| Article written on March 19th, 2020 at 5:41pm | Follow Garrett on Facebook and Instagram |
Preserving optimal levels of bone mass is important as we age. Did you know that approximately 52% of American adults over the age of 50 have low bone mass at the femoral neck or lumbar spine?
Part of the difficulty lies in the fact that the majority of peak bone mass is accrued before 18 years of age in females and 20 years of age in males. Therefore, if we don’t take the necessary steps early in life to be active and/or follow a proper nutrition plan, we could potentially set ourselves up for bone related issues later in life.
Over the years, I have worked with countless people who suffer from osteopenia, osteoporosis, and bone stress injury. Despite being caused by very different factors, all of these can and should be addressed with a structured and progressive exercise program. Exercise and proper loading have been shown to maintain/stimulate bone growth and prevent future decline in bone mineral density. Along with other nutritional and lifestyle factors, a daily dose of exercise can be a worthwhile strategy in promoting overall bone health.
Need help improving bone mass or recovering from a bone stress injury? Click here to speak with Garrett about individualized strategies that can help you.
Before we go on, let’s define the terms osteoporosis, osteopenia, and bone stress injury so we are all crystal clear on what this article is describing…
Osteopenia is a mild thinning of the bone mass where formation of new bone is not sufficient to offset normal bone loss. Not as severe as osteoporosis.
Osteoporosis literally means porous bone and is a disease in which density and quality of bones are reduced. Osteoporosis carries a greater risk of fracture.
Bone Stress Injury refers to a phenomenon in which bones cannot tolerate repeated mechanical loads, resulting in structural fatigue, local bone pain, and tenderness.
Since I work predominantly with runners in the Healthy Running Program, I’d like to use this article to speak directly to those who have a bone related disorder, previous history of a bone stress injury, or a combination of both. With the repetitive, sub-maximal nature of running, bone stress injuries are not uncommon and have been shown to comprise approximately 30% of all running-related injuries. This means a proactive approach and understanding of one’s medical history are important to reduce the likelihood of enduring a bone stress injury with the demands of running.
In long distance runners, approximately 50% of bone stress injuries occur in the tibia alone, while other common injury sites are the femur, fibula, calcaneus, and metatarsal bones. This is highly dependent on a combination of factors, including individual weight-bearing patterns and running biomechanics. Since the majority of long distance runners, compared to short distance runners, strike with a rear foot (heel) pattern, this places greater load on the long bones such as the tibia and femur.
Bone stress injury can be classified by location into two categories, including low-risk and high-risk. These are outlined in the following table…
Aside from running biomechanics, weight-bearing patterns, and increasing your intensity or duration too rapidly, there are several risk factors for bone stress injury which must be taken into consideration. These include…
- Living a sedentary lifestyle
- Genetics- white females are at the highest risk of bone disorders compared to African American females and males
- Drug usage, including: antacids, steroids, and antidepressants
- Lack of calcium, vitamin D, and other nutritional considerations
- A history of previous fractures and low bone mineral density
- Bone characteristics including a thinner cortex
- Female athlete triad and interrelationship of energy availability, menstrual function, and bone mineral density
- Hormonal imbalance
- Biomechanical factors, including: leg length discrepancy, small calf circumference, pes cavus and pes planus, vertical loading rates, peak hip adduction, and rear foot eversion
- Sport, training changes, terrain/running surface, inadequate recovery time, inappropriate or sudden change in footwear
Like I mentioned previously, exercise and a progressive loading program are proven strategies to prevent the decline of bone mineral density, increase overall bone mass, and rehabilitate from a bone stress injury. Doing so under the supervision of a trained healthcare professional is important. That’s because these programs should be individualized to your needs and progressed at a proper rate over time.
Research shows that a minimum of 6-8 months are needed to see measurable results in bone mass. This is largely in part to one remodeling cycle of bone resorption, formation, and mineralization which takes 3-4 months to complete. Therefore, depending on your need to improve bone health, patience and consistency are necessary factors for success.
Exercise, and weight-bearing activities specifically, has been shown to provide beneficial effects on bone health. Not only does it increase or prevent the decline of bone mineral density as we age, but it also improves strength, balance, and coordination to reduce to the risk of falls which may contribute to fracture.
In order to achieve maximum benefits with exercise, the program must…
- Include dynamic movements over static
- Achieve adequate strain intensity
- Consist of discrete and intermittent bouts
- Include variable loading patterns
- Be supported by optimal nutrition
- Emphasize adequate intake of calcium and vitamin D
Plyometrics is a form of exercise that contains higher magnitude jumping, hopping, and landing-type movements which can be helpful in optimizing bone health. This should only be considered when progressed to properly following lower impact weight-bearing exercises and deemed safe by a healthcare professional following a bone stress injury. From a preventive standpoint, I recommend plyometrics to all of my asymptomatic running clients in healthy doses to properly stimulate the skeletal system.
Why plyometrics may be better than other weight-bearing movements is because they are higher intensity with a larger magnitude and rate of loading. This greatly increases ground reaction forces and stress on the bones to stimulate positive changes in bone mineral density. Also, they can range in difficulty and intensity, and require little equipment and minimal time.
Where do you begin? In the following, I outline 5 of my favorite plyometric drills to optimize bone health. These are simple hopping drills that require no equipment and can be completed in any setting. The important thing is they are progressive in nature and also take into consideration variable loading patterns and intermittent bouts.
Plyometric Drill #1: Ankle Hops
Ankle Hops are an entry level plyometric drill that teaches runners how to properly store and release energy at the lower leg. Since tibial and other lower leg bone stress injuries are prominent in the sport of running, this drill begins increasing load directly in that area while paving the way for more complex movements.
Begin with 2 sets of 5-10 repetitions and progress to 4 sets of 5-10 repetitions over time with a greater degree of intensity. Rest for 1-2 minutes in between sets or complete a few sets in the morning and a few sets in the evening.
Plyometric Drill #2: Line Hops: Double Leg Lateral
Double Leg Lateral Line Hops are a nice progression from Ankle Hops that start to introduce a load in the frontal plane (lateral). Running is a very predictable and repetitive movement pattern and, therefore, lateral and rotational movements can help provide variability to stimulate a positive response to the skeletal system.
Begin with 2 sets of 5-10 repetitions in each direction and progress to 4 sets of 5-10 repetitions over time with a greater degree of intensity or distance. Rest for 1-2 minutes in between sets or complete a few sets in the morning and a few sets in the evening.
Plyometric Drill #3: Line Hops: Single Leg Lateral
Single Leg Lateral Line Hops is an important progression from the double leg hopping drills I shared previously. As much as we can increase intensity by performing more repetitions, more distance on each hop, or a faster speed, progressing from double leg to single leg is necessary. Running is an exclusively single leg sport, therefore, implementing plyometrics on a single leg will not only provide a greater load on the skeletal system but better replicates the demands of running.
Begin with 2 sets of 5-10 repetitions in each direction and on each limb and progress to 4 sets of 5-10 repetitions over time with a greater degree of intensity or distance. Rest for 1-2 minutes in between sets or complete a few sets in the morning and a few sets in the evening.
Plyometric Drill #4: 4-Square Single Leg Hops with Stick
The 4-Square Single Leg Hops with Stick continues to increase load on a single leg while adding more variability to these plyometric drills. Since bone needs dynamic and variable movement patterns to continue stimulating growth, this drill is a nice progression when ready. Due to the added complexity of this drill, I recommend emphasizing a “stick” landing each time. This will improve control and stability to be challenged further in the next progression.
Begin with 2 sets of 2-4 complete rotations in each direction and on each limb and progress to 4 sets of 2-4 complete rotations over time with a greater degree of intensity or jump height. Rest for 1-2 minutes in between sets or complete a few sets in the morning and a few sets in the evening.
Plyometric Drill #5: 4-Square Single Leg Hops
The final plyometric drill in this progression is the 4-Square Single Leg Hops. Similar to the last drill, it require multi-directional hopping to provide variability and several ways to increase intensity. Start simple by mastering the drill in a small space. Once proficient, you can increase the distance of each jump, height of each jump, or overall speed going through the square.
Begin with 2 sets of 2-4 complete rotations in each direction and on each limb and progress to 4 sets of 2-4 complete rotations over time with a greater degree of intensity or jump height. Rest for 1-2 minutes in between sets or complete a few sets in the morning and a few sets in the evening.
Thank you for taking the time to read this article on ‘Basic Plyometrics to Improve Bone Health.’ The key thing to remember is that regardless of your situation there are a multitude of factors that go into improving bone health. In terms of exercise, weight-bearing activities and the plyometric drills shared in this article can be helpful in the rehabilitation and prevention of a bone related disorder and/or bone stress injury. However, your best defense is creating good exercise, nutritional, and lifestyle habits early in life to lay a solid foundation of bone mass for later on in adulthood.
If you or someone you know is struggling with a bone related disorder or bone stress injury, click here to schedule your free consultation. Garrett is an athletic trainer and functional movement expert that can you help you implement an individualized program to improve bone health and reduce your risk of bone stress injury.
By: Garrett McLaughlin, MS, ATC, CSCS, ART
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