|Year : 2016 | Volume
| Issue : 3 | Page : 199-204
Comparison of static and dynamic balance between football and basketball players with chronic ankle instability
Ganeswara Rao Melam1, Adel A Alhusaini1, Vaithiamanithi Perumal1, Syamala Buragadda1, Kirandeep Kaur2
1 Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
2 Department of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar, Punjab, India
|Date of Web Publication||28-Sep-2016|
Ganeswara Rao Melam
Researcher, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P. O. Box 10219, Riyadh 11433
Background: Athletic injuries such as ankle sprain are most common in football and basketball games. Chronic ankle injuries affect the balance performance of these players and influence their future sports' performances. Objective: Purpose of this study was to compare static and dynamic balance in ankle instability among university level football and basketball players. Methods: This study cross-sectional observational design included 24 collegiate level players (12 footballers and 12 basketballers) with chronic ankle instability and were inactive from sports for more than 3 months with a score of 85% or less on the Foot and Ankle Ability Measure Sports scale. Static balance was tested by stork standing test, and dynamic balance was assessed using the Star Excursion Balance Test. Results: Significant differences were observed in the static and dynamic balance between the injured and noninjured limbs for both the football and basketball groups (P < 0.05). Further analysis showed that the difference in the dynamic balance between football players and basketball players was not significantly different (P > 0.05), whereas the static balance was better in football players than the basketball players. Conclusion: This record of differences in the balance due to injury supports the need for sports-specific rehabilitation program for injured players to improve their balance which is essential for playing their sports efficiently.
المادة الأصلية: مقارنة بين التوازن والدينامية بين لاعبي كرة القدم وكرة السلة مع عدم مقارنة بين التوازن الديناميكي في عدم الاستقرار في الكاحل بين لاعبي كرة القدم وكرة السلة
خلفية البحث: الإصابات الرياضية مثل التواء الكاحل هي الأكثر شيوعا في كرة القدم وكرة السلة. وإصابات الكاحل المزمنة تؤثر على توازن هؤلاء اللاعبين و على أدائهم الرياضي في المستقبل.
الهدف من الدراسة: مقارنة بين التوازن الديناميكي في عدم الاستقرار في الكاحل بين لاعبي كرة القدم وكرة السلة على مستوى الجامعات.
الطريقة: هذه دراسة شملت 24 لاعباً جامعياً (12 منلاعبي كرة القدم و 12 من لاعبي كرة السلّة يعانون عدم الاستقرار المزمن في الكاحل و كانوا غير نشطين رياضياً لأكثر من 3 أشهر بنتيجة 85٪ أو أقل على قدرة لقدم والكاحل الرياضية. تم اختبار توازن ثابت عن طريق اختبار مكانة اللقلق، والجرى و تقييم التوازن الديناميكي باستخدام اختبار التوازن .
النتائج: وجدت فروقات مهمة في التوازن الثابت والتوازن الديناميكي بين الأطراف المصابة والغير
Keywords: Basketball, chronic ankle injury, dynamic balance, football, static balance
|How to cite this article:|
Melam GR, Alhusaini AA, Perumal V, Buragadda S, Kaur K. Comparison of static and dynamic balance between football and basketball players with chronic ankle instability. Saudi J Sports Med 2016;16:199-204
|How to cite this URL:|
Melam GR, Alhusaini AA, Perumal V, Buragadda S, Kaur K. Comparison of static and dynamic balance between football and basketball players with chronic ankle instability. Saudi J Sports Med [serial online] 2016 [cited 2020 Apr 7];16:199-204. Available from: http://www.sjosm.org/text.asp?2016/16/3/199/187557
| Introduction|| |
Ankle sprains are the most common injury that occur during athletic events, which accounts for up to 40% of all athletic injuries in athletes participating in basketball, soccer, running, and ballet/dance. , Recurrent ankle sprains with various mechanical and neuromuscular factors can result in chronic ankle instability (CAI), leading to impaired performance of functional and sports activities. , Mechanical instability and functional instability are the two hypothesized causes of CAI. 
Basketball is one of the most popular team sports and the largest growing sports in the world. In this game, players need to be able to change directions swiftly, dribble the ball from one end of the court to another, jump to make baskets, and defend the ball from the offending team throughout the game.  Soccer is another form of team game in which players often perform lower extremity passing, shooting, and dribbling skills on variable environments. These tactics are required by the players to score in the game; however, these also expose them to various injuries. Injuries are unfortunately an inseparable part of sports and therefore football and basketball are no exception. Each sports requires different levels of sensorimotor processing to perform skills, especially in contact sports such as basketball and football players require great strength and range of motion.  These sports pose different challenges to the sensorimotor systems depending on the environmental context and demands.
Balance is generally considered an important component of games such as football and basketball. This relies on the body's ability to integrate visual, vestibular, and somatosensory systems in static and dynamic conditions.  The sensorimotor impairments associated with lower extremity injuries may contribute to balance impairments and increase the reinjury risk. , Some evidence in the literature suggests that static and dynamic balance impairments have been associated with chronic ankle stability. ,, As a result of this association between balance deficits and ankle sprain injury, single-leg balance tests have been used as clinical and research examination tool to assess postural instabilities associated with CAI.  Balance tests that are more functional may be better than static single-leg balance tests at detecting balance impairments associated with CAI.  Star Excursion Balance Test (SEBT) is an alternative assessment technique that may challenge balance greater than static single-leg balance tests. ,
Previous studies comparing ankle instability and balance abilities among athletes competing in different sports are limited. Therefore, our purpose was to compare static and dynamic balance in ankle instability among university level football and basketball players. We hypothesized that postural control would be different among players in these sports. A better understanding of the postural stability parameters among players in different sports will provide insight, regarding the type and amount of balance training needed to improve their overall performance.
| Methods|| |
This study is a cross sectional observational design and was approved by Institutional Medical Ethics Committee of Guru Nanak Dev University, Amritsar. This present study was conducted in Khalsa College, Amritsar and in the Department of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar between July and October, 2011. Participants signed an informed consent form approved by the University Ethics Committee. All participants were asked to complete an information questionnaire to gather demographic information. The subjects were explained about the nature of the research, procedure, and tests that would be administered during the course of the study. To be included in the study, participants had to be collegiate level players with the previous history of unilateral CAI, inactive from sports from more than 3 months and must have a score of 85% or less on the Foot and Ankle Ability Measure (FAAM) Sports, which measures self-reported function. 
Participants were excluded if they had a lower extremity injury other than CAI, muscle soreness, cardio or respiratory problems, vestibular problems, visual problems, or a concussion in the 12 weeks before the study. A sample of 24 male volunteers with a mean age of 19.2 ± 1.42 years for football players (n = 12) and 19.6 ± 1.48 years (n = 12) for basketball players participated in the current study. Demographic data of the participants were recorded. Leg length  and limb dominance were determined by the trained therapist. Static balance and dynamic balance were then randomly evaluated using the equipment and procedures described below.
Static balance was tested through stork standing test. In this test, participants stood on barefoot and positioned the nonsupporting foot over the medial part of the knee of the supporting leg which both hands were kept on his hips. After that, he had to raise the heel of the supporting leg to balance on the ball of the foot. Time was measured in seconds using a stopwatch, which was started when the participant raised his heel from the floor and stopped if the nonsupporting foot lost contact with the knee or the heel of the supporting foot touched the floor or the supporting foot swiveled or moved (hopped) in any direction or hand(s) came off the hips. ,
Dynamic balance was assessed using the SEBT as described by Gribble and Hertel.  SEBT testing grid consisted of 8 lines, each 120 cm in length extending from a common point at 45° angle increments, and was created using standard white athletic tape placed on a firm, textured tile surface. The middle of the grid was marked with a small dot that participants were asked to center the stance foot over during testing. The grid was marked at 1 cm increments from the center outward to facilitate scoring during testing. Estimates of intratester and intertester reliability for SEBT were high, with fair to good validity.  Studies have provided evidence that SEBT is sensitive for screening various musculoskeletal injuries and variations in performance by sex and sports. ,
All participants performed the static and dynamic tests in a random manner after adequate training session regarding the protocol.
The mean values of each participant's measurements on all the components of the SEBT scale, and stork standing test scores were analyzed using statistical program SPSS 20 (IBM Corp, Armonk, NY). An independent t-test was used to find out the statistical relationship between CAI limb and normal limb (NL) for static and dynamic balance measures in both the groups. Furthermore, the relationship between both the groups for each limb was also calculated.
| Results|| |
The demographic characteristics of the sample are shown in [Table 1]. Age and self-reported functional impairment score based on FAAM sports scale was not significantly different among the football and basketball players (P ≥ 0.05). This proves the homogeneity of the participants in crucial measures. The weight, height, and limb length were statistically different (P ≤ 0.05) among these two groups, which was expected as most of the basketball players were taller than the footballers and so their weight and limb length were comparatively higher [Table 1]. Statistically significant differences were generally notified in growth parameters such as height, weight, and limb length among footballers and basketballers because the external factors, such as jumping and running (basketball elements), have more influence on morphometrical growth factors of young basketballers, compared with the influence of football elements (mainly running) on young footballers.  Since the differences in the height and weight are the basic characteristics, they would not affect the outcome of this study in anyway.
[Table 2] shows the composite reach distance which is the mean total of all the six components of SEBT shows that NL scores of footballers (820.61 ± 6.20) were higher than the CAI limb (803.80 ± 14.98). Similarly, the composite reach that measures the dynamic balance on the NL (816.31 ± 17.09) was higher than the CAI limb (800.22 ± 25.78) of the basketball players. Both the scores were statistically different (P ≤ 0.05) from each other.
|Table 2: Comparison of dynamic balance values (Star Excursion Balance Test) between both limbs of each group|
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Significant differences were observed in the static balance between both injured and noninjured limbs for both the football and basketball groups [Table 3]. NLs score of stork standing test (34.42 ± 3.50) was statistically different (P < 0.05) than the CAI limb's balance (31.17 ± 2.08). Similarly, in basketball players too significant difference at 0.05 level was seen between normal and CAI limb.
|Table 3: Comparison of static balance values (stork standing test) between both limbs of each group|
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Further, the difference in the dynamic and static balance between football players and basketball players was evaluated. [Table 4] shows no significant difference between footballers and basketballers in the scores of SEBT, which measured the dynamic balance. However, significant difference in static balance was found between footballers and basketballers [Table 5].
|Table 4: Comparison of dynamic balance values (Star Excursion Balance Test) between football and basketball groups|
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|Table 5: Comparison of static balance values between football and basketball groups of each limb|
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| Discussion|| |
Difference in balance ability among athletes of different sports had been studied earlier. In previous studies, football players have demonstrated dynamic balance ability superior or equal to gymnasts and higher static unipedal balance ability than basketball players,  swimmers, and nonathletes.  Since there is no published work reporting the study of static and dynamic balance between collegiate basketball and football players with CAI, this present study for the first time profiled static and dynamic balance in collegiate basketball players and compared this with that of football players.
We hypothesized that static and dynamic balance scores would be different among collegiate athletes competing in different sports with a history of unilateral CAI. Although the idea that sports involvement improves balance is not new, our study extends this knowledge to particular sports and suggests that specific sensorimotor changes after chronic instability, rather than just general sports activity affecting the static and dynamic balance.
In this study, irrespective of the dominance limb, the scores of the affected and NLs of football player and basketball players were analyzed. Results of this study revealed that dynamic balance as assessed by SEBT showed significant differences between NL and CAI limb for all the components of SEBT (P ≤ 0.05) in both footballers and basketballers. Mean values and significance values are mentioned in [Table 2]. Average of NL was better in both the players. The static balance as assessed by the stork standing test also showed significant changes in static balance between CAI limb and NL in both football and basketball players.
The previous study done by Brown and Mynark also showed similar result in which they found that the dynamic balance was affected in individuals with CAI.  Ogwumike and Tijani study on 115 professional footballers using stork balance stand test also showed a similar result that poor balance performance was observed in the injured limb compared to the uninjured limb in injured group.  A study on basketball players with a previously sprained ankle demonstrated significantly increased postural sway due to balance deficits in comparison with normal controls and uninjured players.  The difference in balance in the injured limb could be the result of subtle central sensorimotor changes caused by injury to the musculoskeletal injury. 
No significant changes for dynamic balance were observed between football group and basketball group for both the limbs. Our study results are in accordance with a similar study done by Bhat and Moiz, which also found no significant difference in all the directions of SEBT scores in collegiate field hockey and football players.  The difference in stability among athletes can be due to varying sensitivity of sensory system in athletes. Probably, basketball players and football players could be having equal sensitivity of sensory system as they displayed similarity in their dynamic balance performance players or it may be attributed to SEBT sensitivity to pick up the differences.
When the static balance between basketballers and footballers were analyzed, we found a statistically different score between them on both the injured and noninjured limb. The mean value suggests that football players showed more static balance than the basketball players in our study. Basketball players rarely balance motionless on one leg and often attend to ball and player position cues. So that it is the reason that their static balance might be less developed than the other branches. 
It was assumed that CAI is caused by disturbed neuromuscular control and that the static balance tests applied in this study are good methods to evaluate (disturbed) neuromuscular control. The findings of stork standing test showed that static balance of football players is superior to that of basketball players in agreement with similar studies. , Similar to the results of our study, the soccer players demonstrated higher balance than volleyball players and cricketers in another study done by Khuman et al. 
Few earlier studies on this topic also showed that soccer players had a better standing balance than swimmers, basketball players, and sedentary subjects. ,, Unique sensorimotor challenges imposed on football players, who are required to manipulate the ball on single limb stance in contrast to basketball players may have contributed to significant changes.
In this study, the lack of variation can be due to musculoskeletal ailment of CAI and away from sports for a period of time. Sensorimotor control is impaired after ankle injury and in fatigued conditions. Fatigue-induced alterations of dynamic postural control were greater in athletes with a previous ankle sprain.  The results of the previous studies are to be interpreted with caution, as the results of different studies are conflicting. Variations of results are to be attributed to type of sports and population. In this study, we examined the results in the context of injured leg rather than dominance, assuming that the sensorimotor variations due to chronic instability and lack of training could affect the static and dynamic stability. This record of differences in the balance due to injury supports the need for further rehabilitation program for these players to improve their balance which is essential for playing their sports efficiently.
Although this research has reached its aim, there were some unavoidable limitations. The study sample is limited including only university level players and therefore the extent of generalizability is limited. Functional scales are used in this study, and therefore more objective and sensitive measures must be used to pick miniature differences in future studies.
The authors extend their appreciation to the Deanship of Scientific Research at King Saud University for funding this work through research group no. RGP-256.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]