Balance Training Programs in Athletes – A Systematic Review

Open access

Abstract

It has become almost routine practice to incorporate balance exercises into training programs for athletes from different sports. However, the type of training that is most efficient remains unclear, as well as the frequency, intensity and duration of the exercise that would be most beneficial have not yet been determined. The following review is based on papers that were found through computerized searches of PubMed and SportDiscus from 2000 to 2016. Articles related to balance training, testing, and injury prevention in young healthy athletes were considered. Based on a Boolean search strategy the independent researchers performed a literature review. A total of 2395 articles were evaluated, yet only 50 studies met the inclusion criteria. In most of the reviewed articles, balance training has proven to be an effective tool for the improvement of postural control. It is difficult to establish one model of training that would be appropriate for each sport discipline, including its characteristics and demands. The main aim of this review was to identify a training protocol based on most commonly used interventions that led to improvements in balance. Our choice was specifically established on the assessment of the effects of balance training on postural control and injury prevention as well as balance training methods. The analyses including papers in which training protocols demonstrated positive effects on balance performance suggest that an efficient training protocol should last for 8 weeks, with a frequency of two training sessions per week, and a single training session of 45 min. This standard was established based on 36 reviewed studies.

Introduction

It has become almost routine practice to incorporate balance exercises into training programs for athletes from different sports, fall prevention programs for the elderly and rehabilitation programs. The objectives and benefits seem obvious, e.g., performance improvement and injury prevention as commonly cited goals (Hrysomallis 2011; Kümmel et al., 2016; Lesinski et al., 2015). However, the type of training that is most efficient still remains unclear, and the frequency, intensity and duration of exercise that would be most beneficial have not yet been determined. The main goal of this review was to establish whether a gold standard of balance training exists in this field.

Posture and balance control are fundamental in daily life to safely accomplish any type of movement and motor task that involves displacement of body segments or the entire body. Balance is the process of maintaining the body’s center of gravity (CoG) vertically over the base of the support, and it relies on rapid and continuous feedback from visual, vestibular and somatosensory structures for the subsequent execution of smooth and coordinated neuromuscular actions (Winter, 1995; Zatsiorsky and Duarte, 1999). Efficient postural balance not only reduces the risk of body imbalance, fall, or subsequent injuries, but also contributes to the optimization of motor performance in a number of athletic disciplines (Hrysomallis, 2007; McGuine et al., 2000; Watson, 1999).

Each sport involves specific motor skills that require the completion of particular postures and movements (Hrysomallis et al., 2006; Maurer et al., 2006; Paillard, 2017). Balance is an important factor in many athletic skills, but the relationship between sports competition results and balance is not yet fully understood (Adlerton et al., 2003; Hrysomallis, 2011). A lower level of balance is associated with injuries, such as sprains and, muscle, tendon and ligament strains among others (McGuine et al., 2000; Emery and Meeuwisse, 2010; Eils et al., 2010). Maintaining a standing posture on a stable surface is a major determinant of balance. A sway analysis in a simple task, such as quiet standing, is used as a variable of its description (Visser et al., 2008; Duarte and Freitas, 2010). However, controversy exists in the literature regarding the influence of balance training on athletes’ performance and balance improvement, as well as injury prevention.

Literature search

The following review is based on papers that were found through computerized searches of PubMed and SportDiscus from 2000 to 2016. There is no general consensus in the literature regarding what to call training programs and exercise, therefore, we searched for various terms of training programmes. Based on a Boolean search strategy, consistent with previous meta-analyses on the effects of balance training (Kümmel et al., 2016; Lesinski et al., 2015; Zemková 2014), the following search terms were (individually or in various combinations) used: “balance training” OR “proprioceptive training” OR “core stability training” OR “injury prevention”, OR “postural control” AND “injury prevention” AND “sport” OR “athletes” OR “basketball” OR “baseball” OR “volleyball” OR “football” OR “soccer” OR “handball” OR “tennis” OR “ski” OR “runners” OR “judo” OR “taekwondo” OR “capoeira” OR “figure skating” OR “bicycling”. The search was limited to English language and full-text original articles.

Study selection

Only the studies that met the following criteria were included: (1) the participants of an intervention and a control group had to be healthy at the time of the study, (2) the study subjects were in an age range of 7-30 years old, (3) balance tests were performed before and after the intervention programs. Studies were excluded if (1) they did not meet the criteria for CTs (Control Trials), (2) the PEDro scale was lower than four (Table 3), or (3) balance training was not described in detail. We made an exception for the four papers (PEDro 3) because of the better quality description of training protocols. The reviewers conducted the literature review independently, based on inclusion and exclusion criteria. In total, 50 studies met the inclusion criteria for review (Figure 1).

Figure 1
Figure 1

A flowchart illustrating the different phases of the search and study selection

Citation: Journal of Human Kinetics 58, 1; 10.1515/hukin-2017-0088

Balance training

Training methods

No general agreement may be found in the literature regarding which terms should be used to summarize training programs that aim at the improvement of postural stability (Kümmel, Kramer, Giboin, Gruber, et al., 2016). Some authors (Verhagen et al., 2005; Cumps et al., 2007; Kachanathu et al., 2014; Hammami et al., 2016) described balance or core stability exercises in their training programs. Others (Benis et al., 2016; Hammami et al.; Malliou et al., 2004; 2016; Pau et al., 2012; Verhagen et al., 2002; Zech et al., 2010) described neuromuscular or proprioceptive training and included multi-intervention programs with a combination of balance, strength, plyometric, and sport-specific exercises. Some authors describe the implemented exercises as balance training (Verhagen et al., 2005; Gioftsidou et al., 2006), and others call it sensorimotor training (Heleno et al., 2016; Pauet al., 2011), neuromuscular training (Zech et al., 2014; Benis et al., 2016) or proprioceptive training (Eils et al., 2010; Malliou et al., 2004; Mandelbaum et al., 2005). However, the most common term used seems to be balance training. Therefore, as in other systematic reviews (Kümmel et al., 2016), we use the term “balance training” to describe any training program primarily directed at the improvement of postural stability, regardless of the term used in the studies. Each of the training program described above presents a large variety of exercises. The balance training interventions consisted of balance exercises on both a stable and unstable surface, with or without recurrent destabilization during performance (Cumps et al., 2007; Hübscher et al., 2010; McHugh et al., 2007; Soderman et al., 2000; Verhagen et al., 2002, 2005; Zech et al., 2010). In some studies, training programs also included exercises with visual feedback (Malliou et al., 2004).

Frequently, studies that examined neuromuscular or proprioceptive training interventions similar to balance training included balance exercises on stable and unstable platforms with or without perturbations of postural control (Hübscher et al., 2010; Zech et al., 2010). Some authors also described neuromuscular training as multi-intervention programs with a combination of balance, weight, plyometric and sport-specific agility drills to address all aspects of neuromuscular control (Holm et al., 2004; Hübscher et al., 2010; Mandelbaum et al., 2005; Myer et al., 2009). In some papers, the authors implemented plyometric training alone to improve balance or combined it with balance exercises (Asadi et al., 2015; Manolopoulos et al., 2015; Myer et al., 2006; Pfile et al., 2013, 2016).

Balance assessment

To assess static and dynamic balance, some researchers used clinical and laboratory tests. Balance tests were performed before and after an intervention program. In some reports, also strength, aerobic endurance and specific performance were assessed (Hammami et al., 2016; Imai et al., 2014; Kang et al., 2013; Manolopoulos et al., 2015; Myer et al., 2006).

Static balance was evaluated using simple tests such us the stork test (Daneshjoo et al., 2012; Hammami et al., 2016) or the single leg stance (SLS) test (Dobrijević et al., 2016; Kang et al., 2013; Karami et al., 2014). These tests require the participants to keep their hands on the hips and maintain the foot of their non-tested leg at the knee level with their eyes open or closed. The participants attempted the task a few times, and the best scores were recorded for further analysis. More sophisticated procedures were performed on a force plate (FP) which can monitor the movement of the center of pressure (COP). Different variables derived from the path of the COP during the single leg stance test (Ahmadabadi et al., 2015; Malliou et al., 2004; Saunders et al., 2013), the quiet standing (QS) test (Cankaya et al., 2015; Pau et al., 2011; Steib et al., 2016) or the limit of stability (LOS) test (Mahieu et al., 2006; Romero-Franco et al., 2012) have been used as measures of balance. A balance assessment can also be conducted on an unstable surface. One example is a kinesthetic ability trainer (KAT) (Holm et al., 2004). The KAT consists of an electronic moveable platform that is supported by a small pivot at its central point. The stability of the platform is controlled by pressure that varies in a circular pneumatic bladder between the platform and the base of the unit. High pressure indicates an inflated platform (stable), while low pressure a deflated platform (unstable). An unstable surface makes the balance test more dynamic and possibly more applicable in a sports context.

Dynamic balance was assessed by the Balance Error Scoring System (BESS) (Imai et al., 2014; Mcleod et al., 2009), the Star Excursion Balance Test (SEBT) (Eisen et al., 2010; Filipa et al., 2012; Sato and Mokha, 2009) and the Y-Balance Test (YBT) (Trecroci et al., 2015; Benis et al., 2016; Hammami et al., 2016). The BESS consists of 6 separate 20 s balance tests that the subjects perform in different stances and on different surfaces. The test comprises 3 stance conditions (double-leg, single-leg, and tandem stance) and 2 surfaces (firm and foam). All trials are performed with the eyes closed (Finnoff et al., 2009). Errors are recorded as the quantitative measurement of postural stability under different testing conditions. Another test, originally described by Gray (Gray, 1995) as a rehabilitation tool, the SEBT, is a series of single-limb squats using the non-stance limb to perform maximal reach in order to touch a point along 1 of 8 designated lines on the ground. The lines are arranged in a grid that extends from a center point and are 45° from one another. The reach distances are normalized to leg length. The YBT, was inspired by clinical applications of the SEBT (Coughlan et al., 2012). The participants push the reach-indicator block with one foot in the anterior, posteromedial and posterolateral directions while standing on the other foot on a central footplate. Some researchers used the Modified Star Excursion Balance Test (MSEBT), where the subjects performed movements in the same directions as in the YBT (Zech et al., 2014; Heleno et al., 2016). Dynamic balance was also evaluated by a jumping test. For example, Heleno et al. (2016) conducted the Side Hop Test (SHT) with lateral jumps, and the Figure Eight Test (F8) using forward jumps with rotation. O’Malley et al. (2016) used the Landing Error Scoring System (LESS). The LESS identifies poor jump-landing techniques, such as decreased knee and hip flexion motion, knee valgus, and hip internal rotation, which can cause greater joint loading. Zech et al. (Zech et al., 2014) assessed the time to stabilization (TTS) following single-leg jump landing.

To assess proprioception and the stability of the upper and lower limbs, the isokinetic dynamometer (ID) was used to evaluate joint position sense (Daneshjoo et al., 2012).

Equipment and exercises

We found that there were numerous balance exercises that effectively improve static and dynamic balance. Training methods included exercises on stable and unstable surfaces in anterior/posterior and mediolateral directions, with or without recurrent destabilization (e.g., ball throwing or catching, strengthening exercises, or external perturbation applied by a partner) (Cumps et al., 2007; DiStefano et al., 2009; Hübscher et al., 2010; McHugh et al., 2007; Paillard, 2017; Soderman et al., 2000; Verhagen et al., 2002, 2005; Zech et al., 2010). The balance training programs typically included progression of the exercises. In some studies, balance exercises were performed first with the eyes open and then with the eyes closed in order to increase the difficulty (Hammami et al., 2016; Heleno et al., 2016; McGuine and Keene, 2006; Verhagen et al., 2005). Additionally, the balance training programs included transitions from a double-leg stance to a single-leg stance (Gioftsidou et al., 2006; O’Malley et al., 2016; Pau et al., 2011) on a stable or unstable surface (Eisen et al., 2010; Manolopoulos et al., 2015; Steib et al., 2016).

Occasionally, the authors also used exercises with visual feedback, such as moving a cursor to a target by shifting the weight (Malliou et al., 2004) or maintaining a single-leg stance on a board (Gioftsidou et al., 2006). For these types of exercises, the Biodex Stability System was used. In the studies, wobble boards that allow for multiplanar movement ( Eisen et al., 2010; Holm et al., 2004; Hrysomallis, 2007; Soderman et al., 2000), tilt boards permitting uniplanar movement (Dobrijević et al., 2016; Hrysomallis, 2007), BOSUs (Myer et al., 2006; Romero-Franco et al., 2012), foam mats (McHugh et al., 2007), inflated rubber discs (Saunders et al., 2013) and Swiss balls ( Kang et al., 2013; Sato and Mokha, 2009) were frequently used. These devices were used for different movements such as tilting, rotating, squatting, hopping, jumping, throwing and catching a ball (Eisen et al., 2010; Daneshjoo et al., 2012; Myer et al., 2006; Soligard et al., 2008). These activities were also combined with resistance exercises while balancing (Filipa et al., 2012; Petersen et al., 2005; Romero-Franco et al., 2012). In some papers, the authors implemented plyometric training alone to improve balance or combined plyometric training with balance exercises. These exercises emphasized jumping movements with feedback regarding technical performance and proper limb alignment (Asadi et al., 2015; Manolopoulos et al., 2015; Myer et al., 2006; Pfile et al., 2013, 2016). The plyometric exercises consisted of athletic positions, squat jumps, line jumps, bounding in place, and box drops, among others (Asadi et al., 2015; Myer et al., 2006). Core stability training was also used to improve balance. Some authors understood core exercises as bracing the abdominal muscles with low intensity limb movements (Kachanathu et al., 2014); however, most authors applied global training of larger superficial muscles around the abdominal and lumbar regions (Filipa et al., 2012; Iacono et al., 2014; Lust et al., 2009; Myer et al., 2006; Sato and Mokha, 2009). Core stability training included front planks, side planks, back bridges, quadruped exercises and exercises on a Swiss ball.

The influence of balance training on balance in various sport disciplines

The most widely studied disciplines were soccer (Cankaya et al., 2015; Daneshjoo et al., 2012; Gioftsidou et al., 2006; Imai et al., 2014), basketball (Asadi et al., 2015; Benis et al., 2016; Mcleod et al., 2009; Pfile et al., 2016) and handball (Holm et al., 2004; Karadenizli, 2016a, 2016b; Steib et al., 2016). The majority of the studies revealed significant differences between the groups after the interventions (Asadi et al., 2015; Daneshjoo et al., 2012; Kachanathu et al., 2014; Mcleod et al., 2009; O’Malley et al., 2016; Pfile et al., 2016; Steib et al., 2016). However, a few publications were found that did not show any significant influence of balance training on balance in various sport disciplines (Benis et al., 2016; Eisen et al., 2010; Sato and Mokha, 2009; Zech et al., 2014).

The influence of balance training on balance in various sport disciplines

The most widely studied disciplines were soccer (Cankaya et al., 2015; Daneshjoo et al., 2012; Gioftsidou et al., 2006; Imai et al., 2014), basketball (Asadi et al., 2015; Benis et al., 2016; Mcleod et al., 2009; Pfile et al., 2016) and handball (Holm et al., 2004; Karadenizli, 2016a, 2016b; Steib et al., 2016). The majority of the studies revealed significant differences between the groups after the interventions (Asadi et al., 2015; Daneshjoo et al., 2012; Kachanathu et al., 2014; Mcleod et al., 2009; O’Malley et al., 2016; Pfile et al., 2016; Steib et al., 2016). However, a few publications were found that did not show any significant influence of balance training on balance in various sport disciplines (Benis et al., 2016; Eisen et al., 2010; Sato and Mokha, 2009; Zech et al., 2014).

The majority of the study interventions used full training units (Dobrijević et al., 2016; Filipa et al., 2012; Hewett et al., 1999; Kachanathu et al., 2014; Myer et al., 2006), but several authors applied balance training only as a warm-up (Ahmadabadi et al., 2015; Holm et al., 2004; O’Malley et al., 2016; Trecroci et al., 2015). Among the various exercise types, balance training and neuromuscular training (Eisen et al., 2010; Kang et al., 2013; Verhagen et al., 2005; Matin et al., 2014) were most commonly incorporated, followed by plyometric exercises and core stability training (Asadi et al., 2015; Karadenizli, 2016a, 2016b; Lust et al., 2009; Sato and Mokha, 2009).

To assess static balance, the authors mostly applied the SLS test (n = 18) with 13 studies that used measurements conducted on a force plate. The most common procedure was the QS test (n = 16), and the LOS test was used twice. In the analyzed studies, the researchers mainly relied on the SEBT (n = 13), YBT (n = 4) and BESS (n = 2) to assess dynamic balance. Although the SEBT was the most popular in these studies, at least two difficulties accompanied this procedure. In many cases, the SEBT was assessed only in three directions that corresponded to the YBT (Filipa et al., 2012; Imai et al., 2014; Heleno et al., 2016). In addition, in several studies, the results were presented as composite reach scores (Daneshjoo et al., 2012; Eisen et al., 2010; Pfile et al., 2016). Therefore, even if the differences reached significance, it was not possible to ascertain the direction in which the improvement occurred. The detailed characteristics of the training protocols and tested tasks are shown in Table 1.

Table 1

Influence of balance training on balance in various sports disciplines

Subjects
Training Modality
ReferenceN/SexAge (years)Status TrainingDisciplineD (min)F (n/week)T (week)Training TypeDevice + ProcedureConclusions
Lust et al. (2009)IG:open20.00 ± 1.54NRbaseball30-4536CSTno device,The OKC/CKC/CS
kinetica single testgroup and the
chain/closedconsisted of aOKC/CKC group
kinetic chaincontinuousdemonstrated
(OKC/CKC):alternatingsignificantly
12M, openprocedure togreater scores than
kinetic chain/lift one handthe control group
closed kineticto touch theafter training.
chain/coreline then lift
stabilitythe other
(OKC/CKC/CShand to touch
): 13Mthe line for 15
CG: 15Ms
Asadi et al. (2015)IG (PLT): 8 MIG (PLT): 20.1 ±amateurbasketball3026PLTSEBTAfter a 6-week
CG0.8training period,
(Basketball): 8CG : 20.5 ± 0.3the PLT + BT
Mgroup showed
significant
improvements in
all directions,
whereas the
basketball group
did not show any
significant
changes.
Benis et al. (2016)IG: 14 FIG: 20 ± 2nationalbasketball3028NMTYBTImprovement over
CG: 14 FCG: 20 ± 1leaguebaseline scores
playerswas noted in the
practicing 4posteromedial and
times a weekposterolateral
for 2 hoursreach directions
and in the
composite YBT
scores of the
experimental
group. No
differences in
anterior reach
were detected in
either group.
Differences were
noted in
postintervention
scores for
posteromedial
reach and
composite scores
between the
experimental and
control groups.
McLeod et al. (2009)IG:37 FIG: 15.6 ± 1.1competitivebasketball9026NMTBESSTrained subjects
CG: 25 FCG: 16.0 ± 1.3(functionalSEBTscored
strengthensignificantly fewer
ing, PLT,BESS errors on the
agility BT)single-foam and
tandem-foam
conditions at the
posttest than the
control group and
demonstrated
improvements on
the single-foam
compared with
their pretest, the
authors found a
significant
decrease in total
BESS errors in the
IG at the posttest
compared with
their pretest and
the CG.
Imai et al. (2014)IG: 10 MIG: 16,5 ± 0,5highsoccerNR312CSTFP: SLS (EO,Significant
CG: 9 MCG: 16,1± 0,6school soccerEC) 20s/ 2xdifferences in the
club, practiceSEBTposterolat. and
six times perposteromed.directi
weekons between the
pre and post test.
Significantly lower
values of length of
COP between the
pre and post test.
Pfile et al. (2016)IG: 11 FIG: 19.40 ± 1.3511 Division Ibasketballabout26NMT+PLTSEBT-3The mean
women’s30directions x3composite reach
basketballLESSsignificantly
(Landingimproved over
error scoringtime. LESS scores
system)significantly
improved over
time
Saunders et al. (2013)IG:14 F14.7 ± 4.51 year offigure2036NMTFP: SLS 15No statistically
CG:12 Fcompetitionskatings/3x, SLL 15significant
experiences/3xdifferences
2h of on-icebetween the
practice per w.groups
Ahmadabadi et al. (2015)IG: 8 F9.62 ± 1.45more thangymnastics3034BTFP: QS (EO,A significant
CG: 8 Fthree years ofEC)increase in balance
athleticSLS – 30 sperformance, a
experiencesignificant increase
in dynamic and
static balance with
double feet
Dobrijević et al. (2016)IG: 33 F7-8recreationalgymnastics60212PTno deviceAfter
CG: 27FSLS (EO, EC)proprioceptive
time to losingtraining, the
balanceexperimental
group significantly
improved
performance in all
the tests for
maintaining a
balance position.
Holm et al. (2004)IG: 35 F23 (± 2.5)elite divisionhandballaboutmin. 3NRNMTBalance KATThere was a
14.9 (± 3.2)15during2000: SLSsignificant
years, 4.7 (±5-(right, left leg)improvement in
2.8) years at7weeksx3, 2-legdynamic balance
the top level1 duringdynamic testbetween test 1 and
experiencethex3test 2. The effect
10 to 11seasoncustom madeon dynamic
h/week - totaldevice:balance was
number ofassessment ofmaintained 1 year
hourskneeafter training. For
kinesthesiastatic balance, no
significant changes
were found. For
the other variables
measured, there
were no statistical
differences during
the study period.
Karadenizli (2016)IG: 16 F14.57 ± 0.923.66 ± 0.63handballNR210PLTFP: QS (EO,Significant
years sportEC), SLS – 30sdifferences were
experienceobserved between
Dynamicthe pre- and post-
Balance -test of plyometric
Slalom Test –education training
60 sof flexibility,
standing long
jump, left leg
ellipse
area at unipedal
static balance.
Verhagen et al. (2004)29 (F/M)IG: 22.5 ± 2.4second andvolleyballNR25.5BTFP: SLS, QSBalance training
IG: 10IG (volleyball):thirddid not lead to a
IG (volleyball):23.6 ± 3.2volleyballreduction in the
8CG: 25.5 ±7.8playerscentre of pressure
CG: 11excursion in a
general population
consisting of non-
injured and
previously injured
subjects.
Malliou et al. (2004)30 (IG: 15 M/F,19.3 ± 9noskiing204NRPTBBS: SLS 20No statistically
CG: 15 M/F)experiences/3x (right,significant
left leg)differences
between the
groups were
found.
Karadenizli et al. (2016)IG: 14 FIG:15.64 ± 0.823.5 years ofhandballNR210PLTFP: SLS (right,The IG made
CG: 12 FCG: 15.38 ± 0.92sportleft leg) – 30 ssignificantly
experiencegreater
improvements
than the CG in the
SLS (left).
Matin et al. (2014)IG: 12 M11.34 ± 3.68thefitness6034NMTSLS 3xNeuromuscular
CG: 12 MrepresentativeDynamic test:training can
physical(jumping) fiveenhance important
fitness teamscores werefactors of static
ofdedicated forand dynamic
thecovering thebalance and the
elementarymarkresults showed a
schoolsand fivesignificant increase
scores forin performance of
holding thethe individuals
balanceparticipating in
stance asneuromuscular
static for 5 straining.
Eisen et al. (2010)36 F/M18-22NRsoccer/basketNR34BTSEBTThere was no
IG (dynadisc):balldifference for each
12group
IG (rockerindividually, and
board): 12 CG:no difference
12between trained
and untrained legs
within a subject
Zech et al. (2014)IG: 15IG: 15.7 ± 3.9first regionalhockey20210NMTFP: 3x jump-All balance
CG: 15CG: 14.1 ± 1.4youthlanding timemeasures except
divisionstothe medial-lateral
stabilizationTTS improved
(TTS),significantly over
SLS 30 s/3xtime in both
(preferredgroups. Significant
leg)group by time
MSEBTinteractions were
BESSfound for the BESS
score. The IG
showed greater
improvements
after 10 weeks of
training in
comparison to the
CG.
Myer et al. (2006)IG (PLT): 8 FIG 15.9+/-0.8not less thanvoleyball9037IG: PLTFP: a single-The percentage
IG2 (CST+BT):IG2 15.6+/-1.24 years ofIG2:leg hop andchange from the
11 FexperienceCST+BTBT x3pretest to posttest
(randomizedin vertical ground
trials on eachreaction force was
side)significantly
different between
the PLT and
CST+BT groups
considering the
dominant side.
Romero-franco et al. (2012)IG: 16 MIG: 22.5 ± 5.12NRrunning3036PTFP: QS (EO,Significant
CG: 17 MCG: 21.18 ± 4.47EC) 2x52sdifferences were
BBS: EO 3x20found in stability
s, LOS in 8in the medial-
differentlateral plane with
directionsEO, gravity center
control in the right
direction and
gravity center
control in the back
direction after the
exercise
intervention in the
IG.
Sato and Mokha (2009)IG:12 F/MIG:37.75 ± 10.63recreationalrunningNR46CSTSEBTCST had no
CG: 8 F/MCG: 39.25 ±andsignificant
10.81competitiveinfluence on scores
measured by the
SEBT or any GRF
variables.
Mahieu et al. (2006)IG: 6 F, 11 M9-15competitiveskiing3036VTSMARTNo significant
CG: 8 F, 8 MBalancedifferences except
Master: LOS 8for directional
s/8x, rhythmiccontrol during the
weight shiftLOS and the left-
left /right,right excursion of
forward/backthe rhythmic
wardweight shift test
were found.
Cankaya et al. (2015)IG: athletes 2511NRsoccer4038BTFP: QS (EO,Balance
M, sedentary:EC),performance of the
25 MSLS – 30 sathletes and
CG: 25 Mclockwisesedentary group
rounds 5 x 60simproved
compared to the
CG.
Daneshjoo et al. (2012)CG: 12 M; IGCG: 19.7 ± 1.6professionalsoccer20-2536FIFA 11:ID: JPSBoth warm up
(FIFA 11): 12IG FIFA 11:(five yearBT + ST +SEBTprograms
M, IG19.2 ± 0.9experience ofPTStork Standimproved
(HarmoKnee):IG Ham oplayingHarm oBalance Testproprioception in
12 MKnee: 17.7 ± 0.4soccer atKnee: BT +the dominant leg
professionalST + CSTat 45° and 60° knee
level)flexion. Dynamic
balance assessed
by the SEBT also
showed
improvement in
both groups, with
the HarmoKnee
group showing
significant
difference when
compared to the
CG.
Iacono et al. (2014)IG: 10 MIG: 18.7 ± 0.67competitivesoccerNR45CSTFP: SLS (EO,CST significantly
CG: 10 MCG: 19 ± 0.63playersEC) – 3x20 simproved static
SEBTand dynamic
balance
Gioftsidou et al. (2006)39 (CG:13, IG -16 ± 1The youngsoccer20312BTBBS: SLS 20Significant
beforechampionships/3x (right,differences in the
appropriateof the firstleft leg)IG after training.
training: 13 M,Greek
IG – afterdivision
appropriate
training: 13)
Heleno et al. (2016)IG: 12 M14-16players withsoccerNR35SMTSLS,After a five-week
CG: 10 Ma minimumSide Hop Testtraining program,
of 3 years of(SHT),the intervention
trainingFigure ofgroup obtained
experience;Eight Testsignificant results
participation(F8)in the
in state andMSEBTF8, SHT and SEBT,
nationalas well as in the
competitions;following
training 5variables: area of
times a weekpressure of sway
center (COP),
mean velocity and mean frequency of
COP
Trecroci et al. (2015)IG: 12 M11.3 ± 0.70sub-elitesoccer1528BTYBTSignificantly
CG: 12 Mplayersgreater
improvements in
the YBT
Manolopoulos et al. (2015)IG: 20 (ST: 10ST: 21.3 ± 1.3amateursoccerNR28STFP: storkCOP (cm) in
MSMT: 22 ± 1.7ST + SMTstance, raiseanteriorposterior
SMT: 10 M)the heel offand mediolateral
the ground –axes decreased
5 ssignificantly after
training
Kachanathu et al. (2014)IG: 23 M18 ± 2NRsoccer60Phase-I:4CSTDoubleSignificant
CG: 23 M6Straight Limbdifferences
Phase-II:Lowering test:of dynamic
6x3 SEBT: 8balance and core
Phase-directions x3stability in the IG
III: 3compared to the
CG
Granacher et al. (2016)IG: 12 M12-13first divisionsoccerNR28BTStandingResults indicated
CG: 12 MTunisianPLTStork Test,that BT provided
YBTsignificantly
greater
improvements in
the YBT
Gioftsidou et al. (2012)IG1: 1322.7 ± 3.5first Greeksoccer20IG1: 6IG1: 3BTBBS: SLS 20 sBoth training
IG2: 13divisionIG2: 3IG2: 6x3 (each leg)groups
CG: 12Balancedemonstrated
board: SLSsignificant
time to loseimprovements on
balanceBiodex stability
tests. Similarly for
the balance board,
the results
revealed
significant
improvements for
both IGs.
Alyson et al. (2012)IG: 13 FIG: 15.4 ± 1.5competitivesoccer5028NMTSEBTAfter NMT,
CG: 7 FCG:14.7 ± 0.8subjects
demonstrated a
significant
improvement in
the SEBT score on
the right and left
limb.
O’Malley et al. (2016)IG: 41 MIG: 18.6 (18.4-teams were2 teams:1528GAA 15YBTThere was a
CG: 37 M18.8)required to1 football(GaelicLESSgreater reduction
CG: 18.3 (18.1-train at1 hurlingAthletic(Landingin mean LESS
18.5)least twiceAssociatioError Scoringscore in favour of
per week.n) trainingSystem)the IG post
programexercise training.
Clinically and
statistically
significant
improvements in
dynamic balance
and jump-landing
technique
occurred in
collegiate level
Gaelic football and
hurling players.
Pau et al. (2012)IG: 13 FIG:13.2 ± 0.20-3 years ofvoleyball20-302-36-9NMTFP: QSThe IG exhibited
CG: 13 FCG: 13.0 ± 0.1experience(EO,EC) – 20 ssmaller sway areas
SLS 10 sin EC conditions in
the bipedal stance,
while the other
variables were
unaffected. BT also
reduced sway area
and A-P COP
displacements of
the nondominant
limb for SLS.
Kang et al. (2013)36 MNRmiddleweightliftersNRNR8BTSLS (EC)Significant
IG (high school):school: exp.changes
8of 25.44were found in one-
IG (middlemonths; highleg standing time
school: 8school: exp.with eyes closed in
CG (highof 55.44the IG.
school): 8months
CG (middle
school): 8

NR = non reported; IG = intervention group; CG = control group; F = females; M = males; n = group size; PT = prioproceptive training; BT = balance training; CST = core stability training; PLT = plyometric training; ST = strength training; SLS = single leg stance; NMT = neuromuscular training; D = training duration (min); F = frequency (n/week); T = duration of the intervention (week); FP = force plate; BBS = biodex balance system; SEBT = star excursion balance test; ID = isokinetic dynamometry; EO = eyes open; EC = eyes close; QS = quiet standing; BESS = balance error scoring system; YBT = Y balance test; SLL = single leg landing; SMT = sensory motor training

The influence of balance training on injury prevention

Balance control is a crucial factor in sports and an important component of common motor skills. Disturbances in balance control can increase the risk of injuries during high intensity activities (Burke-Doe et al., 2008; McGuine et al., 2000). The importance of balance control in the prevention of damage and musculoskeletal injuries during sports performance has been emphasized (Carolyn A Emery, 2005) and investigated in many studied cases (see review by Hrysomallis, 2007). Although the cause of injury is not always known, several risk factors for impairment in balance during training have been indicated (McKay et al., 2001). These factors include an insufficient warm-up (Woods et al., 2007), poor flexibility (Hartig and Henderson, 1999; Zakas et al., 2005), muscle imbalances (Parry and Drust, 2006; Croisier et al., 2008), muscle weakness (Croisier, 2004; Junge and Dvorak, 2004), neural tension (Turl and George, 1998), fatigue (Worrell, 1994), and previous injuries (Ekstrand et al., 2011; Parry and Drust, 2006).

The most common sports injuries (60%) are sprains, dislocations, and ligament ruptures that occur at the knees and ankles and at the hands, elbows, and shoulders (Conn et al., 2003; Hawkins and Fuller, 1999; Powell and Barber-Foss, 1999; Schneider et al., 2006). Improving balance in athletes by appropriate training has proven to engender positive effects on the reduction of the discussed injuries (Hrysomallis, 2007). Exercises may be included into a training program as part of an injury prevention strategy or with the primary goal of improving an athlete’s performance (Sannicandro et al., 2014). According to Hrysomalis (2007), Hűbscher (2010) and other authors, we are able to distinguish different design concepts and components of preventive exercises for balance including plyometrics, strengthening, balancing, endurance and stability, with a different approach to preventive programs (Heidt et al., 2000; Myklebust et al., 2003; Soderman et al., 2000). The results of our analysis of the relationship between different balance prevention training protocols and injuries are shown in Table 2. It indicates the effectiveness of balance training in reducing the incidence of sports injuries among athletes. The analysis of the prevention programs contains the results for team sports (such as basketball, soccer, handball, and volleyball), mainly because of their specificity (high-risk of injuries), which may consequently cause long-term disabilities for the injured player (Lohmander et al., 2004; Myklebust and Bahr, 2005; von Porat et al., 2004).

Table 2

Relationship between different balance prevention training and injuries

Subjects
Training Modality
ReferencesN/SexAge (years)Status TrainingDisciplineD (min)F (n/week)T (week)Training TypeConclusions
Eils et al. (2010)n = 198IG1performancebasketball201NRPTThe risk of sustaining an
IG1 = 81 49M : 32F22.6 ± 6.3level of the(allankle injury was
CG1 = 91 54M : 37FCG1playersseason)significantly reduced in
IG2 = 8 4M : 4F25.5 ± 7.2variedthe IG by approximately
CG2 = 8 4M : 4FIG2between the35%. The IG showed a
24.3 ± 2.9seventhsignificantly more stable
CG2highestSLS concerning the
25.9 ± 8.2(Kreisliga)mediolateral direction.
and theThe degree of error for
highest10-dorsiflexion and 15-
leagueplantarflexion and the
(Bundesliga)mean error were
in Germanysignificantly reduced in
the posttest in the IG, but
not in the CG.
Soligard et al. (2008)n =1892 F13-17at least twosoccer20NRNRRunningThere was a
IG = 1055training(8 months-exercisessignificantly lower risk
CG = 837sessions aall season)BTof injuries overall,
week inCSToveruse injuries, and
addition toPLTsevere injuries in the IG.
match play
Kraemer and Knobloch (2009)IG = 24 F21 ± 4Germansoccer3000NRNRPTOne year after training
premier(3 years)BTimplementation,
leaguePLTnoncontact injuries
decreased significantly
by 65% (p = .021).
Overall, the mean injury
rate of all noncontact
injuries during all
intervention periods
significantly decreased
by 42% (p = .045) versus
the control period.
Owen et.al. (2013)n = 67 MIG = 28.6 ± 3.75competitivesoccerNR2NRBTDuring the intervention
IG = 44CG=27.4 ± 4.85players(2 seasons:STseason, the number of
CG = 232008-2010)CSTmuscle strain/tears was
FTless (25% of total
injuries) than the control
season (52% of total
injuries).
Timothy et al. (2006)n = 765 F/MIG = 16.4 ± 1.2high schoolbasketball103NRBTA reduced risk of an
IG =373CG = 16.6 ± 1.1studentssoccer(allankle sprain was
CG = 392trained byseason)observed after
certifiedintervention.
coaches
Eils et al. (2010)n = 198IG1performancebasketball201NRPTThe risk of sustaining an
IG1 = 81 49M : 32F22.6 ± 6.3level of the(allankle injury was
CG1 = 91 54M : 37FCG1playersseason)significantly reduced in
IG2 = 8 4M : 4F25.5 ± 7.2variedthe IG by approximately
CG2 = 8 4M : 4FIG2between the35%. The IG showed a
24.3 ± 2.9seventhsignificantly more stable
CG2highestSLS concerning the
25.9 ± 8.2(Kreisliga)mediolateral direction.
and theThe degree of error for
highest10-dorsiflexion and 15-
leagueplantarflexion and the
(Bundesliga)mean error were
in Germanysignificantly reduced in
the posttest in the IG, but
not in the CG.
Soligard et al. (2008)n = 1892 F13-17at least twosoccer20NRNRRunningThere was a
IG = 1055training(8 months-exercisessignificantly lower risk
CG = 837sessions aall season)BTof injuries overall,
week inCSToveruse injuries, and
addition toPLTsevere injuries in the IG.
match play
Kraemer and Knobloch (2009)IG = 24 F21 ± 4Germansoccer3000NRNRPTOne year after training
premier(3 years)BTimplementation,
leaguePLTnoncontact injuries
decreased significantly
by 65% (p = .021).
Overall, the mean injury
rate of all noncontact
injuries during all
intervention periods
significantly decreased
by 42% (p = .045) versus
the control period.
Owen et.al. Knobloch (2013)n = 67 MIG = 28.6 ± 3.75competitivesoccerNR2NRBTDuring the intervention
IG = 44CG=27.4 ± 4.85players(2 seasons:STseason, the number of
CG = 232008-2010)CSTmuscle strain/tears was
FTless (25% of total
injuries) than the control
season (52% of total
injuries).
Timothy et al. Knobloch (2006)n = 765 F/MIG = 16.4 ± 1.2high schoolbasketball103NRBTA reduced risk of an
IG =373CG = 16.6 ± 1.1studentssoccer(allankle sprain was
CG = 392trained byseason)observed after
certifiedintervention.
coaches
Malachy et al. (2007)n = 17515-18high schoolfootball10213SLSThe injury incidence for
IG = 175studentsBTthe players after the
intervention was
significantly lower than
the combined injury
incidence before the
intervention (p < .01).
Cumps et al.(2007)n = 50 M/FIG= 17.7 ± 3.9elite youthbasketball10322BTRelative risks showed a
IG = 26CG= 18.0 ± 2.7and youngSLSsignificantly lower
CG = 24seniorPLTincidence of lateral ankle
basketballDynamicsprains in the IG
playersexercisescompared to the CG.
Mandelbaum et al. (2005)IG1: 1041 F14-18competitivesoccer20NRNRstretchingDuring the first period
CG1: 1905 Ffemale youth(2 season)ST(IG; CG1), there was an
soccerPLT88% decrease in ACL
IG2: 844 Fplayers in aAgilityinjury in the IG subjects
CG2: 1913 FsouthernNMTcompared to the control
Californiagroup. In the second
soccer leagueperiod (IG2; CG2) there
was a 74% reduction in
ACL tears in the IG
compared to the age-
and skill-matched
controls.
Verhagen et al. (2005)IG = 641IG= 24.4 ± 2.8the secondvoleyball5NRNRBTSignificantly fewer ankle
CG = 486CG= 24.2 ± 2.5and third(oneSLSsprains in the IG were
Dutchseasonfound compared to the
volleyball2001/2002)CG. A significant
divisions;reduction in the ankle
experience insprain risk was found
years 13.3 ±only for players with a
2.3history of ankle sprains.
Soderman et al. (2000)

n = 140 F

IG = 62

CG = 78

IG= 20.4 ± 4.6

CG= 20.5 ± 5.4

players of the

second and

third

Swedish

divisions

soccer

15

NR

NR

(12 weeks)

BT

The results showed no

significant differences

between the groups with

respect either to the

number, incidence, or

type of traumatic injuries

of the lower extremities.

Emery et al. (2012)n = 744 M/FIG: U13-15=46.6%first andsoccer30NR20NMTThere was a 38%
IG = 380U16-18=53.4%secondBTreduction in all injury in
CG = 364CG: U13–CalgarySTthe IG compared with
15=48.9% U16–youthAgilitythe CG and a 43%
18=51.1%division ofStretchingreduction in acute-onset
indoorinjury.
football
Hewett et al. (1999)n = 1263 F/Mhigh schoolhigh schoolsoccer,60-9036NMTThe untrained group
IG = 366 FCG = 463 Fstudentsstudents,basketball,PLTdemonstrated an injury
CGPopulation = 434females werevolleyballrate 3.6 times higher
Mplayers,than the trained group
males wereand 4.8 times higher
notthan the male control
group. The trained
group had a significantly
lower rate of noncontact
injuries than the
untrained group (p =
0.01).
Petersen et al. (2005)N = 276 FNR2 of thehandball1038PTAnkle sprain was the
IG = 134teams werePLTmost frequent diagnosis
CG = 142from thein both groups with 11
third highestankle sprains in the CG
league;and 7 ankle sprains in
4 teams werethe
of a superiorIG. The knee was the
amateursecond frequent injury
level;site. In the CG, 5 of all
4 teams wereknee injuries
at a lowerwere anterior cruciate
amateur levelligament (ACL)
ruptures, while in the IG
only one.
competitiveThere was no difference
players withbetween the IG and CG
13.3 ± 2.1in performance from the
hours ofpre to post-test for any of
footballthe tests used.
activities perCST
n = 36 Fweek andBT
Steffen et al. (2008)IG = 1816-18 ( 17.1 ± 0,8)that had beenfootball15NR10PLT
CG = 16involved inST
organized
football for
10 ± 1.5 years

NR = non reported; IG = intervention group; CG = control group; F = females; M = males; n = group size; PT = prioproceptive training; BT = balance training; CST = core stability training; PLT = plyometric training; ST = strength training; SLS = single leg stance; NMT = neuromuscular training; D = training duration (min); F = frequency (n/week); T = training duration (week)

Table 3

Physiotherapy evidence database (PEDro) scores of the reviewed studies-

ReferencesEligibility criteria specifiedSubjects randomly allocated to groupsAllocation concealedGroups similar at baselineBlinding of all subjectsBlinding of all therapistsBlinding assessorsDropout < 15%Intention-to-treat methodStatistical comparison betweenmeasures and measuresScore
Benis et al.. (2016)++-++--+-++7
Gioftsidou et al.. (2012)++-----++++6
Malliou et al.. (2004)++-----++++6
Mahieu et al.. (2006)++-+---++++7
Zech et al.. (2014)++++---++++8
Pau et al. (2012)+--+----+++5
Daneshjoo et al.. (2012)++-+---++++7
Heleno et al.. (2016)++-+--+++++8
Saunders et al. (2013)++-----++++6
Gioftsidou et al.. (2006)++-+----+++6
Sato and Mokha (2009)++-+-----+-4
Matin et al.. (2014)-+-+---+++-5
Romero-franco et al.. (2012)-+-+---++++6
Myer et al.. (2006)++------+++5
Lust et al.. (2009)++-----++++6
Dobrijevic et al.. (2016)++-----++++6
Pfile et al.. (2016)+------+-++4
Hammami et al. (2016)+---+--++-+5
Emery and Meeuwisse (2012)++-+---++++7
Verhagen et al.. (2004)++++--+++++9
Petersen et al.. (2005)-------+++-3
Imai et al.. (2014)++-+----+++6
O’Malley et al.. (2016)++++---++++8
Trecroci et al.. (2015)++++---+-++7
Steib et al.. (2014)++-+---+-++6
Valovich et al.. (2009)+--+--+--++5
Eisen et al.. (2010)++-+-----++5
Holm et al.. (2004)+------+-++4
Asadi et al.. (2015)++-+---++++7
Verhagen et al.. (2005)-+-----+-++4
Kachanathu et al.. (2014)++-+-----++5
Cankaya et al.. (2015)-+-------++3
Karadenizli (2016)+------+--+3
Ahmadabadi et al.. (2015)++-+---+-+-5
Iacono et al.. (2014)++-+---+-++6
Karadenzili (2016)++-+---+-++6
Eils et al.. (2010)++-+---++++7
Soligard et al..(2008)++-+---++++7
Kraemer and Knobloch (2009)-------+-++3
Owen et al.. (2013)-+-+---+++-5
McGuine and Keene (2006)++-+---++++7
McHugh et al.. (2007)+------+-++4
Steffen et al.. (2008)++++---++++8
Cumps et al.. (2007)---+---+-++4
Mandelbaum et al.. (2005)-------++++4
Soderman et al.. (2000)++-+-----++5

“+” indicates a “YES” score; “-” indicates a “NO” score

Conclusions

In most of the reviewed articles, balance training has proven to be an effective tool for the improvement of postural control. However, a few articles stated that such effect did not occur (Eisen et al., 2010; Mahieu et al., 2006; Malliou et al., 2004; Sato and Mokha, 2009; Saunders et al., 2013; Verhagen et al., 2005), and a few studies, in which the effect was not reflected in all balance measures, suggested that balance training did not influence all of the dimensions of postural control (Benis et al., 2016; Holm et al., 2004; Pau et al., 2011; Zech et al., 2014). In some cases where the authors carried out both static and dynamic tests, significant results occurred in only one test type. Therefore, we would recommend the execution of both types of tests to decrease the risk of making inappropriate or global conclusions that training is ineffective in general.

Another issue is that the duration of training was heterogeneous. In most cases, it was approximately 40-50 min and was implemented as a full training session; however, in some articles, this time was rather short, i.e., only 10-20 min. In several studies, duration was not reported (Table 1). No gold standard is apparent in this field; therefore, it is difficult to make a global conclusion about the effectiveness of various types of balance training. Moreover, we are aware that it may be very difficult to establish one model of training that would be appropriate for each sport discipline, including its characteristics and demands. The main aim of this review was to identify a training protocol that is most commonly used and may lead to improvements in balance. Therefore, on the basis of analyses including papers in which training protocols resulted in positive effects on balance performance, it may be stated that an efficient training protocol should last for 8 weeks, with a frequency of two training sessions per week, and a single training session of 45 min.

Acknowledgements

This research was supported by a grant of the Ministry of Science and Higher Education of Poland (RSA3 00953).

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  • Mandelbaum BR Silvers HJ Watanabe DS Knarr JF Thomas SD Griffin LY Kirkendall DT Garrett WiJ. Effectiveness of a neuromuscular and proprioceptive training program in preventing the incidence of anterior cruciate ligament injuries in female athletes : 2-year follow up. Am J Sports Med 2005; 33(7): 1003–1010

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    • Export Citation
  • Manolopoulos K Gissis I Galazoulas C Manolopoulos E Patikas D Gollhofer A Kotzamandis C. Effect of combined sensorimotor-resistance training on strength balance and jumping performance of soccer players. J Strength Cond Res 2015; 30(1): 53–59

  • Matin KB Yalfani A Farzaneh G Homayoun A Parmoon A. Neuromuscular training as the basis for developing the level of the static and dynamic balance in selected students of physical. Int J Sport Sci Fit 2014; 4(1): 20-38

  • Maurer C Mergner T Peterka RJ. Multisensory control of human upright stance. Exp Brain Res 2006; 171(2): 231–250

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    • Export Citation
  • McGuine TA Greene JJ Best T Leverson G. Balance as a predictor of ankle injuries in high school basketball players. Clin J Sport Med 2000; 10(4): 239–244

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    • Export Citation
  • 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(7): 1103–1111

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    • Export Citation
  • McHugh MP Tyler TF Mirabella MR Mullaney MJ Nicholas SJ. The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players. Am J Sports Med 2007; 35(8): 1289–1294

    • Crossref
    • Export Citation
  • McKay GD Goldie PA Payne WR Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 2001; 35(2): 103–108

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    • Export Citation
  • Mcleod TCV Armstrong T Miller M Sauers JL. Balance improvements in female high school basketball players after a 6-week neuromuscular-training program. J Sport Rehabil 2009; 18 465–481

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    • Export Citation
  • Myer GD Ford KR McLean SG Hewett TE. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. Am J Sports Med 2006; 34(3): 445–455

    • Crossref
    • Export Citation
  • Myer GD Chu DA Brent JE Hewett TE. Of knee joint injury. Med Sci Sport 2009; 27(3): 1–23

  • Myer GD Ford KR Brent JL Hewett TE. The effects of plyometric versus dynamic stabilization and balance training on power balance and landing force in female athletes. J Strength Cond Res 2006; 20(2): 345–353

  • Myklebust G Bahr R. Return to play guidelines after anterior cruciate ligament surgery. BMJ 2005; 39 127–132

  • Myklebust G Engebretsen L Braekken IH Skj⊘lberg A Olsen O-E Bahr R. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 2003; 13(2): 71–78

    • Crossref
    • Export Citation
  • O’Malley E Murphy JC McCarthy Persson U Gissane C Blake C. The effects of the GAA 15 training program on neuromuscular outcomes in Gaelic football and hurling players; a randomized clustertrial. J Strength Cond Res 2016;

  • Paillard T. Plasticity of the postural function to sport and/or motor experience. Neurosci Biobehav Rev 2017; 72 129–152

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    • Export Citation
  • Parry L Drust B. Is injury the major cause of elite soccer players being unavailable to train and play during the competitive season?. Phys Ther Sport 2006; 7(2): 58–64

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    • Export Citation
  • Pau M Loi A Pezzotta MC. Does sensorimotor training improve the static balance of young volleyball players?. Sport Biomech 2011; 11(1): 97–107

  • Petersen W Braun C Bock W Schmidt K Weimann A Drescher W Eiling E Stange R Fuchs T Hedderich J Zantop T. A controlled prospective case control study of a prevention training program in female team handball players: the German experience. Arch Orthop Trauma Surg 2005; 125(9): 614–621

    • Crossref
    • Export Citation
  • Pfile KR Gribble PA Buskirk GE Meserth SM Pietrosimone BG. Sustained improvements in dynamic balance and landing mechanics after a 6-week neuromuscular training program in college women's basketball players. J Sport Rehabil 2016; 25(3): 233-240

    • Crossref
    • Export Citation
  • Pfile KR Hart JM Herman DC Hertel J Kerrigan DC Ingersoll CD. Different exercise training interventions and drop-landing biomechanics in high school female athletes. J Athl Train 2013; 48(4): 450–462

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    • Export Citation
  • Powell JW Barber-Foss KD. Injury patterns in selected high school sports: a review of the 1995-1997 seasons. J Athl Train 1999; 34(3): 277–284

  • Romero-Franco N Martinez-Lopez E Lomas-Vega R Hita-Contreras F Martinez-Amat A. Effects of

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    • Export Citation
  • Sannicandro I Cofano G Rosa RA Piccinno A. Balance training exercises decrease lower-limb strength asymmetry in young tennis players. J Sport Sci Med 2014; 13(2): 397–402

  • Sato K Mokha M. Does core strength training influence running kinetics lower-extremity stability and 5000m performance in runners? J Strength Cond Res 2009; 23(1): 133–140

    • Crossref
    • Export Citation
  • Saunders NW Hanson NJ Koutakis P Chaudhari AM Devor ST. Figure skater level moderates balance training. Int J Sports Med 2013; 34(4): 345–349

  • Schneider S Seither B Tönges S Schmitt H. Sports injuries: population based representative data on incidence diagnosis sequelae and high risk groups. Br J Sports Med 2006; 40(4): 334–339

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    • Export Citation
  • Soderman K Werner S Pietilä T Engström B Werner S. Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surgery Sport Traumatol Arthrosc 2000; 8: 356–363

    • Crossref
    • Export Citation
  • Soligard T Myklebust G Steffen K Holme I Silvers H Bizzini M Junge A Dvorak J Bahr R Andersen TE. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 2008; 337(2): 2469–2469

    • Crossref
    • Export Citation
  • Steib S Zahn P zu Eulenburg C Pfeifer K Zech A. Time-dependent postural control adaptations following a neuromuscular warm-up in female handball players: a randomized controlled trial. BMC Sports Sci Med Rehabil 2016; 8(1): 33–40

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    • Export Citation
  • Trecroci A Cavaggioni L Caccia R Alberti G. Jump rope training: Balance and motor coordination in preadolescent soccer players. J Sport Sci Med 2015; 14(4): 792–798

  • Turl SE George KP. A factor in repetitive hamstring strain?. J Orthop Sport Phys Ther 1998; 27(1): 16–21

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    • Export Citation
  • Verhagen E Bobbert M Inklaar M Van Kalken M Van Der Beek A Bouter L Van Mechelen W. The effect of a balance training programme on centre of pressure excursion in one-leg stance. Clin Biomech 2005; 20(10): 1094–1100

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    • Export Citation
  • 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. Am J Sports Med 2002; 32(6): 1385–1393

  • Visser JE Carpenter MG van der Kooij H Bloem BR. The clinical utility of posturography. Clin Neurophysiol 2008; 119(11): 2424–2436

    • Crossref
    • Export Citation
  • 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(3): 269–273

    • Crossref
    • Export Citation
  • Watson AWS. Ankle sprains in players of the field-games gaelic football and hurling. J Sport Med Phys Fit 1999; 39(1): 66–70

  • Winter DA. Human balance and posture control during standing and walking. Gait Posture 1995; 3(4): 193–214

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    • Export Citation
  • Woods K Bishop P Jones E. Warm-up and stretching in the prevention of muscular injury. Sport Med 2007; 37(12): 1089–1099

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    • Export Citation
  • Worrell T. Factors associated with hamstring injuries. An approach to treatment and preventive measures. Sport Med 1994; 17(5): 338–345

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    • Export Citation
  • Zakas A Balaska P Grammatikopoulou MG Zakas N Vergou A. Acute effects of stretching duration on the range of motion of elderly women. J Bodyw Mov Ther 2005; 9(4): 270–276

    • Crossref
    • Export Citation
  • Zatsiorsky VM Duarte M. Instant equilibrium point and its migration in standing tasks: rambling and trembling components of the stabilogram. Motor Control 1999; 3(1): 28–38

    • Crossref
    • Export Citation
  • Zech A Hübscher M Vogt L Banzer W Hänsel F Pfeifer K. Balance training for neuromuscular control and performance enhancement: a systematic review. J Athl Train Natl Athl Trainers’ Assoc 2010; 45(4): 392–403

  • Zech A Klahn P Hoeft J Zu Eulenburg C Steib S. Time course and dimensions of postural control changes following neuromuscular training in youth field hockey athletes. Eur J Appl Physiol 2014; 114(2): 395–403

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    • Export Citation
  • Zemková E. Sport-specific balance. Sport Med 2014; 44(5): 579–590

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  • Ahmadabadi F Avandi S Aminian-Far A. Acute versus chronic dynamic warm-up on balance and balance the vault performance in skilled gymnast. Int J Appl Exerc Physiol 2015; 4(2): 20–33

  • Asadi A Saez de Villarreal E Arazi H. The effects of plyometric type neuromuscular training on postural control performance of male team basketball players. J Strength Cond Res 2015; 29(7): 1870–1875

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  • Benis R Bonato M Torre A La. Elite female basketball players’ body-weight neuromuscular training and performance on the y-balance test. J Athl Train 2016; 51(9): 688–695

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  • Croisier J-L Ganteaume S Binet J. Strength Imbalances and Prevention of Hamstring Injury in Professional Soccer Players: A Prospective Study. Am J Sports Med 2008; 36: 1469–1475

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  • Cumps E Verhagen E Meeusen R. Efficacy of a sports specific balance training programme on the incidence of ankle sprains in basketball. J Sport Sci Med 2007; 6(2): 212–219

  • Daneshjoo A Mokhtar AH Rahnama N Yusof A. The effects of comprehensive warm-up programs on proprioception static and dynamic balance on male soccer players. PLoS One 2012; 7(12): 1–10

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  • Eisen T Danoff J Leone J Miller T. The effects of multiaxial and uniaxial unstable surface balance training in college athletes. J Strength Cond Res 2010; 24(7): 1740–1745

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  • Ekstrand J Hägglund M Waldén M. Injury incidence and injury patterns in professional football - the UEFA injury study. Br J Sports Med 2011; 45(7): 533–538

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  • Filipa A Byrnes R Paterno MV Gregory D Hewett TE. Neuromuscular training improves performance on the star excursion balance test in young female athletes. J Orthop Sport Phys Ther 2012; 40(9): 551–558

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  • Gioftsidou A Malliou P Pafis G Beneka A Godolias G Maganaris CN. The effects of soccer training and timing of balance training on balance ability. Eur J Appl Physiol 2006; 96(6): 659–664

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  • Heleno LR da Silva RA Shigaki L Araujo CGA Coelho Candido CR Okazaki VHA Frisseli A Macedo C de SG. Five-week sensory motor training program improves functional performance and postural control in young male soccer players. A blind randomized clinical trial. Phys Ther Sport 2016; 22: 74–80

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  • Holm I Fosdahl MA Friis A Risberg MA Myklebust G Steen H. Effect of neuromuscular training on proprioception balance muscle strength and lower limb function in female team handball players. Clin J Sport Med 2004; 14(2): 88-94

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  • Hrysomallis C McLaughlin P Goodman C. Relationship between static and dynamic balance tests among elite Australian Footballers. J Sci Med Sport 2006; 9(4): 288–291

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  • Hübscher M Zech A Pfeifer K Hänsel F Vogt L Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc 2010; 42(3): 413–421

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  • Iacono Dello A Martone D Alfieri A Ayalon M. Core Stability Training Program (CSTP) effects on static and dynamic balance abilities. Gazz Med Ital 2014; 173(4): 197-206

  • Imai A Kaneoka K Okubo Y Shiraki H. Effects of two types of trunk exercises on balance and athletic performance in youth soccer players. Int J Sports Phys Ther 2014; 9(1): 47–57

  • Junge A Dvorak J. Soccer injuries: A review on incidence and prevention. Sport Med 2004; 34(13): 929–938

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  • Kachanathu S Tyagi P Anand P Hameed U Algarni A. Effect of core stabilization training on dynamic balance in professional soccer players. Phys Medizin Rehabil Kurortmedizin 2014; 24(6): 299–304

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  • Kang SH Kim CW Kim Y IL Kim KB Lee SS Shin KO. Alterations of muscular strength and left and right limb balance in weightlifters after an 8-week balance training program. J Phys Ther Sci 2013; 25(7): 895–900

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  • Karadenizli ZI. The effects of plyometric education trainings on balance and some psychomotor characteristics of school handball team. Univers J Educ Res 2016; 4(10): 2286–2293

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  • Karadenizli ZI. The effects of plyometric training on balance anaerobic power and physical fitness parameters in handball. Anthropologist 2016; 24(3): 751–761

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  • Karami B Ali M Farzaneh Y Homayoun G Parmoon A. Neuromuscular training as the basis for developing the level of the static and dynamic balance in selected students of physical. Int J Sport Sci Fit 2014; 4(1): 20–38

  • Kümmel J Kramer A Giboin L-S Gruber M. Specificity of balance training in healthy individuals: a systematic review and meta-analysis. Sport Med 2016; 46(9): 1261–1271

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  • Lesinski M Hortobagyi T Muehlbauer T Gollhofer A Granacher U. Dose-response relationships of balance training in healthy young adults: a systematic review and meta-analysis. Sport Med 2015; 45(4): 557–576

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  • Lohmander LS Ostenberg A Englund M Roos H. High prevalence of knee osteoarthritis pain and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 2004; 50(10): 3145-3152

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  • Lust KR Sandrey MA Bulger SM Wilder N. The effects of 6-week training programs on throwing accuracy proprioception and core endurance in baseball. J Sport Rehabil 2009; 18(3): 407–426

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  • Mahieu NN Witvrouw E Van De Voorde D Michilsens D Arbyn V Van Den Broecke W. Improving strength and postural control in young skiers: Whole-body vibration versus equivalent resistance training. J Athl Train 2006; 41(3): 286–293

  • Malliou P Amoutzas K Theodosiou A Gioftsidou A. Proprioceptive training for learning downhill skiing. Percept Mot Skills 2004; 99(1): 149–154

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  • Mandelbaum BR Silvers HJ Watanabe DS Knarr JF Thomas SD Griffin LY Kirkendall DT Garrett WiJ. Effectiveness of a neuromuscular and proprioceptive training program in preventing the incidence of anterior cruciate ligament injuries in female athletes : 2-year follow up. Am J Sports Med 2005; 33(7): 1003–1010

    • Crossref
    • Export Citation
  • Manolopoulos K Gissis I Galazoulas C Manolopoulos E Patikas D Gollhofer A Kotzamandis C. Effect of combined sensorimotor-resistance training on strength balance and jumping performance of soccer players. J Strength Cond Res 2015; 30(1): 53–59

  • Matin KB Yalfani A Farzaneh G Homayoun A Parmoon A. Neuromuscular training as the basis for developing the level of the static and dynamic balance in selected students of physical. Int J Sport Sci Fit 2014; 4(1): 20-38

  • Maurer C Mergner T Peterka RJ. Multisensory control of human upright stance. Exp Brain Res 2006; 171(2): 231–250

    • Crossref
    • Export Citation
  • McGuine TA Greene JJ Best T Leverson G. Balance as a predictor of ankle injuries in high school basketball players. Clin J Sport Med 2000; 10(4): 239–244

    • Crossref
    • Export Citation
  • 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(7): 1103–1111

    • Crossref
    • Export Citation
  • McHugh MP Tyler TF Mirabella MR Mullaney MJ Nicholas SJ. The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players. Am J Sports Med 2007; 35(8): 1289–1294

    • Crossref
    • Export Citation
  • McKay GD Goldie PA Payne WR Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 2001; 35(2): 103–108

    • Crossref
    • Export Citation
  • Mcleod TCV Armstrong T Miller M Sauers JL. Balance improvements in female high school basketball players after a 6-week neuromuscular-training program. J Sport Rehabil 2009; 18 465–481

    • Crossref
    • Export Citation
  • Myer GD Ford KR McLean SG Hewett TE. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. Am J Sports Med 2006; 34(3): 445–455

    • Crossref
    • Export Citation
  • Myer GD Chu DA Brent JE Hewett TE. Of knee joint injury. Med Sci Sport 2009; 27(3): 1–23

  • Myer GD Ford KR Brent JL Hewett TE. The effects of plyometric versus dynamic stabilization and balance training on power balance and landing force in female athletes. J Strength Cond Res 2006; 20(2): 345–353

  • Myklebust G Bahr R. Return to play guidelines after anterior cruciate ligament surgery. BMJ 2005; 39 127–132

  • Myklebust G Engebretsen L Braekken IH Skj⊘lberg A Olsen O-E Bahr R. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 2003; 13(2): 71–78

    • Crossref
    • Export Citation
  • O’Malley E Murphy JC McCarthy Persson U Gissane C Blake C. The effects of the GAA 15 training program on neuromuscular outcomes in Gaelic football and hurling players; a randomized clustertrial. J Strength Cond Res 2016;

  • Paillard T. Plasticity of the postural function to sport and/or motor experience. Neurosci Biobehav Rev 2017; 72 129–152

    • Crossref
    • Export Citation
  • Parry L Drust B. Is injury the major cause of elite soccer players being unavailable to train and play during the competitive season?. Phys Ther Sport 2006; 7(2): 58–64

    • Crossref
    • Export Citation
  • Pau M Loi A Pezzotta MC. Does sensorimotor training improve the static balance of young volleyball players?. Sport Biomech 2011; 11(1): 97–107

  • Petersen W Braun C Bock W Schmidt K Weimann A Drescher W Eiling E Stange R Fuchs T Hedderich J Zantop T. A controlled prospective case control study of a prevention training program in female team handball players: the German experience. Arch Orthop Trauma Surg 2005; 125(9): 614–621

    • Crossref
    • Export Citation
  • Pfile KR Gribble PA Buskirk GE Meserth SM Pietrosimone BG. Sustained improvements in dynamic balance and landing mechanics after a 6-week neuromuscular training program in college women's basketball players. J Sport Rehabil 2016; 25(3): 233-240

    • Crossref
    • Export Citation
  • Pfile KR Hart JM Herman DC Hertel J Kerrigan DC Ingersoll CD. Different exercise training interventions and drop-landing biomechanics in high school female athletes. J Athl Train 2013; 48(4): 450–462

    • Crossref
    • Export Citation
  • Powell JW Barber-Foss KD. Injury patterns in selected high school sports: a review of the 1995-1997 seasons. J Athl Train 1999; 34(3): 277–284

  • Romero-Franco N Martinez-Lopez E Lomas-Vega R Hita-Contreras F Martinez-Amat A. Effects of

    • Crossref
    • Export Citation
  • Sannicandro I Cofano G Rosa RA Piccinno A. Balance training exercises decrease lower-limb strength asymmetry in young tennis players. J Sport Sci Med 2014; 13(2): 397–402

  • Sato K Mokha M. Does core strength training influence running kinetics lower-extremity stability and 5000m performance in runners? J Strength Cond Res 2009; 23(1): 133–140

    • Crossref
    • Export Citation
  • Saunders NW Hanson NJ Koutakis P Chaudhari AM Devor ST. Figure skater level moderates balance training. Int J Sports Med 2013; 34(4): 345–349

  • Schneider S Seither B Tönges S Schmitt H. Sports injuries: population based representative data on incidence diagnosis sequelae and high risk groups. Br J Sports Med 2006; 40(4): 334–339

    • Crossref
    • Export Citation
  • Soderman K Werner S Pietilä T Engström B Werner S. Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surgery Sport Traumatol Arthrosc 2000; 8: 356–363

    • Crossref
    • Export Citation
  • Soligard T Myklebust G Steffen K Holme I Silvers H Bizzini M Junge A Dvorak J Bahr R Andersen TE. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 2008; 337(2): 2469–2469

    • Crossref
    • Export Citation
  • Steib S Zahn P zu Eulenburg C Pfeifer K Zech A. Time-dependent postural control adaptations following a neuromuscular warm-up in female handball players: a randomized controlled trial. BMC Sports Sci Med Rehabil 2016; 8(1): 33–40

    • Crossref
    • Export Citation
  • Trecroci A Cavaggioni L Caccia R Alberti G. Jump rope training: Balance and motor coordination in preadolescent soccer players. J Sport Sci Med 2015; 14(4): 792–798

  • Turl SE George KP. A factor in repetitive hamstring strain?. J Orthop Sport Phys Ther 1998; 27(1): 16–21

    • Crossref
    • Export Citation
  • Verhagen E Bobbert M Inklaar M Van Kalken M Van Der Beek A Bouter L Van Mechelen W. The effect of a balance training programme on centre of pressure excursion in one-leg stance. Clin Biomech 2005; 20(10): 1094–1100

    • Crossref
    • Export Citation
  • 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. Am J Sports Med 2002; 32(6): 1385–1393

  • Visser JE Carpenter MG van der Kooij H Bloem BR. The clinical utility of posturography. Clin Neurophysiol 2008; 119(11): 2424–2436

    • Crossref
    • Export Citation
  • 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(3): 269–273

    • Crossref
    • Export Citation
  • Watson AWS. Ankle sprains in players of the field-games gaelic football and hurling. J Sport Med Phys Fit 1999; 39(1): 66–70

  • Winter DA. Human balance and posture control during standing and walking. Gait Posture 1995; 3(4): 193–214

    • Crossref
    • Export Citation
  • Woods K Bishop P Jones E. Warm-up and stretching in the prevention of muscular injury. Sport Med 2007; 37(12): 1089–1099

    • Crossref
    • Export Citation
  • Worrell T. Factors associated with hamstring injuries. An approach to treatment and preventive measures. Sport Med 1994; 17(5): 338–345

    • Crossref
    • Export Citation
  • Zakas A Balaska P Grammatikopoulou MG Zakas N Vergou A. Acute effects of stretching duration on the range of motion of elderly women. J Bodyw Mov Ther 2005; 9(4): 270–276

    • Crossref
    • Export Citation
  • Zatsiorsky VM Duarte M. Instant equilibrium point and its migration in standing tasks: rambling and trembling components of the stabilogram. Motor Control 1999; 3(1): 28–38

    • Crossref
    • Export Citation
  • Zech A Hübscher M Vogt L Banzer W Hänsel F Pfeifer K. Balance training for neuromuscular control and performance enhancement: a systematic review. J Athl Train Natl Athl Trainers’ Assoc 2010; 45(4): 392–403

  • Zech A Klahn P Hoeft J Zu Eulenburg C Steib S. Time course and dimensions of postural control changes following neuromuscular training in youth field hockey athletes. Eur J Appl Physiol 2014; 114(2): 395–403

    • Crossref
    • Export Citation
  • Zemková E. Sport-specific balance. Sport Med 2014; 44(5): 579–590

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Impact Factor

IMPACT FACTOR 2018: 1.414
5-year IMPACT FACTOR: 1.858

CiteScore 2018: 1.60

SCImago Journal Rank (SJR) 2018: 0.644
Source Normalized Impact per Paper (SNIP) 2018: 0.941

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