gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Changes in ankle joint position sense in elite female handball-players as a result of a special injury-prevention training

Meeting Abstract

  • corresponding author presenting/speaker Ákos Kynsburg - Landesklinikum Mostviertel, Amstetten, Austria
  • Gergely Pánics - National Institute for Sports Medicine, Budapest, Hungary
  • Tamás Halasi - National Institute for Sports Medicine, Budapest, Hungary
  • András Tállay - National Institute for Sports Medicine, Budapest, Hungary

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm053

doi: 10.3205/11esm053, urn:nbn:de:0183-11esm0536

Published: October 24, 2011

© 2011 Kynsburg et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: In an earlier study, where a special neuromuscular training was applied in a therapeutic fashion for 6 weeks on young athletes with chronic lateral talocrural instability we observed, that the proprioceptive sensory function of the ankle plantarflectors on the injured side didn’t differ significantly from healthy controls before the start of the programme. However at follow-up this function improved vastly and became significantly better, compared to controls. This could be interpreted as an indirect sign on the preventive effect of the training. With an epidemiologically already proven preventive effect of this neuromuscular training on ankle ligament injuries, the main goal of this study was to prove the positive effect on ankle proprioception with the training being applied in a preventive fashion in elite athletes of a high-risk sport.

Material/Methods: First, in order to identify the sport with the highest injury-risk, we defined the sportsspecific incidence of ankle injuries based on comparable literature data. Processing 119 relevant papers in full-text, we have found that handball features the highest injury frequency rates for ankle injuries, leading to 2.14 injuries in 1000 playing hours. In accordance with these epidemiological findings we examined ankle joint position sense function measuring 20 ankles of 10 elite-level players of a female handball club. For the measurements we applied the slope-box test, first described by Robbins et al. The test was performed before the special drills were incorporated into the team’s regular training regimen and 20 months later, measuring joint position sense on 11 different slope amplitudes in four directions (anterior, posterior, lateral and medial) each on both ankles.

Results: Proprioceptive sensory function of the measured ankles improved with a high significance (p<0.0001; avg. mean estimate error improvement: 1.77°). This improvement was also highly significant (p<0.0002) in each single directions, with avg. mean estimate error improvement varying between 1.59° (posterior direction) and 2.03° (anterior direction). These changes were also strongly significant when these handball-players were compared to a control-group of healthy athletes from our previous studies. Regarding improvement between single directions, and also between dominant and non-dominant sides, no significant differences could be observed. As an indicator of the actual preventive effect by means of lowering injury incidence, results of this group (62% fewer ankle injuries) were similar to those of earlier epidemiological studies, investigating larger samples.

Conclusion: In our series of studies the positive effect of this special neuromuscular training on ankle proprioception was proven both when applied in a therapeutic and a preventive fashion. This justifies the name “proprioceptive training” for this preventive method. In comparison to the therapeutic group it can be stated, that in patients with chronic lateral talocrural instability proprioceptive training should be continued on long-term at a lower intensity after it was successfully applied therapeutically. We consider the incorporation of proprioceptive drills into the regular training regimen in contact team sports indispensable, in other sports recommended for the prevention of ankle injuries.