Proprioception/Balance in football

Before I start to elaborate on this topic it seems warrant to give some clarification about proprioception which will then forms the base for balance.

 

Proprioception from Latin “proprius” meaning "one's own", "individual" and perception, is the sense of the relative position of neighboring parts of the body and strength of effort being employed in movement (1 - see references below). The brain integrates information from Proprioceptors (like muscle spindles and the Golgi tendon organ) in addition to the vestibular system into an overall sense of joint position and movement (acceleration/deceleration).

 

How is proprioception measured

As proprioception is practically hard to measure, (some sort of) Balance was used to measure proprioception (18).

The most common test is the single leg stance (23) and most common parameter measured is the sway path (in mm) and the sway index  (the area formed by the sway path in cm2), which is equal to one standard deviation from the mean center of pressure (COP) (17). The sway path describes the way of the COP (13). Basically, the proprioception/balance is better if the movement around/away from the COP is less (and therefore the red cirlce in the left figure smaller).. A bipedal form (basically standing normally) was also used to measure postural control whilst the players had to close their eyes (26).

 

Sway-Index
Sway-Path

What is the importance of Proprioception/Balance in football

A decreased proprioception was seen as a risk factor for injuries (3) and seen as an indication of non-contact ankle sprain (24) in high-school soccer athletes.

Therefore it played a role in injury prevention (12, 19, 23) and rehabilitation from injuries (5, 8, 20, 25).

As ankle sprains and knee injuries are very common in football players (2, 30) proprioceptive/balance training was used in rehabilitation of these body sites (8, 25).

Furthermore, the training was shown to reduce knee injuries (8, 22), ankle sprains (22, 23) (of players who already suffered from ankle sprains) (25) and reduced non-contact hamstring injuries (19) and in general was protective of all injuries (12, 21).

However, there was no effect of training (29) and furthermore proprioceptive/balance training was shown to increase knee injuries (4, 29).

 

Other investigations in Football

With regards to asymmetries (and possible further injury risks), there was no difference between the preferred vs. the non-prefereed kicking leg (16).

It seems that proprioception/balance is affected by fatigue in youth (6, 7) and adult footballers (15). However, was also shown to be unaffected by fatigue in semi-professional football players (15). Training for proprioception/balance (using balance/wobble boards or inflatable disks (9, 12, 29) AFTER the normal training experienced greater gains compared to a group that placed the proprioception/balance training BEFORE the normal training (14). Therefore, the results are in contrast to aforementioned references.

It seems that there are gender differences with female football players are inherent superior balance ability over their male counterparts (28).

 

Additional thoughts

Whether proprioception can really be improved by exercise has been questioned and it is speculated that athletes might just become more skilled at focusing on and attending to important sensory cues with training and producing refined motor responses (18). However, it seems that training can improve proprioception/balance as the ability differ between athletes from different sports (11) and higher level players showed superior proprioception/balance skills over lower level players (17, 26, 27).

In contrast, proprioception/Balance training seemed not to be more affective as strength training or orthotic treatment (9, 24) and there is no evidence if it enhances performance in football (18).

 

References

 

1. Mosby's Medical, Nursing and Allied Health Dictionary. 1994.


2. Agel, J., Evans, T.A., Dick, R., Putukian, M., and Marshall, S.W. Descriptive epidemiology of collegiate

men's soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003. J. Athl. Training. 42: 270-277, 2007.


3. Alentorn-Geli, E., Myer, G.D., Silvers, H.J., Samitier, G., Romero, D., Lazaro-Haro, C., and Cugat, R.

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 17: 705-729, 2009.


4. Alentorn-Geli, E., Myer, G.D., Silvers, H.J., Samitier, G., Romero, D., Lazaro-Haro, C., and Cugat, R.

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 17: 859-879, 2009.


5. Alonso, A.C., Greve, J.M., and Camanho, G.L. Evaluating the center of gravity of dislocations in

soccer players with and without reconstruction of the anterior cruciate ligament using a balance platform. Clinics 64: 163-170, 2009.


6. Arliani, G.G., Almeida, G.P., Dos Santos, C.V., Venturini, A.M., Astur Dda, C., and Cohen, M. The

effects of exertion on the postural stability in young soccer players. Acta ortopedica brasileira 21: 155-158, 2013.


7. Brito, J., Fontes, I., Ribeiro, F., Raposo, A., Krustrup, P., and Rebelo, A. Postural stability decreases in

elite young soccer players after a competitive soccer match. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine 13: 175-179, 2012.


8. Caraffa, A., Cerulli, G., Projetti, M., Aisa, G., and Rizzo, A. Prevention of anterior cruciate ligament

injuries in soccer. A prospective controlled study of proprioceptive training. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 4: 19-21, 1996.


9. Cerulli, G., Benoit, D.L., Caraffa, A., and Ponteggia, F. Proprioceptive training and prevention of anterior

cruciate ligament injuries in soccer. The Journal of orthopaedic and sports physical therapy 31: 655-660; discussion 661, 2001.


10. Cressey, E.M., West, C.A., Tiberio, D.P., Kraemer, W.J., and Maresh, C.M. The effects of ten weeks of

lower-body unstable surface training on markers of athletic performance. J. Strength. Cond. Res. 21: 561-567, 2007.


11. Davlin, C.D. Dynamic balance in high level athletes. Percept. Mot. Skills. 98: 1171-1176, 2004.


12. Emery, C.A. and Meeuwisse, W.H. The effectiveness of a neuromuscular prevention strategy to reduce

injuries in youth soccer: a cluster-randomised controlled trial. Br. J. Sports. Med. 44: 555-562, 2010.


13. Gerbino, P.G., Griffin, E.D., and Zurakowski, D. Comparison of standing balance between female

collegiate dancers and soccer players. Gait & posture 26: 501-507, 2007.


14. Gioftsidou, A., Malliou, P., Pafis, G., Beneka, A., Godolias, G., and Maganaris, C.N. The effects of

soccer training and timing of balance training on balance ability. Europ. J. Appl. Physiol. 96: 659-664, 2006.


15. Greig, M. and Walker-Johnson, C. The influence of soccer-specific fatigue on functional stability.

Physic. Therap. Sport. 8: 185-190, 2007.


16. Gstöttner, M., Neher, A., Scholtz, A., Millonig, M., Lembert, S., and Raschner, C. Balance ability and

muscle response of the preferred and nonpreferred leg in soccer players. Motor Control 13: 218-231, 2009.


17. Hrysomallis, C. Relationship between balance ability, training and sports injury risk. Sports. Med. 37:

547-556, 2007.


18. Hrysomallis, C. Balance ability and athletic performance. Sports. Med. 41: 221-232, 2011.


19. Kraemer, R. and Knobloch, K. A soccer-specific balance training program for hamstring muscle and

patellar and achilles tendon injuries: An intervention study in premier league female soccer. Am J Sports Med 37: 1384-1393, 2009.


20. Lephart, S.M., Pincivero, D.M., Giraldo, J.L., and Fu, F.H. The role of proprioception in the

management and rehabilitation of athletic injuries. Am. J. Sports. Med. 25: 130-137, 1997.


21. Malliou, P., Giofisidou, A., Pafis, G., Beneka, A., and Godolias, G. Proprioceptive training (balance

exercises) reduces lower extremity injuries in young soccer players. Journal of Back and Musculoskeletal Rehabilitation 17: 101-104, 2004.


22. Mallo, J. Effect of block periodization on performance in competition in a soccer team during four

consecutive seasons: A case study. International Journal of Performance Analysis in Sport 11: 476-485, 2011.


23. McGuine, T.A. and Keene, J.S. The effect of a balance training program on the risk of ankle sprains in

high school athletes. Am. J. Sports. Med. 34: 1103-1111, 2006.


24. McHugh, M.P., Tyler, T.F., Tetro, D.T., Mullaney, M.J., and Nicholas, S.J. Risk factors for noncontact

ankle sprains in high school athletes: the role of hip strength and balance ability. Am. J. Sports. Med. 34: 464-470, 2006.


25. Mohammadi, F. Comparison of 3 preventive methods to reduce the recurrence of ankle inversion

sprains in male soccer players. Am. J. Sports. Med. 35: 922-926, 2007.


26. Paillard, T. and Noe, F. Effect of expertise and visual contribution on postural control in soccer.

Scandinavian journal of medicine & science in sports 16: 345-348, 2006.


27. Paillard, T., Noe, F., Riviere, T., Marion, V., Montoya, R., and Dupui, P. Postural performance and

strategy in the unipedal stance of soccer players at different levels of competition. J. Athl. Training. 41: 172-176, 2006.


28. Rozzi, S.L., Lephart, S.M., Gear, W.S., and Fu, F.H. Knee joint laxity and neuromuscular characteristics

of male and female soccer and basketball players. Am. J. Sports. Med. 27: 312-319, 1999.


29. Söderman, K., Werner, S., Pietila, T., Engstrom, B., and Alfredson, H. Balance board training:

prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee surgery, sports traumatology, arthroscopy 8: 356-363, 2000.

 

30. Walden, M., Hagglund, M., and Ekstrand, J. Injuries in Swedish elite football--a prospective study on

injury definitions, risk for injury and injury pattern during 2001. Scand J Med Sci Sports 15: 118-125, 2005.


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