Poor Balance as a Predictor of Injury in Adolescent Athletes Lange CA, Tierney RT, Mansell JL, Russ AC: Collingswood High School, Collingswood, NJ; Temple University, Philadelphia, PA Context: As adolescent participation in sports increases, athletic injury is increasingly common. Balance defi cits, a common occurrence in this population, may increase risk of injury. The purpose of this analysis was to examine the link between injury rates and poor balance in the adolescent population. Methods: PubMed and Medline were searched in July of 2018 using the Boolean phrase: (balance AND adolescent AND athlete AND balance AND injury NOT concussion). Only prospective studies involving adolescent athletes reporting injury rates were considered. Studies using rehabilitation programs or reporting concussions were excluded. The Critical Appraisal Skills Program (CASP) for cohort studies was used for validity. Outcome measures assessed injury rate ratios based on baseline balance scores. Balance scores were accessed using single leg balance test (SLB), Star Excursion Balance Test (SEBT), Y Balance Test (YBT), and a postural sway test on a balance platform. 95% CIs were calculated if not provided. Results: The search returned 149 articles, 4 of which were selected meeting inclusion criteria. There was an increase in injury rates with poor balance found in each study. In one study, injury occurrence was 2.5 times increased in lower extremity injury (p<.05 95% CI 1.4, 5.3) with a side to side anterior reach difference in the SEBT of greater than 4cm. Additionally, females with a composite reach distance less than 94% of their limb length were 6.5 times more likely to have a lower extremity injury (p<.05 95% CI 2.4, 17.5). In another study, a 3.86 increase in lower extremity injury occurred (p=.001 95% CI .24, 10.29) with a side to side reach difference of 4 cm in the YBT. Also, composite reach score differences were more than 12 cm and a 1.93 increase in injury occurred (95% CI .77, 4.56). In another study using single leg balance test, athletes with a positive SLB had a 2.54 overall increase in ankle injuries (95% CI 1.02, 6.03). In a fourth study, single leg postural sway was tested using a balance platform to assess balance. Athletes with high sway had a 6.7 increase in ankle sprains (p=.0002) compared to those with good balance. CASP scores ranged from 8 to 11 out of 12. Conclusions: SORT rating: B. Consistent research indicates that poor balance is a risk factor for injury, however additional research should further examine this relationship. Baseline balance measures should be taken prior to the beginning of the season to identify athletes at risk for injury. Future research should focus on the effectiveness of balance training programs on decreasing risk of injury in at-risk adolescent athletes.
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