Original Article EFFECTIVENESS OF NEUROMUSCULAR TRAINING

Int J Physiother Res 2013;01(5):251-60. ISSN 2321-1822 251

Original ArticleEFFECTIVENESS OF NEUROMUSCULAR TRAINING FOR BASKETBALL PLAYERS ON PERFORMANCE OF STAR EXCURSION BALANCETESTBhargava Kumar Bhaskar 1 , Vinod Babu. K *2, Sai Kumar. N 3, Vikas Kadam V 4.1 Post Graduate MPT student 2012-2014, *2 Assistant Professor, 3 Principal and Professor, 4 Professorin General Medicine.K.T.G. College of Physiotherapy and K.T.G. Hospital. Bangalore. India.

Background and introduction: To determine the effect of neuromuscular training program (NMTP) focused oncore stability and lower extremity strength on performance of star excursion balance test (SEBT) in basketballplayers.Method: : Pre to post test experimental study design randomised thirty Basketball players each 15 into NMTPand control group. Players trained together as a team in which NMTP group participated 4 weeks of NMTPtwice a week and Control group followed their regular protocol as guided by their coach.Results: When means of post intervention compared using Independent ‘t’ between NMTP and Control groupthere is no statistically significant difference (p<0.05) in anterior, posterior-medial and posterior-Lateral directionreach distance of star Excursion test but there is a statistically significant difference in means of anterior, posterior-medial and posterior-Lateral direction reach distance when analyzed within in groups using Paired‘t’ test andWilcoxon signed rank test.Conclusion: Neuromuscular Training program found to be effective for Basketball Players on Performance ofStar Excursion Balance Test and this improvement can significantly predict the prevention of injury.KEYWORDS: Neuromuscular Training Programme; Star Excursion Balance Test; Core Stability; Core Strengthening;Basketball Players.

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International Journal of Physiotherapy and ResearchISSN 2321- 1822

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Received: 10-11-2013 Accepted: 28-11-2013

Published: 11-12-2013

ABSTRACT

INTRODUCTION

Address for correspondence: Vinod Babu.K, Assistant Professor, K.T.G. College of Physiotherapyand K.T.G. Hospital, Bangalore-560 091, India. Email: [email protected]

International Journal of Physiotherapy and Research,Int J Physiother Res 2013, Vol1(5):251-60. ISSN 2321-1822

Peer Review: 10-11-2013

In athletic activities due to running, suddenchanging directions, falling etc, soft tissueinjuries are very common in which ligament tearsand joint sprains are predominate. These injuriesinvolve 68.71% of lower extremities, 29.79% ofknee problems, 2.75% spine, 1.99% of headinjuries and 9% of other injury with fractures.The injuries of lower extremities consistsprimarily of ligament tears and fractures whichare most commonly occurs at upper extremity.1

Basketball players are more prone to get softtissue injuries due to their athletic activities.Most common injuries in basketball players are

Ankle injuries 2 and Anterior cruciate ligamentinjury at knee.3 Randall Dick et. al. state that inbasketball players primary injury mechanismsare due to player contact, other contact (eg,contact with balls, standards, or the ground), andno contact in games and practices. Most game(52.3%) and practice (43.6%) injuries resultedfrom player contact. Few injuries wereassociated with contact with the standard or rimor with running into an out-of-boundsapparatus.4 Oluwatoyosi Babatunde AlexOwoeye et. al. stated that Jumping or landingare the most common cause of injury amongadolescent basketball players in Nigeria in which


Bhargava Kumar Bhaskar, Vinod Babu. K, Sai Kumar. N, Vikas Kadam V. Effectiveness of Neuromuscular Training For Basket Ball Players onPerformance of Star Excursion Balance Test.

most of the injuries were at the lowerextremities with majority at the knee joint.Ligament sprain was the most common types ofinjury.5 Meeuwisse WH et. al. found that thegreatest number of injuries in Canadianintercollegiate basketball players occurring at theknee and at the ankle and stated that the riskfactors for injury were previous injury, games asopposed to practice, player position, playercontact, and court location.Neuromuscular Training Program (NMTP)includes interventions that focus on increasecontrol of center of mass. As the center of massmoves away from the base of support, there isan increased potential for biomechanicaldeviations to occur in the lower extremity. Animproved ability to control this movement hasthe potential to decrease excessive forces on thelower extremity and ultimately decrease injuryrisk.Neuromuscular training is a commontherapeutic exercise component used by athletictrainers in the rehabilitation and prevention ofinjuries. In NMTP the exercises are focused onlower limb strength and core stability. Corestability is defined as dynamic trunk controlwhich allows for the production, transfer, andcontrol of force and motion to distal segmentsof the kinetic chain.6 The goal of the NMTP is toimprove the athlete’s ability to control the centerof mass during dynamic activity. MandekbaumBR et. al. concluded that neuromuscular trainingprogram for 2 years, have benefits in decreasingthe number of anterior cruciate ligament injuriesin female soccer players.3 Myer GD et. al. (2005)found that neuromuscular training programcaused significant improvements in measures ofatheletic performance with improvement inbiomechanical measures related to anteriorcrucite ligament risk in female athletes 7

especially female basketball, soccer andvolleyball players. Kibler WB et. al. stated thatCore stability controls the position and motionof the trunk over the pelvis to allow optimumproduction, transfer and control of force andmotion to the terminal segment in integratedathletic activities.6

The star excursion balance test (SEBT) is afunctional screening tool which assess the lower

extremity dynamic stability, monitorsrehabilitation progress, assess the injuries, andidentifies the athletes who are at high risk forlower extremity injury.2,8,9,10,11,12 To perform SEBTneuromuscular characteristics such as lowerextremity coordination, balance, flexibility, andstrength are required.2,10,11 Plisky et al found thatfemale athletes who had a composite reachdistance on the SEBT of less than 94% of theirlimb length were 6.5 times more likely to have alower extremity injury.2 As a result, the SEBT maybe a useful tool to assess the efficacy of trainingprograms designed to reduce injury risk. LaurenC. Olmsted et al conducted a studied that SEBTsis effective measure for determining reachdeficits in subjects with unilateral chronic ankleinstability.14 Another study by Plisky PJ et. al.found that Star Excursion Balance Test (SEBT)reach distance is associated with risk of lowerextremity injury among high school basketballplayers.2

Despite the studies on NMPT, that has beenfound effective on improving SEBT performanceon female soccer players. There are limitedstudies have done on basketball playersemphasizing on performance of SEBT and thereare no studies have found to find the SEBTperformance after NMTP. Therefore, there isneed to know the effect of NMPT on SEBTperformance in Male basketball players whichis predictable measure of lower limb injuries. Thestudy had a research question doesNeuromuscular Training Program improve theperformance on Star Excursion Balance Test inmale basketball players that can use to predictthe prevention of injury. Hence, the purpose ofthis study to determine the effect of NMTP onSEBT performance for male basketball playerswith chronic ankle injury. The objectives of thestudy to evaluate the effect of NeuromuscularTraining Program by analyzing the pre and posttraining measures of Star Excursion Balance Testin basketball players. To find the effect ofNeuromuscular Training Program onperformance of Star Excursion Balance Testcomparing with regular training programs inbasketball players. We hypothesized that therewill be a significant effect on performance of StarExcursion Balance test following NeuromuscularTraining Program in basketball players.


MATERIALS AND METHODS


Pre and post test experimental study design with30 male basketball players volunteer were re-cruited from Sports Authority of India (SAI) Ban-galore and study was conducted at K.T.G. Hospi-tal from September 2012 to August 2013. Sub-jects included were Players who performed SEBTwith an anterior right/left reach distance differ-ence greater than 4cm, Players unable to com-plete SEBT, Players with history of Grade I and IIankle sprain unilateral ankle sprains, Presenceof Ankle ligament laxity examined by AnteriorDrawer Test on Ankle with the subject in a seatedposition and Age group between 20-30 years.Subjects excluded who were with history ofLower limb fractures, Ligament injury Grade III,Post surgical condition of lower limb, Acute andrecurrent ankle sprain. Materials Used for inter-vention were Swiss ball, Measuring tapes,Marker, Barbells and Dumbles.Procedure: Thirty subjects who fulfilled theinclusion criteria were informed about the studyand a written consent was taken from theparticipants. Subjects were randomly allocatedto either NMTP Group or control group. Thepatients were randomly allocated into twogroups of thirty, 15 were in NMTP and 15 werein control group. Thirty pieces of paper used,with fifteen pieces having the word “NMTPGroup” written on them, and fifteen having thewords “Control Group” written on them. All thepieces of paper were tightly folded and placedin a box. After shaking the box thoroughly, eachpiece of paper was withdrawn individually andthe group name was written on a list thatcorresponds with patient numbers from one tofifteen. The subjects in NMTP group participated4 weeks of NMT program twice a week and otherdays they followed regular exercisesrecommended by their coach. The subjects incontrol group followed their regular protocol oftraining exercises as guided by their coach.Performance on Star excursion balance test(SEBT) was measured before and after 4 weeksof training program in both the groups.Procedure of training for NMTP group: TheNMTP group participated in 4 weeks of NMTPtwice a week training sessions for a total of 8sessions. The program at an Intensity of 80–85%of 1 RM, 8–12 repetitions and 3sets of exercise

with rest period of 160 sec after each set wereperformed.15 Each session consisted of 20-minutes pre training and post training warm-upexercises, two 45-minute increments of lowerextremity strength and core stability training,and a 5-minute cool-down that included staticand dynamic stretches for Calf, Quadriceps,Hamstring, Inner thigh and Hip flexors.Pre training and Post training warm-upexercises16: 1.Running exercises, 8 minutes(opening warm up): Running straight ahead,Running hip out, Running hip in, Running circling,Running and jumping. 2. Strength, Plyometrics,Balance, and 10 minutes: the plank, side plank,single leg balance, squats, jumping. 3. Runningexercises, 2 minutes (final warm up): runningover pitch, bounding run, running and cutting.Neuromuscular Training Program: NMTPincluded core stability exercise and lower limbstrengthening programme. The core stabilitycomponent was divided into 5 phases ofprogressive exercises. Phase 1: Lateral jumpand hold, Step-hold, Single-tuck jump softlanding, Front lunges, Lunge jumps, Swiss ballback hyperextension. Phase 2: Lateral jumps,Jump single-leg hold, Double-tuck jump, Walkinglunges, Scissor jumps, Swiss ball backhyperextension. Phase 3: Lateral hop and hold,Hop-hold, Repeated-tuck jump, Walking lungesunilaterally weighted, Lunge jumps unilaterallyweighted, Swiss ball hyperextensions with backfly. Phase 4: Lateral hops, Hop-hop-hold, Side-to-side barrier tuck jumps, Walking lunges withplate crossover, Scissor jumps unilaterallyweighted, Swiss ball hyperextensions with ballreach lateral. Phase 5: X-hops, Crossover-hop-hop-hold, Side-to-side reaction barrier tuckjumps, walking lunges with unilateral shoulderpress, Scissor jumps with ball swivel, Swiss ballhyperextensions with lateral ball catch.Lower Extremity Strength Training: Componentof the Neuromuscular Training Program includedStrength Training, First day of the week withDumbbell hang snatch, Barbell squat, Barbellbench press, Assisted Russian hamstring curl,Dumbell shoulder press, Hamstring curls,Latissimus pull-down, Lateral lunges. Secondday of the week- Barbell hang cleans, Sumosquat dumbell pick-up, Dumbell incline press,Gluteal/hamstring raise, Dumbell back fly, Band



ankle inversion/eversion, Walking lunges,Dumbell Ys and Ts Dumbell lateral raise.Regular Exercises: The exercises recommendedby their coach included were knee and hipflexibility exercises, ankle dorsiflexion ROMexercises stretching exercises andPlyometrics.17,18 Warm – up exercises:Jog line toline, Shuttle run, Backward running. Stretchingexercises: Calf stretch, Quadriceps stretch, Figurefour hamstring stretch, Inner thigh stretch, Hipflexor stretch. Strengthening exercises: Walkinglunges, Single toe raises. Plyometrics: Lateralhops over cone, Forward/Backward hops overcone, Single leg hops over cone, Scissor jump.Agilities: Shuttle run with forward/backwardrunning, Diagonal runs, Bounding run.Outcome measurement: The reliability of theSEBT has previously been established for specificmeasurement methods. SEBT was performed(Figure: 1) by drawing three lines in whichanterior line faces the mid line and two posteriorlines, which had 450 to anterior base. Theposterior lines were in posteromedial andposterolateral direction. The participant wasasked to reach as far as possible along each ofthree lines by making light touch and reach backto centre while maintaining a single leg stancewith the other leg in centre of grid. The SEBTcomposite score was calculated by dividing thesum of the maximum reach distance in theanterior (AT), posteromedial (PM), andposterolateral (PL) directions by 3 times the limblength (LL) of the individual, then multiplied by100 {[(AT + PM + PL)/(LL × 3)] × 100}. Theterminology of excursion directions is based onthe direction of reach in relation to the stanceleg. When reaching in the anterior,posteromedial and posterolateral directions,participants must reach behind the stance legto complete the task. Each subject receivedverbal instruction and visual demonstration ofthe SEBT from the examiner. The subjects stoodon 1 lower extremity, with the most distal aspectof their great toe on the center of the grid. Thesubjects were then asked to reach in the anterior,posteromedial, and posterolateral direction,while maintaining their single-limb stance. Sixpractice trials were performed on each limb foreach of the 3 reach directions prior to officialtesting.

On the seventh trial, the examiner visuallyrecorded the most distal location of the reachfoot as it contacted the grid in the 3 directions.The trial was discarded and the subject repeatedthe testing trial if the subject was unable tomaintain single-limb stance, the heel of thestance foot did not remain in contact with thefloor, weight was shifted onto the reach foot inany of the 3 directions, or the reach foot did notreturn to the starting position prior to reachingin another direction. The process was thenrepeated while standing on the other lowerextremity. The order of limb testing wascounterbalance randomized by the tester. Thesubject’s limb length measurements, from themost distal end of the anterior superior iliacspine to the most distal end of the lateralmalleolus on each limb, were taken andrecorded.

Figure 1: Subject performing the star excursion balancetest on the left lower extremity in posterolateraldirection.

Figure 2: Subject performing Latissimus pull-down.



Figure 3: Subject performing Dumbell houlder press.

Figure 4: Subject performing Dumbell back fly.

Figure 5: subjectp e r f o r m i n gDumbell inclinepress.

Figure 6: subject performing Barbell sqat.

Figure 7: Subject performing Hamstring curls.

Statistical Methods:Descriptive statistical analysis has been carriedout in this study and presented as mean ± SD.Significance is assessed at 5 % level ofsignificance with p value 0.05 less than this isconsidered as statistically significant difference.Pearson Chi-Square test and has been used toanalyze the significant of basic characteristic ofgender, age and affected side distribution of thesubjects studied. Paired ‘t’ test as a parametricand Wilcoxon signed rank test as a non-parametric test have been used to analysis the

RESULTS AND TABLES

variables pre-intervention to post-interventionwith calculation of percentage of change.Independent ‘t’ test as a parametric and MannWhitney U test as a non-parametric test havebeen used to compare the means of variablesbetween groups with calculation of percentageof difference between the means. The Statisticalsoftware namely SPSS 16.0, Stata 8.0, MedCalc9.0.1 and Systat 11.0 were used for the analysisof the data and Microsoft word and Excel havebeen used to generate graphs, tables etc.

The study was carried on total of 30 malebasketball players. In NMTP group there were15 subjects with mean age 25.73 years and inControl Group there were 15 subjects with meanage 25.47 years (Table 1).

15 15 --

Gender Males 15 15 --Right 9 6 p=0.000Left 6 9 p=0.000

15 15 30

p=0.387 (NS)

Affected limbTotal number of

subjects

Age in years (Mean± SD)

25.73± 3.08 (20-30)

25.47± 3.06 (20-30)

Basic Characteristics of

the subjects d

NMTP group Control

groupBetween

the groups Significance

Number of subjects studied (n)

a- Pearson Chi-SquareTable 1: Basic Characteristics of the subjects studied.



t value a Z valueb Effect Size Parametric

Upper

72.09± 3.95 -3.408

-3.408

61.36± 8.53 -3.408

-3.408

-3.408

51.67± 6.89 -3.408

P =0.003**

Posterior-medial

direction

47.37± 4.94 56.97± 6.04 (46.42-65.82)

20.26% -11.985

Perecntage of change

95%Confidence interval of the difference

Lower

NMTP Group

Anterior direction

63.88± 9.4612.85% -3.552

Post intervention

(Mean±SD in %) min-max

Pre intervention

Anterior direction

67.00± 12.02 (41.30- 87.64) 10.65% -20.134 -7.9 -6.38

-11.31 -7.88 P =0.000**

Posterior-Lateral

direction54.21± 7.79 (43.67- 67.53) 13.18% -5.657 -9.85 -4.43 P =0.000**

( Non parametric significance)

( Parametric)(Mean±SD in %) min-

max

P =0.000**

P valuer value

Posterior-Lateral

direction61.38± 5.86 (52.17-72.00) 18.79% -17.641 -10.89 -8.53

P =0.001**

P=0.000**

Posterior-medial

direction

52.86± 8.18 (43.47-72.41) 60.72± 8.21 (49.31-79.31) 14.86% -15.79 -8.93 -6.79 P =0.000**

P =0.001**

CONTROL GROUP

0.4 (Medium)

0.65 (Large)

0.49 (Medium)

P =0.001**

P =0.001**

P =0.001**

(42.69-64.63)

74.14± 11.51 (49.00-92.13)

P =0.001**(63.09-78.04)

(38.09 -56.32)

(32.19-72.00)

(50.00-76.62)

-13.16 -3.25

0.29 (Small)

0.43 (Medium)

0.6 (Large)

t value a Effect SizeParametric Significance

Lower Upper

63.88± 9.46 -0.996 0.14

47.37± 4.94 -1.95 0.37

51.67± 6.89 -0.893 0.17

74.14± 11.51 -1.037 0.11

-1.017 0.25

P=0.086 (NS) (Small )

61.36± 8.53 -0.228 0.009

Perecntage of difference

Z valueb 95%Confidence interval of the

difference

NMTP Group (Mean±SD) in percentage

min-max

CONTROL GROUP

(Mean±SD) in percentage

min-max

P =0.437 (NS)

Posterior-medial

direction

52.86± 8.18 (43.47-72.41)

-10.95% -2.225 -10.55 -0 .43 P=0 .034

PRE INTERVENTION COMPARSION

Anterior direction

67.00± 12.02 (41.30- 87.64) -4.76% -0.789 -11.21 4.97

P=0.519 (NS)

(42.69-64.63)

Posterior-Lateral

direction

54.21± 7.79 (43.67- 67.53)

4.79% 0.945 -2.96 8.04 P=0.372 (NS)

P value a

(32.19-72.00)

(38.09 -56.32) P=0.051*

P=0.319 (NS)

(Medium)

1.63 P= 0.165 (NS)

Posterior-Lateral

direction

61.38± 5.86 (52.17-72.00)

-0.03% -0.008 -5.5 5.45 P =0.993 (NS)

Posterior-medial

direction

56.97± 6.04 (46.42-65.82)

60.72± 8.21 (49.31-79.31)

-6.37% -1.427 -9.15

P =0.353 (NS)

POST INTERVENTION COMPARSION

Anterior direction

(Small )

(Small )

P=0.309**

P=0.820 (NS) (Small )(50.00-76.62)

(49.00-92.13) (Small )

( Parametric)( Non

parametric) r value

72.09± 3.95 (63.09-78.04)

-2.80% -0.653 -8.49 4.38

** Statistically Significant difference p<0.05 a. Pared t test. b. Wilcoxon Signed Ranks Test ; NS- Not significant

** Statistically Significant difference p<0.05; NS- Not significant; a. Independent t test. b. Mann Whitney U test Test

Table 3:Comparison ofnormativepercentage ofreach distancesStar ExcursionBalance TestPerformancebetween theNMTP Group andControl Group.

Table 2: Analysisof normativepercentage ofreach distances ofStar ExcursionBalance TestPerformancewithin NMTP andControl Group.

There is no significant difference in mean agesbetween the groups. Analysis of normativepercentage of reach distances of Star ExcursionBalance Test Performance within NMTP andControl Group (Table 2) found that there is astatistically significant ( p<0.05) improvement inmeans of anterior, posterior-medial andposterior-Lateral direction reach distance of starExcursion test. Comparison of Star ExcursionBalance Test Performance between Groups(Table 3) found that there is no statisticallysignificant difference in pre-intervention meansof anterior and posterior-lateral direction whereas there is a significant difference in Posterior-medial direction reach distance. When postintervention means were compared there is nostatistically significant difference in means ofanterior, posterior-medial and posterior-Lateral

direction reach distance of star Excursion test.

Chart 1: Analysis of means of anterior direction reachdistance within the NMTP Group and Control Group (Preto post analysis)The above graph shows that there is a statisticallysignificant difference in means of normative percent-age of anterior reach distance in NMTP Group andin Control Group when analyzed within in groupsfrom pre intervention to post intervention.


Chart 2: Analysis of Posterior Medial direction reachdistance within the NMTP Group and Control Group (Preto post analysis)The above graph shows that there is a statisti-cally significant difference in means of norma-tive percentage of posterior Medial directionreach distance in NMTP Group and in ControlGroup when analyzed within in groups from preintervention to post intervention.

Chart 3: Analysis of means of Postero-Lateral Directionreach distance within the NMTP Group and ControlGroup (Pre to post analysis).The above graph shows that there is a statisti-cally significant difference in means of norma-tive percentage of posteriolateral reach distancein NMTP Group and in Control Group when ana-lyzed within in groups from pre intervention topost intervention.

Chart 4: Comparison of pre intervention means betweenNMTP Group and Control Group.The above graph shows that there is nostatistically significant difference in means ofanterior and posterior-lateral direction betweenNMTP Group and Control Group, where as thereis a significant difference between the groups inPosterior-medial direction reach distance.

Chart 5: Comparison of means of post interventionbetween NMTP Group and Control Group.The above graph shows that when means of postintervention compared there is a no statisticallysignificant difference in means of anterior,posterior-medial and posterior-Lateral directionreach distance of star Excursion test.

DISCUSSIONAnalysis from the results found that theNeuromuscular training program groupsignificantly shown greater percentage ofimprovement on performance of star excursionbalance test than control group who receivedonly regular exercises when analysed before toafter intervention, however there is nostatistically significant difference inimprovement when post intervention meanswere compared between the groups.In Control Group the improvement in SEBTscores could be because the subjects eventhough were not in NMTP training program, they

were been recommended for regular exercisesadvised by their coach which might haveinfluence the strengthening of core muscle andlower limbs, and improved knee, hip flexibilityand improved ankle dorsiflexion ROM. Thecoach advised regular basketball trainingprogram which included training sessions aswarming up (up to 20 min.), exercises for theimprovement of individual technical actions (upto 40 min., ball dribble for 10 min., shooting for20 min. and passing for 10 min.); tactical training(up to 30 min.).19 Robinson and Gribblesuggested that improvement in the SEBT are notdue to strength or core stability, it may due togood knee and hip flexibility of the stance limb.20



Curtis R. Basnett et al (2013) studied that ankledorsiflexion ROM can improve the performanceon SEBT.21 in the present study the exercisesincluded knee and hip flexibility exercises, ankledorsiflexion ROM exercises stretching exercisesand Plyometrics.17,18 Warm – up exercises: Jogline to line, Shuttle run, Backward running.Stretching exercises: Calf stretch, Quadricepsstretch, Figure four hamstring stretch, Innerthigh stretch, Hip flexor stretch. Strengtheningexercises: Walking lunges, Single toe raises.Plyometrics: Lateral hops over cone, Forward/Backward hops over cone, Single leg hops overcone, Scissor jump. Agilities: Shuttle run withforward/backward running, Diagonal runs,Bounding run. These combination of regularexercises may influenced improvement inperformance in SEBT.In NMTP group, among three directions there issignificant improvements in the postero-lateraland poster-medial direction of SEBT this couldbe due to effect of Neuromuscular trainingprogram and regular exercises performed by theathletes. Regular exercise program is a commontherapeutic exercise component used by athletictrainers in the rehabilitation and prevention ofinjuries. In NMTP the exercises are focused onlower limb strength and core stability. Corestability is dynamic trunk control which allowsfor the production, transfer, and control of forceand motion to distal segments of the kineticchain.6 Poor core stability and decreasedmuscular synergy of the trunk and hip stabilizersleads to decrease performance in poweractivities and increases the incidence of injurydue to lack of control of the centre of mass.8,22

The NMTP improves the athlete’s ability tocontrol the centre of mass during dynamicactivity. The results of this study are supportedby previous studies. Neuromuscular trainingprogram that focused on lower extremitystrength and core stability significantly improvedthe composite SEBT scores in female soccerplayers.8 Myer GD et. al. studied the effect ofneuromuscular training program on measures ofathletic performance and lower-extremitymovement biomechanics in female athletesspecially female basketball, soccer and volleyballplayers and they found significant improvementsin measures of atheletic performance.7

Decreased neuromuscular control of the trunkappears to influence dynamic stability of thelower extremity during high-speed athleticmaneuvers.13 NMTP Improves the fitnesslevels and enhance resistance to injury. It helpsto maintain balance and improve the ability tocontrol center of mass during dynamic activity.It helps in improving body flexibility andstrength. Following NMTP program the groupshown no significant improvement in anteriordirection. This is supported by the previous studydone by Alyson Filipa et.al., in their study nodifferences in reach were found in the anteriordirection.8

Performance on Star excursion balance testcompared between both groups found nostatistical difference in post means. Howeverthere is clinical significant greater improvementin NMTP group than control group, from pre topost intervention percentage of changes inimprovement in NMTP Group is -12.85% inanterior direction, -20.26% Posterior-medialdirection, -13.18% Posterior-Lateral directionand changes in control Group is -10.65% -Anterior direction, -14.86% Posterior-medialdirection, -18.79% Posterior-Lateral directionshows that greater percentage of change isfound in NMTP group. This could be due to 8-weeks Neuromuscular training program thatfocused on lower extremity strength and corestability found added effect along with regularexercises that significantly improved compositeSEBT scores than the control group who relievedonly regular exercises. Following the trainingprogram, there was no statistical significantdifference in post means of composite scorebetween the groups. This may be due to thedesign of the NMTP and regular exercises whichfocused on the performance of exercises equallyon each limb and likely contributed to thedifference in limb effect. Establishing limbsymmetry was important because limbdominance and side-to-side imbalance in lowerextremity measures have been found to be a riskfactor for ligament injury.23,24 Plisky PJ et alstudied that the individuals who participated inthe NMTP showed improvements in the SEBTcomposite scores when compared to non-trained controls. However, its effect on knee orankle injury rate was not assessed in their study.



In the present study NMTP program wasimplemented twice a week for 4 weeks thereforethe duration of the study carried might have notshown significant difference in between thegroups. Only 15 subjects were studied in eachgroup showing small to medium effect thatsignifies that the small sample size which canaffect the results. The SEBT is reliable andpredictive measure of lower extrimity injury inbasketball players.2 However in the study themeasurement was standardised by consideringthe composite scores of SEBT as measured bythe previous studies.However there is no statistically significancedifference in improvement of SEBT scoreobtained between the groups, based on thefinding in this study found that there is asignificant effect of Neuromuscular trainingprogram along with regular exercise onperformance of Star Excursion Balance Test formale Basket ball players with chronic anklesprain. Hence the present study rejects nullhypothesis.The study has certain limitation small sample sizewhich decreases the applicability to otherpopulations, training was performed without thebenefits of random assignment and without theblinding of the investigators, only short termeffect are found and male basket players withchronic ankle sprain were studied. Further longterm studies are needed to find effect of NMTPon other athletics with different sports on largersample size.CONCLUSIONNeuromuscular Training program found to beeffective for Male Basketball Players with chronicankle sprain on Performance of Star ExcursionBalance Test and this improvement cansignificantly predict the prevention of injury.Therefore implementation of neuromusculartraining program for athletes with chronic anklesprain is recommended to prevent from injuries.ACKNOWLEDGMENTAuthors were expressing their sense ofgratitude’s to the people who helped andencouraged them for the guidance andcompletion of this study.

Conflicts of Interest: None

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How to cite this article:Bhargava Kumar Bhaskar, Vinod Babu. K, Sai Kumar. N, Vikas Kadam V.Effectiveness of Neuromuscular Training For Basket Ball Players onPerformance of Star Excursion Balance Test. Int J Physiother Res2013;05:251-60.

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Original Article EFFECTIVENESS OF NEUROMUSCULAR TRAINING