CLINICAL COMMENTARY

IJSPT POSTACTIVATION POTENTIATION:

ABSTRACT
Improving strength and power in the athlete who is being rehabilitated is a central focus of the sports
physical therapist, particularly in the terminal phases of rehabilitation where the emphasis shifts to readi-
ness to return to sport and sports performance enhancement. High load strength training and power train-
ing through plyometric exercises are two key components of performance enhancement programs.
A current concept in the strength and conditioning literature that is relatively unknown in sports physical
therapy is postactivation potentiation (PAP). Even though we have limited data and there may be limited
application of the concept of PAP for the sports physical therapist, awareness of this phenomenon is impor-
tant nonetheless. The purpose of this clinical commentary is to introduce the sports physical therapist to
the concept of PAP.
Key Words: complex training, power training, postactivation potentiation, strength training

CORRESPONDING AUTHOR
Daniel Lorenz, DPT, PT, ATC/L, CSCS
USA Weightlifting Level 1 Sports
Performance Coach
Sports Medicine Specialist, Providence
Medical Center
The author would like to acknowledge Curtis Kempton, DPT, 8929 Parallel Parkway, Kansas City, KS 66112
PT for serving as the subject for pictures. [email protected]

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INTRODUCTION Recently, a concept known as post-activation potenti-
In the terminal phases of rehabilitation, the focus ation (PAP) has surfaced as a means to maximize
of rehabilitation tends to shift from restoration of acute power development in athletes. While it is not
impairments and functional limitations to return to known yet at this time if there are any positive
sport and improving athletic performance. Once affects other than an acute increase in power, if the
effusion has been minimized or eliminated, range of concept is more appropriate than using plyometrics
motion and strength have been restored, and the ath- alone, or if it has any application in sports rehabilita-
lete has successfully completed a functional progres- tion, it is nonetheless important that the sports
sion, specific return to sport activities commence in physical therapist be familiar with the term as well
order to maximize performance potential. Prior to as the concept behind its application. The purpose
unrestricted participation in sports, improvements of this commentary is to introduce the reader to the
in an athlete’s strength, power, and speed are com- PAP concept which is common in strength and con-
mon goals for the sports physical therapist which are ditioning literature, but a likely unknown in sports
important to address in the rehabilitation plan. Dur- physical therapy. Given that the sports physical
ing this stage, there is often collaborative effort therapist is often actively involved in the long-term
between strength and conditioning staff as well as training regimens of athletes, an understanding of
the athletic training staff due to the transition from a the concept is warranted.
mindset of rehabilitation to that of return to sport
and sport-specific performance. Therefore, it is imper- POST-ACTIVATION POTENTIATION
ative that the sports physical therapist be familiar Originally defined by Robbins,8 PAP is a phenomenon
with terms and training methodologies that may be by which the force exerted by a muscle is increased
implemented during this stage of rehabilitation. due to its previous contraction. Post-activation poten-
tiation is a theory that purports that the contractile
Several methods exist to increase strength and power
history of a muscle influences the mechanical perfor-
in the athlete. Strength is the ability of the muscle to
mance of subsequent muscle contractions. Fatiguing
exert force or torque at a specified or determined
muscle contractions impair muscle performance, but
velocity,1 while power is defined as work per unit of
non-fatiguing muscle contractions at high loads with
time (force times distance divided by time) or as force
a brief duration may enhance muscle performance.9
times velocity (distance x time).1 Traditional weight
The peak torque of an isometric twitch in skeletal
training with relatively heavy loads (80-90% of 1 RM)
muscle is transiently increased after a brief maximum
for relatively few repetitions (4-8 repetitions) has
voluntary contraction.10,11 Thus, PAP is the increase in
shown the ability to improve an athlete’s strength and
muscle force and rate of force development (RFD)
is reported to enhance power to a greater extent than
that occurs as a result of previous activation of the
light loads.2,3 Plyometric training alone has been advo-
muscle,12,13 as well as the force and power of evoked
cated as a means to improve muscular power and rate
high velocity shortening contractions, and the maxi-
of force development (RFD) as compared to tradi-
mum velocity attained by evoked shortening contrac-
tional weight training techniques, leading to improve-
tions under load. In other words, excitation of the
ments in dynamic athletic performance such as
nervous system produces an increase in contractile
sprinting and jumping. Advocates have stated that
function due to a heavy load conditioning stimulus.14
plyometrics are a potential method used to bridge the
The most common indicator of PAP is increased
gap between strength and power training methods.4
evoked isometric twitch force observed following an
Rate of force development is the rate at which strength
evoked isometric tetanic contraction.12
increases, or the rate at which force can be produced.5
RFD is the single most important neural adaptation PAP is typically induced from maximum voluntary
for the majority of athletes.6 Training programs dedi- contractions, but has also been induced by velocity-
cated to the development of power require both high- controlled maximal voluntary concentric and eccen-
force training and high-quality power movements in tric contractions, as well as induced by submaximal
which time and the rapidity of movements play a isometric contractions.12 In a set of weightlifting
vital role in the quality of the exercise.7 exercises, the alternating submaximal concentric

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and eccentric contractions may induce PAP, but the used in training of an athlete.11 Previous studies using
presence and extent of PAP produced by weight lift- PAP have been performed on healthy, trained ath-
ing exercise has not been determined.12 letes. Comyns et al25 found that repeated exposure to
complex training improved sprint performance in
There are two proposed mechanisms of PAP. The first
uninjured rugby players. Santos and Janiera28 found
is the phosphorylation of myosin regulatory light
that complex training significantly improved squat
chains, which renders actin-myosin more sensitive to
jump, countermovement jump, medicine ball throw,
calcium released from the sarcoplasmic reticulum dur-
and the Abalakov agility test (a 4x10-m agility test and
ing subsequent muscle contractions.13,15-17 As a result,
a maximal vertical jump test) in young, uninjured
the force of the each successive twitch contraction is
male basketball players. Low- and high-load complex
increased. The second is that strength training prior to
training was investigated by Matthews and others26
plyometric exercises causes increased synaptic excita-
in basketball players’ ability to perform a push-pass.
tion within the spinal cord, which in turn results in
Authors of the study suggest that high loads are
increased post-synaptic potentials and subsequent
needed to elicit a potentiation effect, and therefore
increased force generating capacity of the involved
loads nearing 85% of 1RM should be used to facilitate
muscle groups.18 The most important muscle charac-
short-term power increases.26
teristic affecting the magnitude of PAP is fiber type,
with the greatest potential for enhanced PAP in mus-
A more recent study by Mitchell and Sale12 sought to
cles with the highest proportion of Type II fibers.15,19,20
determine if weight lifting induces PAP, indicated as
Further, PAP is greater in muscles with the shortest
potentiation of muscle twitch force. Researchers tested
twitch contraction time.17,19,21,22 Based on muscle fiber
whether a five-repetition maximum (5-RM squat) both
type, athletes who perform in maximal intensity activ-
induced PAP and increased height of subsequently
ities that depend on Type II muscle fibers (i.e. sprint-
performed counter-movement jumps (CMJ). Subjects
ing, weightlifting, throwing, jumping) would also show
did five sets of CMJ both before and four minutes after
the greatest PAP in muscles involved in their sports
one set of barbell back squats done with a 5-RM.
performance.23
Researchers observed a 2.9% increase in CMJ height
four minutes after a 5-RM squat. This increase in CMJ
A method that the sports physical therapist can use
was a significant enhancement of jump performance.
to implement the concept of PAP for potential acute
These authors were the first to test the assumption that
increases in power is through utilization of complex
a weight lifting exercise induces PAP. Ultimately, the
training. Complex training alternates biomechanically
researchers concluded that PAP may have contributed
similar high-load weight training with plyometric
to the increase in CMJ height, but the correlation
exercises, set for set, in the same workout.24 Essen-
between the magnitude of PAP and the percentage
tially, complex training involves pairing a high force
increase in CMJ height was not significant.
activity with a high power activity. For example, the
athlete may perform a high-load back squat followed
by a countermovement jump or box jumps. DISCUSSION
Clearly, much more information is needed on the con-
There is evidence supporting the utilization of com- cept of PAP before definitive conclusions can be made
plex training,25-27 although there is also evidence about its application as an actual training method or if
suggesting otherwise.29 At this time however, to the it is simply a muscle phenomenon that causes an
author’s knowledge, there are no studies utilizing acute increase in power. More importantly, it is not
complex training in rehabilitation, nor is the scien- known if it is appropriate for the recovering athlete
tific community certain that complex training impacts due to the high loads used in both the high-load
PAP or if it is simply a natural, acute phenomenon in strength exercise as well as in the high-intensity plyo-
the muscle. Sale has argued that PAP is more of a metric exercises. The challenge for the sports physical
muscle phenomenon than something that can be therapist is to safely and effectively determine the
trained or altered. It may be something that is simply load to use to utilize this concept appropriately. One-
an observation rather than something that can be repetition maximum (1 RM) or a percentage of 1 RM is

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often used as the standard upon which to base the load For the sports physical therapist training the recover-
used in strength and conditioning programs and litera- ing athlete, the PAP concept may be most appropri-
ture, however, this 1 RM is being determined in healthy ately applied during functional training. The sports
athletes. It is generally accepted that determining physical therapist could consider performing high-
1 RM in a recovering athlete is contraindicated because load leg presses early in a training session and then
maximal efforts may cause a deleterious effect on perform plyometric training exercises towards the end
healing or lead to further injury. Therefore, estimates of the session in order to attempt to utilize the PAP
of 1 RM or a 6 RM may be more appropriate. Several concept. One could also use high load resistance activ-
methods exist to potentially help the sports physical ites prior to performing functional testing, in order to
therapist provide adequate stimulus to obtain a PAP maximize performance in such tests as the single leg
effect. The DeLorme technique,29 the Daily Adjusted hop for distance, triple jump, 6 M timed hop, or verti-
Progressive Resistance Exercise (DAPRE),30 and the cal jump testing. However, it is not known if the short-
Oddvar Holten Diagram31 exist to provide a structured term effects are carried over to future training sessions
method to estimate load without performing a 1 RM. or if there is a long-term benefit. Plus, if short-term
Furthermore, because the loads tend to be greater benefits were obtained from using the concept of PAP
than 85% of 1 RM with the use of Olympic lifting bars during functional testing, the sports physical therapist
or machines, equipment availability can also be a con- may not gain an accurate assessment of current sta-
cern for the sports physical therapist. Olympic lifting tus. Again, at this time, the above information is purely
requires Olympic bars, bumper plates, and extra space speculative.
and resources that may not be available or in the bud-
get. Furthermore, there is a tremendous learning If the sports physical therapist were to utilize this con-
curve with these movements. cept clinically, one possibility may be in helping to

Figure 1. High load step ups. Figure 2. Walking lunges with dumbbells.

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Figure 3. Single leg dumbbell squat. Figure 4. Split jumps.

facilitate acute power increases in a unilateral lower Although based entirely on author opinion, resistance
extremity injury. Assuming a unilateral lower extrem- should begin with body weight to ensure appropriate
ity condition (i.e. status post ACL reconstruction), the technique is maintained and that the athlete has no
sports physical therapist may have the athlete per- subsequent effusion or pain. Based on studies using
form exercises such as high-load step ups (Figure 1), the concept of PAP, it is not currently advocated to
walking lunges with dumbbells (Figure 2), single leg perform the plyometric exercise with an external load.
dumbbell squats (Figure 3), or utilize the single-leg At this time, the author cannot support or repudiate
press. These may be advocated over back squats or this approach. Intuitively, in the rehabilitating athlete,
front squats because they enable the athlete to have bodyweight is most appropriate to limit risk of further
unilateral emphasis to assist in the attempt to equalize injury and to ensure proper mechanics.
strength among the extremities. Neitzel et al32 revealed
that it can take several months after an ACL recon- Rest periods between the strength exercise and the
struction to distribute weight evenly on both feet. plyometric exercise in the available literature have
Lunges, step ups, and single leg press may help miti- been the topic of debate, but it appears that most
gate the decrease in weight-bearing that may exist on benefit is obtained when at least an 8-12 minute rest
the involved limb. To maximize strength, no more period is completed prior to the plyometric exercise
than 4-8 repetitions should be performed.2,3 Following when performing it in a complex training format.33
the strength exercise, the athlete may then perform A prolonged rest period with no activity is not practi-
split jumps (Figure 4), box jumps, single leg counter- cal for the sports physical therapist in most settings,
movement jumps from a step or box (Figure 5), or sin- and performing explosive exercises in a state of
gle leg vertical jumps (Figure 6) for up to 6 repetitions. fatigue may impair performance.34

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Figure 5. Countermovement from step. Figure 6. Single leg vertical jump.

CONCLUSIONS
Table 1. Sample method for implementing PAP Concepts Increasing strength and power production is a com-
mon goal for sports physical therapists. Postactiva-
tion potentiation is one of many concepts that exist
that have shown promise in healthy, trained athletes
to help improve acute increases in strength and
power, although at this time, its application for the
rehabilitating athlete is limited. Additionally, it is
not known yet whether or not prolonged effects are
realized or if it is purely an acute phenomenon.
Although more research is needed both on healthy
The reader is referred to Table 1 for a sample work-
and recovering athletes, it is important that the
out utilizing PAP. It should be noted that both the
sports physical therapist be cognizant of this unique
table and the above suggestions are purely specula-
training methodology in order to potentially provide
tive. Note that resistance load (% RM) is not given
optimum stimuli for return to athletic performance.
and must be determined for each athlete. Clearly,
further research is warranted in this area, particu-
REFERENCES:
larly in the recovering athlete. Future research should 1. Knuttgen HG, Kraemer WJ: Terminology and
determine appropriate rest periods between the measurement in exercise performance. J Appl Sport
strength and plyometric exercises, the appropriate Sci Res. 1987;1:1-10.
load, and whether or not training history affects these 2. Schmidtbleicher D, Buerhle M. Neuronal adaptations
variables. and increase of cross-sectional area studying

The International Journal of Sports Physical Therapy | Volume 6, Number 3 | S e p t e m b e r 2011 | Page 239
 different strength training methods. In: Biomechanics 20. Young W, Mclean B, Ardagna J. Relationship between
X-B, Vol. 6-B. Johnson GB, ed. Champaign, IL: strength qualities and sprinting performance.
Human Kinetics, 1987. 615-620. J Sports Med Phys Fitness. 1995; 35: 13-19.
3. Schmidtbleicher D, Harlambie G. Changes in 21. Gordon DA, Enoka RM, Stuart DG. Motor-force
contractile properties of muscle after strength potentiation in adult cats during a standard fatigue
training in man. Eur J Appl Physiol. 1981; 46: 221-228. test. J Physiol. 1990; 421: 569-582.
4. Chu D. Jumping into Plyometrics. Champaign, IL: 22. Vandenboom R, Grange RW, Houston ME. Threshold
Leisure Press, 1992. 1-4. for force potentiation associated with skeletal
5. Siff MC, Verkoshansky YV. Supertraining. Denver, myosin phosphorylation. Am J Physiol Cell Physiol.
CO: Supertraining International, 4th ed. 1999. 1993; 265: C1456-C1462.
6. Clark MA: Integrated Training for the New Millennium, 23. Requena B, De Villareal SS, Gapeyeva H, et al.
Thousand Oaks, CA, 2001, National Academy of Relationship between postactivation potentiation of
Sports Medicine. knee extensor muscles, sprinting, and vertical
7. Fleck SJ, Kraemer WJ: Designing Resistance Training jumping performance in professional soccer players.
Programs, ed 3, Champaign, IL, 2004, Human Kinetics. J Strength Cond Res. 2011; 25: 367-373.
8. Robbins DW. Postactivation potentiation and its 24. Alves JM, Rebelo AN, Abrantes C, Sampaio J. Short-
practical applicability: a brief review. J Strength Cond term effects of complex and contrast training in
Res. 2005; 19: 453-458. soccer players vertical jump, sprint and agility
9. Stone MH, Sands W, Pierce K, et al. Power and power abilities. J Strength Cond Res. 2010; 24(4): 936-941.
potentiation among weightlifters: preliminary study.
25. Comyns TM, Harrison AJ, Hennessy LK. Effect of
Int J Sports Physiol Perform. 2008; 3: 55-67.
squatting on sprinting performance and repeated
10. Hodgson M, Docherty D, Robbins D. Postactivation exposure to complex training in male rugby players.
potentiation: Underlying physiology and J Strength Cond Res. 2010; 24(3): 610-618.
implications for motor performance. Sports Med.
2005; 35: 585-595. 26. Matthews M, O’Conchuir C, Comfort P. The acute
effects of heavy and light resistances on the flight
11. Sale DG. Postactivation potentiation: role in human
time of a basketball push-pass during upper body
performance. Exerc Sport Sci Rev. 2002; 30: 138-143.
complex training. J Strength Cond Res. 2009; 23(7):
12. Mitchell CJ, Sale DG. Enhancement of jump 1988-1995.
performance after a 5-RM squat is associated with
postactivation potentiation. Eur J Appl Physiol. 2011. 27. Santos EJ, Janeira MA. Effects of complex training
Epub ahead of print 1/13/2011. on explosive strength in adolescent male basketball
players. J Strength Cond Res. 2008; 22(3): 903-909.
13. Judge LW. The application of postactivation
potentiation to the track and field thrower. Strength 28. Hopper DM, Hopper JL, Elliott BC. Do selected
Cond J. 2009; 31(3): 34-36. kinanthropometric and performance variables
14. Rixon KP, Lamont HS, Bemben M. Influence of type predict injuries in female netball players? J Sports
of muscle contraction, gender, and lifting experience Sci. 1995; 13(3): 213-222.
on postactivation potentiation performance. 29. DeLorme TL. Restoration of muscle power by heavy
J Strength Cond Res. 2007; 21: 500-505. resistance exercise. J Bone Joint Surg. 1945; 27: 645-667.
15. Grange RW, Vandenboom R, Houston ME. Physiological 30. Knight KL. Quadriceps strengthening with the DAPRE
significance of myosin phosphorylation in skeletal technique: case studies with neurological implications.
muscle. Can J Appl Physiol. 1993; 18: 229-242. Med Sci Sports Exerc. 1985; 17(6): 646-650.
16. Sweeney HL, Bowman BF, Stull JT. Myosin light 31. Holten Institute. www.holteninstitute.com.
chain phosphorylation in vertebrate striated muscle: Downloaded 3/26/2009.
regulation and function. Am J Physiol. 1993; 264:
C1085-C1095. 32. Neitzel, JA, Kernozek TW, Davies GJ. Loading
response following anterior cruciate ligament
17. Vandenboom R, Grange RW, Houston ME. Myosin
reconstruction during the parallel squat exercise.
phosphorylation enhances rate of force development
in fast-twitch skeletal muscle. Am J Physiol. 1995; Clin Biomech. 2002; 17(7):551-4.
268: C596-C603. 33. Kilduff LP, Bevan HR, Kingsley MIC, et al.
18. Rassier DE, Herzog W. Force enhancement following Postactivation potentiation in professional rugby
an active stretch in skeletal muscle. J Electromyogr players: optimal recovery. J Strength Cond Res. 2007;
Kinesiol. 2002;12(6):471-477. 21: 1134-38.
19. Hamada T, Sale DG, Macdougall JD, Tarnopolsky 34. Goosen ER, Sale DG. Effect of postactivation
MA. Postactivation potentiation time in human knee potentiation on dynamic knee extension
extensor muscles. J Appl Physiol. 2000; 88: 2131-2137. performance. Eur J Appl Physiol. 2000; 83: 524-30.

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