Background The training and match injury-incidence in professional men's football remains high and current preventive strategies only seem partially effective, allowing players to present with intrinsic weaknesses each consecutive season. Professional football is a balance-reliant, open skill performed in an environment rich in visual, vestibular and proprioceptive input. Pre-season balance ability - a significant independent intrinsic predictor of injuries and a long-term persisting between-individual difference in injury susceptibility – depends on this input. Measurements of postural control while in a unilateral stance have been shown to predict football injury-susceptibility. Therefore, effective prevention of injury may start with the measurement of postural control followed by interventions targeted at internal risk factor(s). Stomatognathic conditions/malocclusion may have a strong negative impact on the athletes proprioceptive abilities. Therefore, the primary question in this study was: do cranial osteopathic interventions that reduce malocclusion to the better improve balance control in male elite football players?

Aim This study aimed at investigating dental/occlusal factors and unilateral balance as non-contact injury risk factors in professional football players and the contribution of osteopathic techniques to decrease these risks.

Method Sixty three injury-free male professional football players with malocclusion were recruited amongst three Belgian Premier League teams and were tested individually. Balance was measured using COF area recordings during a validated unipodal force plate balance test. Four balance test conditions (dominant/non-dominant leg×eyes open/closed) were used to evaluate the short-term effects of three standardized cranial osteopathic techniques.

Results All the post-treatment measures show smaller mean COF values (balance improvement) when compared to pre-treatment base-line recordings, with the strongest improvement for the conditions with eyes closed (paired t-test, p<0.0005). Indicators of stomatognathic conditions showed significant correlations with base-line COF and balance improvement.

Conclusions This study indicates that cranial osteopathic interventions with professional football players result in substantial improvement of balance in challenging test conditions (i.e. standing on one leg with eyes closed), and especially if one or more specific stomatognathic conditions are present. Improvement of balance as a non-specific indicator of injury susceptibility and of soccer performance is a dynamic process that involves many features, that could be included in future prospective studies. The results are suggestive for implementation of this approach in football, but at the same time point at the need for follow-up studies with a larger sample size and long-term evaluation.