Plyometric Hopping Progressions, Load Management and Education

Plyometrics start once pain is minimal and strength reaches about 70 to 80% of target. A feasibility study by Peter's PhD student added hopping to staged rehab without substantial adverse events. The program runs once a week over at least 12 weeks with 136 contacts in all: double and single leg submaximal hops first, then stiff-knee pogo jumps and forward and back hops, and finally side to side, single leg stiff-knee and forward stiff-knee hops, with two minutes or more of rest between sets. A review found little evidence that plantar flexor strength improves during rehab, so set clear strength targets. Load management cuts stretch-shortening cycle activity: halve daily steps for walkers, reduce or stop running based on load tolerance, and limit painful stretching, flat shoes and barefoot walking, with a boot as an option. Education covers what the condition is, that pain does not equal damage, treatment options, pain monitoring, risk factors such as weight, and an expected timeline closer to six months than six weeks.