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It is clinically and practically relevant to note that the study demonstrated significant improvements in balance ability after a training period of only 2 weeks, which was further improved after 4 weeks in six of the eight directions. These findings appear to indicate that 2 weeks is sufficient time to promote significant improvements in dynamic balance ability that may be important for the maintenance of posture and balance (4), although the precise clinical impact in terms of injury prevention or motor function is impossible to determine. If more time is available to perform specific balance training, then improvements may continue to accrue, but probably at a reduced rate. It is not clear from this study or the existing literature how the gain in balance ability slows after an initial 4 weeks of training. The rapid improvement in balance


ability inside 2 weeks has practical implications and is important in time- limited training such as preseason training. The methods used are also easily transferable into the field, and the practical application of the current data in a clinical setting should be quite straightforward. The improvements observed in the UTD in some directions of the SEBT test provide new data to support that a crossover effect in balance ability is accruing from the TRD leg during the training sessions. The crossover effect has been described previously in a number of strength-training studies (16), and the percentage change in balance ability in the current study is very similar to that reported for strength development (16).


The importance of neural


mechanisms to explain this crossover effect has been reviewed (17,18). The crossover effect may have some implications for rehabilitation from athletic injury. Balance-training a non-injured leg could, in theory, lead to a small improvement in the injured leg, even if it were too early or inappropriate to balance-train the injured leg directly. An example of this has been demonstrated in shoulder injuries (19). Interestingly, the magnitude of the crossover effect may be direction-dependent, with greater effects occurring in transfer from the dominant to the non-dominant limb (20), which also has potential implications for the success of any


10


crossover intervention in a clinical environment. In conclusion, as a result of only


2 weeks of progressive single-leg dynamic balance training, the reach performance of the TRD leg improved significantly across all directions of the SEBT test. Improvements continued to 4 weeks of training in six out of the eight directions employed in the SEBT protocol. Small but significant improvements in the UTD leg in four out of the eight directions of the SEBT test suggest some crossover training effect. The current training programme and test protocols can be transferred easily into the clinical environment to assess balance training and its impact upon function, injury and rehabilitation. This article was adapted from a study published in Physical Therapy in Sport and is reprinted with permission. A more detailed description of this study can be found in Rasool J, George K. The impact of single-leg dynamic balance training on dynamic stability. Physical Therapy in Sport 2007;8:177– 184.


References 1. Cornwall MW, Murrell P. Postural sway following inversion sprain of the ankle. Journal of the American Podiatric Medical Association 1991;81:243–247 2. Lofvenberg R, Kärrholm J, Sudelin G, Ahlgren O. Prolonged reaction time in patients with chronic lateral instability of the ankle. American Journal of Sports Medicine 1995;23:414–417 3. Freeman M. Instability of the foot after injuries to the lateral ligament of the ankle. Journal of Bone and Joint Surgery 1965;47:669–677 4. Rozzi SL, Lephart SM, Sterner R, Kuligowski L. Balance training for persons with functionally unstable ankles. Journal of Orthopaedic and Sports Physical Therapy 1999;29:478–486 5. Emery CA, Cassidy JD, Klassen TP, Rosychuk RJ, Rowe BH. Effectiveness of a home-based balance-training program in reducing sports-related injuries among healthy adolescents: a cluster randomised controlled trail. Canadian Medical Association Journal 2005;172:749–754 6. Hoffman M, Payne VG. The effects of proprioceptive ankle disk training on healthy


Jaffar Rasool, gained a BSc in Physical Therapy from King Saud University in 1994 and an MSc in Sports Injury from Manchester Metropolitan University in 2005. He is currently senior physiotherapist and education coordinator of the Physiotherapy Department in Qatief Central Hospital, Qatief, Saudi Arabia and works with the KSA (Kingdom of Saudi Arabia) national handball team and the AL Khaleej club.


THE AUTHOR Jaffar


TH in 2005. y Department in Qatief Central sportEX medicine 2009;41(Jul):7-10


subjects. Journal of Orthopaedic and Sports Physical Therapy 1995;21:90–93 7. Hertel J, Miller SJ, Denegar CR. Intratester and intertester reliability during the Star Excursion Balance Tests. Journal of Sport Rehabilitation 2000;9:104–116 8. Cohen H, Blatchly CA, Gombash LL. A study of the clinical test of sensory interaction and balance. Physical Therapy 1993;73:346–354 9. Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the Star Excursion Balance Tests in detecting reach deficits in subjects with chronic ankle instability. Journal of Athletic Training 2002;37:501–506 10. Lord S, Ward J, Williams P. Exercise effect on dynamic stability in older women: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 1996;77:232–236 11. Hertel J, Braham RA, Hale SA, Olmstead- Kramer LC. Simplifying the Star Excursion Balance Test: analyses of subjects with and without chronic ankle instability. Journal of Orthopaedic and Sports Physical Therapy 2006;36:131–137 12. Sveistrup H, Woollacott M. Practice modifies the developing automatic postural response. Experimental Brain Research 1997;114:33–43 13. Wiley M, Damiano D. Lower-extremity strength profiles in spastic cerebral palsy. Developmental Medicine and Child Neurology 1998;40:100–107 14. Tononi G, Edelman GM. Consciousness and complexity. Science 1998;282:1846– 1851


15. Chandler TJ, Wilson GD, Stone MH. The effect of the squat exercise on knee stability. Medicine and Science in Sports and Exercise 1989;21:299–303 16. Munn J, Herbert RD, Gandevia SC. Contralateral effects of unilateral resistance training: a meta-analysis. Journal of Applied Physiology 2004;96:1861–1866 17. Carroll TJ, Herbert RD, Munn J, Lee M, Gandevia SC. Contralateral effects of unilateral strength training: evidence and possible mechanisms. Journal of Applied Physiology 2006;101:1514–1522 18. Gabriel DA, Kamen G, Frost G. Neural adaptations to resistive exercise: mechanisms and recommendations for practices. Sports Medicine 2006;36:133– 149 19. Stromber BV. Contralateral therapy in upper extremity rehabilitation. American Journal of Physical Medicine 1986;65:135–143 20. Lee M, Carroll TJ. Cross-education: possible mechanisms for the contralateral effects of unilateral resistance training. Sports Medicine 2007;37:1–14.


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