Annals of Medical Research
DOI: 10.5455/annalsmedres.2019.07.436
Original Article
2019;26(10):2181-6
The relationship between postural stability, core muscle
endurance and agility in professional basketball players
Pelin Aksen Cengizhan1, Gamze Cobanoglu², Cagatay Muslum Gokdogan², Ali Zorlular², Esedullah Akaras²,
Gamze Erikoglu Orer³, Nihan Kafa2, Nevin A Guzel2
¹Kirikkale University Faculty of Sport Sciences, Kirikkale, Turkey
²Gazi University Faculty of Helath Sciences Department of Physiotherapy and Rehabilitation, Ankara, Turkey
³Yildirim Beyazit University Faculty of Health Sciences Department of Sports Sciences, Ankara, Turkey
Copyright © 2019 by authors and Annals of Medical Research Publishing Inc.
Abstract
Aim: The purpose of this study was to identify relationships between postural stability, core muscle endurance and agility in
basketball players.
Materials and Methods: 21 professional male basketball players [age: 17.±0.63 (years), body weight: 78.69±9.22 (kg), height: 186±7
(cm), BMI: 22.72±2.26 (kg/cm²)] were included to this study. Three balance variables were measured using Biodex Biosway™. Core
muscle endurance was measured using three core endurance tests proposed by Mcgill. Agility was assessed by Hexagonal Obstacle
Test (HOT).
Results: The analysis results showed that postural stability is associated with HOT (r: 0.457). In addition, the postural stability was
related to extension muscle endurance test and side bridge test (respectively, r: -0.501 and r: -0.468). There is no correlation between
HOT and core muscle endurance test in basketball players.
Conclusion: The athletes with good postural stability were better core muscle endurance and agility. It is important to apply exercise
programs that enhance postural stability and increase core muscle endurance to improve sportive success.
Keywords: Postural stability; core muscle endurance; basketball.
INTRODUCTION
Basketball is a physically demanding sport requiring
intense lateral, running, sprinting and jumping
movements (1). The physiological requirements of
basketball include aerobic and anaerobic performance
as well as physical characteristics including muscle
strength, power, endurance, flexibility, speed, agility
and sport-specific abilities (2). To be able to play at
the highest level, the athlete must have advanced high
levels of agility, aerobic and anaerobic external muscular
power output (1, 3). Moreover, it is expressed that a
good postural stability can contribute to successful
performance and plays a major role in many athletic
activities as well as sport-specific postural control (4, 5).
Postural stability is the ability to maintain the center of
gravity of the body on the support surface with minimal
postural sway. The maintenance of the balance takes
place through the interaction of three systems. First input
is vestibular system. The second, balance coordinator is a
proprioceptive system originating from somatosensorial
receptors found in tendons and muscles in joints related to
spatial awareness, body posture and kinesthetic sensation.
The last one is a visual system that sends signals about
body position (6). Maintaining postural stability depends
on a complex relationship between visual, vestibular and
sematosensorial systems to keep the center of gravity
of the body in control over the base of support. The
ability of maintaining of postural stability has significant
influence on sport performance. Optimal core stability is
also important for the performance of athletic movements
resulting in body oscillations outside the support surfaces
of the athletes (7). Major core muscles are transversus
abdominis in anterior, multifidus in posterior, pelvic floor
Received: 26.07.2019 Accepted: 29.08.2019 Available online: 21.10.2019
Corresponding Author: Pelin Aksen Cengizhan, Kirikkale University Faculty of Sport Sciences, Kirikkale, Turkey
E-mail: pelinaksen@hotmail.com
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Ann Med Res 2019;26(10):2181-6
at the bottom and diaphragm at the upper side. Minor
core muscles are latissimus dorsi, gluteus maximus and
trapezius (6, 8). Core muscles are assumed to play a role to
stabilize the lumbar region (9, 10). Core plays an important
role in reducing the risk of injury and stabilizing peripheral
joints, especially during intense physical activity (11).
Turner et al (12) defined agility as the ability to quickly
change direction while maintaining stability without
losing speed. As can be understood from this description,
postural stability and agility are parameters that interact
with each other. Balance and postural control are logically
related to their apparent contribution to movements
necessary in good agility. The ability to quickly change
the direction and speed of the entire body center of
gravity is the main locomotor ability in many sports
(13). There are many studies described above in the
literature that investigate the effects of core training on
agility and balance (14, 15). However, there are very few
studies in the literature that investigate the relationship
between postural stability, core endurance and agility
in basketball players. Therefore, we hypothesized that
there is relationship between postural stability, core
muscle endurance and agility in basketball players.
MATERIAL and METHODS
Subjects
This was a descriptive study conducted between January
2017 and April 2017. The study was carried out in Gazi
University Faculty of Health Sciences Application Units.
21 basketball players who have been engaged in sports for
at least 2 years and training 5 days a week (21 males, age:
17.0±0.63 years, Table 1) were included. Participant with
previous lower extremity musculoskeletal injuries, those
with low back pain, those with any upper extremity or lower
extremity surgery, those with upper extremity and lower
extremity deformities, those with neurological problems,
those with vestibular disease and those with systemic
disease were not included in the study. Participants were
given permission from their coaches for those younger
than 18 years old. Participants were questioned about
age, gender, marital status, body weight, height, dominant
side, occupation, level of education, team they played, any
injuries, health history. Control group did not add to this
study. Body mass index (BMI) was calculated according
to body weight (kg) / height (m²) equation (16). Approval
of ethics committee was taken from Yıldırım Beyazit
University (2016/12).
Testing Procedures
Postural stability was assessed using Biodex-Biosway™
(Biodex Medical Systems, Shirley, New York). The Biodex
Balance System was designed to evaluate problems
relating to balance, proprioception, and neuromuscular
control. This testing machine consists of a multiaxial
standing platform, which can be adjusted to provide
varying degrees of platform instability. A static platform
surface can be selected. With this surface, a static situation
is created. The ability of the individual to maintain static
postural balance on this stable platform is assessed (17).
Balance evaluation with Biodex-BioSway™ was done
with Postural Stability Test and Stability Limit Test (LOS).
Before starting the test, the position of the feet of the
individuals on the platform was recorded in the system
with the coordinates. The tests were done with bare feet.
Before the tests started, the individuals were told verbally
how to do the tests. The postural stability test measures
the person’s ability to maintain the balance center. As a
result of the test, the person’s score shows deviations
from the center. The test was done 3 times. During the
test, the athletes were asked to keep the black spot in the
center of the screen for 20 seconds. The test was first
started on the dominant side and the test was repeated
for both legs. The arms were positioned next to the body
during the test. As a result of evaluations, anteroposterior
and mediolateral deviations were determined. The
performance of the athletes was recorded as a stability
index (17). LOS measures the maximum limit that a person
can reach vertically from his body without losing balance.
The test can be done at 3 levels, expressed as easy (50%),
medium (75%) and difficult (100%). For the athletes, the
test was done in the middle (75%) level. The “actual” score
was recorded, indicating the points on each side of the
test obtained in the test result (17).
The core muscle endurance was assessed by three core
endurance tests generated by McGgill (18). It was shown
that the intrarater reliability of these tests was moderate
reliability. McGill endurance tests are trunk flexor test, trunk
extensor test and side bridge test. The trunk flexor test was
performed while the body was 60° in flexion, knees and
hip were 90° in flexion. The arms were joined diagonally
on the chest. Participants were wanted to protect this
position as long as it is possible. The test was terminated
when the individual could not maintain this position. The
trunk extensor test was performed on the treatment table
in a prone position. Pelvis, hip and knees were fixed to the
treatment table up to spina iliaca anterior superior level.
The body and upper extremities were supported with a
chair at the same height as the surface of the table. Then
the chair was removed and the individual tried to keep
the horizontal body position as long as possible while
crossing the arms on the chest. The test was terminated
when the person fell below the horizontal position. The
side bridge test was performed on the dominant side on
the mat. Because no difference between the left and right
side has been previously reported, only the dominant
side was evaluated (10). Knees of the participants were
on the extensions with same line of feet. Body weight
was supported only by the lower elbows and feet while
lifting her hips on the mat. The test was terminated when
the side-lying position deteriorated and the hip fell. The
measurement results of McGill endurance test recorded
in seconds (19).
Agility was assessed by Hexaganol Obstacle test (HOT)
(17). The test was done with the aid of a hexagon drawn
at the floor. Each side of the hexagon was 66 cm and the
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angle of each corner was 120°. The participants started
the test with both feet in the middle of the hexagon,
with the frontal faces facing towards the front line. The
participants jumped to the other side of the line with the
‘Start’ command, then went back to the middle point of
the hexagon on the same line again. As feet and faces
continued to look forward, they leaped to the other side
of the side line and returned to the center of the hexagon.
The participants continued this pattern until three rounds
completed and were tested clockwise. The total test
duration was recorded in seconds (20). The test was
repeated twice and the best value was recorded.
Statistical Analyses
Statistical analysis was performed using SPSS version
22.0. Demographic data were presented as mean and
standard deviation. The normal distribution fitness of
the parameters was examined using histogram and
probability plots and analytical methods (KolmogorovSmirnov / Shapiro-Wilk tests). The statistical significance
for correlations were analyzed by Spearman correlation
analysis. The statistical significance was accepted as 5%.
RESULTS
Demographic data of the all participants was showed in
Table 1. According to the analysis made on basketball
players; there was a moderate positive correlation
between the HOT and the right postural stability
anteroposterior index (r: 0.457, p<0.05, Table 2). There
was a moderate negative correlation between the HOT
and the LOS actual score (r:-0.437, p<0.05, Table 2). There
was moderate negative correlation between the trunk
extensor test and right postural stability mediolateral
index (r: -0.468, p<0.05, Table 2). There was a moderate
negative correlation between the side bridge test and
the right postural stability mediolateral index (r: -0.501,
p<0.05, Table 2). There was no correlation between the
trunk flexion test and other parameters (p> 0.05, Table 2).
In addition, there was no relation between HOT and core
muscle endurance tests.
Table 1. The demographic characteristics of basketball players
x±sd (n=21)
Age (years)
17.00±0.63
Height (cm)
186±7
Body Weight (kg)
78.69±9.22
BMI (kg/m²)
22.25±2.91
x±sd: mean ± standart deviation
Table 2. The correlation of postural stability, core muscle endurance, agility and anaerobic performance in basketball athletes
r
HOT
RPSAP
RPSML
LPSAP
LOS
1
0.457*
-0.029
-0.103
-0.437*
0.037
0.899
0.657
0.048
HOT
p
r
0.288
0.131
0.102
0.011
0.106
p
0.320
0.572
0.658
0.963
0.646
r
-0.166
0.112
-0.468*
-0.193
0.232
p
0.472
0.628
0.032
0.401
0.311
r
-0.265
0.016
-0.501*
-0.124
0.315
p
0.245
0.944
0.021
0.591
0.164
Flex
Ext
Side
HOT: Hexagonal obstacle test, Flex: Flexion endurance test, Ext: Extansion endurance test, Side: Side bridge test, RPSAP: Right postural stability
anteroposterior index, RPSML: Right postural stability mediolateral index, LPSAP: Left postural stability anteroposterior index, LOS: Limits of
stability, *Statistically significant association (p<0.005)
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DISCUSSION
According to the results of this research which was
planned to show the relationship between postural
stability, core muscle endurance and agility in basketball
players, there was a correlation between postural
stability and core muscle endurance. Also, it was shown
a correlation between agility and postural stability.
Postural stability is crucial for maintaining body balance
during locomotion, standing and any other activities
that require a high degree of stability (21). There are
many methods used to evaluate postural stability.
In our study, postural stability was assessed using
Biodex-Biosway™. This device has been shown to be
valid and reliable when measuring the ability of the
patient to balance on foam and/or firm surface (22).
In the postural stability test, low scores indicate less
deviation. Therefore, low scores indicate better postural
stability than high scores. In the LOS, a low score of
‘actual’ means that the person’s stability limit is reduced.
Agility can be defined as the ability to control and
maintain the correct body position while rapidly changing
direction during a series of movements. HOT is one of
the field tests used to evaluate agility. ICC (Intraclass
Correlation Coefficient) for this test is between 0.86
and 0.95, according to Reiman and Manske (23). Those
who complete the HOT in less time are considered
more agile. So, the athlete who decrease postural
oscillations and increase balance ability can supply to
better sudden direction changes in different directions.
Postural control has a significant role in many sports,
and ability in postural control may identify successful
performance (21, 24). The ability of the athlete to move his
body quickly in different directions without losing trunk
control requires good postural stability. It has been shown
that balance can contribute to successful performance
and play a major role in many athletic activities as well
as sport-specific postural control (4, 5, 24). Prospective
studies have shown that by enhancing balance and control
of body positions during movement, agility theoretically
should improve (4, 25, 26). When literature is looked, many
studies have shown that the performances of athletes in
different sports are related to postural stability. Sanborn et
al emphasized in their work that balance skills are related
to speed, agility and rhythm (27). Behm at al showed that
balance ability is significantly related to rifle and arrow
shooting accuracy and maximum skating speed in ice
hockey (28). In the study performed by Okudur et al on
tennis players, it was stated that the agility performance
has a significant relationship with the total balance points
of double leg posture, single leg posture and foam surface
(29). Our study showed that the agility of those with good
postural stability was better according to the relationship
between the HOT and the right foot postural stability
anteroposterior index. Also, it was shown that the agility
of athletes who could take their body farther away in a
controlled way was better according to the relationship
between the HOT and LOS. An athlete with little postural
oscillations will maintain the gravity center much better and
respond quickly to sudden changes in direction. According
to this result, it can be said that the agility of basketball
players with better postural stability is also better.
The core stability minimizes the loads on the proximal
joints while it activates body mechanisms that allow it to
maximize its power in sports. The gains in strength and
endurance of the core muscles is important in reducing
disability as they maintain and stabilize the spinal
segments during activity as well as against external forces
(30). The relationship between core muscle endurance
and postural stability was shown in many different studies
(6, 31, 32). In 2009, Suri et al found moderate correlation
between trunk muscle endurance and balance in their
study in which they evaluated the relationship between
endurance and balance of trunk muscles in the elderly
(31). Ambegaonkar et al found an insignificant positive
correlation between the side bridge test and balance in
the study of female athletes. In this study, the balance
was evaluated by the star excursion balance test and the
correlation only between the posteromedial direction and
the side bridge test was determined. These results were
attributed to the activation of the lower extremity muscles
in the star excursion balance test (32). In our study, we
found that those with higher core muscle endurance had
better postural stability of the dominant side. A strong
core structure allows less postural oscillations through
torcholumbar fascia. The athlete has better postural
stability and balance. These results are consistent with
the findings of Barati et al obtained from male students
and the results of a comparison of core muscle endurance
and static balance (6). Many scientific data on core
exercises refer to similar findings (33, 34, 35). On the
other hand, in another study by Ambegaonkar et al on
dancers, they found no relationship between balance and
core muscle endurance (36). Gordon et al also did not find
any correlation between core endurance (as measured by
the Bent Knee Lowering test) and balance (as measured
by the SEBT) in female lacrosse players (37). These
differences in the literature may be due to the reduced
use of standardized and objective measurement methods.
In theory, it is accepted that core stability and performance
are interrelated. But there is a inconsistency in the literature
regarding this issue. In 2008, Nesser et al investigated the
relationship between balance and agility in soccer players.
They reported that there is a moderate negative correlation
between pro-agility test and core muscle endurance test
(38). Aytar et al showed that there is no relationship
between balance and core endurance in amputee soccer
player (39). In a study conducted in 2011, Sharrock et al
investigated relationship between core stabilization and
athletic performance in male and female collegiate athletes.
They showed that there was no correlation was found
core stability test and T test (40). Similarly in our study,
there was no relationship between core stability and HOT.
This study has several limitations. Firstly, our study
are low sample size. The other is that the population
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Ann Med Res 2019;26(10):2181-6
of our research is done only on male athletes.
CONCLUSION
This study reveals that there is a relationship between
postural stability, muscle endurance and agility in
basketball players. It can be interpreted that the agility
of the athletes who can take their body farther away in
a controlled way is better. Moreover it can be considered
that the postural stability of the athletes with high core
muscle endurance is higher. Therefore, it is important to
apply exercise programs that enhance postural stability
and increase core muscle endurance to improve sportive
success. It should be design exercise programs that
improve endurance and subsequently balance as an
integrated part in optimal performance of athletes.
Future studies, comparisons can be made by adding a
control group. In addition, the research group core postural
stability and muscle endurance exercise programs that
increase be regarded by applying the chronic effects of
exercise.
Competing interests: The authors declare that they have no
competing interest.
Financial Disclosure: There are no financial supports
Ethical approval: This study was approved by the Institutional
Ethics Committee and conducted in compliance with the ethical
principles according to the Declaration of Helsinki.
Pelin Aksen Cengizhan ORCID: 0000-0002-4210-3548
Gamze Cobanoglu ORCID: 0000-0002-3586-7494
Çagatay Muslum Gokdogan ORCID: 0000-0003-3791-2399
Ali Zorlular ORCID: 0000-0003-3791-2399
Esedullah Akaras ORCID: 0000-0002-3586-7494
Gamze Erikoglu Orer ORCID: 0000-0001-6365-7219
Nihan Kafa ORCID: 0000-0002-4210-3548
Nevin A. Guzel ORCID: 0000-0003-3791-2399
REFERENCES
1. Pojskić H, Šeparović V, Užičanin E, et al. Positional role
differences in the aerobic and anaerobic power of elite
basketball players. J Hum Kinet 2015;49:219-27.
2. Drinkwater EJ, Pyne DB, McKenna MJ. Design and
interpretation of anthropometric and fitness testing of
basketball players. Sports Med 2008;38:565-78.
3. Abdelkrim NB, El Fazaa S, El Ati J. Time–motion
analysis and physiological data of elite under-19year-old basketball players during competition. Br J
Sports Med 2007;41:69-75.
4. Hrysomallis C. Balance ability and athletic
performance. Sports Med 2011;41:221-32.
5. Hammami R, Behm DG, Chtara M, et al. Comparison of
static balance and the role of vision in elite athletes. J
Hum Kinet 2014;41: 33-41.
6. Barati A, Safarcherati A, Aghayari A, Azizi F, Abbasi
H. Evaluation of relationship between trunk muscle
endurance and static balance in male students. Asian
J Sports Med 2013;4:289-94.
7. Gribble PA, Hertel J. Considerations for normalizing
measures of the star excursion balance test. Meas
Phys Educ Exerc Sci 2003;7:89-100.
8. Guskiewicz KM. Regaining postural stability and
balance. McGraw Hill NY.2011:145-70.
9. Cho JY, Shim JH, Choi HY, et al. The effects of core
stability exercise using an ultrasound imaging system
on muscle activation of shoulder region. International
Journal of Digital Content Technology and its
Applications 2013;7:375-80.
10. Kanik ZH, Pala OO, Gunaydin G, et al. Relationship
between scapular muscle and core endurance in
healthy subjects. J Back Musculoskelet Rehabil
2017;30:811-17.
11. Kulas AS, Schmitz RJ, Shultz SJ, et al. Sex-specific
abdominal activation strategies during landing. J Athl
Train 2006; 41:381-86.
12. Turner A, Walker S, Stembridge M, et al. A testing
battery for the assessment of fitness in soccer players.
J Strength Cond Res 2011;33:29-39.
13. 13. Ratamess NA. ACSM’s foundations of strength
training and conditioning. Wolters Kluwer Health/
Lippincott Williams & Wilkins; 2012.
14. Lust KR, Sandrey MA, Bulger SM, et al. The effects
of 6-week training programs on throwing accuracy,
proprioception, and core endurance in baseball. J
Sport Rehabil 2009;18:407.
15. Saeterbakken AH, Van den Tillaar R, Seiler S. Effect of
core stability training on throwing velocity in female
handball players. J Strength Cond Res 2011;25:71218.
16. Koçyiğit BF, Okyay RA. The relationship between body
mass index and pain, disease activity, depression and
anxiety in women with fibromyalgia. PeerJ. 2018; 6,
e4917.
17. Basar S, Bakar Y, Keser I, et al. Does lymphedema
affect the postural stability in women after breast
cancer? Top Geriatr Rehabil 2012;28:287-94.
18. McGill, S. (2006). Ultimate back fitness and
performance (pp. 277-285). Backfitpro Incorporated.
19. Waldhelm A, Li L. Endurance tests are the most reliable
core stability related measurements. J Sport Health
Sci 2012;1:121-8.
20. Bal B, Kaur P. Effects of selected asanas in hatha
yoga on agility and flexibility level. J Sport Health Res
2009;1:75-87.
21. Basar S, Duzgun I, Guzel NA, et al. Differences in
strength, flexibility and stability in freestyle and
greco-roman wrestlers. J Back Musculoskelet Rehabil
2014;27:321-30.
22. Systems BM. Balance system operations and service
manual. Shirley, New York 1999.1-67.
23. Reiman MP, Manske RC. Functional testing in human
performance: Human Kinetics. 2009.
24. Adlerton AK, Moritz U, Moe Nilssen R. Forceplate and
accelerometer measures for evaluating the effect of
muscle fatigue on postural control during one legged
stance. Physiother Res Int 2003;8:187-99.
2185
Ann Med Res 2019;26(10):2181-6
25. Miller MG, Herniman JJ, Ricard MD, et al. The effects
of a 6-week plyometric training program on agility. J
Sports Sci Med 2006;5:459.
26. Sever O. Comparison of static and dynamic core
exercises’ effects on Stork balance test in soccer
players. J Human Sci. 2017;14:1781-91.
27. Sanborn C, Wyrick W. Prediction of olympic balance
beam performance from standardized and modified
tests of balance. Research Quarterly American
Association for Health, Physical Education and
Recreation 1969;40:174-84.
28. Behm DG, Wahl MJ, Button DC, et al. Relationship
between hockey skating speed and selected
performance measures. J Strength Cond Res
2005;19:326-31.
29. Okudur A, Sanioğlu A. History of the relationship
between balance and agility in 12 year old tennis
player. Selçuk University Journal of Physical Education
and Sports 2012;14,165-170.
30. Ganesh GS, Chhabra D, Pattnaik M, et al. Effect of trunk
muscles training using a star excursion balance test
grid on strength, endurance and disability in persons
with chronic low back pain. J Back Musculoskelet
Rehabil 2015;28:521-30.
31. Suri P, Kiely DK, Leveille SG, et al. Trunk muscle
attributes are associated with balance and mobility in
older adults: a pilot study. PM R 2009;1:916-24.
32. Ambegaonkar JP, Mettinger LM, Caswell SV, et al.
Relationships between core endurance, hip strength,
and balance in collegiate female athletes. In J Sports
Phys Ther 2014;9:604-16.
33. Parkhouse KL, Ball N. Influence of dynamic versus
34.
35.
36.
37.
38.
39.
40.
2186
static core exercises on performance in field based
fitness tests. J Bodyw Mov Ther 2011;15:17-524.
Aksen-Cengizhan P, Onay D, Sever O, et al. A
comparison between core exercises with theraband
and swiss ball in terms of core stabilization and
balance performance. Isokinetics and Exercise Sci
2018;26,183-9.
Sever O. Comparison of static and dynamic core
exercises’ effects on Stork balance test in soccer
players. J Human Sci 2017;14,1781-91.
Ambegaonkar JP CN, Caswell S, Ambegaonkar
GP, Wyon M. Lower extremity hypermobility, but
not core muscle endurance influences balance in
female collegiate dancers. Int J Sports Phys Ther.
2016;11:220.
Gordon AT, Ambegaonkar JP, Caswell SV. Relationships
between core strength, hip external rotator muscle
strength, and star excursion balance test performance
in female lacrosse players. Int J Sports Phys Ther
2013;8:97-104.
Nesser TW, Huxel KC, Tincher JL, et al. The relationship
between core stability and performance in division I
football players. J Strength Cond Res 2008;22:17504.
Aytar A, Pekyavas NO, Ergun N, et al. Is there a
relationship between core stability, balance and
strength in amputee soccer players? A pilot study.
Prosthet Orthot Int 2012;36:332-8.
Sharrock C, Cropper J, Mostad J, et al. A pilot study
of core stability and athletic performance: is there a
relationship? Int J Sports Phys Ther 2011;6:63-74..