The Effect of Proprioceptive Training on Directional Dynamic Stabilization

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $74.00

1 year subscription

USD  $99.00

Student 2 year subscription

USD  $141.00

2 year subscription

USD  $185.00

Objectives: Significant loss of playing time and the impact of treatment costs due to lower limb injury in football demonstrates a need for improved protocols for injury risk reduction. The aim of the present study is to assess the effect of a proprioceptive training program on the lower limb dynamic stability of elite footballers. Methods: A total of 16 elite premier league footballers were randomly allocated by matched pair design to a 8-week proprioception training group (group A, n = 8) or nontraining group (group B, n = 8), to determine the effect of this training over a 16-week period. Group A completed 8 weeks of bilateral proprioceptive training, 5 times per week for 10 minutes. The Biodex Stability System measures of overall stability index, anterior–posterior (A–P), and medial–lateral stability (M–L) at levels 8-6-4-1 were taken for both groups at baseline, 4, 8, and 16 weeks. Main effects of time, level of stability, and direction of stability were determined, with comparisons of effect made between the 2 groups. Results: The training group displayed significant differences for multidirectional stability at week 8 (P ≤ .05). The A–P stability within the training group displayed significant differences between baseline measures and 16 weeks (P > .05), with significant increases in scores displayed for M–L and A–P stability between weeks 8 and 16 (P ≤ .05), representing a detraining effect. No significant differences were detected at any time point for the nontraining group (P > .05). Conclusions: Proprioceptive training over 8 weeks has a positive effect on all directions of stability. Greater declines in A–P stability were evident at 16 weeks when compared with M–L and overall stability index. Consideration must be given to the increased stability scores presented pretesting for A–P when compared with M–L. Findings of this work present implications for training design.

Rhodes is with the Institute of Coaching and Performance, University of Central Lancashire, Preston, Lancashire, United Kingdom. Leather, Birdsall, and Alexander are with the School of Sport and Health Sciences, University of Central Lancashire, Preston, Lancashire, United Kingdom.

Rhodes (Drhodes2@uclan.ac.uk) is corresponding author.
  • 1.

    Rahnama N, Reilly T, Less A. Injury risk associated with playing actions during competitive soccer. Br J Sports Med. 2002;36:354359. PubMed ID: 12351333 doi:

  • 2.

    Arnason A, Sigurdsson SB, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Risk factors for Injuries in football. Am J Sports Med. 2004;32:516. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Ekstrand J, Krutsch W, Spreco A, van Zoest W, Roberts C, Meyer T, Bengtsson H. Time before return to play for the most common injuries in professional football: a 16-year follow-up of the UEFA Elite Club Injury Study. Br J Sports Med. 2020;54:421426. PubMed ID: 31182429 doi:

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

    Leventer L, Eek F, Hofstetter S, Lames M. Injury patterns among elite football players: a media based analysis over 6 seasons with emphasis on playing position. Int J Sports Med. 2016;37:898908. PubMed ID: 27467906 doi:

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

    Ekstrand J. Keeping your top players on the pitch: the key to football medicine at a professional level. Br J Sports Med. 2013;47:723724. doi:

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

    Walden M, Hagglund M, Magnusson H, Ekstrand J. ACL injuries in men’s professional football: a 15 year prospective study on time trends and return to play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. Br J Sports Med. 2016;50:744750. PubMed ID: 27034129 doi:

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

    Hawkins RD, Fuller CW. A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med. 2001;33:196203. doi:

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

    Woods C, Hawkins R, Maltby S, Hulse M, Thomas A, Hodson A. The football association medical research programme: an audit of injuries in professional football– analysis of hamstring injuries. Br J Sports Med. 2004;38:3641. PubMed ID: 14751943 doi:

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

    Walden M, Hagglund M, Ekstrand J. Time-trends and circumstances surrounding ankle injuries in men’s professional football: an 11 year follow up of the UEFA Champions League Injury Study. Br J Sports Med. 2013;47:748753. PubMed ID: 23813486 doi:

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

    Wikstrom EA, Hubbard-Turner T, McKeon PO. Understanding and treating lateral ankle sprains and their consequences. Sports Med. 2013;43:385393. PubMed ID: 23580392 doi:

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

    Von Porat A, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. 2004;63:269273. PubMed ID: 14962961 doi:

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

    Ekstrand J, Hagglund M, Walde M. Epidemiology of muscle injuries in professional football (Soccer). Am J Sports Med. 2011;39:12261232. PubMed ID: 21335353 doi:

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

    Croix MBA, Elnagar YO, Iga J, James D, Ayala F. electromechanical delay of the hamstrings during eccentric muscle actions in males and females: implications for non-contact ACL injuries. J Electro Kinesiol. 2015;25:901906. doi:

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

    McHugh MP, Tyler TF, Mirabella MR. The effectiveness of a balance training intervention in reducing the incidence of non-contact ankle sprains in high school football players. Am J Sports Med. 2007;35:12891294. PubMed ID: 17395956 doi:

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

    Gioftsidou A, Malliou P, Pafis G, Beneka A, Tsapralis K, Sofokleous P, Kouli O, Roka S, Godolias G. Balance training programs for soccer injuries prevention. J Hum Sport Exerc. 2012;7:639647. doi:

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

    Hertel J. Functional instability following lateral ankle sprain. Sports Med. 2000;29:361371. PubMed ID: 10840868 doi:

  • 17.

    Lephart SM, Kocher MS, Fu FH, Borsa PA, Harner CD. Proprioception following anterior cruciate ligament reconstruction. J Sport Rehabil. 1992;1:188196. doi:

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

    Haidary M. Effects of proprioception exercises in the rehabilitation process of football players after arthroscopic surgery anterior cruciate ligament (ACL). J Sport Biomech. 2017;3:1525.

    • Search Google Scholar
    • Export Citation
  • 19.

    Witchalls J, Turnbull M, Pacecca E. A neuromuscular training programme for reduction of leg injury risk in netball: improving those at greater risk. J Sci Med Sport. 2014;18:e132135. doi:

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

    Ribeiro F, Venancio J, Quintas P, Oliveira J. The effect of fatigue on knee position sense is not dependent on the muscle group fatigued. Muscle Nerve. 2010;44:217220. doi:

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

    Thomas AC, McLean SG, Palmieri-Smith RM. Quadriceps and hamstrings fatigue alters hip and knee mechanics. J App Biomech. 2010;26:159170. doi:

  • 22.

    López-Valenciano A, Ayala F, De Ste Croix M, Barbado D, Vera-Garcia F. Different neuromuscular parameters influence dynamic balance in male and female football players. Knee Surg Sports Traumatol Arthrosc. 2019;27:962970. PubMed ID: 30088029 doi:

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

    Hosseini S, Hejazi K, Abbasian S, Khazaie M, Azimkhani A. Effect of fatigue protocol on dynamic balance in soccer players with functional ankle instability. Aust J Basic Appl Sci. 2013;7:468472.

    • Search Google Scholar
    • Export Citation
  • 24.

    Pickerill ML, Harter RA. Validity and reliability of limits-of-stability testing. A comparison of 2 postural stability devices. J Athl Train. 2011;46:600606. PubMed ID: 22488184 doi:

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

    Blonc S, Perrot S, Racinais S, Aussepe S, Hue O. Effects of 5 weeks of training at the same time of day on the diurnal variations of maximal muscle power performance. J Strength Cond Res. 2010;24:2329. PubMed ID: 19966592 doi:

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

    Malhorata D, Narula R, Zutshi K. Effect of time of day and concentric or eccentric strength training on muscle strength. Indian J Physiother Occup Ther. 2014;8:134138. doi:

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

    Schmitz K, Arnold B. Intertester and intratester reliability of the biodex stability system. J Sport Rehabil. 1998;7:95101. doi:

  • 28.

    Franklin S, Grey MJ, Heneghan N, Bowen L, Li FX. Barefoot vs common footwear: a systematic review of kinematic, kinetic and muscle activity differences during walking. Gait Posture. 2015;42:230239. PubMed ID: 26220400 doi:

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

    Arifin N, Abu Osman NA, Wan Abas WA. Intrarater test-retest reliability of static and dynamic stability indexes measurement using the biodex stability system during unilateral stance. J Appl Biomech. 2014;30:300304. PubMed ID: 23878204 doi:

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

    Herda TJ, Cramer JT, Ryan ED, McHugh MP, Stout JR. Acute effects of static versus dynamic stretching on isometric peak torque, electromyography, and mechanomyography of the biceps femoris muscle. J Strength Cond Res. 2008;22:809817. PubMed ID: 18438236 doi:

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

    Cohen J. Statistical Power Analysis for the Behavioural Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

  • 32.

    McCall A, Dupont G, Ekstrand J. Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA elite club injury study teams: a survey of teams head medical officers. Br J Sports Med. 2015;50:725730. doi:

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

    Whitaker JL, Emery CA. Impact of the FIFA 11+ on the structure of select muscles in adolescent female soccer players. Phys Ther Sport. 2015;16:228235. doi:

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

    Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000;23:573578. PubMed ID: 10875418 doi:

  • 35.

    Fauno P, Wulff Jakobsen B. Mechanism of ACL injuries in soccer. Int J Sports Med. 2006; 27:7579. PubMed ID: 16388446 doi:

  • 36.

    Letafatkar K, Alizadeh MH, Kordi MR. The effect of exhausting exercise induced muscular fatigue on functional stability. J Social Sci. 2009;4:416422. doi:

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

    Cordeiro N, Cortes N, Fernandes O, Diniz A, Pezarat-Correia P. Dynamic knee stability and ballistic knee movement after ACL reconstruction: an application on instep soccer kick. Knee Surg Sports Traumatol Arthrosc. 2014;23:11001106. PubMed ID: 24519621 doi:

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

    Hogervorst T, Brand RA. Current concepts review: mechanoreceptors in joint function. J Bone Joint Surg. 1998;80:13651378. doi:

  • 39.

    Lee B, Min K, Choi HS, Kwon SW, Chun D, Yun ES, Lee DW, Jin SY, Yoo JH. Immunohistochemical study of mechanoreceptors in the tibial remnant of ruptured anterior cruciate ligament in human knees. Knee Surg Sports Traumatol Arthrosc. 2009;17:10951101. PubMed ID: 19533097 doi:

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

    Dhillon MS, Bali K, Prabhaker S. Proprioception in anterior cruciate ligament deficient knees and its relevance in anterior cruciate ligament reconstruction. Indian J Orthop. 2011;45:294300. PubMed ID: 21772620 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 687 687 91
Full Text Views 3 3 1
PDF Downloads 3 3 1