Abstract
duction: Chronic Ankle Instability (CAI) is characterised by a subjective feeling of recurrent instability, continued episode of giving way and self-reported disability. A wealth of literature is available reporting
of current Roshni 1 , Sheetal kalra 2 , Sajjan PAL 3 , Sonia Pawaria 4 , Joginder Yadav 5 Keywords: Athletic rehabilitation, Dynamic exercises, Functional instability, Physical disability ABSTRACT Introduction: Chronic Ankle Instability (CAI) is characterised by a subjective feeling of recurrent instability, continued episode of giving way and self-reported disability. A wealth of literature is available reporting causes and risk factors related to CAI, still there is a lack of understanding regarding rehabilitation procedures. Aim: To compare effect of BOSU ball and wobble board along with strength training on muscle strength, dynamic balance, agility and functional performance in recreational runners with CAI. Materials and Methods: It was an experimental study design conducted at Physiotherapy Outpatient Department (OPD) of SGT Hospital, Gurugram. Data collection was done from July 2019 to October 2019. Analysis and report writing took 2 months i.e from November 2019 to December 2019. Total 60 male runners in the age group of 18-35 years with CAI were randomly divided into two groups i.e. A (Wobble board) and B (BOSU Ball) with 30 players in each group. All subjects were evaluated for ankle muscle strength, agility, dynamic balance and functional performance as measured by Manual muscle tester, T-test, Y balance test and figure of eight hop test respectively on day one and last day of 3 rd and 6 th week of intervention. Statistical Package for the Social Science (SPSS) software version 20.0 was used to analyse result. Mean and Standard deviations were calculated. Analysis of Variance (ANOVA) and Student t-test was used for analysing inter group differences. Results: The statistical findings in this study postulate that both groups had significantly improved fitness and skill related variables but BOSU ball group showed highly significant improvement compared to wobble board group (p<0.05). Conclusion: The current results support that sensorimotor training can be progressed in difficulty by systematically reducing the base of support with help of BOSU ball.
to wobble board group (p<0.05). Conclusion: The current results support that sensorimotor training can be progressed in difficulty by systematically reducing the base of support with help of BOSU ball.
Roshni et al., Comparison Study of Wobble Board and Bosu Ball along with Strength Training www.jcdr.net Journal of Clinical and Diagnostic Research. 2021 May, Vol-15(5): YC01-YC0622 The examiner measured the distance from the center of the grid to the touch point with a tape measure in centimeters. All trials were performed in sequential order in either the clockwise or anticlockwise directions. Trials were discarded and repeated if the subject: 1) does not touch the line with the reach foot while maintaining weight bearing on the stance leg; 2) lifts the stance foot from the center grid; 3) loses balance at any point in the trial. Average of three scores was taken as final reading [Table/Fig-1]. 4. Functional performance was measured by figure of eight hop test: Participants hopped in a 5-m course around the cones in an “8” design on the involve ankle. The participants were instructed to hop as quickly as possible thrice through the course. Speed was measured in second with stopwatch. Average of three readings was taken [Table/Fig-2]. study was to compare the effect of two different balance training programs i.e., wobble board and BOSU ball exercises along with strengthening exercise in both the groups on selected fitness and performance variables in runners with chronic ankle instability. MATERIALS AND METHODS It was an experimental study design conducted at Physiotherapy OPD of SGT Hospital, Gurugram, from July 2019 to October 2019. The study was approved by the Ethical Research Committee of Faculty of Physiotherapy, SGT University Ref. No. SGT/FOP/2019/25. A sample size of 60 was calculated using G power. Players who fulfilled the inclusion and exclusion criteria participated in the study. Inclusion and Exclusion criteria: The inclusion criteria for the study were male recreational runners in the age group of 18-35 years with lateral ankle instability score less than 27 as measured by Cumberland ankle instability Index and with no history of any injury in past six months. Subjects having recent injury of ankle, a history of recent ankle surgery or fracture and not willing to participate were excluded from the study. The whole procedure of the training
group of 18-35 years with lateral ankle instability score less than 27 as measured by Cumberland ankle instability Index and with no history of any injury in past six months. Subjects having recent injury of ankle, a history of recent ankle surgery or fracture and not willing to participate were excluded from the study. The whole procedure of the training program was explained to the subject and written informed consent was taken from them. Subjects who fulfilled the inclusion and exclusion criteria were divided into two groups by simple random sampling method i.e., Group A included 30 athletes which received Wobble board training along with strengthening exercises and Group B included 30 athletes that received BOSU ball training along with strengthening exercises. Both groups received training 4 times a week for 6 weeks. Measurements were taken for age, height, weight and Body Mass Index (BMI) for all subjects. All players underwent baseline assessment for agility, ankle muscle strength, dynamic balance and functional performance. Outcome Measures 1. Agility was measured by T-test: 4 Cones were placed to form alphabet T. The participants started at cone A. On the command of the timer, the participants sprinted to cone B and touch the base of the cone with their right hand. They then turned left and shuffle sideways to cone C, and also touched its base, this time with their left hand. Then they shuffled sideways to the right to cone D and touching the base of cone with the right hand and again shuffled back to cone B touching the base of cone with the left hand, and ran backwards to cone A. The stopwatch was stopped as they passed cone A. Time was recorded with the help of a stopwatch. 2. Ankle muscle strength: The instrument was calibrated before each participant was tested. Four directions were tested- dorsiflexion, plantar flexion, inversion and eversion. Participants were placed in subtalar neutral position for all testing. Foot was neither supinated nor pronated and examiner palpated the prominent position of the medial and lateral aspects of the talus. The manual muscle tester (Make-Biomed) was placed
Ankle muscle strength: The instrument was calibrated before each participant was tested. Four directions were tested- dorsiflexion, plantar flexion, inversion and eversion. Participants were placed in subtalar neutral position for all testing. Foot was neither supinated nor pronated and examiner palpated the prominent position of the medial and lateral aspects of the talus. The manual muscle tester (Make-Biomed) was placed at the superior aspect of the metatarsal heads, participants were instructed to pull or push against the device as hard as they could for each direction for five seconds per trial. The test was conducted three times. Manual muscle tester is a reliable and valid instrument to assess isometric muscle strength at different joint angles [6]. 3. Dynamic balance was measured by Y balance test: It incorporates a single-leg stance on one leg with greatest reach of the opposite leg. The test was performed with the subject standing at the center of a grid placed on the floor, with three lines extending at 458 increments from the center of the grid. The three lines positioned on the grid were labeled according to the direction of excursion relative to the stance leg: Anterior (A), Posteromedial (PM), Posterolateral (PL). The subject lightly touched the furthest point possible on the line with the most distal part of the reach foot. The subject then returned to a bilateral stance while maintaining their balance. [Table/Fig-2]: Subject performing figure of eight Hop test. [Table/Fig-1]: Subject performing Y Balance test. Procedure Group A: Wobble board training along with strength exercise program [Table/Fig-3,4]. Group B: BOSU ball training along with strength exercise program [Table/Fig-5,6]. Both the groups started with warm up for five to ten minutes which included exercise
www.jcdr.net Roshni et al., Comparison Study of Wobble Board and Bosu Ball along with Strength Training Journal of Clinical and Diagnostic Research. 2021 May, Vol-15(5): YC01-YC06 33 Protocol of Strengthening Exercise The athletes sat on the floor one end of the band wrapped around the metatarsal head of the foot and other end therapist is holding one end of Theraband. Exercises were performed in 4 directions: dorsiflexion, plantar flexion, inversion and eversion in long sitting position and full knee extended. Exercise was performed with the colour band that was prescribed for the subject or with a colour that allowed him to complete two to three sets of 10 to 15 repetitions with mild fatigue on the last set. Then progression was done to the next colour band when patient was able to complete the three sets of 10 to 15 repetitions. All these exercise were done for about three to five seconds per repetition the full range of motion. Increasing number of sets participants were progress each week. Before moving on to the next set athletes completed all four directions [7]. S. No.Exercises Repetitions×Sets 1. Maintain forward position 10×3 2. Maintain backward position 10×3 3. Maintain right lateral position 10×3 4. Maintain left lateral position 10×3 Rest between exercises-10-20 seconds Rest between set of exercises-40-60 seconds [Table/Fig-3]: Group A: Wobble board exercise. [Table/Fig-4]: Maintaining balance in Forward, backward, right and left lateral positions on balance board. like walking, running, jogging, stretching and other free exercises. Both groups received intervention for 45 minutes thrice a week for six weeks under the supervision of the therapist. S. No.Exercises Repetition×Sets 1. First two weeks-Maintain proper balance in a double and single limb stance. 10×3 2. Weeks 2/4- Maintain proper balance in a double and single limb stance surface on the floor. 10×3 3. Weeks 4/6- Standing position in a double and single limb stance combined with throwing and catching 10×3 [Table/Fig-5]: Group B (BOSU ball exercises). Rest between exercises-10-20 seconds; Rest between set of exercises-40-60 seonds [Table/Fig-6]: Maintaining balance on BOSU ball in unilateral, bilateral stance during dynamic activities like catching ball. STATISTICAL
and single limb stance surface on the floor. 10×3 3. Weeks 4/6- Standing position in a double and single limb stance combined with throwing and catching 10×3 [Table/Fig-5]: Group B (BOSU ball exercises). Rest between exercises-10-20 seconds; Rest between set of exercises-40-60 seonds [Table/Fig-6]: Maintaining balance on BOSU ball in unilateral, bilateral stance during dynamic activities like catching ball. STATISTICAL ANALYSIS The data was analysed by using the software package Statistical Package for Social Sciences (SPSS 24.0) for window version. Mean and standard deviation of all the variables were calculated. The level of significance was set at p<0.05. Repeated measure ANOVA test and Student t-test was used to compare the intergroup differences. RESULTS Mean comparison of age, height, weight and BMI was done. The study was done on 60 players who were equally divided into two groups, with 30 subjects in each group. Between group analysis of these baseline characteristics showed that there was no significant difference in mean age, mean height. Changes in Muscle Strength The results of present study showed improvement in dorsiflexion, plantar flexion, inversion and eversion ankle muscle strength in both groups i.e., Group A and Group B. Group which performed BOSU ball along with strengthening exercise showed improvement in dorsi flexor muscle strength by 88.16%, plantar flexor muscle strength by 72.71%, invertor muscle strength by 91.92% and evertor muscle strength by 76% at the end of 6 th week as compared from baseline value. Group A in which wobble board along with strength exercise was performed showed improvement in dorsi flexor muscle strength by 57.59%, plantar flexor muscle strength by 55.21%, invertor muscle strength by 56.8% and evertor muscle strength by 47.05% at the end of 6 th week from the baseline value. Between groups, comparison showed that Group B (BOSU ball group) showed highly significant improvement in dorsi flexor muscle strength by 30.57%, plantar flexor muscle strength by 17.5%, invertor muscle strength by 35.12% and evertor muscle strength by 28.95% as compared to Group A on 6 th week [Table/Fig-7]. Changes in Functional performance as measured by figure of eight Hop test At the
comparison showed that Group B (BOSU ball group) showed highly significant improvement in dorsi flexor muscle strength by 30.57%, plantar flexor muscle strength by 17.5%, invertor muscle strength by 35.12% and evertor muscle strength by 28.95% as compared to Group A on 6 th week [Table/Fig-7]. Changes in Functional performance as measured by figure of eight Hop test At the end of 6 th week Group A showed 67.47% improvement and Group B showed 61.21% improvement from the baseline value. Between groups comparison showed that group B (BOSU ball group) showed highly significant improvement by 6.24% as compared to group A [Table/Fig-8].
Roshni et al., Comparison Study of Wobble Board and Bosu Ball along with Strength Training www.jcdr.net Journal of Clinical and Diagnostic Research. 2021 May, Vol-15(5): YC01-YC0644 Ankle muscle strengthGroups Mean baseline Std. Deviation Mean 3 rd week Std. Deviation Mean 6 th week Std. Deviation t-value p-value Dorsi flexon Wobble board 8.3027 1.28284 10.566 1.05279 13.08 1.76 04.69 0.001** BOSU ball 8.282 1.33624 11.734 1.70502 15.58 2.34 Plantar flexion Wobble board 8.2483 1.40924 10.2603 1.08069 12.7963 1.21441 2.66 0.01* BOSU ball 8.1033 1.39376 11.379 2.08258 13.999 2.15771 Inversion Wobble board 7.4967 1.3115 10.31 1.52 11.764 1.18738 2.40 0.021* BOSU ball 6.8167 1.91571 11.25 1.82 13.072 2.74542 Eversion Wobble board 7.82 1.43 9.09 1.77 11.51 2.08 2.10 0.032* BOSU ball 7.21 1.48 10.77 1.80 12.69 2.10 [Table/Fig-7]: Comparative table of ankle muscle strength. Mean comparison of Dorsiflexion, Plantar Flexion, Inversion, Eversion between the groups; p-value <0.001 (Highly significant); p-value <0.05 (Significant) Functional performanceGroups Mean SD t-valuep-value Baseline Wobble board9.52570.53237 0.4830.631 BOSU ball 9.43930.82148 3 rd week Wobble board7.46031.12374 0.6650.509 BOSU ball 7.24371.38654 6 th week Wobble board5.69631.19335 -0.4540.652 BOSU ball 5.84931.41053 [Table/Fig-8]: Comparison between the groups for Functional performance. Difference of means from baseline to 3 rd week; Difference of means from 3 rd week to 6 th week; Difference of means from baseline to 6 th week; **p-value <0.001 (Highly Significant); *p-value <0.05 (Significant) AgilityGroups Mean SD t-valuep-value Baseline Wobble board 17.3157 1.01458 -1.491 0.141 BOSU ball 17.8513 1.68647 3 rd week Wobble board 15.3057 1.29046 0.337 0.737 BOSU ball 15.1697 1.79521 6 th week Wobble board 13.9717 1.37007 2.11 0.039* BOSU ball 12.7113 2.97127 [Table/Fig-9]: Comparison between the groups for Functional performance. *: Significant; Difference of means from baseline to 3 rd week; Difference of means from 3 rd week to 6 th Week; Difference of means from baseline to 6 th week; **p-value <0.001 (Highly Significant); *p-value <0.05 (Significant) Dynamic balance Groups Mean baseline Std. Deviation Mean 3 rd week Std. Deviation Mean 6 th week Std. Deviation t-value p-value Anterior component Wobble board 131.63 22.88299 104.71 12.20084 123.22 20.33269 2.017 0.049* BOSU ball 133.83 8.58515
3 rd week to 6 th Week; Difference of means from baseline to 6 th week; **p-value <0.001 (Highly Significant); *p-value <0.05 (Significant) Dynamic balance Groups Mean baseline Std. Deviation Mean 3 rd week Std. Deviation Mean 6 th week Std. Deviation t-value p-value Anterior component Wobble board 131.63 22.88299 104.71 12.20084 123.22 20.33269 2.017 0.049* BOSU ball 133.83 8.58515 98.03 14.74792 111.28 25.28265 Posteriomedial (PM) Wobble board 138.33 8.18734 114.83 12.34928 128.21 18.24562 2.19 0.033* BOSU ball 139.32 9.73274 109.06 20.86371 117.38 20.01058 Posteriolateral (PL) Wobble board 145.60 8.21927 124.78 14.84633 140.65 10.22583 0.519 0.026* BOSU ball 150.28 7.19157 119.99 16.97737 138.61 10.22583 [Table/Fig-10]: Mean scores of dynamic balance in both groups. p-value <0.001 (Highly significant); p-value <0.05 (Significant) DISCUSSION In the present study, the effect of six weeks of comparison of Wobble board and BOSU ball along with strength training was done to see the effects on dynamic balance, agility, ankle muscle strength and functional performance in recreational runners with chronic ankle instability. Results showed improvement in both the groups but statistically BOSU ball group showed better improvements compared to wobble board group. Effect on Muscle Strength BOSU ball device is used for Ankle muscle activation when both sides of ball are used. According to Leetun DT et al., both sides use of BOSU ball or balance trainer has become popular among fitness trainers. BOSU ball along with strength exercises also focus on the mind and body coordination. It can decrease anxiety and increase athletic performance [8]. The findings of this study are in accordance with the results of Demir A 2019. They compared the effect of balance disc and BOSU ball in runners and found that the strength of ankle dorsi flexor and plantar flexor muscle groups improved in athletes. Results showed improvement in both the groups but statistically BOSU ball group showed better improvements compared to balance disc group [9]. Results of the study by Balogun J et al., found that a muscle must be under stressed to a greater degree than it is regularly used in order for the muscle to respond by enhancing contractile