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Effect of Neuromuscular Training on Proprioception, Balance, Muscle Strength, and Lower Limb Function in Female Team Handball Players

Holm, Inger PT, PhD*; Fosdahl, Merete Aarsland PT*; Friis, Astrid PT*; Risberg, May Arna PT, PhD; Myklebust, Grethe PT, PhD; Steen, Harald MD, PhD*

Clinical Journal of Sport Medicine: March 2004 - Volume 14 - Issue 2 - p 88-94
Original Research

Objective Introduction of a neuromuscular training program will increase muscle strength, balance, and proprioception in elite female handball players.

Design Prospective intervention study.

Participants Thirty-five female team handball players from 2 teams in the elite division participated. Their mean age was 23 (±2.5) years, and their mean weight was 69.2 (±7.3) kg. They had played handball for 14.9 (±3.2) years, 4.7 (±2.8) years at the top level. The total number of training hours per week was 10 to 11.

Intervention Based on earlier studies and knowledge about common risk situations in team handball, an anterior cruciate ligament (ACL) injury prevention program with 3 different sets of exercises was developed, each set with a 5-step progression from simple to more challenging exercises. The teams were instructed to use the program a minimum of 3 times a week during a training period of 5 to 7 weeks, and then once a week during the season. The duration of each training session was approximately 15 minutes.

Main outcome measures Balance (KAT 2000), proprioception (threshold to detection of passive motion), muscle strength (Cybex 6000), and 3 functional knee tests. The players were tested pretraining (test 1) and 8 weeks (test 2) and 12 months (test 3) after the training started.

Results There was a significant improvement in dynamic balance between test 1 and test 2, with a balance index (BI) of 924 (±225) and 778 (±174), respectively (P = 0.01). The effect on dynamic balance was maintained 1 year after training (BI, 730 ± 156). For static balance, no statistically significant changes were found. For the other variables measured, there were no statistical differences during the study period.

Conclusion The ACL injury prevention training program improved dynamic balance in an elite team handball players.

From *Rikshospitalet University Hospital; the †Center for Clinical Research, Ullevaal University Hospital; and ‡Oslo Sport Trauma Research Center, Norwegian University of Sports and Physical Education, Oslo, Norway.

Received for publication February 2003; accepted November 2003.

Reprints: Inger Holm, PT, PhD, Physiotherapy Department, Rikshospitalet University Hospital, 0027 Oslo, Norway (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.