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The Physio insights Podcast by Runeasi
Welcome to The Physio Insights Podcast by Runeasi, your trusted space for real conversations at the intersection of science and sport.
Every two weeks, we sit down with passionate clinicians, biomechanists, and rehab experts to share the insights, tools, and stories shaping the future of running performance, injury recovery, and movement science.
🔍 Created for physical therapists, gait geeks, and rehab specialists who care deeply about helping athletes move better, faster, and stronger.
Hit subscribe and elevate your clinical game!
Welcome to the Physio Insights podcast presented by Runeasi. I'll be your host, doctor Jimmy Picard. I'm a physical therapist, running coach, and team member here at Runeasi. On this show, we have real conversations with leading experts digging into how we recover from injuries, train smarter, and use data to better guide care. Whether you're a clinician, coach, or an athlete, we're here to explore what really matters in rehab and performance.
Jimmy:Let's dive in.
Jimmy:Ky, welcome to the Physio Insights podcast. How's your day been?
Ky:Hey, Jimmy. Yeah. Thanks for having me. It's been a good day. It's been a full day.
Ky:There's a lot on the plate at the moment, but full of the assignment, good things happening, and really good to speak to you.
Jimmy:Awesome. Well, briefly before this recording, we were chatting and it sounds like you definitely have a lot going on in life right now, opening a business, treating patients, and a new father. So congrats on that.
Ky:I think they say these things, you can't really plan these things. You plan out when you think the timeline of everything's gonna work, and it ends up all happening together. And they say busy people get things done, and and I suppose at the moment, I'm hoping I'm evidence of that. Yeah. As you mentioned, I've got my new business a week away from opening, Athlete's Ed Physiotherapy, which is really exciting.
Ky:I've got a beautiful newborn, Luca. He's he's six months in a couple of days, and so I'm not sleeping too much, but he's a bundle of fun. And then I'm juggling clinical. I'm juggling research and teaching. And so there's lots of hats, but I really enjoy it all.
Jimmy:Awesome. Yeah. Well, so I have three kids. My youngest is 11 and I can tell you it gets better. You'll start sleeping hopefully soon.
Jimmy:Alright. Ky, do you mind just sharing your background with running and then with physio as well?
Ky:Let's start as a runner. In Australia, we play Australian rules football, and I played through juniors Australian rules football. I played in some really good teams, but I wasn't that good myself. I was the classic really good athlete that didn't have amazing ball skills, and I worked hard and I tried hard. And I probably should have done athletics as a kid because I would have been really good at it through school and and as a young adult.
Ky:But I wanted to just play team sport, and I kinda got to the end of that. And as a young adult, and I was pretty fit, but I I wanted to hit the gym a bit. So I I kind of left running for a little bit and unfortunately probably should have dived into a bit more at that stage because I would have been pretty good at it, but I left running for for probably five or six years. And then I've got back into it probably the last five or six years. And, you know, I'm now kind of training for Valencia marathon.
Ky:At the end of this year, it'll be my third marathon, and I'm kind of taking it pretty seriously at the moment. So I can relate a lot to all the runners listening and to all the runners I treat of the roller coaster that is being a marathoner and and doing the big training weeks in the big training sessions. But I love it, and I think as most runners attest to, usually, their running is one of their favorite parts of the day. So for me at the moment, even with the busy schedule, fitting that running in is is something I really look forward to. And I think I suppose from the the professional sense, I was talking to you before, Jimmy, I followed a pathway from going into personal training in the fitness industry.
Ky:I went into exercise and sports science and then followed into physiotherapy or what in The US what is called physical therapy and and then from there I've I've been in the physiotherapy industry for about ten years and about fifteen years in the fitness industry all up and over that ten years the first sort of five years I was working a fair bit in team sports and the last five years I've kind of focused a lot more into working with runners, working with lower limb rehab and started to do some teaching in some of the postgraduate physio courses, doing a bit of research. So a few different bits there to keep myself stimulated, but also to hone my clinical areas of interest and and expertise.
Jimmy:Awesome. What spurred you to kind of transition to seeing more runners or work on going from team sports over to the runners?
Ky:I always had an affinity to running naturally because it was something that I had dabbled in and was interested in. And and I think, as you would know, the running based sports, there's an element that crosses over a lot with running, even though they are, distinctly different in many ways. But I think like a lot of clinicians, I was already kind of starting to focus on this area and then and then COVID, which you mentioned yourself, we saw an explosion of running in Melbourne. And the beauty of that was that for someone who was interested in it, suddenly your caseload went from seeing a few you know, you may be seeing twenty percent of your caseloaders runners a week to maybe fifty percent of your caseloaders runners a week. And you're able to really, one, hone your skills, but two, realize how working with runners was very fulfilling.
Ky:You could have really big change with these runners that were new to the sport or that, you know, had never been exposed to things like plyometrics, which we're gonna talk about later. And you could have these really big positive changes on a runner, whether it be from an injury perspective or from a performance perspective as well. So I found that I've worked with a vast majority of athletes, and and the the athletes I feel most fulfilled with typically are working with runners, even though I do really enjoy the lower limb rehab process, things like ACLs and that.
Jimmy:Yeah. Awesome. And then the research component. So you obviously, we're gonna talk about an article you recently published on plyometrics for runners. How did you get involved in doing research like this?
Ky:Yeah. It's a good question. I'm a little bit, you know, you could probably say a little bit nerdy with some of the research side of things. And as part of me is essentially specializing into the running space, I've purposely done a lot of self driven research to make myself in a position where I feel very comfortable that I know a lot of knowledge and I'm, you know, a subject matter expert in the area. And for me, I feel like one part of being a clinical expert is having the knowledge and then obviously the other part is the clinical expertise and pairing them together is really important.
Ky:So I suppose as part of my journey of exploring the research from a learning perspective and then, I suppose, marrying it with some areas of clinical interest, And plyometrics is something that, one, I've been interested in, but two, I've seen done poorly. I've seen underutilized. And I think for me, it was an area that I thought would be really interesting to other individuals. I've spoken about it at uni. I've spoken about it on some online webinars.
Ky:But I think that putting the article out there was something that for me that was self driven off my own back. And so for me, it's something to go, I think it's going to have a lot of benefit to coaches, lot of benefit to hopefully runners out there. And I'm very passionate about clinically applicable research. And we've all read papers out there that are very hard to apply or that are, you know, very clinical in or lab based in terms of their outcomes. And while that might be important from a research perspective as a clinician, which I am first and foremost, it is very hard to implement that.
Ky:So for me, if I'm going to do any research, which I'm sampling in, I want it to be clinically applicable and I want people to read the paper and go, oh, that was really useful. I can take something and I can use it tomorrow. So for me, that was kind of lots of little bits in there, and then I think I kind of went, alright. Well, this will be useful for me in my career, but this will be useful for other people. And I'm hopeful from the feedback I've had from the paper that it is just that.
Ky:So but I'm keen to talk and hear your thoughts. I know you've you've read the paper, and I'm keen to hear and to delve into a bit more.
Jimmy:Yeah. Awesome. Well, first off, I'd say I love what you just said. You're investigating in a topic. You're interested because you wanna share this knowledge with the public.
Jimmy:But what's interesting to me is most people would just write a blog or do the webinar thing. Went this extra step and got this published in a peer review journal. What was that process like? Was that really challenging? Did it take a long time?
Jimmy:What it Yeah. Tell me about that.
Ky:Yeah. So it's a good question. And I've done some of the the blogs, you know, the the evidence based or the blog blog stuff before, and I I like doing that form, and I've done some of the webinars, I really enjoy doing that as well. But I think this was a little bit about me challenging myself to achieve a few things that are, you know, I was calling them side quests at the moment because while I'm building my business, there's been a few other things going on like this paper, but challenging myself to achieve a few other things that are, I suppose, goals for me, and for those that haven't been through the process of a peer review journal, it can be pretty full on in terms of the time required and the work required. Typically around not only do you have to put together a really good product first and foremost, you then need to go through the review process, which usually involves multiple stages, which which was the case for me.
Ky:You typically have a couple of experts in the field anonymously who review your article, give you feedback. If it's like the case for me with with this article and and subsequent ones, there's a lot of comments that you have to action and you have to justify, and and I think that's important. Right? If if you're publishing in a scientific journal, you want these things to not just be your opinion. You want these things to be backed up by a science or your questioning of things to be backed up by an opinion that's that's validated by other opinions rather than it just being your opinion or or, you know, I suppose that's the difference between our peer reviewed research and other mediums like social media or podcasts or or blogs.
Ky:So it look it's it's a interesting process. I don't love the research process, but I do like the outcome, and I do like the, you know, the the structure and and kind of the rules that come with that to make it a high quality product. So I'm proud of the outcome of it, but for those that are thinking about it, make sure you've got a bit of time and make sure you're willing to have the attention to detail required because it's it's no easy feat. I'll say that.
Jimmy:Yeah. Well, congratulations on getting it published. So, yeah, let's dig into the paper itself. So you start the paper with a pretty interesting statistic, and that is that we know that biometrics have this perform or let's say benefit for endurance runners, but only fourteen to forty seven percent of endurance runners use plyometrics in their training. Why do you think that is?
Ky:It's a good question and I think, I don't know if you found this Jimmy, but working with runners over a few years now, you typically will investigate, alright, what are you doing as part of your routine? You know, what are you doing in your gym program? Are you doing any exercise? You break it down, and you'll often find or I'll find that there's not many plyometric exercises in there. If I sample it, it would probably fit in the thirty to 50% category of people that are doing some plyometric exercises clinically.
Ky:And then if you break that down again, how many people are doing high quality plyometric exercises? Probably very small. And so that was part of the drive for me to go, right, let's look into this a bit more. How can we educate a bit more? And I think there's a variety of reasons.
Ky:One of them is that, and this is the case for strength training and plyometric training, but runners like running. Right? And the core thing with with runners is they wanna run. They wanna run typically as much as they can, and they don't really wanna fit too much else into their routine. And while it's improving and there's a lot of education online, some good, some bad, there are a lot more runners doing strength training, but typically the core is still runners want to run and you maybe have to convince them or educate them why they should be doing other things, which is a part of my job that I love.
Ky:The other consideration is that plyometrics are typically high amplitude, high force movements. And there is some risk or exposure to injury, and we'll talk about this a little bit later. If someone is uneducated or doesn't have a knowledge base and just goes into an exercise that they've seen online or that, you know, the best program for runners, plyometric that they see on social media, which involves, you know, high amplitude movements or high force movements, they may actually pull up sore or they may you know, their grumbly Achilles that they were kind of able to manage with their three runs a week is suddenly now pretty sore, they they have to take a week off. And they go, well, plyometric thing was was pretty silly. I'm not gonna do that again.
Ky:So I think there's a couple of reasons. I mean, time's always a factor with this stuff. Everyone's got busy lives, but that's an education piece which we can talk about. You don't need that much time for plyometrics. You know, I think the other consideration is from people like yourself and myself, running coaches, health professionals to have the education piece that will actually this is another tool in your toolkit.
Ky:It's not necessarily better than something else, but it's another tool to add into your toolkit that can potentially improve your performance, improve your resilience. So I think there's a few reasons. The evidence doesn't point to one hard and fast fact there, but I think the studies that look at these are, you know, just surveying runners and and probably is an area that could be investigated more. I don't know if you found any in your expertise, Jimmy, with working with runners, any reason that maybe they're not engaging in things like plyometrics as much as we'd like?
Jimmy:Yeah. Sometimes I think it's just a confusion. When you say plyometrics, they look at you like you have two heads and they're not really sure what you mean by plyometrics. So how would you define plyometrics for everyone? So the runner comes to your office, yeah, you say, are you doing plyometrics?
Jimmy:And they say, what do you mean? What is a plyometric?
Ky:Look, it's a good question. And plyometrics is one of those jargon words that we have. And we're getting better at minimising them, I think, in healthcare, but that's one that sort of sticks around. I typically like to talk about it as we're training your spring. We're looking at the intuitive spring that helps you be economical with your movement, and, you know, there's some research which is part of the paper I've talked about that says if we get rid of our spring, we lose 30 to 40% of our movement economy, you know, so this spring is vital for us to be able to move how we do, to walk, to run, to jump, to do sport, and so for runners, it's talking about, well, that spring, which typically is referring to your muscular tendinous system, and even more specifically, probably your tendons and their ability to absorb energy and recoil and how effectively they can do that.
Ky:And plyometrics is essentially training or looking to train or amplify or augment that natural spring that we've got, which we call our stretch shorten cycle. So I would typically talk to the the runners about going, well, we're looking at our tendon or we're looking at our spring, and we're looking at how we can potentially make that work a little bit more efficiently, and that will have benefits for things like your performance and your running economy. And I think if you break it down a little bit and typically dangle the carrot of performance, it's an easy sell for runners because they often don't care as much about the other factors. But if you talk about a couple of percent on their running performance, that's a nice carrot sometimes.
Jimmy:Yeah. When you're talking to the patient or even like we're educating the audience here, plyometrics for training that stress shortening cycle, I think when I say it to a patient, often the first thing they think about is a box jump. But I feel like a box jump maybe isn't the best example of a plyometric. How do you feel about that?
Ky:Yeah. So I think there's a few different, I suppose, ways to look at plyometrics. And I've been a little bit loose with my definition in the article with some of the exercises intentionally. If you want to look at truly the definition of plyometric, you need to have a a load absorption and a quick recoil and typically work that stretch shorten cycle, things like hops, skipping, pogos, rapid jumps, that sort of stuff. And a box jump, you know, is probably on on some end of that, but doesn't have as much of that quick stretch shorten cycle as some of these other movements.
Ky:It's more of a, I suppose, a concentric based jump. This is where we talk about the optimum program. You'll talk about runners like, oh, I do a few box jumps. I do a few few lunge jumps, or I do some burpees or whatever, and I I do some jumping stuff in the alright. Well, you know, that's a good start, but probably isn't actually what we call running specific plyometrics that maybe don't give you the best benefit of getting the most bang for buck in terms of what you wanna get out of it.
Ky:So, I mean, you can get really technical with your definition and some people do, and and there'll be some people online that kind of call out and go, well, that's not a plyometric and that's a plyometric. And I suppose that's where you're looking at a true plyometric has to have the stretch shorten cycle, but you can be a little bit loose with a way you put it on the continue is what I like to look at it. And I think it helps when you're thinking about periodizing your plyometrics because not everyone's gonna start at the optimum goal of the exercise. You may have to start somebody at the early entry point and then build them through systematically so that they can then get to the point where you want them to do the kind of perfect running exercise. And that's where the individual nature of humans and and runners is really important to consider and and a core reason why good, you know, running physios and physical therapists like yourself is is important.
Jimmy:So maybe a box jump is on the spectrum, but it's on the initial, like, introduction to plyometric. And then it goes, like you said, to more running specific movements. When we look at plyometrics as a whole, your article goes into this a bit with what we're training when we do it. But when you look at it, do you see it as something like, so when we strength train, we're building capacity. It's easier to look at that as like a capacity building exercise.
Jimmy:When we look at plyometrics, maybe it's harder to say for sure, but what's your opinion on, are we training a skill or are we training a capacity?
Ky:I like that question and I like the both because the answer is really probably both. And I'll explain why. The first bit is that the capacity is definitely one part of it and that comes from muscular tenderness stiffness, typically. Mean, there's other factors, but typically, the large majority of the structural changes to plyometrics are from stiffness changes or improvements in stiffness. And what that looks like is essentially stiffness refers to your tendons capacity and your tendon's ability to essentially tolerate these loads and be more responsive to these loads.
Ky:And so our plyometrics improves your muscular tendon stiffness. And so that's our structural or our capacity element that we do see as part of plyometrics. The other part though, which you mentioned, which is the skill component, is really important to consider. And, there's probably a few parts to it. The first one is that for those that are not used to doing plyometrics or not used to these sort of movements, like any type of movement that we learn, whether it be strength training, whether it be running, whether it be a sport or plyometrics, there's a motor learning effect.
Ky:Our motor learning effect is primarily neural and cognitive, and and we'll have that as, you know, the skill acquisition phase of plyometrics, which is, you know, really important of any kind of new skill. But there's also the nervous system adaptation that comes from plyometrics, which are, you know, changes in how your nervous system fires, changes in your movement coordination. And so I would be saying it's it's probably a bit of both. For your highly trained athletes that are, you know, got really good movement coordination, there's probably less of that skill acquisition, and and there's probably a little bit more of the stiffness changes that you get your benefits from. But for the intro or the beginner athlete or the beginner runner or the runner that, you know, maybe hasn't done a lot of movement capacity training or strength training or they're probably gonna get a lot of benefit from this movement coordination improvement.
Jimmy:Mhmm.
Ky:And then they probably have the secondary benefit of the stiffness component as well. So probably a bit of both. I'm sitting on the fence on that one, Jimmy.
Jimmy:Yeah. It's something I think I've been thinking about often. You look at other sports where there's often a focus on both of those components. Like, we do this for our skill work. We do this for our capacity building.
Jimmy:And in running, it seems like we just like focus all the way over here on capacity building and never do any skill work. I think especially when you look at recreational runners, when I was in college, we always did things like drills, strides are always like a pretty regular part of our training, which I think I would lump into that like skill work. But plyometrics, yeah, they seem like they sit on the fence. They're kind of blending both and it depends on the individual, how much of it's capacity building, how much of it is building.
Ky:Argument that run drills too that you mentioned, especially some of the higher end run drills fall into the category of, you know, pseudo plyometric type movements. Know, getting a single leg, you know, low amplitude, you know, extensive type movement, which is part of, you know, that sort of plyometric style movement. And so there's an argument that those style movements, which I'm a huge fan of, by the way. So those style movements that are done repetitively help to build some of these capacity and movement control and coordination. So, yeah, I think that's probably another area and and maybe that's a a paper you and I can write about the, run drills and how we build that into recreational runners and some of that side of things,
Jimmy:but keep going, No, sorry that would be interesting because what I was about to bring up was early in the paper, I believe, correct me if I'm wrong, but from my understanding of reading it was that we have a bunch of benefits from adding plyometrics into a runner's routine. One thing that we do not see was changes in kinematics. Is that right?
Ky:Typically, I mean, this is the problem with research is that it's very hard to measure things and, you know, not all papers look at measuring these things. But some of the studies that have looked to try and implement a plyometric routine and measure biomechanical movement to see if we get any changes, It's been quite inconclusive, and I think there was a couple of studies that showed, you know, some changes in ground contact time and but overall, there was no, you know, large changes in our movement kinematics from adding plyometrics in. We get the performance benefits. We get the running economy benefits, but not necessarily the motor control or the gate biomechanical changes. So that, I suppose, feeds back into, I suppose, and there's some some papers like Rich Willey and and Irene Davis and some of these running researchers talk about that running gait is a skill, and you need to train a skill.
Ky:Doesn't matter if you're strong and have good capacity. It doesn't necessarily mean that you're gonna have good skill. And and so for some of those runners, they'll need to focus on that element as well as you I'm sure you work on with with your runners in terms of your, you know, movement gate retraining and and drills and all that sort of stuff.
Jimmy:Yeah. And maybe also it's just one of the reasons maybe it's hard to to see those changes is the variable nature of running gait and that it's unique. We know that it is fairly unique to the individual. So maybe it's hard to quantify those kinds of changes across a broad range of individuals.
Ky:100%. And to get a reliable change in a study, know a lot of these studies have you know relatively small sample sizes compared to you know big medicine studies and things like that. Nature of getting a statistically significant change in researches, you need to have large sample sizes and that can be hard in some of these studies that might have, you know, 50 or 100 runners where they need a thousand runners for it to say that, you know, your change in, you know, overstride is improved by doing plyometrics, for example. So, yeah, I think there's a lot of elements of the variability clustering runners into the same types of movement patterns, but also the challenges of trying to apply a clinical lens onto research, which unfortunately has a lot of, you know, structure that needs to happen for it to be high quality.
Jimmy:Yeah. Awesome.
Jimmy:I'd like to take a moment to thank our sponsor, Runeasi. Runeasi is a running and jumping analysis tool that helps provide objective data on things like impact loading, dynamic stability, and symmetry. I've been using it in the clinic for the past three years and I love how easy it is to add to my evaluations. Not only that, but it backs up my clinical reasoning and helps me with my decision making process when I'm doing exercise prescription. So if you're a physical therapist or running coach, head on over to Runeasi and book a demo.
Jimmy:If you're lucky, it will be with me.
Jimmy:So, so far we've talked about what plyometrics are, whether we're training skill or capacity. Next thing I wanted to dive into was you had an Instagram post, which everyone should check out where you looked at like your five takeaways from the paper. So we'll just go through those. I think it'll be give some structure to the talk here and kind of help the listeners. So takeaway number one, I believe was baseline capacity matters.
Ky:Yeah. So the nature of these days where a lot of people are getting information online, they're getting information from apps, they're getting information from social media, AI, is that a lot of people start things because they see other people doing it. A lot of people will, you know, the classic example, and I'm I don't like to knock running influences, but, you know, there's a lot of try this workout or try this program, and and a lot of people will try and sample some of these these workouts, and and some of them are plyometric programs. And the reality of each individual is not everyone is at a point where they can tolerate or have the capacity to tolerate these movements. And the example is a plyometrics, even our lower amplitude plyometrics typically play place large forces at rapid speeds on our musculoskeletal system.
Ky:And if your body isn't and and typically, these are some of these forces are higher than the demands of running. And so if your body isn't at a point where you got the capacity or you haven't adapted to that level of demand, you're probably putting yourself at risk of injury. You're potentially putting yourself at risk of either doing the movement incorrectly, loading up other areas. And so I think for me, that baseline testing and getting your capacity is really important, particularly if you're someone who's looking to to do a high quality, well planned plyometric program and you actually want to get a lot out of it. And that's for me going, there's lots of different ways to do it.
Ky:But, you know, clinically for me, I'm lucky enough. I have access to the valve technology force plates. So I can measure with really high quality some of our force profile type measurements and and power profile type measurements. We can look at reactivity. We can look at some of our things like jump height and and different phases of our jump movements, which give us an indication of someone's capacity and then, you know, our capacity of the muscles that are really important to be used.
Ky:A calf is probably the number one that that is important, especially in running because we know not only we mentioned it before when we're talking about the podcast, the previous episode with Luke, being really important from a running perspective and the demands like the Dawn paper talks about that, you know, the amount of force that the calf has to do, but also then a lot of our plyometric movements that are specific to running are more ankle based plyometrics. And so these ankle based plyometrics will use your calf and your Achilles complex quite a lot. So if we don't have that baseline capacity or we don't know what our baseline capacity is, you're potentially putting yourself at risk of either not being able to progress the program in the way you want or, you know, getting injury or getting sore and having to take a step back or take take some time off. So the article I detailed some of the things that are important, but clinically for me, I think I really like to do a strength assessment of your ankle plantar flexors or your calf. There's different ways to do that for me.
Ky:I typically use an isometric test with the force frame or and then potentially doing some form of a loaded test as well. I like to look at some force play testing. And then we mentioned movement skill. I really like to have a look at the movement quality and movement skill in jumping, in, you know, single leg and double leg movement, whether that be a squat, whether that be a landing movement. Because if somebody doesn't have these core, you know, biomechanical competencies, trying to get them to do rapid jumping and landing when they don't have the movement control is probably a recipe for disaster and any good clinician would probably agree with that.
Ky:So, yeah, for me, I think there's a there's a few things that are important. It depends how much time you've got. I really like to do performance biomechanical screening with runners, which involves this and and and more. But not every runner you have have kind of time or capacity or interest in doing that. So definitely ankle capacity would be number one, movement control and coordination would be number two.
Ky:And if you can, some measure of their plyometric capacity, whether that's just watching them hop or watching them jump, whether that's been using some wearable tech or, you know, getting them onto the force plates would be some of the minimum ones that I'd look at. I don't know about you, Jimmy. What you'd look at as measures to just get an idea of someone's capacity and whether they're, you know, I suppose ready to or appropriate to tolerate plyometrics?
Jimmy:Yeah. Before I say what I do, with your kind of what you laid out in the article and then what you do clinically, sometimes I think when we see these like specific capacity standards, I think we we can get a little bit caught up in them sometimes. How, like, nitty gritty do you think we need to get with this? I think the goal the goal with you putting this in there and saying this is a big takeaway, we gotta get some baseline capacity, I think is really to mitigate the risks that we're gonna injure the person by adding this in. So if you see somebody and like, let's say, like, I think one of the things was 30 single leg calf raises.
Jimmy:If they can do 25, is that gonna be a deal breaker? Are you gonna say, hey, we're probably not gonna do this? Or are gonna say, hey, maybe we just start on the lower end? Like, what's the nuance there?
Ky:I think that's what comes with clinical reasoning in a good clinician, right? The keyword that I've put in the table there, and I've had a few people actually kind of talking to me about this that have that have read this part of it, is consider in in the table. And I think it's really important to consider some of these standards. The key reason being is most people would skip this step and go straight to giving the program. Right?
Ky:And that's one of the key things that I wanted to bring up as part of this paper is that, well, we actually need to make sure people have the capacity to tolerate it well so that you can do the exercise as well so we're not causing more problems and so we can set someone up for really nice progression. I think that's what the clinical judgment of going 15 calf raises and a history of Achilles tendinopathy, that's probably not a great spot to start for our plyometric capacity. 25 calf raises versus, you know, 24 on the other side. And, you know, I I think you could probably go, well, I mean, we need to work on your calf a little bit potentially, but but, you know, maybe we can start you on the lower end of our lower amplitude, you know, lower yeah, more extensive biometrics, and we can build you in and and, you know, assess our progress. So I like to look at it as a guide because if we're using things as a recipe already, that's probably not the best way to function as a clinician.
Ky:But there'll be people that'll look at it and and take it as gospel. And and if they do, they'll be you know, if if everyone meets those standards, they'll be typically in a good place to start their runners. But you're probably gonna find that a lot of runners aren't necessarily gonna meet all of those standards to start purely because not every runner strength trains as much as we would like, and that's a topic for another day. But, yeah, I don't I don't know what you think, Jimmy. I mean, what
Jimmy:Yeah. So I use Runeasi, they're a sponsor of the podcast, and I look at the reactive screens or reactive jump test, which is a double egg hops 10 times or ten seconds of double egg hopping, getting things like RSI, ground contact time, jump height. Same thing with single leg, left leg ten seconds, right leg ten seconds. I'll do a calf capacity single leg heel raise like you're doing. I will do often I'll just like see how they look with running and see what the quality looks like there on the treadmill.
Jimmy:Also using Runeasi to see if there's any asymmetries or anything like that. But from there, off if I
Ky:Just with that the the Runeasi stuff, what what what's for you the flag to go? This is you know, if you were wanting to get someone into a, you know, performance style program you you're doing your single leg left versus right, what sort of level of difference or or flag for you would be enough clinically to go, that's probably a concern. We maybe want to even that out before we would get them going into their performance program.
Jimmy:Yeah. So we're talking a healthy patient here. So not somebody Yeah. So Runeasi makes it super easy for me. So they, it's all color coded.
Jimmy:So they have benchmark data to say, hey, for our endurance runners, we like to see you in this range. So that's the first thing I look at is like, hey, where are you in this range for jump height? If they're out of the range, which almost every distance runner I see is they suck at this. We just don't like we, like you said at the very beginning of this article, people aren't doing this. So it's just like a quick easy way for me to show the patient, hey, you're in the red range.
Jimmy:We need to get you up here into this like orange yellow range. We don't need you to be able to slam dunk a basketball, right? But we need you to be a bit more springy and more reactive. So that's the first thing I look at. And then also it's just like the quality.
Jimmy:So if we get away from the data, just like, what does this look like when visually, what do I see? Do they look like they're struggling? They're trying super hard and they're barely leaving the ground? So those are kind of the main things I'm looking for. And also, I'm probably, it doesn't even matter what I see in the assessment, I'm probably still going to encourage them to do at least one or two plyometrics on a consistent basis, just because I think there's value and like, as we'll continue to talk about there is we see this running economy value.
Jimmy:It's also just something I think we as we get older, especially as runners get older, this is something we talked about I talked about with Luke is like, we see the capacity of the calf muscle complex go down. We see a lot more injuries in the calf muscle complex. So if we can keep some of this bouncing in the or what a plyometric work in the routine, maybe there's benefit to help improve the capacity of that tissue so that we don't end up with all these injuries down the road.
Ky:Yeah, no, 100% agree. I think two things you said there I really resonate with. The first one being, I really like the point of having data and showing data. We're lucky these days, whether it be wearable tech like we use, whether it be the force plate. That I use, we have these data to show baseline data and that can be a really nice carrot not only to show someone where they're at versus performance benchmarks and like you mentioned, I think benchmarks are really useful as a a tool.
Ky:But then as a reassessment measure, there's nothing better than being able to show somebody percentage of change or improvement, especially relative to where they were. It's such a powerful powerful tool to get people on board with your your program and and a ball with your plant.
Jimmy:So Yeah. Because it's not like strength training where they can just see the number. Like, you can see the weight on the bar go up. Plyometrics, we don't see that. So if we're not measuring with something like this you have a post, I think, on Instagram saying that if you're not testing, you're guessing, I believe.
Jimmy:Is that right?
Ky:I'm very passionate about performance testing, about objective measures. And I think for me, I mean, part of what I do is in lower limb rehab and kind of, you know, longer term rehab like ACLs along with the running side of things. But I think both in the running space and a performance perspective and the lower limb rehab space, the testing is so important. And I think we're now lucky enough that we have so many measures of testing, whether it be high quality technology, whether it be wearable technology or even things like our smartphones and apps. There are lots of measures and ways to track our performance beyond just, I suppose, guesswork or beyond my opinion says this is the right way to go.
Ky:And so I think as a high performing clinician, especially if you want to work in spaceflight runners, you want to have a measure or or measures of of tracking progress in different different spheres. But the old the other bit that you mentioned that I think is really beneficial is observing movement for plyometrics is huge. And I did put this in the paper in terms of observing the ability to to tolerate and and capacity to tolerate some single echoing or some some jumping because I think you can get a lot out of that. Right? You mentioned that yourself.
Ky:That is essentially giving you an indication of what their spring is doing. And so that that is a really useful tool. We shouldn't just throw that out and only look at the data. So couple of points you mentioned there really good.
Jimmy:Yeah. And I I don't know if this is right, but this is how I operate is, like yesterday I had a older, let's say 60 year old woman, mostly a hiker, but I still wanted her doing some hopping because it wasn't something she had been doing. And I would guess she would fail most of these capacity tests, but I still incorporated in her warm up some double leg hopping. I told her to keep it light and bouncy, but like trying to initiate some of that, even though her capacity is quite low, because we're still doing some heel raises in her program. We're doing other stuff to work on capacity.
Jimmy:And I think as long as we're cautious with the dose, because again, I think the reason we're tested or we're looking at baseline capacity is again to mitigate the risk of injury. And if the dose is low enough, I think we can we can pull that lever too to kind of have the same effect.
Ky:Yeah. I think that's the clinical judgment of going, what's my starting point? Is your starting point a pre plyometric exercise to get somebody to the point where they can cope? Maybe you start with doing, you know, calf pulses or you're doing, you know, a drop land type exercise to get them ready to absorb load before you start your plyometrics because their capacity is not great and you need to work on that and get them ready to tolerate or they're coming back from injury and you're kind of getting ready to recondition them to the point where you can start doing your pogos or your hops or your hurdle jumps, you know, progressing towards our goal of doing something more high amplitude like, you know, your drop jump or, you know, repetitive jumps and things like that. So that's the decision making, the higher level thinking rather than going everyone has to do this ABC ticket off ABCs has to be done this way.
Ky:It's it's the the nuance of the realities of working with these individuals.
Jimmy:Awesome. Yeah. Love to hear that because in this world of social media, I feel like people getting so nitpicky. They'll see one part of this article like that, and they'll say like, oh, this is garbage. Like, we don't have to do all of that.
Jimmy:But there there's nuance there.
Ky:Yeah. I mean, I think any of this stuff, if if people are thinking and it's it's sparking discussion like this, that's a good thing. Right? I mean, the whole purpose of any of this is to improve the profession. It's one of my big kind of areas of of passion is to improve the profession.
Ky:And then also, you know, work on runners in kind of adopting things like this even more. Right? So Yeah. Yeah. Excellent.
Ky:I think good to have the discussion. Right?
Jimmy:Yeah. So if we go back to this, the testing and you brought it up as like showing progress. I think it's awesome. You get buy in with the initial data, you can show the patient or the client, here's where you're starting. And then we reassess down the road and here's where you're at now.
Jimmy:Your statement number two of like your takeaways was it takes time or this program takes time. So at what point would you reassess? How long, what's timeline that we need before we see any changes with these interventions?
Ky:So it's a good question. And I think there's evidence as looked into this, and there's a number of studies that show, you know, you can't really get benefit with only a few weeks of doing these exercises. And there's a few reasons potentially for that. But typically programs you want to be at least six weeks or this they're kind of I think the threshold is about 15 sessions of plyometrics potentially. And if you think about it, how many sessions you might do, let's say you're doing two sessions a week, you know, it's gonna take at least that, you know, seven weeks, eight weeks for you to get enough of the sessions in to potentially get the adaptations that we want.
Ky:And there's some argument from some of these studies that show, you know, longer amounts, even twelve weeks would be even more beneficial than, say, four weeks or six weeks. Now, the reason for that is, you you're gonna get some nervous system adaptation early, and that will occur in the first few weeks. But typically changes to our stiffness component or our elastic component, which is the tenderness changes, will typically take a little bit longer, these structural changes. And the other component is that we typically want to move somebody from, you know, through a periodized program. And if you're just staying on one exercise, you're not necessarily going to get as much adaptation.
Ky:And as you would know, Jimmy, moving someone through a periodized program typically takes a bit of time to do it well. You're going to need, you know, at least a couple of sessions, if not a couple of weeks per block before you then add subsequent blocks to get adaptation. So this can take time. And so if we put all that together, you're looking at at least six weeks before you're going be able to put some of these blocks together, you're going get some newer changes, you're going to get some muscular tenderness stiffness changes. And so for me, from an assessment perspective, I would probably like to keep an eye on these patients if we take injury out of it every couple of weeks and progress things.
Ky:But when I would reassess some of these performance measures would typically be every four to six weeks because I'm not expecting to see changes before then. So for me, for something like this, if we're just looking purely performance or say, after we've exited an injury protection phase and we're looking more at a return to performance phase, I would look to test at that four to six week mark and ideally at another four to six week mark. And that can be your carrot potentially to keep the sell off to the patient. We know as a clinician that doing this stuff is beneficial, but, you know, very easy for the patient to potentially not have the same desire to continue to progress along the course of the program as you. So this can be part of your cell to go, well, actually, we're we are improving.
Ky:We're still getting a couple of percent more improvement or 5% more improvement from this one. You know, there is more scope to improve here. Yeah, I don't know about you, Jimmy, how often you would assess your formal assessment measures. But for me, probably that four to six week mark is the zone. I wouldn't do any earlier than four weeks unless it's an injury perspective.
Ky:Yeah. And we're looking at, you know, data changing a little bit more rapidly potentially.
Jimmy:Yeah. I I I'm in the same boat. Think when it's an injured client, often you see those changes much in shorter time frames. So it's testing kind of more frequently and then four to six. Yeah, that sounds about where I'm at with my follow ups for tests and these things.
Jimmy:During that timeframe, what is changing? Is it, let's say like at that six week mark, are we getting true, like, tissue changes at that point, like tendon stiffness? Are we or is it more neuroadaptated neurological adaptations? What do you think is happening?
Ky:Yeah. So I think the early phase is the neural adaptations, and then it probably depends on how much you're changing your program and your exercises and how much there is of the, I suppose, new stimulus to get that new nervous system and neural adaptation. But the early phase, let's say, let's call it two to four weeks or even two to six weeks, you're going to get a lot of nervous system adaptation, firing rate, synchronization, coordination, and movement control changes. From probably two, even four weeks onwards is when we start seeing a lot more of the tenderness adaptation or that true tendon stiffness change. There's some data out there around how long it takes for tendons to adapt, and they do adapt slower than some other tissues, which is some of the reasons we can see tendinopathies grumble along a little bit because, you know, tendon collagen adaptation and tenoside adaptation and things, they can take a little bit longer than, say, a muscle can to recover.
Ky:And so that also applies from a performance standpoint. It might take a little bit longer to get true structural adaptation because we mentioned at the start, we're probably getting both. Right? We're getting the the nervous system and we or the skill, and we're getting the the structural change. So you're probably getting that that phased, not dissimilar to what we see in some of the strength literature around you get the big spike in in nervous system and neural recruitment early, then you get the more progressive improvement in your structural changes after that.
Jimmy:Yeah. And you you brought up a good point here about progression, and I feel like this is anecdotal, but when I see runners who do add plyometrics, it's often they pick like two or three and that's the thing they just do. It's the same volume all year round. It's not like strength training where we see like people are progressing, they're changing exercises. It's like, oh, these are what the plyos that I do and this is the the sets and reps that I do and that's it.
Jimmy:And you're bringing up this point of it needs to be progressive, it needs to be changed, it needs to be evolving as a runner's capacity changes.
Ky:Yeah. Really nice clinical point there. And I think our body is really good at adapting to the stimulus we give it. And so while you may still get some benefit, whether it be a movement coordination, whether it be a motor control benefit, whether it be a warm up benefit of doing the same exercise. The stimulus that you'll get will be diminishing returns if you keep the same exercise and do it forever.
Ky:And you're actually missing out on a potential window of continued opportunity of improving your, muscular tenderness capacity. And so that's where looking to have a well planned progression, and this is the nice sell to patients and to athletes to go, actually, we want to start you here, but I want you to end up here. Right? And we don't want to start you here for a variety of reasons, which some of which we've explained around injury and and capacity and ability to tolerate it. But I'd love you to get to the point where you're doing this exercise, and you're doing it really well, and you you'd be able to tolerate this many repetitions, but we need to build you up to that, and we need to progress over time.
Ky:That can cycle a little bit. You know, in race peak weeks, you might you the the load might drop or you might revert back to less lower amplitude and and less taxing nervous system exercises that you get closer to race week. But then we, know, you may then cycle back into, you know, higher volume or higher amplitude exercises when you kind of got a little bit more time or you get a little bit less intensive schedule. And and it should be, you know, the elements of a really well planned, well periodized program can apply to this, whether it be in a simple sense or whether you get quite technical with
Jimmy:it. Yeah. And I think it's also a nice sell for your paper because you do a good job like outlining, I don't know how many total plyometric exercises you have listed in the paper, but it's a lot. And you have them grouped into different categories of like beginner to more advanced. So I think, yeah, for the clinicians or even runners that are interested, like looking at that paper and you can kind of see how you break it down, which is great.
Ky:Yeah. I think the thing I would say is these are just some exercises. I I do reference in the article that there are literally thousands of different types of plyometric exercises. And the exercise I put in there are evidence based because they are used in studies that show beneficial improvements. But, you know, I am also biased.
Ky:These are some of the exercises that I think are great as well, and they are backed up by by evidence. But are there exercises in there that people would use all the time that are still fitting the principles of what are effective that maybe aren't listed in there as well. And as long as you're looking at what are the key characteristics that make a really good exercise, plyometric exercise for runners and and the principles of progressing it, if you fit in within that system, then we can be you know, you don't have to stick to just strictly that group of exercises, even though as you mentioned, there's a reasonable amount that I've put in there.
Jimmy:Yeah. Awesome. You mentioned at the beginning, like, one of the hang ups with runners adopting plyometrics into the routine is this time. We wanna run. We wanna be spending time running, often not spending time in the gym or time doing plyometrics is time away from running.
Jimmy:Where there's a big push now for runners to strength train and the benefits of doing heavy resistance training. Do plyometrics offer benefits beyond heavy slow resistance training or even lower load resistance training?
Ky:Yeah. So and this is the argument of going we have to do one or the other or we can only fit one in is something that should be dispelled because as I mentioned at the start, everything should be part of your toolkit. I mean, if you're chasing what you can do to improve performance and resilience, then this should be part of your toolkit. And I think the argument is you get complementary but also uniquely different benefits from both. There will be some crossover in the nervous system benefits, but in theory, based off the evidence and the mechanism of what you're training, you're training essentially different characteristics to some degree.
Ky:So there's an argument that you can get benefits from both. And then the studies that combine both typically get better benefits than the ones that just have one in isolation. So the argument is I'm a huge fan of the heavy strength training and watch this space with some more research in that field, but around that with endurance runners. But from a plyometric perspective, I'd be arguing and really educating my patients or educating the coaches that I work with is to go, well, we want to include some of this in as part of it. Should it replace your heavy strength training?
Ky:Absolutely not. But does a low dose that's progressed over time that doesn't actually take that much time offer potentially large benefits? Definitely. I mean, there's one paper by Machado that pretty much just included drop jumps in their paper and they got huge performance benefits. And this was a small sample size and there's a few limitations with it, but they pretty much added in just one plyometric exercise along with strength training.
Ky:And so there's some argument that if you do the right exercises periodized well, it can be small dosage and high benefit, would be typically the cell, especially if you're progressing it, you're doing the right stuff, and you're avoiding some of these gimmicky stuff we've seen online.
Jimmy:So there's potentially unique benefits to adding plyometrics into our routine. In an ideal scenario, we're going to have our runners do both heavy heavy resistance training plus some plyometrics.
Ky:In a perfect world, that would be if a runner comes in and tells me they're doing both, I'm very happy. And if they're happy to do both, that's something that, yeah, I'm highly advocating for.
Jimmy:Love it. And then your takeaway number three is exercise selection matters. So we've kind of like talked about this throughout the talk so far, but you're saying avoid gimmicks, right? Like you said, social media is full of all these plyometrics. It's great to add them, but it's almost like we need to make sure we understand why we're adding them before we just start throwing whatever you see on social media.
Jimmy:That probably goes for anything you see on social media. Like understand why you're doing it before you just start throwing it in. As we're selecting the plyos further individual, what are the things you're thinking about? Like, is it the ground contact time? Is it the explosiveness?
Jimmy:Like, yeah. What are you looking at with exercise selection?
Ky:Yeah. I I mean, I think typically something is better than nothing to some degree. There's an asterisk on that because if that something is, you know, really inappropriate exercise, you're probably gonna risk injury. But but if if a runner is trying to do something and it offers some benefits, probably better than they're doing nothing. However, the argument is that specificity is important and then the studies also back that up.
Ky:So for me, and this is evidence based and I talk about it in the paper, but what I consider really important is a couple of key things from a running specific exercise. The first thing is your goal should be to work towards fast ground contact time. And the reason I say goal is not everyone will be able to tolerate fast ground contact time plyometrics to start, but the goal should be that you want to work towards not spending a lot of time on the ground and that can vary depending on the exercise, but that's much more running specific than slow ground contact time. And typically, that's measured by zero point two five seconds above or below, but you can use your clinical judgment around, you know, and and clinical cues, right, around cueing your athletes can make a difference too in exercises. So that's the first one is ground contact time.
Ky:Super important. The second one is that generally for running, you wanna look at what we call extensive plyometrics versus intensive plyometrics because there's some thought that the extensive plyometrics will offer more benefit from a running perspective than our intensive ones will. Now I like to ideally end up with both in a program. However, especially at the start and higher bang for buck and less taxing on the nervous system, less injury risk, our extensive plyometrics, which are typically lower amplitude, more repetitions. Let's use an example of, say, a pogo jump or a skipping movement versus, say, a drop jump or a hurdle jump.
Ky:The the pogo movement will be less nervous system taxing, less injury risk, much easier entry point, and probably better bang for buck, especially if you're not adapted to plyometrics than your higher amplitude, higher intense movement. However, you ultimately want to try and end up with some extensive and intensive. And then the other point that I think is really important is you want to have a goal of working towards single leg. Now you may not end up there. You may not start there because as we referenced before with capacity, not everyone's potentially going to be ready for single leg plyometrics.
Ky:They may not have enough calf capacity. They may have an injury history. They may have a sore knee that's going to limit their ability to to absorb single leg loading. There may be a few reasons why, but the goal with your periodized exercise, if you're doing it well, is that you want to end up doing some form of single leg plyometric because running is inherently more of a single leg movement even that, you know, in well, there's at least a single leg phase. Right?
Jimmy:Mhmm.
Ky:The last thing to consider is probably the evidence suggests horizontal movements will be slightly more effective than vertical, but the consensus is can you include both of them because you get different benefits from both. But but running being a little bit more of a horizontal force projection. So, you know, can we include that? And if you're looking at faster ground contact time, your harder surfaces will be more effective than your softer surfaces. So, you know, people who want to do plyometrics on grass or sand or softer surfaces, it may be less shock force, less ground reaction force, but you're gonna have a struggle to get as much ground contact time.
Ky:So it may give you be an easier entry point for someone with an injury history or stress fractures or as you you build in, but the goal should probably be to try work up to harder surfaces so you can do faster ground contact. So there's some of the things I think about that are important. I talk about in the paper. You can't always start there, but you might want to have that as your goal to go, alright, well, we're starting with some intro exercise that we're starting here, but we want to end up a little bit more running specific down the line.
Jimmy:Yeah. You kind of tied in the next takeaway, which was progression matters. Progression and foot contacts. Talk about foot contacts because that's kind of the next step of how we're measuring volume or dosage. So with foot contacts, as we're progressing those, think I the paper references like beginners were starting with like 30 to a 100 contacts, intermediate 80 to one twenty, and then over one twenty for advanced.
Jimmy:Is that right?
Sander:Hi everyone. I'm so sorry to interrupt this podcast episode. My name is Sander and I'm the editor for this series. The reason why you are hearing my voice is because the software used to record their video call, it malfunctioned without them knowing of it. So the second part of this episode never got saved.
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