Effects of Textured Balance Board Training in Adolescent Ballet Dancers With Ankle Pathology

in Journal of Sport Rehabilitation

Click name to view affiliation

Nili Steinberg
Search for other papers by Nili Steinberg in
Current site
Google Scholar
PubMed
Close
,
Roger Adams
Search for other papers by Roger Adams in
Current site
Google Scholar
PubMed
Close
,
Oren Tirosh
Search for other papers by Oren Tirosh in
Current site
Google Scholar
PubMed
Close
,
Janet Karin
Search for other papers by Janet Karin in
Current site
Google Scholar
PubMed
Close
, and
Gordon Waddington
Search for other papers by Gordon Waddington in
Current site
Google Scholar
PubMed
Close
Restricted access

Context: Ankle sprains are common among adolescent ballet dancers and may be attributed to inadequate ankle proprioception. Thus, a short period of training utilizing proprioceptive activities requires evaluation. Objective: To assess training conducted for 3 or 6 weeks on a textured-surface balance board using ankle proprioception scores for ballet dancers with and without chronic ankle instability, and with and without previous ankle sprain (PAS). Design: Intervention study. Setting: The Australian Ballet School. Participants: Forty-two ballet dancers, aged 14–18 years. Interventions: Dancers randomized into 2 groups: group 1 undertook 1 minute of balance board training daily for 3 weeks; group 2 undertook the same training for 6 weeks. Main Outcome Measures: Preintervention, Cumberland Ankle Instability Tool questionnaire data were collected, and PAS during the last 2 years was reported. Active ankle inversion movement discrimination ability was tested immediately pre and post intervention and at 3 and 4 weeks. Results: Ankle discrimination acuity scores improved over time for both groups, with a performance decline associated with the early cessation of training for group 1 (P = .04). While dancers with PAS had significantly worse scores at the first test, before balance board training began (P < .01), no significant differences in scores at any test occasion were found between dancers with and without chronic ankle instability. A significantly faster rate of improvement in ankle discrimination ability score over the 4 test occasions was found for dancers with PAS (P = .002). Conclusions: Three weeks of textured balance board training improved the ankle discrimination ability of ballet dancers regardless of their reported level of chronic ankle instability and at a faster rate for dancers with PAS. Previous ankle sprain was associated with a lower level of ankle discrimination ability; however, following 3 weeks of balance board training, previously injured dancers had significantly improved their ankle discrimination acuity scores.

Steinberg, Waddington, and Adams are with the Faculty of Health, University of Canberra, Canberra, ACT, Australia. Steinberg is also with the Wingate College of Physical Education and Sport Sciences, The Wingate Institute, Netanya, Israel. Tirosh is with the School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia. Karin is with The Australian Ballet School, Melbourne, VIC, Australia; and the Australian Catholic University, Sydney, NSW, Australia.

Steinberg (knopp@wincol.ac.il) is corresponding author.
  • Collapse
  • Expand
  • 1.

    Hiller CE, Refshauge KM, Beard DJ. Sensorimotor control is impaired in dancers with functional ankle instability. Am J Sports Med. 2004;32(1):216223. PubMed ID: 14754747 doi:10.1177/0363546503258887

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Bowling A. Injuries to dancers: prevalence, treatment, and perceptions of causes. BMJ. 1989;298(6675):731734. PubMed ID: 2496824 doi:10.1136/bmj.298.6675.731

  • 3.

    Smith TO, Davies L, de Medici A, Hakim A, Haddad F, Macgregor A. Prevalence and profile of musculoskeletal injuries in ballet dancers: a systematic review and meta-analysis. Phys Ther Sport. 2016;19:5056. PubMed ID: 27080110 doi:10.1016/j.ptsp.2015.12.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Hiller CE, Refshauge KM, Herbert RD, Kilbreath SL. Intrinsic predictors of lateral ankle sprain in adolescent dancers: a prospective cohort study. Clin J Sport Med. 2008;18(1):4448. PubMed ID: 18185038 doi:10.1097/JSM.0b013e31815f2b35

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Fuchs E, Hess H, Kunz M. Injuries and chronic damages in classic ballet. Sportverletz Sportschaden. 2003;17(3):123131. PubMed ID: 12975727 doi:10.1055/s-2003-42151

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: evolution of the model. J Athl Train. 2011;46(2):133141. PubMed ID: 21391798 doi:10.4085/1062-6050-46.2.133

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL. The Cumberland Ankle Instability Tool: a report of validity and reliability testing. Arch Phys Med Rehabil. 2006;87(9):12351241. PubMed ID: 16935061 doi:10.1016/j.apmr.2006.05.022

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123140. PubMed ID: 24105612 doi:10.1007/s40279-013-0102-5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Mokha M, Sprague PA, Gatens DR. Predicting musculoskeletal injury in National Collegiate Athletic Association Division II athletes from asymmetries and individual-test versus composite functional movement screen scores. J Athl Train. 2016;51(4):276282. PubMed ID: 26794630 doi:10.4085/1062-6050-51.2.07

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Lin CF, Lee IJ, Liao JH, Wu HW, Su FC. Comparison of postural stability between injured and uninjured ballet dancers. Am J Sports Med. 2011;39(6):13241331. PubMed ID: 21335350 doi:10.1177/0363546510393943

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Herb CC, Chinn L, Hertel J. Altering shank-rear-foot joint coupling during gait with ankle taping in patients with chronic ankle instability and healthy controls. J Sport Rehabil. 2016;25(1):1322. PubMed ID: 25658069 doi:10.1123/jsr.2014-0244

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Waddington G, Adams R. Football boot insoles and sensitivity to extent of ankle inversion movement. Br J Sports Med. 2003;37(2):170174. PubMed ID: 12663362 doi:10.1136/bjsm.37.2.170

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Kiefer AW, Riley MA, Shockley K, et al. Lower-limb proprioceptive awareness in professional ballet dancers. J Dance Med Sci. 2013;17(3):126132. PubMed ID: 24069947 doi:10.12678/1089-313X.17.3.126

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Han J, Waddington G, Adams R, Anson J, Liu Y. Assessing proprioception: a critical review of methods. J Sport Health Sci. 2016;5(1):8090. doi:10.1016/j.jshs.2014.10.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Han J, Anson J, Waddington G, Adams R, Liu Y. The role of ankle proprioception for balance control in relation to sports performance and injury. Biomed Res Int. 2015;2015:842804. PubMed ID: 26583139

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Waddington G, Adams R, Jones A. Wobble board (ankle disc) training effects on the discrimination of inversion movement. Aust J Physiother. 1999;45:95101. PubMed ID: 11676754 doi:10.1016/S0004-9514(14)60341-X

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Waddington G, Adams R. Discrimination of active plantarflexion and inversion movements after ankle injury. Aust J Physiother. 1999;45(1):713. PubMed ID: 11676748 doi:10.1016/S0004-9514(14)60335-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008;40(10):18101819. PubMed ID: 18799992 doi:10.1249/MSS.0b013e31817e0f92

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Wright CJ, Linens SW, Cain MS. A randomized controlled trial comparing rehabilitation efficacy in chronic ankle instability. J Sport Rehabil. 2017;26(4):238249. PubMed ID: 27632874 doi:10.1123/jsr.2015-0189

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Hutt K, Redding E. The effect of an eyes-closed dance-specific training program on dynamic balance in elite pre-professional ballet dancers: a randomized controlled pilot study. J Dance Med Sci. 2014;18(1):311. PubMed ID: 24568798 doi:10.12678/1089-313X.18.1.3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Steinberg N, Tirosh O, Adams R, Karin J, Waddington G. Does wearing textured insoles during non-class time improve proprioception in professional dancers? Int J Sports Med. 2015;36(13):10931099. PubMed ID: 26332901 doi:10.1055/s-0035-1554633

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Steinberg N, Waddington G, Adams R, Karin J, Begg R, Tirosh O. Can textured insoles improve ankle proprioception and performance in dancers? J Sports Sci. 2016;34(15):14301437. PubMed ID: 26618395 doi:10.1080/02640414.2015.1117120

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Kosik KB, McCann RS, Terada M, Gribble PA. Therapeutic interventions for improving self-reported function in patients with chronic ankle instability: a systematic review. Br J Sports Med. 2017;51(2):105112. PubMed ID: 27806951 doi:10.1136/bjsports-2016-096534

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Thompson JY, Byrne C, Williams MA, Keene DJ, Schlussel MM, Lamb SE. Prognostic factors for recovery following acute lateral ankle ligament sprain: a systematic review. BMC Musculoskelet Disord. 2017;18(1):421. PubMed ID: 29061135 doi:10.1186/s12891-017-1777-9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Jacobson BH, Redus B, Palmer T. An assessment of injuries in college cheerleading: distribution, frequency, and associated factors. Br J Sports Med. 2005;39(4):237240. PubMed ID: 15793095 doi:10.1136/bjsm.2004.014605

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Kirialanis P, Malliou P, Beneka A, Gourgoulis V, Giofstidou A, Godolias G. Injuries in artistic gymnastic elite adolescent male and female athletes. J Back Musculoskeletal Rehabil. 2002;16(4):145151. doi:10.3233/BMR-2002-16405

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Garrick JG, Requa RK. The epidemiology of foot and ankle injuries in sports. Clin Sports Med. 1988;7(1):2936. PubMed ID: 2900695

  • 28.

    Attenborough AS, Sinclair PJ, Sharp T, et al. The identification of risk factors for ankle sprains sustained during netball participation. Phys Ther Sport. 2017;23:3136. PubMed ID: 27665248 doi:10.1016/j.ptsp.2016.06.009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Waddington GS, Adams RD. The effect of a 5-week wobble-board exercise intervention on ability to discriminate different degrees of ankle inversion, barefoot and wearing shoes: a study in healthy elderly. J Am Geriatr Soc. 2004;52(4):573576. PubMed ID: 15066073 doi:10.1111/j.1532-5415.2004.52164.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Cain MS, Garceau SW, Linens SW. Effects of a 4-week biomechanical ankle platform system protocol on balance in high school athletes with chronic ankle instability. J Sport Rehabil. 2017;26(1):17. PubMed ID: 27632846 doi:10.1123/jsr.2015-0045

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Wright CJ, Arnold BL, Ross SE, Linens SW. Recalibration and validation of the Cumberland ankle instability tool cutoff score for individuals with chronic ankle instability. Arch Phys Med Rehabil. 2014;95(10):18531859. PubMed ID: 24814563 doi:10.1016/j.apmr.2014.04.017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Han J, Anson J, Waddington G, Adams R. Proprioceptive performance of bilateral upper and lower limb joints: side-general and site-specific effects. Exp Brain Res. 2013;226(3):313323. PubMed ID: 23423167 doi:10.1007/s00221-013-3437-0

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Sainburg RL. Evidence for a dynamic-dominance hypothesis of handedness. Exp Brain Res. 2002;142(2):241258. PubMed ID: 11807578 doi:10.1007/s00221-001-0913-8

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Sainburg RL. Convergent models of handedness and brain lateralization. Front Psychol. 2014;8(5):1092. PubMed ID: 25339923 doi:10.3389/fpsyg.2014.01092

    • Search Google Scholar
    • Export Citation
  • 35.

    Han J, Waddington G, Anson J, Adams R. Level of competitive success achieved by elite athletes and multi-joint proprioceptive ability. J Sci Med Sport. 2015;18(1):7781. doi:10.1016/j.jsams.2013.11.013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Steinberg N, Waddington G, Adams R, Karin J, Tirosh O. The effect of textured ballet shoe insoles on ankle proprioception in dancers. Phys Ther Sport. 2016;17:3844. PubMed ID: 26563491 doi:10.1016/j.ptsp.2015.04.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Rein S, Fabian T, Zwipp H, Rammelt S, Weindel S. Postural control and functional ankle stability in professional and amateur dancers. Clin Neurophysiol. 2011;122(8):16021610. PubMed ID: 21435946 doi:10.1016/j.clinph.2011.01.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Perrin P, Deviterne D, Hugel F, Perrot C. Judo, better than dance, develops sensorimotor adaptabilities involved in balance control. Gait Posture. 2002;15(2):187194. PubMed ID: 11869913 doi:10.1016/S0966-6362(01)00149-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Horstmann T, Mundermann A, Rapp W. Reduced lower leg muscle activity while balancing on cobblestone shaped surfaces. Gait Posture. 2015;41(2):562567. PubMed ID: 25593008 doi:10.1016/j.gaitpost.2014.12.017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Lubetzky AV, McCoy SW, Price R, Kartin D. Response to tendon vibration questions the underlying rationale of proprioceptive training. J Athl Train. 2017;52(2):97107. PubMed ID: 28125270 doi:10.4085/1062-6050-52.1.06

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Verhagen E, van der Beek A, Twisk J, Bouter L, Bahr R, van Mechelen W. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med. 2004;32(6):13851393. PubMed ID: 15310562 doi:10.1177/0363546503262177

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Mohammadi F. Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players. Am J Sports Med. 2007;35(6):922926. PubMed ID: 17379918 doi:10.1177/0363546507299259

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Witchalls JB, Newman P, Waddington G, Adams R, Blanch P. Functional performance deficits associated with ligamentous instability at the ankle. J Sci Med Sport. 2013;16(2):8993. PubMed ID: 22743237 doi:10.1016/j.jsams.2012.05.018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Muaidi QI, Nicholson LL, Refshauge KM, Adams RD, Roe JP. Effect of anterior cruciate ligament injury and reconstruction on proprioceptive acuity of knee rotation in the transverse plane. Am J Sports Med. 2009;37(8):16181626. PubMed ID: 19439759 doi:10.1177/0363546509332429

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Simon J, Hall E, Docherty C. Prevalence of chronic ankle instability and associated symptoms in university dance majors: an exploratory study. J Dance Med Sci. 2014;18(4):178184. PubMed ID: 25474297 doi:10.12678/1089-313X.18.4.178

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Witchalls J, Waddington G, Blanch P, Adams R. Ankle instability effects on joint position sense when stepping across the active movement extent discrimination apparatus. J Athl Train. 2012;47(6):627634. PubMed ID: 23182010 doi:10.4085/1062-6050-47.6.12

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Pourkazemi F, Hiller C, Raymond J, Refshauge K. Perceived ankle instability is not related to ankle joint position sense, movement detection and inversion/eversion peak power: an observational study. J Foot Ankle Res. 2012;5(suppl 1):52. doi:10.1186/1757-1146-5-S1-O52

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48.

    de Noronha M, Refshauge KM, Kilbreath SL, Crosbie J. Loss of proprioception or motor control is not related to functional ankle instability: an observational study. Aust J Physiother. 2007;53(3):193198. PubMed ID: 17725477 doi:10.1016/S0004-9514(07)70027-2

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 6225 1206 77
Full Text Views 205 44 4
PDF Downloads 201 51 5