Plyometrics for Conditioning

Today I finished treating a runner who had been struggling to recover from a foot injury. She is back on the road again, hoping to complete her first marathon in early 2017. 

In order to run faster and stay healthy, she began an on-line strength training routine for runners. The injury she sustained while doing the program set her back at least six months. This is not the first or last occasion of treating an injury caused by an on-line or DVD program like P90X. This is not even the first time that IronStrength For Runners has brought business to my office.

This particular program was created by a "nationally known sports medicine physician" and sponsored by Runners World magazine. The workouts are not terrible if you consider the mode of delivery. But they're not good, either.

I assume that Dr. Metzi, the creator, ignored or does not know what I'm about to tell you. I have mixed feeling about saying it outright. After all, injuries keep me gainfully employed. But here goes:

      ---  DO NOT PERFORM PLYOMETRICS FOR CONDITIONING (i.e. what most people call burning calories or generally getting in shape).  ---

Inappropriate use and progression of plyos are some of the top reasons for active young- and middle aged people to require physical therapy.

[Plyometrics are explosive powerful training exercises (usually variations of jumping, hoping, and throwing) that effectively activate a quick response and elastic properties of muscles and joints. Here is the Wikipedia entry.]

Plyometrics are included in most home-based programs because they are challenging, require very little equipment, and they produce results.

I'm not against them. Plyometrics are actually great...so long as they don't destroy you.

Almost every single DVD or on-line fitness guru will have you doing plyometrics inappropriately:

-You will be doing plyometrics without feedback on your form.

-You will be doing plyometrics without even knowing if your body possesses the flexibility and strength to achieve proper form.

-You will often be jumping into plyometrics without systematically increasing the resiliency of the muscles and connective tissue.

-You will often be jumping and thrusting around until you're blue in the face (in a state of high fatigue).

Each one of these factors -alone- is enough to cause injury, even in young people. Sorry, but it's the nature of the beast. On-line and DVD fitness programs simply cannot be custom tailored to assess and coach each person on the other side of the screen. And some of them are downright bad (poorly designed).

People of all fitness levels and walks of life make errors in their training. We go too hard or heavy, for too long, too often. We perform exercises incorrectly. We assume that what is healthy or "worked" for someone else is necessarily going to "work" for us. A fitness program or DVD simply cannot navigate the details of where you fit in.

I've made my share of training errors and experienced (and continue to experience) the consequences. Injuries...they happen. But the risks are often manageable, and well worth the benefit (and fun!) of leading an active lifestyle.

So put some thought into your plyometric training:

-While plyometrics impose various amounts of impact on the joints, the target body part is the nervous system. Plyos teach the brain to control and coordinate the entire body to be powerful and quick. If 20 minutes once or twice per week is good, more is NOT better.

-Seek instruction from someone who knows what they are doing. Ask questions like "Why am I doing this?" and "What does that certification mean?" If the answers sound like fitness jargon b.s., it is.

Image result for bambi legs
 Has some work to do before hitting the plyos

-Ideally, you should go through a basic movement screen to see that you pass the known prerequisites to beginning plyometric exercise.

-If you do stand to benefit from and tolerate plyometric activities, do not perform them in a state of fatigue. Keep the rest periods long and the work periods short and powerful. You should never feel completely gassed from these activities.

-For conditioning (getting in shape, calorie burning for weight loss, etc), find lower impact, grinding alternatives like variations of sled push, kettlebell swings and carry, farmer walk, rowing and stationary bike intervals, battling ropes, hill walks, jogs, and sprints, etc.

-If you are a serious runner or other endurance based athlete, see the above points AND do not confuse your resistance and plyometric training with just adding more endurance work. Your muscular endurance is already stellar, and you will benefit most from increasing your strength and power. So "lift" relatively heavy, leap and bound in short, powerful blasts, and be smart about exercise selection.

Again, find a guide for six or 8 weeks. This is usually plenty of time for you to ...

lose 30 pounds and gain huge amounts of strength and vertical jump and rock hard 12 pack abs 

...you to TRULY LEARN how to best fit an effective exercise program to the structure of your body and the demands of your activity.

My apologies to Insanity. I want to thank them for the referrals. And if I spared you an injury, please direct your friend, uncle, or cousin who sustained an Insanity injury to my office.


Should Football Players do Neck Exercises?

Today this question came in:

I have a question that is somewhat controversial. What is your professional opinion about doing neck exercises for football players? If so, what do you recommend for exercises, reps
volume etc...

Football players are one of the few athletic population where direct neck exercises are absolutely warranted. Football imposes demands in this area and it makes sense that athletes should train to build some resiliency there.
Here are a few guidelines and caveats:
-The reps and resistance do not need to be extreme to derive benefit. Direct neck work should be done two to (at most) three times per week. Two to three moderate intensity sets of 6 to 8 reps in all planes (front, back, side) is plenty.
-The reps should be completed in the middle of the range of motion. This means that the athlete should NOT take their head as far as it should go. Take, for example, this training video found at NFL.com.  It hurts my head to see guys cranking their cervical spine into maximum side bend, flexion and extension under load!
-Direct neck work is a great time to integrate some thoracic extension and rotation mobility drills to make sure and ingrain neutral cervical and thoracic spine posture from which to work the neck out of. Just like any other "core" exercise, one of the most beneficial things an athlete can do is take the time to achieve proper resting alignment and to understand what this feels like before they load the movements.
-Not all athletes have access to expensive neck isolation training machines and wall mounts. Using manually resisted movements (like in the video) is likely just as beneficial and encourages the athlete to work at less than maximal load - this is a good thing!
So no extra credit for 1 rep max neck personal records!


Heel pain in soccer players

Heel pain is a common problem in any "cleated" athlete, and something often treated at my physical therapy office. This essay will focus on the most common cause of heel pain in young soccer players.

Differential diagnoses includes Achilles tendinitis, stress fracture, recurring ankle sprain, nerve entrapment, and plantar fasciitis. Just...don't assume that your Google degree has enabled you to reliably determine Severs disease from a stress fracture or achilles tendinitis. 

The problem is most often a condition known as apophysitis of the calcaneus (heel bone) or Sever's Disease. This label describes a repetitive overuse injury, with inflammation of the growth area of the calcaneus which has not completely closed together. It is most commonly seen in boys and girls between the ages of 10-15 who frequently participate in sports that involve running and jumping. The pain is usually present in the back and bottom surface of the heal.

Causes of Sever's Disease Include:

1. Training Errors

The issue often occurs abruptly when the athlete resumes running, cutting, and jumping activities too frequently or intensely after a period of relative inactivity. Other times, the condition develops gradually as the athlete continues to pound their joints with insufficient time for recovery between games and practices.

2. Footwear

Soccer cleats are intentionally created to minimize interference of the function of the foot. This is great for quick cuts and precision touches to a soccer ball, but leaves very little between the foot and the ground. Cleats that are too small are often a culprit, as are shoes with less than four cleats in the heel area.

3. Foot Structure and Function

Biomechanical imbalances such as high or low arches, or very stiff or loose joints, can be the root cause of the abnormal strain across the Achilles tendon insertion point on the heel bone.

Treatment: Beyond rest and heel cups

The most effective treatment usually includes measures to address some combination of the above problems.

1. Systematically apply stress to the body.

Plan ahead to gradually apply more stress the foot and ankle before jumping into a lot of repetitive agility and sprint work. At least initially, apply a limited number of high impact activities to build resiliency in the foot and ankle. 

Wear cleats around the house for "everyday life" and light skill work before using them for more intense activities.

2. Address biomechanical issues.

The details of foot structure and function are beyond the scope of this essay. This is highly individual, and demands a thorough orthopedic evaluation of the entire athlete (not just the foot). Not all "low arch" feet need orthotics. They may respond well to a few exercises and shoe modification. But some athletes certainly do require an appropriate off-the-shelf or custom orthotic device.

3. Modalities

Applying ice and massaging the calf muscles and the area around (but not directly to) the tender area often helps. I've found Ultrasound treatment to be worthwhile to decrease pain and inflammation. While these do indeed help manage the symptoms, they don't address the root cause.

4. Taping Techniques

There are a few flexible (aka kinesiotape) and traditional taping techniques that effectively reduce the overload of the heel bone. Sometime this is enough to get the athlete outside of the threshold of injury. Which technique and type of tape may work best depends on the static and dynamic (movement) patterns the athlete displays.

5. The quick fix. ***

I've hit upon a quick fix (of sorts), and will usually try this in combination with a few targeted exercises and temporary activity modification prior to considering an orthotic or other more intensive intervention.

The quick fix is a 1/4" semi soft heel lift that runs from the heel and gradually tapers to the ball of the foot. This works far better than Dr. Scholls type insole because they don't take up room in the toe box area where the athlete is accustomed to a form fitting shoe. And unlike gel "cushion" heel cups, they don't slide around in the shoe. They also provide more lift than squishy gel. A quarter inch is usually enough to lift the posterior half of the foot just enough to allow for mitigating the Achilles tendon pull on the calcaneus.

I make these in the orthotic lab and they often do wonders for athletes stuck in a rut of heel pain. 

Try these tips and let me know if you have any questions. 


Should soccer players lift heavy weights?

I know what you're thinking. When most people think of lifting heavy weights, they think of this:



Or this:

But when speaking of lifting heavy, I'm not referring to any of those. May I have a clean slate?

Heavy is a relative term with many qualifiers. There is context, intent of training, training experience,  expectations regarding form, as well as individual factors such as body size, leverage, mental determination, and age.

Plus, the individuals depicted in the images above have achieved proficiency in their sport, which is lifting things or bodybuilding. But they're not necessarily fast or athletic in other arenas.

Soccer, like many sports, is concerned with how much power an athlete can generate relative their own body mass. Relative power is a primary factor that underlies the speed, quickness, and acceleration that everyone is seeking.

This relative power demands the ability to generate a high amount of force (strong muscles) and the ability to generate the force quickly (primed central nervous system). Sport specific skill and an aggressive mindset also come into play, such as what we commonly refer to "being strong on the ball." But we will leave those attributes out of the equation for now in order to focus on the question at hand.

Many coaches and players in the soccer community fear soccer players taking part in traditional heavy resistance training. I believe they should. The threat is real, especially if soccer players are simply given to do what the (American) football team does.

But the soccer players' fear of heavy lifting is partially unfounded. This fear holds them back from achieving their greatest potential in power, speed, and quickness.

Too Big?

Heavy resistance exercise has the potential to cause a gain in muscle mass. Quite frankly, many soccer players could use an additional 10 or 20 pounds of muscle distributed proportionally throughout their body. It's true that a lean, well conditioned athlete who gains some muscle mass may suffer slightly in terms of endurance events like running the mile. But who cares? The increased speed,  acceleration ability, and field presence that comes with a modest increase in muscle mass far outweighs the small cost in aerobic endurance.

Soccer is not a marathon or even a Cross Country run. Athletes typically accelerate, decelerate, cut, and sprint for between two and five seconds, then have a chance to recover or even sub out. I have never seen or heard of an athlete who plays, practices, and conditions for soccer, resistance train two or three days per week and still manage to get too big. That scenario rarely, if ever exists.


Larger muscles have the potential to produce more force than smaller muscles. Again, depending on the individual involved, larger muscles may be beneficial to an extent. But power is the ability to generate force rapidly, and is primarily a neurological quality.

Soccer players should be "amping" the nervous system through powerful moves like plyometric training with generous rest between sets, as well as total body resistance exercises that demand total body control. Exercise selection matters. Seated leg extension (for the quadriceps) are nowhere even close to something like barbells squats or reverse lunges.

"But this does not look like muscular endurance..."

Exactly. Yes. Do not attempt to use resistance training to provide a cardiovascular or power-endurance stimulus to athletes who are already well conditioning in that regard. To be clear, when you're practicing soccer, playing soccer, and otherwise running most days of the week, P90X and Insanity (popular fitness DVDs) and their look-a-likes are not the way to go. They are redundant and less than ideal for the sake of improving cardiovascular or strength/power attributes in this population of athletes.

Let us now revisit what I would like you to envision when you think of going heavy. Think of strong, lean athletes with a primed nervous system.

How to get brutally strong without getting huge. 

-Don't use steroids.
-Do physical activity other than lifting weights (such as playing and practicing soccer).
-Don't sit around eating the house all day.
-Do keep the reps relatively low whether you're going light or heavy. Complete two to three sets of 3 to 5 reps.
-Do NOT add a lot of variety to the weight raining. But instead become VERY efficient in a few total body exercises.

Don't let fear of heavy lifting hold you back. Again, heavy is a relative term. But gradually, safely finding the groove on a handful of the big lifts just may be the key to developing the foundation of the speed, quickness, and field presence that so many athletes desire.

I pulled some photos from the dead lifting gallery. I don't often have athletes attempt 1 rep-max lifts, but here are a few of them. Do ANY of these athletes look just too big and bulky to you?

Ben 425 lbs  >> double body weight

Zeb 355 >> 1.5X body weight
Loc 275>> double bodyweight

Melanie 215 nearly double body weight
Nick 305 lbs - double body weight
Brady 300 lbs >> double body weight
Ben 125 (I allow  my kids to train when they want to, which is not yet often.). 
Owen 135