Original article
Risk-Factor Analysis of High School Basketball–Player Ankle Injuries: A Prospective Controlled Cohort Study Evaluating Postural Sway, Ankle Strength, and Flexibility

https://doi.org/10.1016/j.apmr.2006.02.024Get rights and content

Abstract

Wang H-K, Chen C-H, Shiang T-Y, Jan M-H, Lin K-H. Risk-factor analysis of high school basketball–player ankle injuries: a prospective controlled cohort study evaluating postural sway, ankle strength, and flexibility.

Objective

To analyze risk factors, including postural sway, ankle strength, and flexibility, for the prediction of ankle injuries in men’s high school basketball players.

Design

A cohort study with follow-up duration of 1 basketball season.

Setting

Biomechanics laboratory.

Participants

Forty-two (age, 16.5±1.1y) players competing in first league of the High School Basketball Association without history of injury in the lower extremities within 6 months before recruitment and without significant malalignment in the lower extremities were included. None of these players met exclusion criteria such as using ankle braces or taping or failed in wearing low-top sports shoes during the follow-up season.

Interventions

Not applicable.

Main Outcome Measures

Biomechanic measurements including isokinetic ankle strength, 1-leg standing postural sway, and ankle joint dorsiflexion flexibility were performed before the basketball season by 1 physical therapist. The subsequent monthly follow-up questionnaires were sent and returned by mail to prospectively record the incidence of ankle injury occurring in the season. Results of these preseason measurements were analyzed to correlate if any of these measured variables could predict future ankle injuries.

Results

Eighteen ankle sport injuries were recorded for 42 players during the follow-up season. High variation of postural sway in both anteroposterior and mediolateral directions corresponded to occurrences of ankle injuries (P=.01, odds ratio [OR]=1.220; P<.001, OR=1.216, respectively). All other variables were not associated with injury.

Conclusions

High variations of postural sway in 1-leg standing test could explain partly the increased prevalence of ankle injury in basketball players. It may be used as a screening tool to recommend balance training before basketball season.

Section snippets

Participants

Our institutional review board approved this study. Members of 10 teams who registered and competed in the first league of the High School Basketball Association, Taiwan, Republic of China (ROC), were selected before the 2003 season as eligible subjects. The teams were selected because their schools have indoor basketball stadiums with standard sports floors (hard maple wood, 28×15m) and no specifically designed prevention programs for ankle injury. Five teams with 70 players (age, 16.7±1.2y)

Results

The duration of the 2003 basketball season was estimated by coaches for each team, with a mean of 46.0 ± 2.5 weeks. Eighteen ankle sports injuries were recorded for 42 players during the follow-up season, and 11 occurred in the dominant foot and 7 occurred in the nondominant foot. Fourteen and 4 injuries were categorized as mild and moderate degrees, respectively. Age, physical characteristics, training history, and training hours did not differ significantly between injured and uninjured

Discussion

Findings of this study reveal that only the players who displayed a high variation of postural sway were most likely to have an injured ankle during the basketball session (see table 2). Significant differences of the variation between the uninjured and injured ankles in the ML direction were found. This may be because postural sway represents the ability to maintain a standing balance, and a large variation of postural sway may indicate inconsistent or poor control of ankle stability.

Conclusions

Results of the high postural sway in eyes-open 1-leg standing test before basketball session correlated significantly with subsequent ankle injuries, although it could explain only a slight increase of prevalence in the rate of ankle injury. However, we suggest that sports medicine personnel may use this 1-leg standing as a screening tool to recommend balance training before the basketball season. Further studies are suggested to compare postural sway variables before and after ankle injuries.

Acknowledgment

We thank the High School Basketball Association, Taiwan, ROC, for its administrative support.

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Supported by the High School Basketball Association, Taiwan, Republic of China.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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