Background Impaired core stability has been suggested to influence lower extremity functioning and might contribute to the development of acute lower extremity injuries. Prospective studies that examine this relationship are currently lacking.

Objective The objective of this study was to investigate the role of different components of core stability as risk factors for the development of acute lower extremity injuries.

Design A prospective study was set up with a follow-up and injury registration period of 1,5 years. Afterwards, cox regression analyses were performed to identify significant contributors in the development of acute lower extremity injuries.

Setting Male and female freshmen students, enrolled in the physical education teacher studies of the University Colleges in Ghent participated in this study. The study was performed at the Ghent Sports Arena.

Patients (or Participants) 150 healthy participants enrolled and were excluded if they had a history of lower extremity surgery or if they reported a musculoskeletal injury in the 6 months prior to testing. Eleven participants were excluded which resulted in 139 included participants.

Interventions (or Assessment of Risk Factors) Measures for dynamic postural control, isometric core and hip muscle strength, core muscle endurance, core neuromuscular control and proprioception were taken at baseline.

Main Outcome Measurements The occurrence of an acute lower extremity injury was the primary study outcome.

Results During follow-up, 27 injuries of interest occurred (19%). After multivariate model building, a significant predictive effect was found for a muscle strength imbalance for hip flexion (p=0.016). The risk of developing an injury increased with a greater strength imbalance, regardless of sex and other core stability measures.

Conclusions This study identified hip strength imbalance as a risk factor for the development of acute lower extremity injuries. Normalizing hip strength imbalance might be beneficial for injury prevention. However, further research is needed to support this claim.