Balance Tests Used in Athletes with Lower Extremity Injuries: A Systematic Review

Year 2024, Volume: 8 Issue: 1, 103 - 115, 31.01.2024

Rabia Tuğba Kılıç , Emre Uysal , Ayşe Toraman Karagülmez , Ali Ceylan , Ayşegül Atlı , Hayri Baran Yosmaoğlu , Savaş Kudaş

https://doi.org/10.46237/amusbfd.1074658

Abstract

Athletes with lower extremity injuries are at the stage of returning to sports after the completion of rehabilitation; exhibits significant deficits in balance, proprioception, muscle strength and neuromuscular control. Especially, the presence of balance disorder increases the risk of lower extremity injury of the athletes during the return to sports. The purpose of this systematic review is to present a summary of the available evidence by evaluating balance tests used after lower extremity injuries. The review was performed according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) with a literature review covering three databases. The methodological quality of the studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. A total of 1259 articles were reviewed at the beginning of the study, and 8 of them were included in the study. The full text of 8 studies consisting of 1575 athletes, 1515 of whom were female, with a mean age of 20.03±2.88 years, with and without a history of lower extremity injury, were analyzed. All studies were methodologically classified according to the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. It was determined that the athletes in the included study had a history of injury involving the knee and ankle joint. It was seen that the Star Excursion Balance Test was more preferred in the evaluation of the balance of the athletes. In this review, four Star Shaped Balance Tests, one Lower Extremity Quarter-Y Balance Test, one Dynamic Postural Stability Index, one Postural Stability Balance Test on One Leg, and one pressure center, which are performed for returning to sports after lower extremity injury. It was determined that there is no definite information in the literature regarding the balance criteria required for returning to sports of athletes with lower extremity injuries. As a result, we determined that the balance criterion changed depending on the sports performed after the lower extremity injury, the time of the injury, the form of the evaluation, and whether there was a previous injury history.

Keywords

Athlete, Balance, Lower extremity, Injury, Return to sports

Alt Ekstremite Yaralanması Geçirmiş Sporcularda Kullanılan Denge Testleri: Sistematik Derleme

Abstract

Alt ekstremite yaralanması geçiren sporcular rehabilitasyonun tamamlanmasından sonra spora dönüş aşamasında; denge, propriyosepsiyon, kas gücü ve nöromüsküler kontrolde önemli eksiklikler sergilemektedir. Özellikle de denge bozukluğunun varlığı, spora dönüş aşamasında sporcuların alt ekstremite yaralanma riskini arttırmaktadır. Bu sistematik derlemenin amacı: alt ekstremite yaralanmaları sonrası kullanılan denge testlerini değerlendirerek mevcut kanıtların özetini sunmaktır. İnceleme, üç veritabanını kapsayan bir literatür taraması ile PRISMA yönergelerine göre yapıldı. Çalışmaların metodolojik kalitesi, NIH Study Quality Assessment Tools kullanılarak değerlendirildi. Çalışmada alt ekstremite yaralanma öyküsü olan ve olmayan yaş ortalaması 20,03±2,88 yıl, 1515’i kadın toplam 1575 sporcudan oluşan 8 çalışmanın tam metni incelendi. Tüm çalışmalar Study Quality Assessment Tools’a göre metodolojik olarak sınıflandırıldı. Dahil edilen çalışmadaki sporcuların diz ve ayak bileği eklemini içeren yaralanma öykülerinin olduğu belirlendi. Sporcuların denge değerlendirilmesinde Star Excursion Balance Test (SEBT)’ nin daha çok tercih edildiği görüldü. Bu derlemeye alt eksremite yaralanması sonrasında spora dönüş için yapılan, dört adet SEBT, bir adet The Lower Quarter Y-Balance Test, bir adet Dynamic Postural Stability Index bir adet Single-leg stance postural stability ve bir adet de COP ile sporcuların dengelerini değerlendiren çalışma dahil edildi. Alt ekstremite yaralanması olan sporcuların spora dönüş için gerekli denge kriterleri açısından literatürde kesin bilgi bulunmadığı tespit edildi. Sonuç olarak denge kriterinin alt ekstremite yaralanması sonrasında spora dönüşte yapılan sporun, yaralanmanın zamanının, değerlendirmenin şeklinin, daha önceden yaralanma öyküsünün olup olmadığına bağlı olarak değiştiğini tespit ettik.

Keywords

Alt ekstremite, Denge, Sporcu, Spora dönüş, Yaralanma

References

• 1. Nagle, K., Johnson, B., Brou, L., Landman, T., Sochanska, A., & Comstock, R.D. (2017). Timing of lower extremity injuries in competition and practice in high school sports. Sports Health, 9(3), 238-246.
• 2. Plisky, P., Schwartkopf-Phifer, K., Huebner, B., Garner, M.B., & Bullock, G. (2021). Systematic review and meta-analysis of the Y-balance test lower quarter: Reliability, discriminant validity, and predictive validity. Int J Sports Phys Ther,16(5), 1190-1209.
• 3. Ardern, C.L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen, B., Cools, A., et al. (2016). 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med,50(14), 853-864.
• 4. Barber-Westin, S.D., & Noyes, F.R. (2011). Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy, 27(12), 1697-1705.
• 5. Dai, B., Layer, J., Vertz, C., Hinshaw, T., Cook, R., Li, Y., et al. (2019). Baseline assessments of strength and balance performance and bilateral asymmetries in collegiate athletes. J Strength Cond Res, 33(11), 3015-3029.
• 6. Kaya, D., Yertutanol, F.D.K., & Calik, M. (2018).Neurophysiology and assessment of the proprioception. Kaya, D., Yosmaoglu, B., Doral, M., (Ed). Proprioception in orthopaedics, sports medicine and rehabilitation. (ss.123-142).London:Springer.
• 7. Plisky, P. J., Rauh, M.J., Kaminski, T.W., & Underwood, F.B. (2006). Star excursion balance test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther, 36(12), 911-919.
• 8. Trojian, T.H., & McKeag, D.B. (2006). Single leg balance test to identify risk of ankle sprains. Br J Sports Med,40(7), 610-613.
• 9. Schnurrer-Luke Vrbanić, T., Ravlić-Gulan, J., Gulan, G., & Matovinović, D. (2007). Balance index score as a predictive factor for lower sports results or anterior cruciate ligament knee injuries in Croatian female athletes–preliminary study. Coll Antropol, 31(1), 253-258.
• 10. Aminaka, N., & Gribble, P.A. (2008). Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. J Athl Train, 43(1), 21-28.
• 11. Akbari, M., Karimi, H., Farahini, H., & Faghihzadeh, S. (2006). Balance problems after unilateral lateral ankle sprains. J Rehabil Res Dev, 43(7), 819-824.
• 12. Gribble, P.A., Hertel, J., Denegar, C.R., & Buckley, W.E. (2004). The effects of fatigue and chronic ankle instability on dynamic postural control. J Athl Train, 39(4), 321.
• 13. Gribble, P.A., Hertel, J., & Denegar, C.R. (2007). Chronic ankle instability and fatigue create proximal joint alterations during performance of the star excursion balance test. Int J Sports Med, 28(03), 236-242.
• 14. Herrington, L., Hatcher, J., Hatcher, A., & McNicholas, M. (2009). A comparison of star excursion balance test.reach distances between ACL deficient patients and asymptomatic controls. The Knee, 16(2), 149-152.
• 15. Delahunt, E., Chawke, M., Kelleher, J., Murphy, K., Prendiville, A., Sweeny, L., et al. (2013). Lower limb kinematics and dynamic postural stability in anterior cruciate ligament-reconstructed female athletes.J Athl Train, 48(2), 172-185.
• 16. Culvenor, A.G., Alexander, B.C., Clark, R.A., Collins, N.J., Ageberg, E., Morris, H.G., et al. (2016). Dynamic single-leg postural control is impaired bilaterally following anterior cruciate ligament reconstruction: implications for reinjury risk. J Orthop Sports Phys Ther, 46(5), 357-364.
• 17. Paterno, M.V., Schmitt, L.C., Ford, K.R., Rauh, M.J., Myer, G.D., Huang, B., et al. (2010). Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med, 38(10), 1968-1978.
• 18. Bakken A., Targett S., Bere T., Eirale C., Farooq A., Tol J.L., et al. (2018). The functional movement test 9+ is a poor screening test for lower extremity injuries in professional male football players: a 2-year prospective cohort study. Br J Sports Med, 52(16), 1047-1053.
• 19. McCall, A., Carling, C., Davison, M., Nedelec, M., Le Gall, F., Berthoin, S., et al. (2015). Injury risk factors, screening tests and preventative strategies: a systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues. Br J Sports Med,49(9), 583-589.
• 20. Nilstad, A., Andersen, T.E., Bahr, R., Holme, I., & Steffen, K. (2014). Risk factors for lower extremity injuries in elite female soccer players. Am J Sports Med, 42(4), 940-948.
• 21. Padua, D.A., DiStefano, L.J., Beutler, A.I., De La Motte, S.J., DiStefano, M.J., & Marshall, S.W. (2015). The landing error scoring system as a screening tool for an anterior cruciate ligament injury–prevention program in elite-youth soccer athletes. J Athl Train, 50(6), 589-595.
• 22. Mayer, S.W., Queen, R.M., Taylor, D., Moorman III, C.T., Toth, A.P., Garrett Jr, W.E., et al. (2015). Functional testing differences in anterior cruciate ligament reconstruction patients released versus not released to return to sport. Am J Sports Med,43(7), 1648-1655.
• 23. Plisky, P.J., Gorman, P.P., Butler, R.J., Kiesel, K.B., Underwood, F.B., & Elkins, B. (2009). The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sports Phys Ther, 4(2), 92-99.
• 24. Shaffer, S.W., Teyhen, D.S., Lorenson, C.L., Warren, R.L., Koreerat, C.M., Straseske, C.A., & Childs, J.D. (2013). Y- balance test: a reliability study involving multiple raters. Mil Med,, 178(11), 1264-1270.
• 25. Hertel, J., Braham, R.A., Hale, S.A., & Olmsted-Kramer, L.C. (2006). Simplifying the star excursion balance test: analyses of subjects with and without chronic ankle instability. J Orthop Sports Phys Ther, 36(3), 131-137.
• 26. Paterno, M.V., Schmitt, L.C., Ford, K.R., Rauh, M.J., & Hewett, T.E. (2013). Altered postural sway persists after anterior cruciate ligament reconstruction and return to sport. Gait &Posture, 38(1), 136-140.
• 27. Sell, T.C. (2012). An examination, correlation, and comparison of static and dynamic measures of postural stability in healthy, physically active adults. Phys Ther Sport, 13(2), 80-86.
• 28. Hertel, J., Miller, S.J., & Denegar, C.R. (2000). Intratester and intertester reliability during the star excursion balance tests. JSR, 9(2),104-116.
• 29. Plisky, P., Schwartkopf-Phifer, K., Huebner, B., Garner, M.B., & Bullock, G. (2021). Systematic review and meta-analysis of the y-balance test lower quarter: reliability, discriminant validity, and predictive validity. Int J Sports Phys Ther, 16(5),1190-1209.
• 30. Plisky, P.J., Rauh, M.J., Kaminski, T.W., & Underwood, F.B. (2006). Star excursion balance test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 36(12),911-919.
• 31. Wikstrom, E.A., Tillman, M.D., Smith, A.N., & Borsa, P.A. (2005). A new force-plate technology measure of dynamic postural stability: the dynamic postural stability index. J Athl Train, 40(4), 305-309.
• 32. Wikstrom, E.A., Tillman, M.D., Chmielewski, T.L., Cauraugh, J.H., Naugle, K.E., & Borsa, P.A. (2010). Dynamic postural control but not mechanical stability differs among those with and without chronic ankle instability. Scand J Med Sci Sports, 20(1):e137-144.
• 33. Cappozzo, A., Catani, F., Croce, U.D., & Leardini, A. (1995). Position and orientation in space of bones during movement: anatomical frame definition and determination. Clin Biomech (Bristol, Avon). 10(4),171-178
• 34. Doyle, R.J., Hsiao-Wecksler, E.T., Ragan, B.G., & Rosengren, K.S. (2007). Generalizability of center of pressure measures of quiet standing. Gait Posture, 25(2),166-711.
• 35. Schmitz, R., & Arnold, B. (1998).Intertester and intratester reliability of a dynamic balance protocol using the biodex stability system. JSR, 7(2),95-101.
• 36. Tegner, Y., Lysholm, J., Lysholm, M., & Gillquist, J. (1986). A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med, 14(2), 156-159.
• 37. Arifin, N., Abu Osman, N.A., & Wan Abas, W.A. (2014). Intrarater test-retest reliability of static and dynamic stability indexes measurement using the biodex stability system during unilateral stance. J Appl Biomech, 30(2),300-304.
• 38. Ma, L.L., Wang, Y.Y., Yang, Z.H., Huang, D., Weng, H., & Zeng, X.T. (2020). Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res, 7(1), 1-11.
• 39. Brumitt, J., Patterson, C., Dudley, R., Sorenson, E., Hill, G., & Peterson, C. (2019). Comparison of lower quarter y-balance test scores for female collegiate volleyball players based on competition level, position, and starter status. Int J Sports Phys Ther, 14(3),415-423.
• 40. Head, PL., Kasser, R., Appling, S., Cappaert, T., Singhal, K., & Zucker-Levin, A. (2019). Anterior cruciate ligament reconstruction and dynamic stability at time of release for return to sport. Phys Ther Sport, 38(5), 80-86.
• 41. Huurnink, A., Fransz, DP., Kingma, I., Verhagen, EA., & Van Dieën, J.H. (2014). Postural stability and ankle sprain history in athletes compared to uninjured controls. Clin Biomech, 29(2), 183-188.
• 42. Myklebust, G., Bahr, R., Nilstad, A., & Steffen, K. (2017). Knee function among elite handball and football players 1-6 years after anterior cruciate ligament injury. Scand J Med Sci Sports, 27(5), 545-553.
• 43. Lion, A., Gette, P., Meyer, C., Seil, R., & Theisen, D. (2018). Effect of cognitive challenge on the postural control of patients with ACL reconstruction under visual and surface perturbations. Gait Posture, 60(7), 251- 257.
• 44. Kline, P. W., Johnson, D. L., Ireland, M. L., & Noehren, B. (2016). Clinical predictors of knee mechanics at return to sport following ACL reconstruction. Medicine and science in sports and exercise, 48(5), 790-795.
• 45. Fältström, A., Hägglund, M., Hedevik, H., & Kvist, J. (2021). Poor validity of functional performance tests to predict knee injury in female soccer players with or without anterior cruciate ligament reconstruction. Am J Sports Med, 49(6), 1441-1450.
• 46. Fältström, A., Hägglund, M., & Kvist, J. (2017). Functional performance among active female soccer players after unilateral primary anterior cruciate ligament reconstruction compared with knee-healthy controls. Am J Sports Med, 45(2), 377-385.
• 47. Picot, B., Terrier., R., Forestier, N., Fourchet, F., & McKeon., P. O. (2021). The star excursion balance test: an update review and practical guidelines,. International Journal of Athletic Therapy and Training, 26(4), 285- 293.
• 48. Gonell, AC., Romero, JA., & Soler, LM. (2015). Relationship between the Y balance test scores and soft tissue injury incidence in a soccer team. Int J Sports Phys Ther, 10(7), 955-966.
• 49. Yosmaoglu, HB., Baltaci, G., Kaya, D., & Ozer, H. (2011). Tracking ability, motor coordination, and functional determinants after anterior cruciate ligament reconstruction. Journal of Sport Rehabilitation, 20(2), 207-218.
• 50. Heinert, B., Willett, K., & Kernozek, T.W. (2018). Influence of anterior cruciate ligament reconstruction on dynamic postural control. Int J Sports Phys Ther, 13(3), 432-440.
• 51. Paterno, M.V., Rauh, M.J., Schmitt, L.C., Ford, K.R., & Hewett, T.E. (2012). Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin. J. Sport Med, 22(2),116-21.