Research Review by Dr. Shawn Thistle©



Study Title:

The effect of a balance training program on the risk of ankle sprains in high school athletes


McGuine TA & Keene JS

Publication Information:

American Journal of Sports Medicine 2006; 34(7): 1103-1111.


Ankle sprain is the most common injury suffered by athletes. In fact, anyone who has ever played sports at any level has likely sprained an ankle, or seen someone sprain an ankle. What most people don't realize is that ankle sprains result in numerous visits to emergency medicine facilities, high health-care costs, and significant time lost from sports or work.

Despite the prevalence and cost of ankle sprains, critical reviews have identified only a small amount of published research into the efficacy of various preventive approaches.

This study investigated whether a balance training program could reduce the number of ankle sprains in a large group of male and female high school athletes. 765 high school soccer and basketball athletes (523 girls and 242 boys) were randomly assigned to either an intervention group that underwent a structured balance training program or a control group that performed only standard conditioning exercises.

The balance program was implemented in the preseason for those in the study group and maintained throughout the season. Each athlete had baseline physical measurements taken by an athletic therapist, as well as a history of any previous ankle sprains or injury. An orthopedic test (anterior drawer) for ankle ligament laxity was also performed.

The balance training program consisted of 5 progressive phases, and included variations of the following tasks:
  1. maintaining a single leg stance with eyes open and closed
  2. performing functional sports activities while standing on one leg
  3. maintaining double stance while rotating on a balance board
  4. maintaining single leg stance on a balance board with eyes open and closed
  5. performing functional sports activities while in single leg stance on a balance board
Five balance training sessions were performed each week for a month before the start of the season, and three times per week during the season. If a subject missed more than four consecutive sessions, he or she was considered noncompliant with the balance training protocol.

Ankle sprains were defined as any injury that disrupted the ligaments of the ankle and occurred during a coach-directed competition, practice, or conditioning session. Further, the athlete had to miss the rest of the practice or competition, or a subsequent practice or competition.

Data was collected for the duration of the season, and revealed the following:
  • 8.1% of the athletes in the study sustained an ankle sprain during the season, missing an average of 7.6 days
  • balance training significantly reduced the incidence of ankle sprains
  • the risk of ankle injury for those in the balance training group was only 62% compared to the control group
  • in athletes without a history of ankle sprain, 7.7% of the controls and 4.2% of the intervention group sustained an ankle sprain
  • the risk of sustaining an ankle sprain was twice as high for subject who had sustained an ankle sprain within the previous 12 months

Conclusions & Practical Application:

This study suggests that a simple balance training program (taking only about 10 minutes per session) can reduce the risk of ankle sprains in high school athletes, whether they had sustained a previous sprain or not.

High school strength and conditioning coaches or those that work with high school athletes should consider incorporating simple balance training into off-season and in-season training regimens.