 2024 Sep 1;19(9):1152.
  18. ↑ Davies G, Riemann BL, Manske R. Current Concepts Of Plyometric Exercise. Int J Sports Phys Ther. 2015 Nov;10(6):760-86.
  19. ↑ Stone MA, Jalali O, Alluri RK, Diaz PR, Omid R, Gamradt SC, Tibone JE, Mayer EN, Weber A. Nonoperative treatment for injuries to the in-season throwing shoulder: a current concepts review with clinical commentary. Int J Sports Phys Ther. 2018 Apr;13(2):306-320. Erratum in: Int J Sports Phys Ther. 2019 Feb;14(1):1.
  20. ↑ Acar NE, Umutlu G, Gencer YG, Güven E, Taşman GA. Strength asymmetries and their impact on landing dynamics during countermovement jump and drop jump tests in professional female basketball players. BMC Sports Sci Med Rehabil. 2025 Sep 29;17(1):282.
  21. ↑ Mitchell A, Greig M, Palmer M. An Evidenced-Informed Approach to How Injured Professional Soccer Players Can Successfully Return to Running and Begin Grass-Based Rehabilitation. JOSPT Open. 2025 Jul;3(3):1-5.
  22. ↑ Çağlayan A. Effectiveness of Return to Sport Training Program on Limb Symmetry Index After Anterior Cruciate Ligament Reconstruction. Yalova Üniversitesi Spor Bilimleri Dergisi.2025;4(2):132-57.
  23. ↑ Gallagher J, Needleman I, Ashley P, Sanchez RG, Lumsden R. Self-reported outcome measures of the impact of injury and illness on athlete performance: a systematic review. Sports medicine. 2017 Jul;47(7):1335-48.
  24. ↑ Arias-Vázquez PI, Quezada-González HR, Loeza-Magaña P, Castillo-Ávila RG, del Carmen Hernández-Gil K, Poblete-Magaña J. Jumps and plyometric exercises in the return to play after sports injuries. Clinical Journal of Sport Medicine. 2024 Jul 1;34(4):386-92.
  25. ↑ Wight, CR. A Review of Plyometric Training and Its Implications on Rehabilitation and Prevention of Lower Extremity Injuries in Collegiate Volleyball Athletes. All Student Scholarship 2025;454.
  26. ↑ Rodríguez S, Suarez-Cuervo AN, León-Prieto C. Exercise progressions and regressions in sports training and rehabilitation. Journal of Bodywork and Movement Therapies. 2024 Oct 1;40:1879-89.
  27. ↑ Saw AE, Main LC, Gastin PB. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. British journal of sports medicine. 2016 Mar 1;50(5):281-91.
  28. ↑ Barber-Westin SD, Noyes FR. Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. The Physician and Sports Medicine. 2011 Sep 1;39(3):100-10.
  29. ↑ 29.0 29.1 29.2 29.3 Flanagan EP, Comyns TM. Contact time and the reactive strength index optimise fast stretch-shortening cycle training. Strength & Conditioning Journal. 2008 Oct 1;30(5):32-8.
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