Indian Journal of Physiotherapy and Occupational Therapy,DOI Number: January-March 10.5958/0973-5674.2020.00009.X 2020, Vol. 14, No. 1 49 Effect of Wobble Board Exercises on Star Excursion Test in Athletes of Belagavi- An Experimental Study

Basavaraj Motimath1, Sadhvi Koyande 2 1Associate Professor – Head of Department of Sports Physiotherapy, 2Post Graduate Student, Sports Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India.

Abstract Background: In every sporting activity, balance is important, be it static or dynamic. Balance training is a part of training sessions in sports so as to reduce the risk of injuries. Wobble board has shown effective results on decreasing the risk of falls and injuries

Aim: To determine the effectiveness of wobble board exercises on star excursion balance test in athletes.

Method: The study was a single group pre-post experimental design in which 32 athletes were included. The star excursion balance test was measured before and after the protocol. Wobble board training was given to the athletes for a period of 3 weeks with 3 sessions per week on alternate days.

Results: The results showed significant increase in the reach distances of SEBT scores at p<0.001.

Conclusion: The present experimental study concluded that the three week wobble board training was effective in increasing dynamic balance in all 8 directions of the SEBT scores.

Keywords: Balance, SEBT, wobble board, athletes.

Introduction activity, as it stresses the sensory and motor feedback loops4. Balance can be defined “statically as the ability to maintain a base of support with minimal movement Balance is maintained when vision, , and dynamically as the ability to perform a task while vestibular function are interacting together.5 Any maintaining a stable position.”1 Static balance, is when sporting activity requires visual proprioception to track an individual can maintain a stable state during a still the information about the activity in the environment upright position, be it standing or sitting. Dynamic around him, for example, the position of the opponent balance is when an individual is able to maintain balance and flight of the ball, etc. Hence, the central nervous while the center of gravity and base of support are system has to count on the proprioceptive information moving 2,3 for balance control from various body parts6.

To maintain balance, the and brainstem Balance is considered as a prerequisite for sporting process the afferent information and initiate motor activities and used as a measure to indicate risk of commands. While standing on an unstable surface, there injuries. Hence it is necessary to evaluate and train the is increase in postural sway and lower limb muscle athletes for balance7,6. Various studies have been done using wobble board to improve balance and prevent injury. Hence the present study is designed to evaluate Corresponding author: the effect of wobble board exercises on star excursion Post Graduate Student, balance test. Sports Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India. Materials and Methodology Email ID: [email protected] Ethical clearance was obtained from the 50 Indian Journal of Physiotherapy and Occupational Therapy. January-March 2020, Vol. 14, No. 1

Institutional Ethical Committee of KAHER Institute of A warm up session of 5 minutes was given to the Physiotherapy, Belagavi. Both male and female athletes athletes prior to the training program which included above the age of 18 years from various sports clubs in jog in place, trunk rotation, high knees, side shuttle and Belagavi, Karnataka were included, only after obtaining sprint/back pedal. The training was done using a wooden a written informed consent prior to the study. The study wobble board of 40cm diameter and base height of 10cm. included 32 athletes out of which 20 were males and 12 The training program was carried out for 25-30 mins per were females. The inclusion criteria of the study were session. Familiarization session to the wobble board was a) athletes of various sports disciplines, b) age above 18 administered prior to the protocol. Each of the exercises years, and c) subjects willing to participate. The athletes was given for 30s followed by 10s rest. The entire set were excluded if they had a) any neurological deficits, b) was then repeated for 5 times. The following exercise been operated to the lower limb in the past 6 months, c) regimen was given 3 sessions per week for 3 weeks. history of trauma to the hip, knee or ankle, d) pain in the hip, knee or ankle, e) mental illness and f) any vestibular The study protocol on the wobble board included problems (vertigo), visual problems (blind in one eye). the following exercises:

Outcome Measure: 1. Double leg stance with eyes open

Star excursion balance test 2. Double leg stance with eyes closed

The test consists of a grid in eight directions. At 3. Single leg stance the center of the grid is a tile surface where the subject 4. Rocking the board front and back stands with single leg stance8. The subject was asked to touch the most distal part of the great toe on each of 5. Rocking the board side to side the lines, without shifting weight or losing balance. 6. Rocking front of the board from side to side The test was repeated3. Singleif the athleteleg stance lifted the heel of the stance foot, lunged on the opposite foot while reaching 7. Rotating on balance board or was not able4. to maintainRocking thebalance board frontwhile and reaching.back The athlete executed5. Rockingthe test thein board8 directions; side to side namely, 8. Performing physical activities anterior, anterolateral, lateral, posterolateral, posterior, 6. Rocking front of the board from side to side posteromedial, medial and anteromedial9. The test was Statistical analysis: performed for both7. theRotating lower limbson balance and boardrecorded on the Statistical analysis for the present study was done first and last session of the study. 8. Performing physical activities using statistical package of social sciences (SPSS) version 20 so as to verify the results obtained. Normality Procedure:

a) SEBT in antrolateral direction b) SEBT in posterior direction

Indian Journal of Physiotherapy and Occupational Therapy, January-March 2020, Vol. 14, No. 1 51

c ) SEBT in medial direction d) SEBT in posteromedial direction

e) double limb standing on wobble board f) single limb standing

Statistical analysis:

Statistical analysis for the present study was done using statistical package of social sciences (SPSS) version 20 so as to verify the results obtained. Normality of changes from pre-test to post-test of different variables were done using Kolmogorov Smirnov test. Comparison of pre 52 Indian Journal of Physiotherapy and Occupational Therapy. January-March 2020, Vol. 14, No. 1 of changes from pre-test to post-test of different variables The descriptive characteristics of the athletes were done using Kolmogorov Smirnov test. Comparison included in the study were analysed statistically. The of pre and post values score for the outcome measures mean age of the athletes was 20.88 ±2.11. The mean were analyzed using Dependent-t test. Probability values BMI of the athletes was 21.96±3.10, suggesting that less than 0.001 were considered significant. they had a normal BMI.

Table no. 1: Comparison of SEBT values between left and right lower limbs in 8 directions.

Variable Time Mean ± SD p-value

Anterior right Pretest 98.38 ± 15.93

Posttest 105.63 ± 13.11 <0.001

Anterior left Pretest 100.69 ± 14.30

Posttest 105.91± 13.38 <0.001

Anterolateral right Pretest 103.22± 13.57

Posttest 108.72± 10.52 <0.001

Anterolateral left Pretest 103.69± 12.93

Posttest 108.81 ± 10.08 <0.001

Lateral right Pretest 106.06 ± 10.77

Posttest 111.25 ± 8.48 <0.001

Lateral left Pretest 104.81 ±13.45

Posttest 111.44 ±8.84 <0.001

Poster lateral right Pretest 102.84 ±11.02

Posttest 109.72 ± 7.84 <0.001

Indian Journal of Physiotherapy and Occupational Therapy, January-March 2020, Vol. 14, No. 1 53

Cont... Table no. 1: Comparison of SEBT values between left and right lower limbs in 8 directions.

Poster lateral left Pretest 102.22 ±15.46 <0.001

Posttest 108.19 ±11.94

Posterior right Pretest 94.22 ± 18.96 <0.001

Posttest 102.94 ± 12.88

Posterior left Pretest 96.06 ±17.46 <0.001

Posttest 103.19 ±12.49

Poster medial right Pretest 90.34 ±16.33 <0.001

Posttest 96.75 ±13.65

Poster medial left Pretest 92.00 ±16.18 <0.001

Posttest 94.72 ±19.98

Medial right Pretest 83.91 ±19.56 <0.001

Posttest 91.41 ±16.61

Medial Left Pretest 81.72 ±19.10 <0.001

Posttest 89.25 ±16.46

Anteromedial right Pretest 95.50 ±14.62 <0.001

Posttest 102.09 ±12.09

Anteromedial left Pretest 95.91 ±14.97 <0.001

Posttest 102.25 ±12.12

Table no. 1 shows the results of the Star Excursion Discussion Balance Test in all the 8 directions following the wobble The current study was done on athletes of various board training. There was significant increase in the fields of sports, involving the lower extremities. reach distance in all the directions of the SEBT for both Researchers in the past have examined balance abilities the lower limbs. The maximum pre-post difference in athletes of various sports stating that balance abilities was seen in the posterior direction on the right lower differ in athletes of various sports and also depending limb. The minimum pre-post difference was seen in the on their performance levels. A study compared balance posteromedial direction in the left lower limb. on high school, collegiate and professional athletes which suggested that the professional athletes had better 54 Indian Journal of Physiotherapy and Occupational Therapy. January-March 2020, Vol. 14, No. 1 dynamic balance than the other athletes. The more the soccer, basketball, and gymnastics athletes. Journal experience of the athletes, more is the proprioception, of athletic training. 2007 Jan;42(1):42. 10 range of motion, strength and movement abilities 2. Eylen MA, Daglioglu O, Gucenmez E. The Effects of Different on Static and The present study assessed dynamic balance using Dynamic Balance Ability of Volleyball Players. the Star excursion Balance test in 8 directions. The Journal of Education and Training Studies. 2017 results have shown significant improvement in all the Dec;5(13):13-8. direction for both the lower limbs following a 3 week wobble board training. A study suggests that the increase 3. Fusco A, Giancotti GF, Fuchs PX, Wagner H, in the reach distance could have been due to increased Varalda C, Capranica L, Cortis C. Dynamic neuromuscular control of the lower limbs which was balance evaluation: reliability and validity of a seen by increasing the difficulty level of the exercise and computerized wobble board. Journal of strength number of repetitions11. and conditioning research. 2018 Feb 22. 4. Anderson K, Behm DG. The impact of instability A study done by Butler et al on dynamic balance resistance training on balance and stability. Sports has shown higher SEBT scores in anterior direction medicine. 2005 Jan 1;35(1):43-53. in high school athletes when compared to collegiate 5. Hahn T, Foldspang A, Vestergaard E, Ingemann‐ and professional athletes10. In contrast to that, Mccann Hansen T. One‐leg standing balance and sports et al who compared SEBT scores in high school and activity. Scandinavian journal of medicine & collegiate athletes did not find any difference in the science in sports. 1999 Feb 1;9(1):15-8. scores12. 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Using the Star study was that exercises were not monitored on the days Excursion Balance Test to assess dynamic postural- when the training was not given. control deficits and outcomes in lower extremity injury: a literature and systematic review. Journal Conclusion of athletic training. 2012 May;47(3):339-57. The present experimental study concluded that 9. Gribble PA, Hertel J. Considerations for the three week wobble board training was effective in normalizing measures of the Star Excursion increasing the reach distance in all the 8 directions of the Balance Test. Measurement in physical education star excursion balance test in athletes. and exercise science. 2003 Jun 1;7(2):89-100. 10. Butler RJ, Southers C, Gorman PP, Kiesel KB, Future scope: This wobble board training can be Plisky PJ. Differences in soccer players’ dynamic incorporated in the training sessions for sports-specific balance across levels of competition. Journal of activities. 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