Clinical Health Updates

Balance exercise program prevents ankle sprains

Clinical Question:
Are balance exercises more effective at preventing ankle sprains than traditional strength and conditioning exercises among high school athletes?

Bottom Line:
A balance training program will significantly reduce the risk of ankle sprains in high school soccer and basketball players.

McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med 2006;34:1103-1111.

Study Design:
Randomized controlled trial (nonblinded)

These researchers conducted a cluster randomized trial in which 55 high school soccer and basketball teams (523 girls, 242 boys) were randomized to either their usual strength and conditioning program or to a 5-phase balance program. Phases 1-4 each lasted 1 week and were completed prior to the start of their season. The fifth phase was a maintenance phase in which subjects performed the exercises 3 times each week for 10 minutes throughout the competitive season. The program began with open-eye training on the floor and increased in complexity, ending with closed-eye exercises on a balance board. Since the rate of ankle sprains is a function of exposures, the athletic trainers at the schools tracked all coach-directed competition, practice, or conditioning sessions. In addition to measuring the rate of ankle sprains (assessed via intention to treat), they determined severity on the basis of the number of days lost to sports: minor (1-7 days); moderate (8-21 days); severe (more than 21 days). To return to play, injured athletes needed: (1) approval by the athletic trainer and physician; (2) full ankle strength and pain-free range of motion; and (3) the ability to complete a series of functional activities similar to the demands of his or her individual sport. The intervention group sustained fewer sprains (6.1%, 1.13 per 1000 exposures) than the control group (9.9%, 1.87 per 1000 exposures). One would need to treat 26 high school soccer and basketball players with this program to prevent 1 sprain per season. The authors report that the program was more effective in preventing sprains in athletes with prior sprains, however, the study was not powerful enough to determine if the program was also effective in the primary prevention of sprains. There was no statistically significant difference in sprain severity, but the study lacked the power for this to be conclusive.