Balance Training: How Much Does It Reduce the Risk of Ankle Sprain

The key points in 30 seconds

• The updated meta-analysis included 15 randomised or cluster-randomised trials.
• The pooled relative risk of injury was 0.659 (95% CI 0.558–0.778), meaning the relative frequency was about 34% lower.
• GRADE certainty was rated moderate; the optimal programme and transferability between sports remain unclear.
• A reduction in relative risk does not mean that 34 injuries out of 100 are prevented for every athlete.

Why the ankle

An ankle sprain is one of the most common sports injuries, especially in sports with jumping, landing and sudden changes of direction. Not only the first injury is dangerous: after it a feeling of instability often remains, and the risk of a repeat sprain rises. That is why prevention has long been studied, and balance training is one of its most popular tools.

What proprioception training trains

Proprioception is the perception of the position and movement of body parts. Practice usually includes single-leg stances, unstable surfaces, landings and responses to external perturbations. The aim is to improve sensorimotor control, not simply to "pump up balance": to teach the nervous system to quickly recognise an unfavourable foot position and correct it.

Shen and colleagues included programmes where such training was either stand-alone or a clearly distinct part of multicomponent prevention. They updated earlier reviews, including the 2015 work by Schiftan and colleagues, by adding new trials.

What the meta-analysis showed

The pooled estimate across 15 trials: relative risk (RR) 0.659 with a 95% confidence interval of 0.558–0.778. Low heterogeneity (I²=22.7%) means that results of individual trials are fairly consistent, which increases confidence. Even so, programmes, definitions of injury and populations differed.

Relative and absolute risk

RR 0.659 means that the risk in the training group was about 65.9% of the risk in the control group. This is a relative reduction of about 34.1%.

Absolute benefit depends on baseline risk. If 30 of 100 athletes are injured without the programme, such an RR corresponds to about 20 of 100 — roughly 10 prevented cases. If the baseline risk is 3 in 100, the expected difference is closer to one case. This is an illustration, not the result of a particular trial. That is why in teams and sports with a high baseline risk prevention yields more "saved" injuries than where such injuries are rare.

For which sports

The authors found no statistically noticeable difference in effect by sport or programme composition, but the absence of an interaction does not prove an identical result everywhere: there were not many subgroups. For pole sport there are no direct estimates. Here its usefulness is logically viewed as part of broader prevention: technique, strength, load progression, equipment and recovery. Balance training can be one element, but it does not replace the others.

Practical meaning

If an athlete has already had ankle sprains, or the sport involves landings, proprioceptive exercises are sensible to include in the warm-up or as a separate block. Regularity and gradual progression matter more than exotic platforms: from standing on a firm surface to an unstable one, eyes closed, jumps with landing. After a recent injury, the programme should be agreed with a rehabilitation specialist.

How to read the confidence interval

The interval 0.558–0.778 shows the range of RR values compatible with the data. Because the whole interval lies below 1, the result is statistically significant: the reduction in risk is unlikely to be explained by chance. But this does not mean the exact size of the effect is known: the real relative reduction in different populations may be larger or smaller than 34%. The wider the interval and the more varied the trials, the more cautiously the figure should be transferred to a particular team.

What the meta-analysis does not show

It does not determine the optimal programme: how many times a week to train, which exercises are best, how long to continue. It does not say whether balance training is enough without strength work and work on landing technique. It does not allow conclusions about people without sporting load or with chronic ankle instability, and does not show whether such training helps after an injury has already happened. It is an estimate of prevention in athletes, not a treatment method.

How not to overestimate the result

The phrase "reduces risk by 34%" sounds loud, but without the baseline injury rate it says little. A good practice is to ask for two numbers: how many injuries without the programme and how many with it. Then it becomes clear whether prevention is a priority in your situation or whether you have more important risk factors.

How convincing is the evidence

Randomised trials and the robustness of sensitivity analyses are strengths. The limitations include differing definitions of injury, protocols and athlete level, and partial overlap with earlier reviews: some trials may have entered several reviews at once.

Motivation should be taken into account too. A prevention programme works only if it is carried out: short exercises built into the warm-up three or four times a week are, as a rule, more realistic than separate long sessions that are quickly abandoned. Effectiveness in trials was measured in those who actually performed the programme under supervision, and in everyday life adherence may be lower.

Sport in Luxembourg conclusion

Proprioceptive training is an evidence-supported component of preventing ankle sprains in the sporting populations studied. It is not a guarantee for a particular person and not universal protection against all injuries.