The effect of a balance training programme on centre of pressure excursion in one-leg stance
Introduction
The ankle is at high risk for sports injuries. About a quarter of all injuries for a wide range of sports affect the ankle (Boruta et al., 1990, Jerosch and Bischof, 1996). Between 90% and 95% of all ankle injuries are acute ankle ligament injuries, i.e. ankle sprains, causing a partial or complete rupture of the anterior talofibular ligament and in some cases also the calcaneofibular ligament (Tropp et al., 1984). Freeman (1965) stated that trauma to mechanoreceptors of the ankle ligaments after an ankle sprain can produce a proprioceptive impairment in the ankle. This might explain the increased risk of re-injury within one year after an ankle sprain (Brand et al., 1977, Ekstrand and Gillquist, 1983, Tropp and Odenrick, 1988).
Since the publication of the study of Freeman (1965), a deterioration of the ability to maintain balance in single limb stance after an ankle sprain has been well documented (Hertel, 2000). Many balance parameters are altered, of which an increased area of postural sway during single limb stance is the most commonly described. Postural sway is defined as the deviation from the mean centre of pressure (CoP) of the foot (Guskiewicz and Perrin, 1996).
Balance training is designed for the rehabilitation after an ankle sprain and is thought to have a positive effect on postural sway (i.e. a decrease of postural sway). Previous studies have tried to establish an association between balance training and a decrease in postural sway in a variety of populations, of which populations with chronic ankle instability are the most common (De Carlo and Talbot, 1986, Garn and Newton, 1988, Hertel, 2000, Sahlstrand et al., 1978). However, a recent review concluded that the number of studies reporting alterations in postural control due to such a programme matches the number of studies failing to show such alterations (Riemann, 2002).
A (suggested) preventive effect of proprioceptive balance training on the risk of re-injury after an initial ankle sprain has been shown multiple studies (Bahr et al., 1997, Stasinopoulos, 2004, Tropp et al., 1985, Verhagen et al., 2004, Wedderkopp et al., 1999, Wedderkopp et al., 2003). Although these intervention studies did not measure chronic ankle instability, it is unlikely that a preventive effect only exists for athletes with chronic ankle instability. Therefore, from a societal perspective balance training should be advocated to all athletes with previous injury. One problem that arises in achieving this goal is that compliance with such preventive programmes is generally low. Adherence to a preventive balance programme could be improved if there is evidence that balance training improves other sports related factors as well. Therefore, the purpose of our study was to investigate whether a balance-training programme leads to a smaller postural sway in a general population, showing in a decreased CoP excursion.
Section snippets
Subjects
Thirty university students (5 male and 25 female) participated voluntarily in this study. Written informed consent was obtained after the purpose, nature and potential risks were explained to all subjects. Twenty-two untrained subjects who did not participate in an organized volleyball competition were randomly assigned to either an intervention group (n = 11) or a control group (n = 11). The remaining eight subjects participated in an organized volleyball competition and trained at least two times
Subjects
One subject of the intervention group did not complete the training programme due to an acute lateral ankle ligament injury to this leg. It is suggested that an ankle sprain to one leg has an influence on the postural control of the other leg. In order to rule out any effect this dominant sided sprain might have on the measurements of the non-dominant leg, this subject was excluded from all analyses. This resulted in a final sample size of 29. Subject characteristics are given in Table 1.
Discussion
We hypothesized that the balance training programme would improve postural sway as shown by a reduced range of CoP excursion. This hypothesis was based on the assumption that ankle (in)stability can be measured through CoP measurements in single limb stance (De Carlo and Talbot, 1986, Garn and Newton, 1988, Guskiewicz and Perrin, 1996, Hertel, 2000, Sahlstrand et al., 1978). However, postural sway was unaffected as a result of the training programme since range of CoP excursion after the
Conclusion
The week balance training programme applied in this study did not reduce CoP excursion in a general population consisting of non-injured and previously injured subjects.
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