TECHNICAL NOTE

Motor Control, 2009, 13, 218-231 2009 Human Kinetics, Inc.

Balance Ability and Muscle Response of the Preferred and Nonpreferred Leg in Soccer Players
Michaela Gstttner, Andreas Neher, Arne Scholtz, Martin Millonig, Sandra Lembert, and Christian Raschner
The aim of this study was to evaluate balance abilities and electromyographic (EMG) latency times of the preferred and nonpreferred leg in soccer players. Whereas side differences between the two legs in force, kicking speed, and joint laxity have been demonstrated in athletes in previous studies, no data are so far available on balance differences. Low balance ability is generally associated with an increased risk of ligament injuries, and the detection of a possible asymmetry in balance is important because a bilateral difference may be a contributing factor to injury. Twenty-one amateur soccer players were tested. Two different balance test instruments were used: the Biodex Stability System and the Tetrax System. For the evaluation of muscle latency times, EMGs were recorded by means of the EquiTest system. None of the tests performed in this study revealed statistically significant differences in balance ability between the preferred and the nonpreferred leg. The investigations of balance function and muscle response in amateur soccer players did not reveal significant differences between the preferred and nonpreferred leg in the current study. However, a certain tendency to better balance in the nonpreferred leg was observed.

Keywords: balance, Biodex System, EquiTest, soccer, Tetrax System

Soccer is one of the most popular sports. With more than 240 million amateur players worldwide, it has the highest participation rate in the world, and it accounts for more than 10% of sport injuries requiring medical attention in adolescents (Emery, Meeuwisse, & Hartmann, 2005; Emery, Meeuwisse, & McAllister, 2006; Junge, Rosch, Peterson, Graf-Baumann, & Dvorak, 2002). Ankle sprains, knee sprains, and muscle strains are reported to be the most common injuries. Adequate intermuscular activity has been proved to be of enormous importance in the prevention of injuries. Freiwald, Papadopoulus, Slomka, Bizzini, and Baumgart (2006) reported on deficient trunk and leg axis stability as an endogenous factor for soccer injuries. Moreover, low balance ability has been
Gstttner is with the Dept. of Orthopaedic Surgery, and Neher, Scholtz, and Millonig are with the Dept. of Otorhinolaryngology, Medical University Innsbruck, Anichstrasse 35, Innsbruck, Tyrol, Austria. Lembert and Raschner are with the Dept. of Sport Science, Leopold-Franzens University Innsbruck, Fuerstenweg 185, Innsbruck, Tyrol, Austria.

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demonstrated to be associated with an increased risk of ligament injuries (Hrysomallis, McLaughlin, & Goodman, 2007; Caraffa, Cerulli, Projetti, Aisa, & Rizzo, 1996). The detection of deficits in balance abilities was shown to be a reliable predictive tool for injuries of the lower extremities in young athletes (Plisky, Rauh, Kaminski, & Underwood, 2006). Edwards (1981) and Grace, Sweetser, Nelson, Ydens, and Skipper (1984) pointed out the importance of detecting a possible asymmetry between the left and right leg because a bilateral difference may be a contributing factor to injury. A test evaluating balance and stance stability can help trainers to decide whether players need physical therapy to improve their balance skills by means of special training programs for the worse leg. During rehabilitation, an existing side difference between the dominant and nondominant leg has been found to be an important criterion to define a regained normal state of the injured extremity (Kovaleski, Heitman, Gurchiek, Erdmann, & Trundle, 1997). Therefore, clinicians should be aware of this side difference and its normal range. Freiwald emphasized the importance of coordinative balance training in science-based training programs to prevent injuries and improve performance (Freiwald et al., 2006). Also in matters of technique, such as stop-out-of-running, safe stance in kicking, and in one-on-one situations, good balance abilities are crucial in soccer. For a good soccer player, it is essential to kick the ball well with both legs. But even top-level players show bilateral differences and fail to score when it is not possible to play the ball with their preferred leg. Former studies have demonstrated asymmetries in muscle strength, muscle activation, and muscle thickness between the two legs (Kearns, Isokawa, & Abe, 2001; Lembert et al., 2006; Rahnama, Lees, & Bambaecichi, 2005; Ross, Guskiewicz, Prentice, Schneider, & Yu, 2004; Schuepfer et al., 2006). In addition, McLean and Tumilty (1993) found differences in kick velocity and kick accuracy for the preferred and nonpreferred leg. The aim of this study was to compare the balance abilities and muscle responses of the preferred and nonpreferred leg in soccer players, which has not been investigated so far. Balance and equilibrium constitute a complex reflexive response initiated by three primary sensory systems (vestibular, visual, and somatosensory) and coordinated by the central nervous system. Up until about 20 years ago, simple behavioral tests, such as the Rhomberg and the Mann test, were used to test postural control. More recently, computerized posturography has been developed and evaluated (Turner, 1998). These devices allow the assessment of balance functions more exactly, objectively, and efficiently. We used two different systems, the Biodex and the Tetrax System. In addition, EMG responses were measured during tests with the EquiTest System.

Materials and Methods

This study was approved by the Ethical Review Board of the Department of Sport Science, Leopold-Franzens University Innsbruck. Because most sports injuries appear in amateur athletes (Freiwald et al., 2006), we aimed at investigating

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nonprofessional soccer players. Subjects were recruited from five local amateur teams and gave their written consent to participate. Injuries of the lower limbs in the preceding year and known deficits of the equilibrium (sensory systems [vestibular, visual, and somatosensory] and the central nervous system) were defined as exclusion criteria. We were able to recruit and test 21 amateur soccer players regularly playing in a local team (age: 26 3.3 years, weight: 74.6 8.5 kg, height: 176.8 6.1 cm). They had to declare their preferred leg for kicking. This kicking leg was defined as the preferred or dominant leg. One player was left-footed; 20 declared their right leg to be preferred for kicking. Balance tests were performed with two different types of equipment: The Biodex Stability System and the Tetrax System. EMGs were recorded using the EquiTest System. To exclude possible influencing factors, such as tiredness caused by training, all players were tested in one group and on an afternoon on which no soccer training was scheduled. The test conditions were presented in random order.

Biodex Stability System

The Biodex Stability System (BSS) consists of a multiaxial standing platform with a maximum of 20 of surface tilt. It is used to assess the subjects ability to maintain dynamic postural stability on an unstable tilting platform; a cursor, which represents the center of the platform, has to be maintained in the center of the bulls-eye on a visual feedback screen. A chosen level of platform instability is usually tested for 20 or 30 s while the test person tries to keep the platform in the level position. The manually preset degree of surface instability ranges from a completely firm surface, stability level 8, to a very unstable surface, stability level 2. Three indexes are electronically generated. Based on the degrees of tilt over the anterior-posterior (AP) and the medial-lateral (ML) axes, the BSS calculates the medial-lateral stability index (MLSI), the anterior-posterior stability index (APSI), and the overall stability index (OSI). These indexes are standard deviations indicating fluctuations around the zero point (i.e., horizontal). The MLSI and the APSI measure the fluctuations from horizontal along the AP and ML axes of the BSS. In contrast, the OSI is a composite of the MLSI and APSI and is, therefore, sensitive to changes in both directions. Formulas for calculating the APSI, MLSI, and OSI have been described by Arnold and Schmitz (1998). Lower values represent better stability than higher ones. The reliability of the BSS has repeatedly been scientifically proven. Capuche, Shifflett, Kahanov, and Wughalter (2001), for instance, demonstrated for the accomplishment of two practice and two test trails on stability level 2 acceptable to excellent reliability for all three indexes (R = .90 [OSI], R = .86 [APSI], and R = .76 [MLSI]). All subjects completed a standardized warm-up program with an ergometer and a My Fitness Trainer balance board. We assessed unilateral stance at level 3 with the BSS over a period of 20 s. The subjects were asked to step on the platform of the BSS and adopt a comfortable position while maintaining slight flexion in their knees (15). All players were evaluated with their eyes open and without footwear. The posture of the arms was not regulated.

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The subjects completed one practice trial and two test trails with each leg. The order of testing, with preferred and nonpreferred, was chosen randomly. The test trail that achieved the lowest stability index was analyzed.

The Tetrax System

The Tetrax Interactive Balance System (IBS) is different from traditional posturographic methods, which essentially measure the displacement patterns of the point of gravity. IBS is based on the assessment of vertical pressure fluctuations on four independent platforms, each one serving as a support for one heel and toe part. The Tetrax balance system is a fixed platform with a railing that includes four separate plates. The subjects stand on the platform with each heel and toe part on one of the plates, guided by a foot-shaped sketch on each of the plates. The test procedure consists of four positions that have to be kept for 32 s: (1) eyes open, solid surface, standing on right foot; (2) eyes open, solid surface, standing on left foot; (3) eyes open, elastic surface on foam-rubber pad, standing on right foot; (4) eyes open, elastic surface on foam-rubber pad, standing on left foot. The Tetrax device provides a parameter called General Stability. General Stability expressed by the Stability Index (ST) measures the amount of sway over the four plates. The Stability Index is an indicator of the subjects overall steadiness. It represents the ability of the subject to control postural balance. This parameter does not depend on the subjects weight and height. A low value indicates high stability. The stability index was evaluated in single-leg stance with and without foamrubber pillows (height: 8 cm).

EquiTest System
Finally, the subjects were tested on a computerized posturographic platform (EquiTest, NeuroCom, Clackamas, USA). During the procedure, the subjects were asked to stand upright and center each foot directly on the stripe on the dual-force plate while heeding the lateral foot placement, which was dependent on their height. The participants faced a visual surround that also included a color picture to enhance their attention. The subjects safety was ensured by the operator, who was standing within touching distance. No safety harness was worn. The EquiTest protocol is designed to analyze the subjects ability to interactively use the sensory systems to maintain balance (Mayagoitia, Ltters, Veltink, & Hermens, 2002; Rahnama et al., 2005). The system determines the location of the center of gravity (COG) within predefined 75% of the limits of stability (LOS) while adjusting to an individual subjects height (COG = 0.55 height). It measures the postural sway and the ability to maintain the COG within a predefined target area. The posturographic platform included a dual-force plate that may be pitched up, down, or translated in the anterior-posterior direction. The two single-force plates (23 46 cm each) consisted of a flat, rigid surface supported by independent

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force-measuring devices at four points to record the pressure on the right and left anterior and posterior plantar surfaces. For the subjects, the Movement Coordination Test (MCT) was applied (Masuda, Kikuhara, Demura, Katsuta, & Yamanaka, 2005). MCTa component of the EquiTest protocoldemonstrates the subjects ability to coordinate automatic movement responses to maintain standing posture (Arnold & Schmitz, 1998; Baczkowski, Marks, Silberstein, & Schneider-Kolsky, 2006). MCT is divided into six separate trials: small and large backward and forward translation perturbations of the platform to simulate falling forward and backward. In addition, the platform is tilted toes-down and toes-up. The translations were performed at two intensities in sets of three trials. Their amplitudes were height normalized to yield the following equivalent sways (small [0.7 sway] and large [3.2 sway]). The durations were 250 ms for small translation perturbations and 400 ms for the large ones. The translation protocol evaluates the latency and force vectors of the response. The latency represents the time interval from onset of support surface perturbation to the point a patient begins to actively resist the induced sway. In the adaptation protocol, the toes-up and toes-down rotations were delivered in sets of five trials each (8 amplitude, 400-ms duration). The delay time between rotation trials varied randomly between 3 s and 5 s. These ankle rotations represent unusual and difficult balancing tasks because the proprioceptive stretch stimulation results in a maladaptive, destabilizing contraction of leg muscles. The rotational trials evaluate the ability to adapt automatic movement responses to recurrent platform movements. This protocol evaluates the adaptation score, which quantifies how well the subject can minimize anterior-posterior sway after unexpected rotations of the support surface. Simultaneously with both translation and rotation, EMG signals were recorded from surface electrodes placed over the muscles of the upper and lower limbs. Surface electrodes, two active electrodes and one common electrode of about 1.3 cm in diameter, were placed on the biceps femoris, quadriceps, medial gastrocnemius, and the anterior tibialis muscles bilaterally. EMG signals were preamplified, full-wave rectified, and band-pass filtered (10 Hz to 30 kHz). Twelve trials were recorded and averaged. Latencies of the averaged EMG activity after the onset of the platform tilt were calculated after visual identification of the onset of each EMG component. Criteria for visual identification of onset were as follows: onset was considered to be an approximately 15% increase from baseline in the EMG.

Statistical Analysis
As the Kolmogorov-Smirnov Test confirmed the normal distribution of results of the Biodex System, the statistical comparison between the preferred and nonpreferred leg was performed using Students t test for dependent variables. Because the results received from the Tetrax and EquiTest were not normally distributed, differences between preferred and nonpreferred legs in these two test systems were investigated using the Wilcoxon Test. The level of statistical significance was set at p < .05. To determine effective sample sizes and testing power, a power analysis was performed using G-Power 3.0.8.

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Results
Biodex Stability System
Stability measurement using the Biodex Stability System revealed no statistically significant difference between the preferred and the nonpreferred leg (Table 1).

Tetrax System
Stability was much higher in two-leg stance. In single-leg stance with and without an underlying soft pillow, the nonpreferred leg showed better stability, but this was not statistically significant (Table 2). The difference between the legs was higher when using the pillow.

EquiTest System
There was no statistically significant difference in any of the four tested muscles between the two legs (Table 3 and Table 4). The m. biceps femoris of the preferred leg reacted faster in all test conditions. The latencies of the m. quadriceps femoris of the nonpreferred leg were shorter when the plate was moving forward and toes up and down. The m. tibialis anterior of the preferred leg reacted faster when the plate was moving forward and toes down, whereas in moving backward and toes up, the nonpreferred leg reacted faster. The m. gastrocnemius of the nonpreferred leg reacted faster in plate movement forward and toes up; in moving toes down, both legs showed the same latency time. The results of the power analyses of the balance tests are shown in Table 5. The power analyses for EMG tests ranged from a power of 6.9% for testing the m. gastrocnemius (movement of the plate: toes up) to 57.8% for testing the m. biceps femoris (movement of the plate: forward). The effective sample sizes ranged from 38 in testing the m. biceps femoris (movement of the plate: forward) to 4577 in testing the m. gastrocnemius (movement of the plate: toes up). This means that between 38 and 4577 soccer players would have to be tested to reveal probable statistically significant differences between the preferred and nonpreferred legs. Table 1 Biodex Indexes of the Preferred and the Nonpreferred Leg
Mean value 2.381 2.429 1.924 1.824 1.576 1.748 SD 0.5938 0.6619 0.5612 0.3846 0.3974 0.6353 95% CI 2.1112.651 2.1272.730 .27 1.6682.179 1.6491.999 .23 1.3951.757 1.4582.037 Statistical significance, p .75

Stability index Overall Stability Index nonpreferred leg preferred leg Anterior-Posterior Stability Index nonpreferred leg preferred leg Medio-Lateral Stability Index nonpreferred leg preferred leg

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Table 2 Tetrax Stability Indexes of the Preferred and the Nonpreferred Leg
Stability index Stability Index with pillow nonpreferred leg preferred leg Stability Index without pillow nonpreferred leg preferred leg Mean value 38.08 40.09 37.24 37.55 SD 11.07 13.6 12.26 10.62 95% CI 33.04243.116 34.14746.034 .45 31.66042.820 32.71242.380 Statistical significance, p .12

Discussion
Numerous previous studies have been published on measuring differences between the preferred and nonpreferred leg in soccer players. The data comprise investigations on kicking speed (Masuda et al., 2005; Dorge, Anderson, Sorensen, & Simonsen, 2002), muscle strength and activity (Lembert et al., 2006; Rahnama et al., 2005; Schuepfer et al., 2006; Baczkowski et al., 2006; Masuda et al., 2005), and instability of the knee joint (Ergun, Islegen, & Taskiran, 2004). Some authors found no side-to-side difference (Agre & Baxter, 1987; Capranica, Cama, Fanton, Tessitore, & Figura, 1992; Ostenberg, Roos, Ekdahl, & Roos, 1998). Other studies clearly revealed differences between the preferred and nonpreferred leg. Dorge et al. (2002) found higher ball speeds as a result of higher foot speed and coefficient of restitution at the time of impact in the preferred leg in seven skilled soccer players. The authors conclude that the difference in ball speed is caused by a better intersegmental motion pattern. Masuda et al. (2005) reported that ball velocity was significantly related with hip adductor strength; knee extension and hip flexion of the kicking leg; and with knee flexion, hip extension, and hip abduction of the supporting leg. Asymmetries between the kicking and supporting leg in soccer players were also reported by Baczkowski et al. (2006); Nunome, Ikegami, Kozakai, Apriantono, and Sano (2006); McLean and Tumilty (1993); and Rahnama et al. (2005). Several studies have been published on laxity differences between dominant and nondominant extremities in athletes. Although some authors demonstrated differences (Ergun et al., 2004; Rosene & Fogarty, 1999), others did not (Andersson & Gillquist, 1990; Edixhoven, Huiskes, & de Graff, 1989; Rangger, Daniel, Stone, & Kaufman, 1993). A difference in postural control between the two legs of soccer players has not been investigated so far. McCurdy and Langford (2006) did not establish a significant correlation between strength and static balance in university students. Their results also suggest that differences in static balance performance between the legs cannot be determined by leg dominance. The investigations of balance function and muscle response did not reveal significant differences between the preferred and nonpreferred leg in the current study either, but showed a certain tendency to better balance in the nonpreferred leg. There was a slight tendency toward better stability in the OSI and the MLSI for the nonpreferred leg when the Biodex System was used. In the Tetrax

Table 3
Leg Mean value SD 95% CI

EquiTest Latency Times of EMGs of the Thigh in the Preferred and the Nonpreferred Leg
Statistical significance, p .174 .331 .119 .464 .909 .936 .495 .580

Muscle

Movement of the plate

M. biceps femoris

M. biceps femoris

M. biceps femoris

M. biceps femoris

M. quadriceps femoris

M. quadriceps femoris

M. quadriceps femoris

M. quadriceps femoris

forward forward backward backward toes up toes up toes down toes down forward forward backward backward toes up toes up toes down toes down

nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred

129.07 111.33 126.93 114.57 149.60 142.69 130.83 120.80 102.94 107.76 118.58 122.54 156.94 169.00 101.57 104.31

33.83 28.72 23.64 30.73 29.44 68.53 56.06 61.45 35.25 29.35 30.50 31.18 54.09 57.87 47.38 33.33

88.62152.63 94.89147.36 102.28138.72 94.15135.60 129.55181.95 93.33144.42 75.77177.48 65.35163.15 89.22127.78 88.73133.77 111.14144.11 117.08154.92 125.30159.70 135.56169.19 55.56158.44 74.14116.86

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Table 4
Leg Mean value SD 95% CI

EquiTest Latency Times of EMGs of the Shank in the Preferred and the Nonpreferred Leg
Statistical significance, p .624 .433 .525 .660 .402 .343 .636 .973

Muscle

Movement of the plate

M. tibialis anterior

M. tibialis anterior

M. tibialis anterior

M. tibialis anterior

M. gastrocnemius

M. gastrocnemius

M. gastrocnemius

M. gastrocnemius

forward forward backward backward toes up toes up toes down toes down forward forward backward backward toes up toes up toes down toes down

nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred nonpreferred preferred

93.58 91.79 94.76 98.74 118.42 124.95 85.56 87.12 91.56 97.29 94.40 89.84 110.00 112.72 90.53 95.65

7.71 11.78 11.85 17.44 17.44 25.54 19.05 23.39 18.43 19.85 13.30 9.87 44.31 32.97 24.41 28.22

88.2297.38 84.3198.09 88.10101.77 87.27109.13 107.47127.86 110.40140.80 76.9398.27 73.8194.59 84.78107.47 87.46110.04 87.13103.14 84.1993.68 68.10127.15 107.22136.28 77.45117.30 74.62120.13

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Table 5 Power Analysis of the Postural Tests

Test Biodex Overall Stability Index Biodex Anterior-Posterior Stability Index Biodex Medio-Lateral Stability Index Tetrax Stability Index with pillow Tetrax Stability Index without pillow Effective sample size 1235 101 87 96 7060 Power (%) 9 29.55 32.5 37.4 6.5

measurements, the difference between the legs was higher when using the pillow. This may result from the higher demand on the proprioceptive system in an instable situation, created by the soft pillow. The difference between the preferred and nonpreferred leg is more obvious in a test that is more difficult for the locomotor system. This is explicable by the higher demand on stabilizing in stance, compared with the kicking leg. When searching for causing mechanisms, some previous studies may help to find answers. In balance testing with the Biodex Stability System, core stability plays an important role because the person has to maintain the equilibrium on an instable plate. During our investigations, most of the soccer players showed poor overall balance abilities. They had to use their arms for balancing and went into an exaggerated flexed or rotated position to put the gluteal or shorter rotator muscles on greater tension to compensate for other muscular weaknesses as described by Kibler, Press, and Sciascia (2006). This compensation of core stability weakness may mask differences between the two legs. The importance of training stability and coordination skills has become clear in many disciplines. Alpine skiers, for instance, spend a lot of their conditioning training time on balance training to improve the steering performance on the edges of the skis (e.g., in a carved turn) but also to avoid injuries resulting from deficits in coordination abilities (e.g., cutting the edge of a ski during high-speed competition such as downhill race or super G, or having a balanced position over the short slalom skis, Malliou et al. [2004]). Compared with the stability test results of ski racers, the soccer players investigated were found to have inferior results on the Biodex system. Amateur players in particular still have to invest most of their training time in technical and tactical training as well as in endurance and strength training, whereas coordinative training is not encouraged so much. More positive effects of balance training may be expected if the sport-specific muscle activation patterns are kept in mind during practice (Popovic et al., 2000). The systemic approach stated by Schoellhorn (1999) allows using the concept of differential training in proprioceptive and coordination training. The objective of this training method is to create goal-oriented sensory differentiation abilities through various exercises. To use the systemic approach, adequate, modular system-based training or therapy tools should be used. They allow a variety of

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soccer-specific training variations to be performed in a methodical and progressive way, while immediate changes are possible to suit the specific abilities in soccer. One could also speculate that better stabilization of the standing leg during a shot or pass leads to better ball-hit accuracy and subsequently to a faster ball speed and/or better ball-flight accuracy. Only few authors have reported on EMG investigations in soccer players so far. Dorge et al. (1999) stated that the m. iliopsoas was active during the entire kicking motion. In our study, the EMG latencies of the muscles of the lower leg did not reveal any relevant differences between the preferred and the nonpreferred leg. It was only in the case of the m. biceps femoris that shorter latencies were found for the preferred leg. We expected faster compensation and, therefore, better stability of the nonpreferred leg because soccer players have to stabilize their stance leg in different positions for kicking the ball. This expectation could not be established by the results of this study. In soccer training and during rehabilitation of injured players, trainers should focus on easy balance exercises such as one-leg standing, for example. Possible deficits should be reduced by specific training because the risk of injuries may be lowered by improved coordination skills. However, the role of postural instability as a risk factor for injuries remains controversial. Some studies have reported an association between diminished balance and injury (McGuine, Greene, Best, & Leverson, 2000; Soderman, Alfredson, Pietila, & Werner, 2001; Tropp, Ekstrand, & Gillquist, 1984; Docherty, 2006). Two studies found no association (Beynnon, Murphy, & Alosa, 2002; Hopper, Hopper, & Elliott, 1995). The discussion whether there are differences between the dominant and nondominant leg remains controversial. The discrepancy of results may even be caused by the uncertainty of which leg is defined as the dominant one. A consensus is required to define the term dominant extremity, and standardized tests should be established to find out the preferred side. The statistically nonsignificant results of the current study may also be the result of the amateur level of the athletes. Their limb dominance is probably not so distinct that it can be detected by the balance tests used in this trial.

References
Agre, J.C., & Baxter, T.L. (1987). Musculoskeletal profile of male collegiate soccer players. Archives of Physical Medicine and Rehabilitation, 68(3), 147150. Andersson, C., & Gillquist, J. (1990). Instrumented testing for evaluation of sagittal knee laxity. Clinical Orthopaedics and Related Research, 256, 178184. Arnold, B., & Schmitz, R. (1998). Examination of balance measures produced by the Biodex Stability System. Journal of Athletic Training, 33(4), 323327. Baczkowski, K., Marks, P., Silberstein, M., & Schneider-Kolsky, M.E. (2006). A new look into kicking a football: An investigation of muscle activity using MRI. Australasian Radiology, 50(4), 324329. Beynnon, B.D., Murphy, D.F., & Alosa, D.M. (2002). Predictive factors for lateral ankle sprains: A literature review. Journal of Athletic Training, 37(4), 376380. Cachupe, W., Shifflett, B., Kahanov, L., & Wughalter, E. (2001). Reliability of Biodex Balance System Measures. Measurement in Physical Education and Exercise Science, 5(2), 97108.

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Capranica, L., Cama, G., Fanton, F., Tessitore, A., & Figura, F. (1992). Force and power of preferred and non-preferred leg in young soccer players. Journal of Sports Medicine and Physical Fitness, 32(4), 358363. Caraffa, A., Cerulli, G., Projetti, M., Aisa, G., & Rizzo, A. (1996). Prevention of anterior cruciate ligament injuries in soccer: A prospective controlled study of proprioceptive training. Knee Surgery, Sports Traumatology, Arthroscopy, 4(1), 1921. Docherty, C.L., Valovich McLeod, T.C., & Shultz, S.J. (2006). Postural control deficits in participants with functional ankle instability as measured by the balance error scoring system. Clinical Journal of Sport Medicine, 16(3), 203208. Dorge, H.C., Anderson, T.B., Sorensen, H., & Simonsen, E.B. (2002 April). Biomechanical differences in soccer kicking with the preferred and the non-preferred leg. Journal of Sports Science, 20(4), 293299. Erratum in: Journal of Sports Science, 2002 August, 20(8), 657. Dorge, H.C., Andersen, T.B., Sorensen, H., Simonsen, E.B., Aagaard, H., Dyhre-Poulsen, P., et al. (1999). EMG activity of the iliopsoas muscle and leg kinetics during the soccer place kick. Scandinavian Journal of Medicine & Science in Sports, 9(4), 195 200. Edixhoven, P., Huiskes, R., & de Graaf, R. (1989). Anteroposterior drawer measurements in the knee using an instrumented test device. Clinical Orthopaedics and Related Research, 247, 232242. Edwards, A.M. (1981). Comparison of quadriceps and hamstring torque values during isokinetic exercise. The Journal of Orthopaedic and Sports Physical Therapy, 3, 4856. Emery, C.A., Meeuwisse, W.H., & Hartmann, S.E. (2005). Evaluation of risk factors for injury in adolescent soccer: Implementation and validation of an injury surveillance system. American Journal of Sports Medicine, 33(12), 18821891. Emery, C.A., Meeuwisse, W.H., & McAllister, J.R. (2006). Survey of sport participation and sport injury in Calgary and area high schools. Clinical Journal of Sport Medicine, 16(1), 2026. Ergun, M., Islegen, C., & Taskiran, E. (2004). A cross-sectional analysis of sagittal knee laxity and isokinetic muscle strength in soccer players. International Journal of Sports Medicine, 25(8), 594598. Freiwald, J., Papadopoulus, C., Slomka, M., Bizzini, M., & Baumgart, C. (2006). Prvention im Fuballsport. Sportorthopdie Sporttraumatologie, 22, 140150. Grace, T.G., Sweetser, E.R., Nelson, M.A., Ydens, L.R., & Skipper, B.J. (1984). Isokinetic muscle imbalance and knee-joint injuries: A prospective blind study. The Journal of Bone and Joint Surgery. American Volume, 66(5), 734740. Hopper, D.M., Hopper, J.L., & Elliott, B.C. (1995). Do selected kinanthropometric and performance variables predict injuries in female netball players? Journal of Sports Sciences, 13(3), 213222. Hrysomallis, C., McLaughlin, P., & Goodman, C. (2007). Balance and injury in elite Australian footballers. International Journal of Sports Medicine, 28, 844847. Junge, A., Rosch, D., Peterson, L., Graf-Baumann, T., & Dvorak, J. (2002). Prevention of soccer injuries: A prospective intervention study in youth amateur players. American Journal of Sports Medicine, 30(5), 652659. Kearns, C.F., Isokawa, M., & Abe, T. (2001). Architectural characteristics of dominant leg and muscles in junior soccer players. European Journal of Applied Physiology, 85, 240243. Kibler, W.B., Press, J., & Sciascia, A. (2006). The role of core stability in athletic function. Sports Medicine (Auckland, N.Z.), 36(3), 189198. Kovaleski, J.E., Heitman, R.J., Gurchiek, L.R., Erdmann, J.W., & Trundle, T.L. (1997). Reliability and effects of leg dominance on lower extremity isokinetic force and work using the closed chain rider system. Journal of Sport Rehabilitation, 6, 319326.

230

Gstttner et al.

Lembert, S., Schuepfer, N., Raschner, C., Platze, H.P., Niederkofler, A., Patterson, C., et al. (2006). Comparison of isokinetic extension and flexion strength between stance and kicking leg in closed kinetic chain of soccer players. Abstract Band of the 5th International Conference on Strength Training, Odense. Malliou, P., Amoutzas, K., Theodosiou, A., Gioftsidou, A., Mantis, K., Pylianidis, T., et al. (2004). Proprioceptive training for learning downhill skiing. Perceptual and Motor Skills, 99(1), 149154. Masuda, K., Kikuhara, N., Demura, S., Katsuta, S., & Yamanaka, K. (2005). Relationship between muscle strength in various isokinetic movements and kick performance among soccer players. Journal of Sports Medicine and Physical Fitness, 1, 4452. Mayagoitia, R.E., Ltters, J.C., Veltink, P.H., & Hermens, H. (2002). Standing balance evaluation using a triaxial accelerometer. Gait & Posture, 16(1), 5559. McCurdy, K., & Langford, G. (2006). The relationship between maximum unilateral squat strength and balance in young adult men and women. Journal of Sports Science and Medicine, 5, 282288. McGuine, T.A., Greene, J.J., Best, T., & Leverson, G. (2000). Balance as a predictor of ankle injuries in high school basketball players. Clinical Journal of Sport Medicine, 10(4), 239244. McLean, B.D., & Tumilty, D.M. (1993). Left-right asymmetry in two types of soccer kick. British Journal of Sports Medicine, 27(4), 260262. Nunome, H., Ikegami, Y., Kozakai, R., Apriantono, T., & Sano, S. (2006). Segmental dynamics of soccer instep kicking with the preferred and non-preferred leg. Journal of Sports Sciences, 24(5), 529541. Ostenberg, A., Roos, E., Ekdahl, C., & Roos, H. (1998). Isokinetic knee extensor strength and functional performance in healthy female soccer players. Scandinavian Journal of Medicine & Science in Sports, 8(5 Pt 1), 257264. Plisky, P.J., Rauh, M.J., Kaminski, T.W., & Underwood, F.B. (2006). Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. The Journal of Orthopaedic and Sports Physical Therapy, 36(12), 911919. Popovic, M.R., Pappas, P.I., Nakazawa, K., Keller, T., Morari, M., & Dietz, V. (2000). Stability criterion for controlling standing in able bodied subjects. Journal of Biomechanics, 33, 13591368. Rahnama, N., Lees, A., & Bambaecichi, E. (2005). Comparison of muscle strength and flexibility between the preferred and non-preferred leg in English soccer players. Ergonomics, 48(11-14), 15681575. Rangger, C., Daniel, D.M., Stone, M.L., & Kaufman, K. (1993). Diagnosis of an ACL disruption with KT-1000 arthrometer measurements. Knee Surgery, Sports Traumatology, Arthroscopy, 1(1), 6066. Rosene, J.M., & Fogarty, T.D. (1999). Anterior tibial translation in collegiate athletes with normal anterior cruciate ligament integrity. Journal of Athletic Training, 34(2), 93 98. Ross, S., Guskiewicz, K.M., Prentice, W., Schneider, R., & Yu, B. (2004). Comparison of biomechanical factors between the kicking and stance limbs. Journal of Sport Rehabilitation, 13(2), 135150. Schoellhorn, W. (1999). Individualitaet ein vernachlaessigter Parameter? Leistungssport, 2(29), 711. Schuepfer, N., Lembert, S., Raschner, C., Platzer, H.P., Niederkofler, A., Patterson, C., et al. (2006). Bilateral differences in electromyographic responses of thigh and knee muscles during repeated maximal isokinetic knee extension and flexion in soccer players. Abstract Band of the 5th International Conference on Strength Training, Odense. Soderman, K., Alfredson, H., Pietila, T., & Werner, S. (2001). Risk factors for leg injuries in female soccer players: A prospective investigation during one out-door season. Knee Surgery, Sports Traumatology, Arthroscopy, 9(5), 313321.

Balance Ability in Soccer Players

231

Tropp, H., Ekstrand, J., & Gillquist, J. (1984). Factors affecting stabilometry recordings of single limb stance. American Journal of Sports Medicine, 12(3), 185188. Turner, D.M. (1998). Evaluation of the Tetrax interactive balance system and Equitest using normal subjects. Thesis, University of South Hampton, South Hampton, UK.