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“Ballistic Six” Upper-Extremity Plyometric Training for the Pediatric

Volleyball Players

Article in The Journal of Strength and Conditioning Research · September 2017

DOI: 10.1519/JSC.0000000000002060

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Journal of Strength and Conditioning Research Publish Ahead of Print
DOI: 10.1519/JSC.0000000000002060

Title: “Ballistic Six” Upper Extremity Plyometric Training for the Paediatric

Volleyball Players

Running Head: Plyometric Training for Paediatric Volleyball Players

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Elif Turgut1*, Ozge Cinar-Medeni2, Filiz Fatma Colakoglu3, Gul Baltaci4

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1
Hacettepe University, Department of Physiotherapy and Rehabilitation,
Ankara, Turkey.
2
Çankırı Karatekin University, Department of Physiotherapy and
Rehabilitation, Çankırı, Turkey.
3
Gazi University, School of Sports Sciences Ankara, Turkey.
4
Private Guven Hospital, Department of Physiotherapy and Rehabilitation
Ankara, Turkey.
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Conflict of interest: None
Funding: None

*Address correspondence to Elif Turgut, Hacettepe University, Faculty of

Health Sciences, Department of Physiotherapy and Rehabilitation, 06100,
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Samanpazari, Ankara, Turkey.

E-mail: elifcamci@hacettepe.edu.tr, elif.turgut.pt@gmail.com
Phone: 0090-312-3052525
Fax: 0090-312-3052012
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Copyright ª 2017 National Strength and Conditioning Association

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1 Abstract

2 The Ballistic Six exercise program includes commonly used upper body exercises

3 and the program is recommended for overhead-throwing athletes. The purpose of

4 the current study was to investigate the effects of a 12-week The Ballistic Six upper

5 extremity plyometric training program on upper body explosive power, endurance,

6 and reaction time in paediatric overhead athletes. Twenty-eight female paediatric

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7 volleyball players participated in the study. The participants were randomly divided

8 into two study groups: an intervention group (upper extremity plyometric training in

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9 addition to the volleyball training; n = 14) and a control group (the volleyball training

10 only; n = 14). All of the participants were assessed before and after a 12-week

11 training program for upper body power, strength & endurance, and reaction time.

Statistical comparison was performed using an analysis of variance test.

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12

13 Comparisons showed that after a 12-week training program, the Ballistic Six upper

14 body plyometric training program resulted in more improvements in an overhead

15 medicine-ball throwing distance and a push-up performance, as well as greater

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16 improvements in the reaction time in the non-throwing arm when compared to control

17 training. In addition, a 12-week training program was found to be effective in

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18 achieving improvements in the reaction time in the throwing arm for both groups

19 similarly. Compared to regular training, upper body plyometric training resulted in

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20 additional improvements in upper body power and strength & endurance among

21 paediatric volleyball players. The findings of the study provide a basis for developing

22 training protocols for paediatric volleyball players.

23

24 Keywords: Strength, endurance, power, reaction time

25

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26 INTRODUCTION

27

28 Maintaining a successful athletic lifestyle requires that players enhance their

29 performance while remaining injury free. Especially for female athletes who start an

30 overhead sports such as volleyball, their participation in high-risk sports may result in

31 suffering from various musculoskeletal injuries (14, 17, 22, 31). These characteristics

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32 might often be related to a reduced sports performance (15). Therefore, an

33 improvement of physical fitness, such as muscular strength and endurance, power,

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34 neuromuscular characteristics, and technical skills is important, especially for young

35 female athletes (25).

36

Volleyball players should have sport-specific skills characterized by an optimal

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37

38 neuromuscular properties in both of the upper and lower limbs such as muscular

39 coordination and reaction time, muscle strength, endurance, and power (13, 30).

40 There is a growing literature on the training regimes aimed to improving such

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41 characteristics (24). There is evidence supporting the utilization of plyometric training

42 to be effective in strengthening bone, improving the running speed and jumping

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43 ability, and increasing strength among adults and children (9, 20). Previously, the

44 Ballistic Six exercise program is recommended for overhead-throwing athletes and

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45 the program includes commonly used upper body exercises (3, 35). This training

46 requires the coordination of agonist and antagonist muscles to sustain the rhythmic

47 plyometric movements to be able to involve a high-intensity concentric contraction

48 immediately after an eccentric contraction (23). Therefore, the nervous system

49 trained to react more quickly (12). Thus, plyometric training may be an appropriate

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50 intervention for improving the neuromuscular ability to enhance power, endurance,

51 and reaction time.

52

53 Although there is an increasing amount of literature about lower limb

54 performance (24), there is limited evidence regarding the effect of plyometric training

55 on upper body performance among young overhead athletes engaging various

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56 sports. Previously, Ignjatovic et al (16) stated that training with a medicine-ball can

57 provide greater improvements among adolescent handball players. In a more recent

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58 study by Raeder et al (36) have investigated the effects of a medicine-ball training

59 program in women handball players, reported that training reveals developments in

60 the performance parameters, such as the throwing velocity and the isokinetic

strength of the shoulder rotators, whereas the throwing precision remained

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62 unaffected. In another study on tennis players, s combined training program

63 including plyometric exercises resulted in improved reaction time (38). However, to

64 date, the effect of a sole upper extremity plyometrics on upper body power,
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65 endurance, and reaction time was not investigated in paediatric volleyball players.

66
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67 Thus, investigating the effects of plyometric training on upper body explosive

68 power, endurance, and reaction time in paediatric volleyball players may enable the
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69 enhancing of comprehensive knowledge about neuromuscular control enhancement

70 and may further provide a basis for developing training protocols encouraging

71 lifelong regular physical activity for paediatric volleyball players. Therefore, the

72 purpose of the current study was to investigate the effects of 12-week upper

73 extremity plyometric training on upper body power, endurance, and reaction time in

74 paediatric overhead athletes. We hypothesized that an additional 12-week plyometric

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75 training program would result in improvements in the explosive power, strength &

76 endurance, and reaction time when compared to control training alone in paediatric

77 volleyball players.

78

79 METHODS

80

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81 Experimental Approach to the Problem

82

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83 A pre-test post-test design and between groups comparisons were used to

84 investigate the effects of the 12-week Ballistic Six upper extremity plyometric training

85 program on upper body explosive power, endurance, and reaction time in pediatric

volleyball players.
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86

87

88 Subjects

89
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90 A total of 28 paediatric female volleyball players participated in the study

91 (Table 1). All of the participants were selected from asymptomatic volunteers who
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92 had been a national competitive volleyball player with no history of pain, injury, or

93 surgery related to their upper body, shoulders, or arms. All of the participants had a
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94 two to four-year background of volleyball training and competition experience.

95 Sexual maturation status was assessed using the Tanner stages (27). Participants

96 who were classified as preadolescent (Tanner stage 1) were included in the study.

97 Participants were excluded if they had any known systemic, neurological, or

98 rheumatologic disorders, or if they failed to complete the pre- or post-testing, or

99 failed to cooperate in a minimum of 80% of the training (29 out of 36 sessions). The

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100 data from 28 participants were used for a statistical analysis. We randomly divided

101 the participants into one of the following study groups: the intervention group or the

102 control group.

103

104 (Table 1 about here)

105

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106 The Institutional Review Board approved the protocol for this study. All of the

107 participants/guards were informed of the nature of the study, parental/guardian

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108 informed consent was obtained, and informed assent was obtained from the

109 participants.

110

Procedures
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111

112

113 Participants in the intervention group followed a supervised 12-week “Ballistic

114 Six” upper extremity plyometric training program in addition to the regular volleyball
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115 training program. The Ballistic Six program was originally described by Pretz (35)

116 and is designed to build performance and to prevent injury for the throwing athletes.
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117 All of the exercises are listed, and the progression of the training program is shown

118 in Table 2. Considering the potential muscle-tendon unit stress produced during the
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119 plyometric exercises in children, the intensity of the program was progressed from

120 low to moderate level (2, 29). The program includes six upper extremity exercises

121 which are commonly preferred exercises in the late stages of rehabilitation (3, 35)

122 including (a) an elastic band (a blue colour coded Theraband, The Hygenic Corp.,

123 Akron, OH, USA) shoulder external rotation at 0°; (b) an elastic band shoulder

124 external rotation at 90°/90°; (c) an overhead throw using a 2-kg medicine ball; (d) a

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125 90°/90° external rotation side-throw; (e) a deceleration throw; and (f) a volleyball

126 serve. The participants in the intervention group were assigned to the Ballistic Six

127 program three times weekly for 12 weeks in addition to a regular training program,

128 whereas the participants in the control group only underwent the regular volleyball

129 training. The regular volleyball training program was a standard training which was

130 designed to develop passing, setting, serving, spiking, and blocking techniques,

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131 game tactics and positioning skill including volleyball specific skill and team strategy

132 training, strength, and endurance conditioning.

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133

134 (Table 2 about here)

135

The outcome measures were evaluated before and after the 12-week training
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136

137 for all of the participants. Before the testing, all of the participants performed an

138 appropriate standard warm-up routine and familiarisation trials (10) .

139
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140 Upper body power. An overhead medicine-ball throw was performed to

141 evaluate the ability of generating explosive power in the upper body (26). The
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142 standing overhead medicine-ball throw performance was assessed with a 3-kg

143 rubber medicine ball after a standard familiarization session. The participants were
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144 asked to hold the medicine ball, and to perform an overhead toss as far as possible.

145 The test was performed in three trials with two-minute resting between the tests. The

146 score was measured as a distance to the place where the ball landed, and the best

147 score was taken for a further analysis.

148

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149 Upper body strength & endurance. The push-up performance was assessed

150 in order to evaluate the upper body strength and endurance (37). The participants

151 were instructed to maintain an appropriate push-up position; hands placed under the

152 shoulders, elbows extended, straight body position maintained with extended knees

153 and downwardly tucked toes. Then, the participants were asked to perform push-up

154 until elbows flexed to a 90° and return starting position while maintaining straight

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155 body position which was defined as the successful push-ups. The participants were

156 encouraged to perform the successful push-ups as many times as possible. A

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157 metronome was used to set a rhythm and to create an auditory sign every three

158 seconds. The test ended when the participant did not manage to continue or to

159 sustain body position, did not achieve a 90° flexed and extend the elbows on at least

two push-ups. The numbers of completed successful push-ups were recorded.

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160

161

162 Reaction time. The simple reaction time was measured using an electronic

163 timing system (Newtest 1000 device, Newtest Oy, Oulu, Finland) including a digital
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164 display, a light, and a button, and the protocol was followed that has been described

165 in the literature (11, 33). Each athlete was seated so that the resting arm was on the
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166 table in a quiet environment. The testing side’s second index was placed one cm

167 away from the button of the device. Then, the participants were asked to press the
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168 button when the visual or auditory input appeared. A total of ten repetitions was

169 recorded, and the mean score of the last five tests was further analysed (18). The

170 visual and auditory reaction time was randomly assigned, and the throwing and non-

171 throwing arms were tested separately. The reaction time was recorded with 1/1000 s

172 sensitivity.

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174 Statistical Analyses

175

176 The student t-test was used to test the differences in demographic data

177 between the study groups. Group comparisons were done with repeated-measures

178 ANOVA to determine the effect of time (pre-training or post-training), group

179 (intervention or control) on the outcome scores. When an interaction term was not

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180 significant, the main effect for the group was evaluated. Statistical analysis was

181 performed in SPSS, version 21.0 (SPSS Inc., Chicago, IL, USA). The statistical

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182 significance level was p < 0.05.

183

184 RESULTS
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185

186 The intervention group (n=14) and control group (n=14) shared similar

187 demographic and initial characteristics (Table 1).

188
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189 There was a statistically significant group-by-time interaction for the overhead

190 medicine-ball throwing distance (F1, 26 = 35.68, p < 0.001). Comparisons between the
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191 initial and the 12-week follow-up indicated that the upper body power was improved

192 in the intervention group (p < 0.001; mean difference (MD), 137.14 cm), whereas
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193 there was no difference found in the control group (p > 0.05, Figure 1).

194

195 (Figure 1 about here)

196

197 There was a statistically significant group-by-time interaction for the push-up

198 performance (F1, 26 = 27.43, p < 0.001). The comparisons between the initial and the

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199 12-week follow-up indicated that the upper body strength & endurance were more

200 improved in the intervention group (p < 0.001; MD, 19.07 reps), whereas there was a

201 significant difference found in the control group (p = 0.03; MD, 4.2 reps).

202

203 For the throwing arm, there was no statistically significant group-by-time

204 interaction for the auditory (F1, 26 = 0.73, p = 0.4) and for the visual reaction time (F1,

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205 26 = 0.48, p = 0.4). However, there was a main effect of time for the auditory (F1, 26 =

206 14.73, p = 0.001) and for the visual reaction time (F1, 26 = 11.33, p = 0.002),

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207 indicating that with training, there was an improved reaction time for both study

208 groups (Figure 2).

209

(Figure 2 about here)

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210

211

212 For the non-throwing arm, there was a statistically significant group-by-time

213 interaction for the auditory reaction time (F1, 26 = 5.9, p = 0.02). Comparisons
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214 between the initial and the 12-week follow-up indicated that the auditory reaction

215 time was improved in the intervention group (p < 0.001; MD, 67.07 ms), whereas
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216 there was no difference found in the control group (p > 0.05, Figure 3). Also, there

217 was no statistically significant group-by-time interaction for the visual reaction time
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218 (F1, 26 = 3.79, p = 0.6). However, there was a main effect of time for the visual

219 reaction time (F1, 26 = 11.49, p = 0.002), indicating that with training, there was an

220 improved reaction time for both study groups (Figure 2).

221

222

223

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224 DISCUSSION

225

226 This study has investigated the effects of an additional upper extremity

227 plyometric training program versus control training on upper body explosive power,

228 strength & endurance, and reaction time in female paediatric volleyball players. A 12-

229 week plyometric training program resulted in more improvements in explosive power

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230 and strength & endurance scores when compared to regular volleyball training alone.

231

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232 Volleyball is a complex sport with both lower and upper extremity plyometric

233 components and requires sport-specific skills (7). To be able to enhance

234 performance characteristics and to prevent injuries, plyometric training has been

recommended to be integrated in the training program for athletes of all ages

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235

236 because of the effect of long-term training on muscle-activation strategies and

237 performance (5). The findings of this study showed that additional plyometric training

238 to skill training for paediatric volleyball players can be suggested to have potential
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239 advantages for gaining explosive power, strength & endurance, and reaction time on

240 the non-throwing arm.

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241

242 Plyometric exercises provide a stretch-shortening cycle of the muscles, and

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243 therefore, it is suggested for improving muscular power performance (6, 8). Our

244 findings were in line with previous research in a variety of population groups from

245 various sports in all age groups. Previously, a 6-week plyometric push-up program

246 had been found to improve the throwing distance in adolescent handball players (4).

247 Similar findings were represented for paediatric tennis players for a neuromuscular

248 training program, including upper extremity plyometrics (1). In the current study,

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249 athletes underwent the Ballistic Six upper body plyometric program which had

250 previously resulted in an improved throwing velocity in collegiate baseball players

251 (3), which has shown that strength and endurance improved with plyometric training

252 in adults, and our study supported this finding for paediatric female volleyball

253 players. In addition, in paediatric volleyball players who were older than this study’s

254 population, a combined upper and lower extremity plyometric program had positive

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255 effects on the throwing distance (34). Plyometric training, therefore, can be

256 considered as a link between strength and performance (8).

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257

258 It is relatively hard to interpret our findings with the current evidence, since the

259 effect of plyometric exercises on reaction time was investigated to a lesser extent.

The study by Salonikidis et al (38) showed a positive effect for a lower extremity
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261 reaction time with lower extremity plyometric training. For ball sports, the ability to

262 react to a visual stimulus is related to the organization of the motor control system

263 which utilizes the output of the perceptual system (28). Because plyometric training
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264 is a way to improve the sensory-motor system (32), the result of an improved

265 reaction time may be an expected result. Furthermore, the perceptual and cognitive
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266 component of the test used for assessing reaction time is an important element that

267 would be improved. For the throwing arms, both plyometric and regular volleyball
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268 training improves visual and auditory reaction times; however, for the non-throwing

269 arms, only in the plyometric group, an enhancement was showed. The reason may

270 be because the regular training program simply does not include bilateral throwing

271 activities such as an overhead throw using a medicine ball like that done in the

272 Ballistic Six program.

273

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274 Although the common volleyball training includes regular plyometric activities

275 such as serving, without progressively implemented plyometric training, skill training

276 was found to have no additional effect on the upper body explosive power and

277 endurance. In this study, the method followed was previously recommended as the

278 safest and most effective one for progressing the exercise load and to clarify the

279 need for strength or motor skills that are prerequisites for participating in plyometric

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280 training in children (2, 19). Regular participation in sports alone without preparatory

281 conditioning did not appear to improve upper body power and to prevent injuries in

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282 young players.

283

284 There are some limitations of this study. First, the findings of this study are

only applicable to female paediatric volleyball players and do not provide information
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285

286 about other populations. Additionally, the intervention group participated in greater

287 weekly volume of training; the results presented may simply be because they did

288 more physical work than the control group. On the other hand, the vigorous work
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289 often associated with overuse injuries (39), however the content per session added

290 to the regular training program was progressive based on the quality of the work as
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291 suggested by Davies et al (8) and weekly volume of the work under suggestions by

292 Loud et al (21). Also, there was no passive control group that participated in monitor
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293 changes due to maturation. Further longitudinal studies are needed in order to

294 investigate the effect of plyometric training on injury amounts. In the current study,

295 the effects of the Ballistic Six program on the other physical fitness parameters were

296 not investigated and should be analysed in further studies of this population.

297

298

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299 PRACTICAL APPLICATIONS

300

301 There is limited evidence regarding the effect of plyometric training on upper

302 body performance among young overhead athletes. The findings of this study

303 supported the idea that plyometric training can be utilized safely in addition to the

304 regular volleyball training program for paediatric volleyball players. Since the upper

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305 extremity plyometric training elicits an additional gain in tested parameters, it can be

306 considered as a prevention program for possible injuries in the sport. The Ballistic

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307 Six program is an option for the pre-pubertal female volleyball players to improve

308 their upper extremity power, strength & endurance, and reaction time.

309

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A

418 novice tennis players. J Strength Cond Res 22: 182-191, 2008.

419 39. Valovich McLeod TC, Decoster LC, Loud KJ, Micheli LJ, Parker JT, Sandrey

420 MA, and White C. National Athletic Trainers' Association position statement:

421 Prevention of pediatric overuse injuries. J Athletic Train 46: 206-220, 2011.

422

423

Copyright ª 2017 National Strength and Conditioning Association

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424 Figure 1. Results of overhead medicine ball throw test evaluated at baseline and

425 after 12-week training. Note: Data were presented as Mean and Standard Deviation.

426 * indicates statistically significant group-by- time interaction.

427
428
429

D
430
431
432
433

TE
434
435
436
437
438
439
440
EP
441
442
443
444
445
446
C

447
448
449
450
C

451
452
453
454
A

455
456
457
458
459
460
461
462
463
464
465
466
467

Copyright ª 2017 National Strength and Conditioning Association

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468
469 Figure 2. Results of reaction time assessment evaluated at baseline and after 12-

470 week training. Note: Data were presented as Mean and Standard Deviation. *

471 indicates statistically significant group-by-time interaction.

472

473

D
474

TE
475

476
EP
477

478

479
C

480
C

481
A

482

483

484

485

486

Copyright ª 2017 National Strength and Conditioning Association

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487 Table 1

488 Characteristics of Cohorts

Intervention Group Control Group p

n = 14 n = 14

Age (years) 11 (0.7) 11 (0.8) 0.9

Height (m) 162.7 (4.7) 159.1 (6.7) 0.1

D
Body mass (kg) 45.2 (6.8) 47.1 (8.7) 0.5

Body mass index (kg/m2) 17.05 (1.8) 18.4 (2.5) 0.1

TE
Sports age (years) 2.4 (0.6) 2.3 (0.7) 0.7

489 Note: Data given as mean and standard deviation. P values resulting from Student-t

490 test.
EP
C
C
A

Copyright ª 2017 National Strength and Conditioning Association

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491 Table 2

492 The 12-week Ballistic Six Plyometric Training Program for Intervention Group.

1 to 2 weeks 3 to 4 weeks 5 to 6 weeks 7 to 8 weeks 9 to 10 weeks 11 to 12 weeks

D
Training Training Training Training

Number of Sets

Number of Sets

Number of Sets

Number of Sets

Number of Sets

Number of Sets
Training Training
/ Rest / Rest / Rest / Rest

TE
Duration Duration
Duration Duration Duration Duration
(s) (s)
(s) (s) (s) (s)

EP
1. Elastic band shoulder external rotation at 0° 30 1 40 1 30/30 2 40/40 2 30/30 3 40/40 3

2. Elastic band shoulder external rotation at 90°/90° 30 1 40 1 30/30 2 40/40 2 30/30 3 40/40 3

3. Overhead throw using a 2-kg medicine ball 30 1 40 1 30/30 2 40/40 2 30/30 3 40/40 3

4. 90°/90° external rotation side-throw 30 1 40 1 30/30 2 40/40 2 30/30 3 40/40 3

5. Deceleration throw
C 30 1 40 1 30/30 2 40/40 2 30/30 3 40/40 3
C
6. Volleyball serve 30 1 40 1 30/30 2 40/40 2 30/30 3 40/40 3

493 Note. S, seconds.

A

Copyright ª 2017 National Strength and Conditioning Association

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427
428

D
TE
EP
429

430 Figure 1. Results of overhead medicine ball throw test evaluated at baseline and

431 after 12-week training. Note: Data were presented as Mean and Standard Deviation.
C

432 * indicates statistically significant group-by- time interaction.

C

433
A

Copyright ª 2017 National Strength and Conditioning Association

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434
435

D
436
TE
EP
437 Figure 2. Results of reaction time assessment evaluated at baseline and after 12-

438 week training. Note: Data were presented as Mean and Standard Deviation. *

439 indicates statistically significant group-by-time interaction.

C
C
A

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