ARTICLE IN PRESS

Available online at www.sciencedirect.com

Journal of Sport and Health Science 00 (2021) 1 10

Review

The effects of plyometric jump training on lower-limb stiffness in healthy

individuals: A meta-analytical comparison
Jason Moran a,*, Bernard Liew a, Rodrigo Ramirez-Campillo b, Urs Granacher c, Yassine Negra d,
Helmi Chaabene c,e
a
School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex CO43SQ, UK
b
Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno 5290000, Chile
c
Division of Training and Movement Science, University of Potsdam, Potsdam 14469, Germany
d
Higher Institute of Sport and Physical Education of Ksar Saı¨d University of Manouba, Tunis 2037, Tunisia
e
High Institute of Sports and Physical Education of Kef, University of Jendouba, Jendouba 8189 , Tunisia
Received 21 October 2020; revised 31 December 2020; accepted 22 February 2021

2095-2546/Ó 2021 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)

Abstract
Purpose: To examine the effects of plyometric jump training (PJT) on lower-limb stiffness.
Methods: Systematic searches were conducted in PubMed, Web of Science, and Scopus. Study participants included healthy males and females
who undertook a PJT programme isolated from any other training type.
Results: There was a small effect size (ES) of PJT on lower-limb stiffness (ES = 0.33, 95% confidence interval (95%CI): 0.07 0.60, z = 2.47,
p = 0.01). Untrained individuals exhibited a larger ES (ES = 0.46, 95%CI: 0.08 0.84, p = 0.02) than trained individuals (ES = 0.15,
95%CI: ‒0.23 to 0.53, p = 0.45). Interventions lasting a greater number of weeks (>7 weeks) had a larger ES (ES = 0.47, 95%CI: 0.06 0.88,
p = 0.03) than those lasting fewer weeks (ES = 0.22, 95%CI: ‒0.12 to 0.55, p = 0.20). Programmes with
2 sessions per week exhibited a larger
ES (ES = 0.39, 95%CI: 0.01 0.77, p = 0.04) than programmes that incorporated >2 sessions per week (ES = 0.20, 95%CI: 0.10 to 0.50,
p = 0.18). Programmes with <250 jumps per week (ES = 0.50, 95%CI: 0.02 0.97, p = 0.04) showed a larger effect than programmes with
250 500 jumps per week (ES = 0.36, 95%CI: 0.00 0.72, p = 0.05). Programmes with >500 jumps per week had negative effects (ES = 0.22,
95%CI: 1.10 to 0.67, p = 0.63). Programmes with >7.5 jumps per set showed larger effect sizes (ES = 0.55, 95%CI: 0.02 1.08, p = 0.04) than
those with <7.5 jumps per set (ES = 0.32, 95%CI: 0.01 0.62, p = 0.04).
Conclusion: PJT enhances lower-body stiffness, which can be optimised with lower volumes (<250 jumps per week) over a relatively long
period of time (>7 weeks).
Keywords: Jumps; Stretch shortening cycle; Tendon

1. Introduction the storage of elastic energy that is used to potentiate further

movement beyond the movement that was initially executed.1
High performance in activities that require a “bouncing”
A key mechanical property governing the aforementioned
motion, such as running, jumping, and hopping, form a basis
spring-like behavior of musculotendinous tissue is the term
for success in both individual and team sports alike. At the tis-
“stiffness”.3 Stiffness is calculated as the ratio of the applied
sue level, in movements such as these, the musculotendinous
force to the change in displacement of a body.3 During
unit (MTU) exhibits spring- or elastic-like behavior whereby
spring-like movements, the individual stiffness values of vari-
the MTU stretches as the lower limb joints undergo angular
ous passive tissues (i.e., ligaments, tendons) and active tissues
flexion before tissue shortening occurs as the joints extend.1,2
(i.e., muscles) are integrated with neural contributions
In this way, the stretch-shortening cycle (SSC) is facilitated by
(e.g., reflexes) to enable the musculoskeletal system to behave
like a spring.4,5 Stiffness can be quantified directly by using
Peer review under responsibility of Shanghai University of Sport.
methods such as ultrasonography,6 free oscillation,7 sinusoidal
* Corresponding author. perturbation,5 quick release,8 short-range stiffness experi-
E-mail address: [email protected] (J. Moran). ments,9 and the “alpha” method.10 In addition, stiffness can
https://doi.org/10.1016/j.jshs.2021.05.005

Please cite this article as: Jason Moran et al., The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison, Journal of Sport and
Health Science (2021), https://doi.org/10.1016/j.jshs.2021.05.005
 ARTICLE IN PRESS
2 J. Moran et al.

also be quantified indirectly by using whole-body kinetics and We aimed to examine the effects of PJT on lower limb stiff-
kinematics,11 13 although such variables would be more ness in healthy individuals. We also aimed to establish the
appropriately termed measures of quasistiffness.3 characteristics of the dose-response between PJT variables (e.
Lower limb stiffness can enhance performance in various g., training volume, duration, and frequency) and lower-limb
athletic movements, such as vertical jumping,14 endurance stiffness, with a view to optimising training prescription guide-
running,15 sprint running,16 and performances requiring a lines for coaches.
changing of direction.17 This was demonstrated in a recent
study16 in which stiffness of the entire lower limb was shown
to share significant relationships with key indicators of athleti- 2. Methods
cism, such as maximal running velocity (r = 0.74), squat jump This meta-analysis was conducted in accordance with the
height (r = 0.51), and reactive strength index (r = 0.44). In per- Preferred Reporting Items for Systematic Reviews and Meta-
forming these movements, an athlete must repeatedly leverage Analyses (PRISMA) statement.30
the stretch-shortening cycle, which exploits the elastic charac-
teristics of the MTU as it absorbs braking forces and generates 2.1. Literature search
propulsive forces.18 This process exploits the aforementioned
spring-like behavior of the MTU because the resultant kinetic With no date restrictions, a systematic search was conducted
energy facilitates faster locomotion.18 in the electronic databases PubMed (including MEDLINE),
Different types of exercise can be used to target lower limb Web of Science, and Scopus. Keywords were collected through
stiffness,19 21 although current conclusions concerning the experts’ opinions, a systematic literature review, and controlled
optimal form of training remain equivocal. For example, vocabulary (i.e., Medical Subject Headings : (MeSH)). Boolean
Kubo et al.22 compared the effects of plyometric jumping and iso- search syntax, using the operators “AND” and “OR” was
metric resistance training on muscle and joint stiffness in previ- applied, in various combinations, to the following terms:
ously untrained adult males. The authors reported that plyometric “ballistic”, “complex”, “explosive”, “force-velocity”,
jump training (PJT), but not isometric training, improved direct “plyometric”, “stretch-shortening cycle”, “jump”, “plyometric
measures of active plantarflexor muscle stiffness and indirect exercise”, “resistance training”, “training”, “muscle”, “tendon”,
measures of joint stiffness during jumping actions. However, it “musculotendinous”, “compliance”, “elasticity”, “viscoelastic”,
has also been reported that changes in stiffness, but not in the pat- and “hysteresis”. Only original articles written in English were
tern of muscle activation, accounted for the observed gains in considered. Although we used the default values of the database
jump performance following PJT in male participants aged 22 search engines, manual data checking was also performed to
years of age.23 The different results found in these studies, in increase the precision of data collection from relevant studies.
addition to the conflicting findings in other investigations
that have reported significant improvements22,24 26 or no change 2.2. Selection of retrieved articles
at all,23,27 show that there is currently no clear consensus in the
current body of literature about on the effect of PJT on measures After an initial search, accounts were created in the relevant
of stiffness. databases. Through these accounts, we received automatically
Where different types of exercise are considered effective generated E-emails for updates regarding the search terms
in enhancing stiffness, this may, in part, be due to variations in used. Thus, our search in the 3 databases was ongoing, with
total training volume or dosage, which includes factors such as updates received on a weekly basis. Studies were eligible for
the number of sessions, repetitions, and sets and the time spent inclusion until the initiation of manuscript preparation in July
under muscular tension.28 For example, it has been shown that 2020.
exercise that induces higher levels of strain is more effective
for increasing stiffness,29 with minimal loading durations, at
2.3. Inclusion criteria
90% of maximal voluntary contraction, shown to be around
3 s per repetition. In terms of traditional forms of training for To determine the eligibility of studies for inclusion in our
performance enhancement, higher levels of strain are, there- meta-analysis, we used the PICOS (participants, intervention,
fore, more readily achievable with traditional resistance train- comparators, outcomes, and study design) framework.30 The
ing than with PJT. Nevertheless, as evidenced above, this does PRISMA flow diagram illustrating the number of studies
not exclude PJT as an effective mechanism for enhancing excluded at each stage of the systematic review and meta-anal-
direct and indirect stiffness, and PJT seems to remain a prom- ysis is shown in Fig. 1. Inclusion and exclusion criteria are
ising method for enhancing these qualities. To our knowledge, shown in Table 1, and the characteristics of the included stud-
the effects of PJT on direct and indirect measures of lower ies are displayed in Table 2. For PJT intervention studies that
limb stiffness have not yet been examined in the form of a were identified as being potentially relevant, the full text was
comprehensive pooled analysis, which could help to gauge the used to determine if whether the study contained a relevant
actual level of effectiveness of PJT in enhancing this particular measure of stiffness, as stipulated in Table 1. Lower limb stiff-
physical quality. Accordingly, to better understand the effec- ness can be assessed using either direct measures, such
tiveness of PJT on lower limb stiffness, we undertook a com- ultrasonography,29,31 or indirect measures using kinetics and/
prehensive meta-analysis. or kinematics.11

Please cite this article as: Jason Moran et al., The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison, Journal of Sport and
Health Science (2021), https://doi.org/10.1016/j.jshs.2021.05.005
 ARTICLE IN PRESS
Effects of jump training on lower-limb stiffness 3

intervals (95%CI). The calculated ESs were interpreted by using

the conventions as outlined by Hopkins et al.35 (<0.19 = trivial,
0.20 0.59 = small, 0.60 1.19 = moderate, 1.20 1.99 = large,
2.00 3.99 = very large, 4.00 = extremely large). In cases in
which there was more than one intervention group in a given
study, the comparison group was proportionately divided to
facilitate comparison across all participants.36
To gauge the degree of heterogeneity amongst the included
studies, the I2 statistic was calculated. This represents the pro-
portion of effects that are caused by heterogeneity as opposed to
chance.30 Low, moderate, and high heterogeneity correspond to
I2 values of 25%, 50%, and 75%, respectively; however, these
thresholds are considered tentative.37 A value >75% is rated as
Fig. 1. Flow chart for inclusion and exclusion of studies. being considerably heterogeneous.33 The x2 (chi-square) is
assessed if any observed differences in results are compatible
2.4. Analysis and interpretation of results with chance alone. A low p-value, or a large x2 statistic relative
to its degree of freedom, provides evidence of heterogeneity of
Data were extracted from included articles with a form cre-
intervention effects beyond those attributed to chance.33
ated in Microsoft Excel. Where required data were not clearly
or completely reported, the article’s authors were contacted
2.5. Assessment of risk of bias
for clarification. Meta-analytical comparisons were carried out
in RevMan Version 5.3.32 Means and SD for measures of stiff- The Physiotherapy Evidence Database (PEDro) scale was
ness were used to calculate an effect sizes. The inverse-vari- used to assess the risk of bias and methodological quality of
ance random-effects model for meta-analyses was used the included studies. This scale evaluates internal study valid-
because it allocates a proportionate weight to trials based on ity on a scale from 0 (high risk of bias) to 10 (low risk of bias).
the size of their individual standard errors33 and facilitates Two reviewers (HC and YN) independently rated each study.
analysis whilst accounting for heterogeneity across studies.34 Any ratings that yielded different results between the 2
Effect sizes (ESs) are represented by the standardised mean reviewers were further adjudicated by a third reviewer (UG), a
difference and are presented alongside 95% confidence course of action that did not have to be followed. The agreed

Table 1
Participants, intervention, comparators, outcomes, and study design (PICOS) framework for study inclusion and exclusion criteria.

Category Inclusion criteria Exclusion criteria

Participant Healthy males and females of any age Individuals who had sustained a recent injury
intervention A plyometric jump training programme that conformed to the follow- Interventions that were carried out in conjunction with alternative
ing definition: training methods such as strength or balance training
“Lower body unilateral and bilateral bounds, jumps, and hops that uti- Interventions that were carried out in water or that used additional
lise a pre-stretch or countermovement that incites usage of the stretch- manipulative techniques such as electrostimulation
shortening cycle”31,68 Interventions <3 weeks
Comparator Studies must have included an experimental group that undertook Studies that did not have a control group
plyometric training and a control group to which it could be compared.
The control group could not have been engaged in any plyometric
training
Outcome Each study must have included a measure of direct or indirect lower Studies with no measure of stiffness, apparent stiffness or
body stiffness, taken both prior to and after the intervention period. quasistiffness
Lower-limb stiffness can be assessed using either laboratory measures
such ultrasonography to quantify muscle and tendon stiffness
directly29,31 or field-related measures such as vertical hopping stiff-
ness.11 In our meta-analysis, when the included studies used methods
to quantify muscle and/or tendon stiffness, the resultant term tissue
stiffness is used. In contrast, when included studies used field-based
measures, the term quasistiffness is used.3,64
The classification of stiffness, as we judged it, must have conformed to
One of the following, as described by Latash and Zatsiorsky3:
Stiffness: the elastic properties of tendons and passive muscles
Apparent stiffness: the response of active muscles to stretch forces
Quasistiffness: proxies of the above qualities as measured with tests
such as rebound hopping
Study design Controlled training intervention studies containing 2 independent The second treatment sequence of a crossover study, cross-sectional
groups for comparison studies, or studies that evaluated acute performance variables only (i.e.,
postactivation potentiation)

Please cite this article as: Jason Moran et al., The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison, Journal of Sport and
Health Science (2021), https://doi.org/10.1016/j.jshs.2021.05.005
 4
Health Science (2021), https://doi.org/10.1016/j.jshs.2021.05.005
Please cite this article as: Jason Moran et al., The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison, Journal of Sport and

Table 2
Study characteristics.
Study Age Height Weight Training status Weeks Mean frequency Total Mean Jump type Test Type of
(year)a (cm)a (kg)a (per week) sessions weekly stiffness
jumps
Chaouachi et al. 13.7 § 0.8 161.5 § 7.7 45.9 § 9.7 Inactive (physical 8 3.0 24 292.5 Countermovement jump, line jump (standing dis- Leg stiffness Direct
(2014)65 education only) tance jump), drop jump + 1 step, front to back cone (submaximal
hops, lateral box jump push off, 1-leg distance hopping test)
jump + 1 step, single-leg cone jumps front to back,
single-leg cone jumps side to side, single-leg box
push off
Cornu et al. (1997)5 22.3 § 2.4 — — Athletes (basketball 7 2.0 14 1200.0 Squat jumps, drop jumps, hopping, jumps from high Mechanical Indirect
and volleyball) (70 cm) and low (40 cm) platforms, jumps over impedance
hedges using 1 or both feet
Four
e et al. (2014)27 18.8 § 0.9 179.2 § 6.1 68.5 § 7.1 Athletes (basketball, 8 2.0 16 400.0 Squat jumps, counter-movement jumps, drop jumps Maximal musculo- Direct
volleyball, and from either low (40 cm), medium (60 cm), or high articular stiffness
handball) (80 cm) platforms, jumps over hedges using 1 or with dynamometer
both feet
Four
e et al. (2010)26 18.8 § 0.9 177.3 § 6.2 68.4 § 6.5

ARTICLE IN PRESS
Active (10.5 h per 14 2.4 34 485.7 Squat jumps, counter-movement jumps, drop jumps Maximal musculo- Direct
week) from either low (40 cm), medium (60 cm), or high articular stiffness
(80 cm) platforms, jumps over hedges using 1 or with dynamometer
both feet (stiffness index)
Garc
ıa-Pinillos et al. 27.2 § 8.6 172.0 § 10.0 66.0 § 10.4 Recreationally 10 3.2 32 1000.0 Bilateral and unilateral—alternating jump rope Arch stiffness Indirect
(2020)64 trained (3‒5 weekly
running sessions)
Hirayama et al. 22.0 § 3.0 172.0 § 5.8 66.9 § 10.5 Recreationally active 12 3.0 36 300.0 Unilateral depth jumps Achilles’ tendon stiff- Direct
(2017)69 with no plyometric ness (ultrasound)
experience
Houghton et al. 21.0 § 4.0 174.6 § 3.1 73.7 § 10.3 Athletes (no prior 8 1.9 15 223.1 Land off box, standing long jump in squat jump Achilles’ tendon stiff- Direct
(2013)70 plyometric position, standing long jump, forward jump over ness at 90% MVC
experience) hurdle, vertical countermovement jump, lateral jump (dynamometer)
over hurdle, reactive jumps, forward jump (50 cm
apart), bounding forward hurdles, forward jumps to
box, box jumps, bounding forward repeated hurdles,
forward jumps, lateral jumps to box, drop jumps,
drop jump and jump over hurdle
Jeffreys et al. 20.3 § 1.6 182.0 § 5.0 91.6 § 10.4 Trained (1‒2 years 6 2.0 12 320.0 Standing vertical jumps (tuck jumps), multiple 2- Leg stiffness (force Indirect
(2019)58 (HPG) plyometrics) foot hurdle jumps, repeated 2-foot jumps (horizon- plate)
tal), alternate leg bounds, lateral 2-foot jumps, multi-
ple 2-foot hurdle jumps, single-foot hops, drop
jumps, lateral 1-foot jumps, single-foot drop jumps
Jeffreys et al. 20.3 § 1.6 183.0 § 5.0 91.6 § 10.4 Trained (1‒2 years 6 2.0 12 80.0 Standing vertical jumps (tuck jumps), multiple 2- Leg stiffness (force Indirect
(2019)58 (LPG) plyometrics) foot hurdle jumps, repeated 2-foot jumps (horizon- plate)
tal), alternate leg bounds, lateral 2-foot jumps, multi-
ple 2-foot hurdle jumps, single-foot hops, drop
jumps, lateral 1-foot jumps, single-foot drop jumps
Laurent et al. 22.5b 180.5 § 5.8 68.7 § 14.0 Active but untrained 10 2.0 20 298.0 Stationary hopping, drop jump on the spot, drop Achilles’ tendon stiff- Direct
(2020)65 (KE) jump with displacement ness (ultrasound)
Laurent et al. 22.5b 180.9 § 10.5 69.7 § 10.8 Active but untrained 10 2.0 20 298.0 Stationary hopping, drop jump on the spot, drop Achilles’ tendon stiff- Direct
(2020)65 (KF) jump with displacement ness (ultrasound)
Lloyd et al. (2012)71 12.3 § 0.3 151.8 § 7.9 44.8 § 9.4 Inactive (physical 4 2.0 8 92.5 Squat jump, countermovement jump, pogo hopping, Absolute leg stiffness Indirect

J. Moran et al.
(G12) education only) standing long jump, lateral hops, hop scotch, bilat- (submaximal
eral “power” hops, ankle jumps, “power” skipping, hopping)
unilateral pogo hops, max rebound hops, drop
jumps, hurdle “power” hops, total foot contacts

(continued on next page)

 ARTICLE IN PRESS
Effects of jump training on lower-limb stiffness 5

stiffness

Abbreviations: G9 = age 9 experimental group; G12 = age 12 experimental group; G15 = age 15 experimental group; HPG = high volume plyometric group; KE = knees extended; KF = knees flexed; LPG = low vol-
Type of

Indirect

Indirect
rating was used in the risk of bias scale. A median score of 6

Direct

Direct
represents the threshold for studies with a low risk of bias.38

chanical potentiation)
Absolute leg stiffness

Absolute leg stiffness

Stiffness (Chemome-
stiffness (seated calf
Musculotendinous
2.6. Analysis of moderator variables
(submaximal

(submaximal
To assess the potential effects of moderator variables, sub-
hopping)

hopping)

raise)
group analyses were performed. We selected, a priori, modera-
Test

tors likely to influence the main effect of PJT on stiffness. For

this, a subgroup division between direct and indirect measures
standing long jump, lateral hops, hopscotch, bilateral

jump, double-leg hurdle jump, single-leg hurdle hop

Squat jump, countermovement jump, pogo hopping,

Squat jump, countermovement jump, pogo hopping,

“power” hops, ankle jumps, “power” skipping, uni-

eral “power” hops, ankle jumps, “power” skipping,

jump, pike jump, double-leg tuck jump, double-leg

standing long jump, lateral hops, hop scotch, bilat-

lateral pogo hops, max rebound hops, drop jumps,

alternate leg bound, single-leg forward hop, depth

Squat jump, split scissor jump, double-leg bound,
of stiffness was made. Indirect stiffness is that which can be

zigzag hop, double-leg hop, in-depth jump, box

jumps, hurdle “power” hops, total foot contacts

Squat jump, split squat jump, cycled split squat

unilateral pogo hops, max rebound hops, drop

quantified using whole-body kinetics and kinematics11 13 and

can be alternatively termed quasistiffness because it does not
hurdle “power” hops, total foot contacts

necessarily evaluate the mechanistic elements of this physical

quality. Conversely, direct stiffness, which is representative of
localised passive stiffness in anatomical structures such as the
Achilles tendon,39 is that which is quantified with methods
such as ultrasonography,6 free oscillation,7 sinusoidal pertur-
bation,5 quick release,8 short-range stiffness experiments,9 and
the “alpha” method.10 Other subgroups included the number
Jump type

of weeks in the applied programme, the total number of train-

jump

ing sessions, and the weekly frequency of those sessions.

These variables were chosen based on the accepted influence
weekly
jumps
Mean

131.1

180.0
92.5

92.5

of the FITT (frequency, intensity, time, and type) principle on

adaptations to exercise.40 The median number of sets and repe-
sessions

titions per exercise were chosen on the basis of their use in pre-
Total

vious PJT meta-analyses.41 A cumulative total of mean weekly

15

16
8

jumps was also used as a moderator. The training status of the

study participants was considered due to the presence of an
Mean frequency

upper threshold of adaptation to exercise after a particular

(per week)

level is achieved.42 For this moderator, study participants were

2.0

2.0

2.5

2.0

divided into “trained” and “untrained” subgroups, with ath-

letes, active individuals, and those with >1 year of training
Weeks

experience considered for the former group and inactive and

4

recreationally trained individuals allocated to the latter. For

these classifications, we depended on the study authors’ own
Trained athletes (10

Untrained students

assessment of the level of activity undertaken by participants

Inactive (physical

Inactive (physical
education only)

education only)
Training status

in their study. We did not, however, consider children engaged

in physical education only as “active”. For all other variables,
years)

a median, or “natural split”, was used to divide subgroups,

ume plyometric group; MVC = maximum voluntary contraction.

whereby clear divisions in the data were identified and used as

a delineator. For example, the most logical division of mean
65.0 § 8.9

32.6 § 7.0

72.4 § 5.5

65.8 § 8.6

weekly jump total resulted in the formation of subgroups of

Weight

<250 jumps, 250 500 jumps, and >500 jumps per week.
(kg)a

This constitutes a more intuitive division, where indiscriminate

use of the median split would be inappropriate.
174.4 § 6.6

133.2 § 8.7

178.0 § 4.0

174.4 § 7.6

These data are represented by a median.

Height

The data are presented as mean § SD.

(cm)a

3. Results
15.3 § 0.3

25.0 § 4.0

22.1 § 1.6
9.4 § 0.5

3.1. Study selection

(year)a
Age

The PRISMA flow diagram illustrating the number of stud-

ies excluded at each stage of the systematic review and meta-
Table 2 (Continued)

Spurrs et al. (2003)15

Lloyd et al. (2012)71

Lloyd et al. (2012)71

analysis is shown in Fig. 1. Together, the studies were consid-

Wu et al. (2010)25

ered to be at low risk of bias (median quality score = 6.0).

These data are presented in Table 3. In total, 12 studies, with
16 experimental groups, met the inclusion criteria and were
(G15)
Study

(G9)

included in the systematic review. A total of seven of these

b
a

Please cite this article as: Jason Moran et al., The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison, Journal of Sport and
Health Science (2021), https://doi.org/10.1016/j.jshs.2021.05.005
 ARTICLE IN PRESS
6 J. Moran et al.

Table 3
Physiotherapy Evidence Database (PEDro) scale ratingsa

Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8 Item 9 Item 10 Item 11 Total (from a possible
maximal of 10)
Chaouachi et al.(2014)65 1 1 0 1 0 0 0 1 1 1 1 6
Cornu et al. (1997)5 1 0 0 0 0 0 0 1 1 1 1 4
Four
e et al. (2009)27 1 1 0 1 0 0 0 1 1 1 1 6
Four
e et al. (2010)26 1 1 0 1 0 0 0 1 1 1 1 6
Garc
ıa-Pinillos et al. (2020)66 1 1 0 1 0 0 0 1 1 1 1 6
Hirayama et al. (2017)67 1 1 0 1 0 0 0 0 1 1 1 5
Houghton et al. (2013)68 1 0 0 0 0 0 0 1 0 1 1 3
Jeffreys et al. (2019)69 1 1 0 1 0 0 0 1 1 1 1 6
Laurent et al. (2020)70 1 1 0 1 0 0 0 1 1 1 1 6
Lloyd et al. (2012)71 1 0 0 0 0 0 0 1 1 1 1 4
Spurrs et al. (2003)15 1 1 0 1 0 0 0 1 1 1 1 6
Wu et al. (2010)25 1 1 0 1 0 0 0 1 1 1 1 6
Notes: Here is a brief explanation: Item 1, eligibility criteria were specified; Item 2, subjects were randomly allocated to groups; Item 3, allocation was concealed;
Item 4, the groups were similar at baseline; Item 5, there was blinding of all subjects; Item 6, there was blinding of all therapists; Item 7, there was blinding of all
assessors; Item 8, measures of at least 1 key outcome were obtained from more than 85% of the subjects initially allocated to groups; Item 9, all subjects for whom
outcome measures were available received the treatment or control condition as allocated, or data for at least 1 key outcome was analysed by “intention to treat”;
Item 10, the results of between-group statistical comparisons were reported for at least 1 key outcome; Item 11, the study provided both point measures and meas-
ures of variability for at least 1 key outcome.
a
A detailed explanation of each PEDro scale item can be accessed at https://www.pedro.org.au/english/downloads/pedro-scale (Access for this review: March 11, 2020.)

groups incorporated measures of indirect stiffness, and nine of 95%CI: 0.08 0.84, p = 0.02), whereasile no effects were
them incorporated measures of direct stiffness. observed for “trained” participants (ES = 0.15, 95%CI: 0.23
to 0.53, p = 0.45). For test type, those tests for direct measures
3.2. Primary analyses of stiffness showed a small effect (ES = 0.48, 95%CI: 0.03 to
0.98, p = 0.06) that exceeded the borderline trivial to small
For the main effect analysis on the effect of PJT on lower
effect for indirect measures of stiffness (ES = 0.21,
limb stiffness, there was a small effect size (ES = 0.33,
95%CI: 0.03 to 0.45, p = 0.09). For programme duration,
95%CI: 0.07‒0.60, z = 2.47, p = 0.01). Between-study hetero-
those interventions lasting a greater number of weeks (>7
geneity was moderate (I2 = 38%, p = 0.06). These results are
weeks) displayed a larger (ES = 0.47, 95%CI: 0.06 0.88,
displayed in Fig. 2.
p = 0.03) than those lasting a lower number of weeks
(ES = 0.22, 95%CI: ‒0.12 to 0.55, p = 0.20). A contradictory
3.3. Effect of moderator variables
trend was seen for total sessions per programme, with pro-
The results of the moderator analysis are displayed in grammes having
16 sessions showing a larger (ES = 0.37,
Table 4. Differences between subgroups demonstrated low 95%CI: 0.04 to 0.77, p = 0.08), though still small, effect
heterogeneity and were non-significant. For training status, compared to its opposite subgroup (ES = 0.24, 95%CI: ‒0.05
“untrained” individuals exhibited a small effect (ES = 0.46, to 0.53), p = 0.11). Similarly, programmes with
2 sessions

Fig. 2. Forest plot of main effect of plyometric training on lower-limb stiffness.a The sum of the percentages is not 100% due to the rounding. 95%CI = 95% confi-
dence interval; G12 = age 12 experimental group; G15 = age 15 experimental group; G9 = age 9 experimental group; HPG = high volume plyometric group;
KE = knees extended; KF= knees flexed; LPG = low-volume plyometric group.

Please cite this article as: Jason Moran et al., The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison, Journal of Sport and
Health Science (2021), https://doi.org/10.1016/j.jshs.2021.05.005
 ARTICLE IN PRESS
Effects of jump training on lower-limb stiffness 7

Table 4 some of the key factors to positively influence effect magni-

Moderator analyses for the effect of plyometric training on tendon stiffness. tude positively.
Outcome or subgroup Studies ES (95%CI)
Training status 16 0.33 (0.07 to 0.60) 4.1. Main effect
Trained 7 0.15 (‒0.23 to 0.53)
Untrained 9 0.46 (0.08 to 0.84)* Mechanical loading of the MTU results in increases in ten-
Stiffness type 16 0.33 (0.07 to 0.60) don stiffness due to enhanced collagen synthesis.43,44 Such
Indirect stiffness 7 0.21 (‒0.03 to 0.45) loading can enhance both the size and the mechanical charac-
Direct stiffness 9 0.48 (‒0.03 to 0.98) teristics of the tendon,44 but the nature of these changes is
Mean weekly jumps 16 0.33 (0.07 to 0.60)
dependent on the type of loading that is habitually applied.45
>500 jumps 2 ‒0.22 (‒1.10 to 0.67)
250‒500 jumps 7 0.36 (0.00 to 0.72) Indeed, this may be why conclusions in the literature related to
<250 jumps 7 0.50 (0.02 to 0.97)* the effectiveness of PJT for the enhancement of tendon stiff-
Programme duration (week) 16 0.33 (0.07 to 0.60) ness have been equivocal. Two reviews,45,46 whilst acknowl-
>7 9 0.47 (0.06 to 0.88)* edging the propensity of PJT to enhance tendon stiffness,

7 7 0.22 (‒0.12 to 0.55)
reported similarly results, with these inconsistencies’ possibly
Total sessions 16 0.33 (0.07 to 0.60)
>16 6 0.24 (‒0.05 to 0.53) being explained by differentials in adaptive potential across

16 10 0.37 (‒0.04 to 0.77) various anatomical structures in the body or by differentials in
Weekly training frequency 16 0.33 (0.07 to 0.60) active and passive components of the musculotendinous com-
>2 sessions per week 5 0.20 (‒0.10 to 0.50) plex.22 Hypertrophic gains of up to 35% in tendon tissue are

2 sessions per week 11 0.39 (0.01 to 0.77)*
possible in adults.45 However, it seems that such changes, and
Median number of sets per session 13 0.40 (0.12 to 0.69)
3 sets per session 8 0.41 (0.13 to 0.69)* subsequent increases in tendon stiffness, are more likely to
<3 sets per session 5 0.45 (‒0.23 to 1.14) occur due to traditional resistance training rather than PJT.23
Median number of jumps per set 13 0.40 (0.12 to 0.69) This could be because the comparatively smallower amount of
>7.5 jumps per set 7 0.55 (0.02 to 1.08)* time spent under an applied force (or tension) during PJT47
<7.5 jumps per set 6 0.32 (0.01 to 0.62)*
may not be sufficient to induce a hypertrophic response48,49
* Represents a statistically significant effect within moderator subgroups. and, by extension, an increase in tendon stiffness. Thus, resis-
Abbreviation: 95%CI = 95% confidence interval; ES = effect size.
tance training, and, in particular, its eccentric variant, may be
a more appropriate stimulus for achieving stiffness-related
per week exhibited a larger effect size (ES = 0.39, 95%CI: 0.01 adaptations.50
0.77, p = 0.04) than programmes that incorporated >2 ses- Although PJT can be readily utilised to enhance tendon
sions per week (ES = 0.20, 95%CI: ‒0.10 to 0.50, p = 0.18). stiffness, it may not necessarily represent the optimal method
This trend is also apparent in the subgroups for number of with which to drive such adaptation, through hypertrophic
jumps per week, with <250 jumps (ES = 0.50, 95%CI: 0.02 pathways at least. This is supported not only by the existing lit-
0.97, p = 0.04) showing a larger effect than 250‒500 jumps erature but also by the small magnitude of the main effect in our
(ES = 0.36, 95%CI: 0.00 0.72, p = 0.05), which was, in turn, meta-analysis, which suggests that a potentially low level of
larger than the negative effect size for >500 jumps per week change in stiffness occurs due to PJT, particularly in the short
(ES = ‒0.22, 95%CI: ‒1.10 to 0.67, p = 0.63). Interventions term. To understand this small effect size, the multidimensional
with >7.5 jumps per set showed a larger effect size nature of sports performance must be considered. For example,
(ES = 0.55, 95%CI: 0.02 1.08, p = 0.04) than interventions the attainment of muscular strength is underpinned by various
with <7.5 jumps per set (ES = 0.32, 95%CI: 0.01 0.62, interdependent pathways of adaptation relating to neurological
p = 0.04). Interventions with 3 sets or <3 sets displayed simi- and morphological changes.51 There is a differential in the time
lar effect sizes (ES = 0.41, 95%CI: 0.13 to 0.69, p = 0.04 vs. it takes for muscle and tendon tissue to adapt to training, with
ES = 0.45, 95%CI: ‒0.23 to 1.14, p = 0.20, respectively). PJT seeming to preferentially stimulate adaptations in muscle tis-
sue as opposed to tendons.45 Also, increases in muscle strength
seem to be more sensitive to neuromuscular training stimuli in
4. Discussion that they have been found to precede increases in tendon stiff-
This meta-analysis examined the effects of PJT on lower ness by up to 2 months.21,52 The average duration of the studies
limb stiffness in healthy males and females. The main results included in our meta-analysis was just 7.5 weeks, indicating that
indicate that PJT can induce small but statistically significant even if tendon stiffness were assumed to be highly achievable
increases in lower limb stiffness. Of potentially greater interest through PJT, the time course of the included studies may not
to practitioners are the results of the subgroup analysis, which have been of sufficient duration to allow this phenomenon to be
demonstrated a non-uniform pattern of adaptation across popu- observed. This is supported by our finding that programmes last-
lations. Of potentially greater interest to practitioners are the ing >7 weeks produced a two-fold greater magnitude of effect
results of the subgroup analysis, which demonstrated a non- compared to programmes lasting
7 weeks. Accordingly, until
uniform pattern of adaptation across populations with longer-term interventions that examine the effects of PJT on ten-
untrained individuals, the programming of a greater number of don stiffness are undertaken, definitive conclusions concerning
jumps per set, and an upper weekly limit of 250 jumps were their true effect will be difficult to make. Indeed, this variance in

Please cite this article as: Jason Moran et al., The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison, Journal of Sport and
Health Science (2021), https://doi.org/10.1016/j.jshs.2021.05.005
 ARTICLE IN PRESS
8 J. Moran et al.

duration could be this reason that discrepancies exist in the studies do not relate directly to a measure of tendon stiffness,
results from studies on the potential to enhance stiffness through they do lend weight to the notion of an upper limit to the effec-
PJT. Long-term interventions would also be in line with the prin- tiveness of larger volumes of PJT. As has been previously
ciples of athletic development programmes for youth partici- demonstrated, higher volumes of PJT are not universally opti-
pants (which accounted for nearly 30% of the study groups in mal.60,61 This could be further elucidated with additional
our meta-analysis) and would better facilitate the assessment of research implemented over a longer period of time than the
potential imbalances in the development of muscle and tendon research cited in our meta-analysis.
adaptations, thus reducing injury risk.45,53,54 The finding that lower volumes of PJT (<250 jumps) may
be more beneficial for enhancing stiffness than higher volumes
is further supported by our results, which indicated that pro-
4.2. Effect of moderators
grammes with
16 sessions were marginally more effective
With respect to the impact of moderators on the main effect, than programmes with >16 sessions. Furthermore, pro-
a notable result relates to the higher effect size observed in grammes with <3 sets of PJT were as effective as those with
untrained, compared to trained, participants. This could indi- >3 sets, whilst lower training frequencies (
2 sessions per
cate a pattern of adaptation that is characterised by a rapid week) were preferable to higher training frequencies (i.e., >2
onset of small changes in stiffness, with the potential for con- sessions per week). These results imply that, alongside lower
tinued adaptation quickly reduced as an individual attains a jump volumes within individual sessions, having fewer train-
larger body of training experience. This could potentially ing sessions across a longer time frame may help to optimise
reduce the chances of further development in the longer term adaptations for tendon stiffness, with higher doses seemingly
since the bulk of adaptive responses are seen in the early stages not required to initiate adaptation in the short term. Coaches
of training. In order to continue stiffness-related adaptations in could, therefore, maximise tendon-stiffness adaptations by
more advanced athletes,29 coaches may want to place a greater programming a lower frequency of PJT alongside low within-
emphasis on traditional strain-inducing resistance training than session training volumes but over a higher number of training
on PJT, underpinning the importance of a multidimensional weeks. Such a programming structure would enable coaches to
programme to achieve highly specific aims. This is an impor- target stiffness specifically without compromising, through
tant consideration for coaches because advanced athletes, in fatigue, the other training goals that must be achieved in a
particular, are accustomed to a “biological ceiling” in their physical-preparation programme. A prudent training strategy,
development, beyond which further adaptations to training are therefore, would include jumps that are specifically appropri-
reduced or negated.42 Furthermore, coaches should be aware ate specifically for enhancing stiffness as a physical quality,
of the potential for mismatches in the time course of muscle including jumps those that require resistance to knee and hip
and tendon adaptations, which can result in problematic out- flexion and short ground contact times,62 such as ankle hops,
comes for an individual. For example, an increase in muscle skipping, hurdle hops, and depth jumps. Because in many
strength that occurs independent of any change in tendon stiff- cases these jumps are of low intensity,63 they can regularly be
ness can lead to higher tendon strain during maximal perfor- incorporated into warm-up activities that conform to the low
mance, culminating in an increase of the mechanical demand load of semiregular PJT, thus underpinning progression in this
exerted on the tendons by acting musculature.55 Thus, multidi- area. Coaches are encouraged to avoid having athletes engage
mensional programmes that concurrently develop the strength in high volumes of PJT to achieve greater stiffness because
and stiffness of all tissues should be an integral component of this seems unnecessary and could be detrimental to an athlete’s
athletic development. conditioning.61
Another notable moderator finding relates to the apparently
inverse dose-response of PJT for the enhancement of stiffness.
4.3. Limitations
Mean weekly jumps in our meta-analysis were divided into
low (<250 jumps), medium (250 500 jumps), and high Because there are some limitations to our study, our results
(>500 jumps) load classifications. It is interesting to note that should be interpreted with caution. Female participants were
the higher the dose, the lower the observed effect. This inverse part of only 2 studies64,65 in our meta-analysis; thus, the results
trend seems to imply that lower volumes of PJT may be more of our review may not be fully applicable to that population.
beneficial than higher volumes for the achievement of Also, because stiffness was measured and represented in the
enhanced stiffness. Indeed, previous research lends support to included studies in a number of different ways, it is not possi-
this finding, with lower volumes of PJT found to be almost as ble to conclude that the positive increases we report can be
effective and more efficient than higher volumes when jump- attributed to changes in muscle activity, mechanical properties
ing performance was measured.56,57 A recent investigation58 of the MTU, or a combination of both. It has been shown that
also revealed the effect of low and high volumes of PJT on the changes in muscle morphology and architecture can occur in
reactive strength index in collegiate rugby players. Across var- as few as 3 weeks in response to resistance training, whilst
ious measures of the reactive strength index,59 larger effects rapid adaptations of tendon morphological or mechanical
were reported from different jump drop heights following low- properties seem unlikely.45 Additionally, in our moderator
volume PJT (480 foot contacts) than following high-volume analyses, the dichotomisation of continuous data with the
PJT (1920 foot contacts).58 Although the results of these cited median split could have resulted in residual confounding and

Please cite this article as: Jason Moran et al., The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison, Journal of Sport and
Health Science (2021), https://doi.org/10.1016/j.jshs.2021.05.005
 ARTICLE IN PRESS
Effects of jump training on lower-limb stiffness 9
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Please cite this article as: Jason Moran et al., The effects of plyometric jump training on lower-limb stiffness in healthy individuals: A meta-analytical comparison, Journal of Sport and
Health Science (2021), https://doi.org/10.1016/j.jshs.2021.05.005