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Training at the foot and ankle is an important consideration during lower limb rehab for the implications that it has to the athlete when they commence their return to run journey. Having the ability to optimally load through ankle dorsiflexion and plantarflexion will ensure optimal force transfer during foot strike and developing the elastic recoil capacity of the achilles will place less demand higher up the chain both eccentrically and concentrically.
Low amplitude plyometric progressions often get utilised as an entry stage drill for athletes in the early stages of rehab but then commonly get abandoned once the athlete progresses into more advanced stages of plyometric development.
Energy storage and release from the achilles tendon, quasi-isometric capacity of the calf and the shanks ability to control yielding forces are fundamental components to quality running mechanics and therefore considerations should be made for low amplitude options throughout the entire rehabilitation journey.
Using a complexity and load continuum we can highlight entry to advanced options for the athlete to use throughout their entire rehab process. Here is an example progression stream:
Level 1 - Penguin March
Suitable for athletes in a protection or load introduction phase the primary goal of this exercise is to promote dissociation of ankle dorsiflexion and plantarflexion whilst creating tension isometrically through the calf complex
Level 2 - Pogo Jumps
Pogo jumps are an easy way to introduce an athlete to low amplitude plyometrics. Forming the foundation of a skipping technique, you can easily control the number of ground contacts as well as the amplitude and speed that the athlete jumps at. The aim is to promote as little knee flexion as possible when the athlete hits the ground and continue to build on the components of ankle dorsiflexion and plantarflexion that were established during the penguin march stage. This is suitable for an athlete throughout a load introduction phase ideally.
Level 3 - Ankle Skips
Ankle skips begin to transition an athlete towards unilateral based demands however provide a double contact element as the athlete hits the ground to dissipate ground reaction forces, they are suitable for athletes in either a load introduction phase or strength accumulation phase.
Level 4 - Alternating Pogo
Alternating pogos place a heavy demand on the athlete and require large amounts of force placed into the ground to be able to establish enough height from the recoil to effectively prepare for the next rep, as the load is alternating between limbs however it allows each limb time to recover between reps. This is suitable for an athlete from a strength accumulation phase onwards
Level 5 - Single Leg Pogos
Single leg pogo jumps are a highly complex drill that require immense levels of elastic recoil in the achilles and technical proficiency to ensure that the leg drive isn't provided through the knee and hips and rather solely from the ankle. My experience is that very rarely do field sport athletes perform these well and thus many will never reach this stage however there is no harm in trialling it as an assessment piece and if the athlete delivers good technique then prescribing it in their program.
Having a progression and regression model for exercise streams is a critical tool to have as a clinician to ensure athletes have the right exercise prescribed for both their particular stage of rehab as well as their training age.