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Assessment of the Postural Stability of Female and Male Athletes

Howell, David R. PhD, ATC*,†,‡; Hanson, Emily BS, ATC*,†; Sugimoto, Dai PhD, ATC*,†,§; Stracciolini, Andrea MD*,†,¶; Meehan, William P. III MD*,†,‡,§,¶

Clinical Journal of Sport Medicine: September 2017 - Volume 27 - Issue 5 - p 444–449
doi: 10.1097/JSM.0000000000000374
Original Research

Objective: Postural stability is often affected by sport-related injuries and subsequently evaluated during postinjury examinations. Intrinsic factors, however, may also affect postural control. We sought to compare the postural control of female and male athletes as measured simultaneously by (1) the modified balance error scoring system (mBESS) and (2) a video-force plate system.

Design: Cross-sectional study.

Setting: Sports injury prevention center.

Participants: Pediatric, adolescent, and young adult athletes who performed mBESS during an injury prevention evaluation.

Independent Variables: We compared the postural control of female and male athletes. We also accounted for independent variables associated with postural stability, including age, body mass index, and history of ankle injury, concussion, and migraine headache.

Main Outcome Measures: Total errors committed during the mBESS and measurements derived from integrated kinematic and kinetic data obtained by a video-force plate system. Differences between males and females were tested using analysis of covariance.

Results: Participants (n = 409) ranged in age from 10 to 29 years (mean = 14.6 ± 2.8); 60% were female. No significant differences on mBESS were detected between females and males; however, female athletes demonstrated significantly better postural stability on the video-force plate analysis during double-leg (P = 0.03, d = 0.28), single-leg (P < 0.001, d = 0.62), and tandem stances (P < 0.001, d = 0.53) when compared with males.

Conclusions: Uninjured female athletes demonstrate better postural stability on video-force plate analysis than their uninjured male counterparts. These findings provide an important information assistive to clinicians during interpretation of postinjury balance tests.

*The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts;

Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts;

Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts;

Departments of §Orthopaedic Surgery; and

Pediatrics, Harvard Medical School, Boston, Massachusetts.

Corresponding Author: David R. Howell, PhD, ATC, The Micheli Center for Sports Injury Prevention, 9 Hope Ave, Suite 100 Waltham, MA 02453 (

W. P. Meehan receives royalties from ABC-Clio publishing for the sale of his book, Kids, Sports, and Concussion: A Guide for Coaches and Parents, and royalties from Wolters Kluwer for working as an author for UpToDate. He is under contract with ABC-Clio publishing for a future book entitled, Concussions, and with Springer International publishing for a future book entitled, Head and Neck Injuries in Young Athletes. His research is funded, in part, by a grant from the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. The remaining authors report no conflicts of interest.

Received July 31, 2015

Accepted June 05, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.