Vol 14, No 4: 2018:239-247

The Effect of Trunk Core Stability Training and Total-Body Resistance Exercise (TRX) on the Performance, Balance, and Strength of Athletes with Ankle Sprain: A Clinical Randomized Trial Study

Fatemeh Hozhabrpour-Fereydani, Farzaneh Taghian, Mohamad Saleki

DOI: 10.22122/jrrs.v14i4.3121


Introduction: Ankle sprain is one of the common injuries among athletes, and is associated with imbalance. Therefore, the purpose of the present study was to compare the effect of trunk core stability training and total-body resistance exercise (TRX) on the performance, balance, and strength of athletes with ankle sprain.

Materials and Methods: 40 women athletes with ankle sprain (age: 24.02 ± 2.99 years and weight: 58.52 ± 4.08 kg) were randomly divided into four equal groups including trunk core stability training, TRX, combined training (core stability training + TRX), and control. Experimental groups were trained for eight weeks and 3 sessions/week. The balance, performance, and strength of the subjects before and after the exercises were evaluated using balance (Stork balance stand test and Y test), performance (side-hop test and figure-of-8 hop test), and strength (isokinetic machine) tests. One-way ANOVA and Bonferroni post hoc test were used for data analysis at the significance level of P < 0.05.

Results: All three training models resulted in improvement of performance as well as static and dynamic balance compared to the control group (P < 0.001). Moreover, there was a significant difference between the two groups of combined and trunk core stability training in performance, and dynamic and static balance, and also between the TRX and trunk core stability training groups in static balance (P = 0.014). However, only combined training resulted in increased muscle strength in athletes (P = 0.001), and there was no significant difference between the other groups (P < 0.001).

Conclusion: All three training models lead to improved performance and static and dynamic balance in athletes with ankle sprain. However, it seems that the combined training (core stability training + TRX) has more significant effects on improvement of balance, performance, and muscle strength in these athletes.


Trunk core stability;, Resistance training; Postural balance; Ankle sprains

Full Text:



Zoch C, Fialka-Moser V, Quittan M. Rehabilitation of ligamentous ankle injuries: A review of recent studies. Br J Sports Med 2003; 37(4): 291-5.

Woods C, Hawkins RD, Maltby S, Hulse M, Thomas A, Hodson A. The Football Association Medical Research Programme: An audit of injuries in professional football--analysis of hamstring injuries. Br J Sports Med 2004; 38(1): 36-41.

Kaminski T, Gerlach T. The effect of tape and neoprene ankle supports on ankle joint position sense. Phys Ther Sport 2001; 2(3): 132-40.

Freeman MA, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 1965; 47(4): 678-85.

Trojian TH, McKeag DB. Single leg balance test to identify risk of ankle sprains. Br J Sports Med 2006; 40(7): 610-3.

Arnold BL, De La Motte S, Linens S, Ross SE. Ankle instability is associated with balance impairments: A meta-analysis. Med Sci Sports Exerc 2009; 41(5): 1048-62.

Docherty CL, Valovich McLeod TC, Shultz SJ. Postural control deficits in participants with functional ankle instability as measured by the balance error scoring system. Clin J Sport Med 2006; 16(3): 203-8.

Beynnon BD, Murphy DF, Alosa DM. Predictive factors for lateral ankle sprains: A literature review. J Athl Train 2002; 37(4): 376-80.

McGovern RP, Martin RL. Managing ankle ligament sprains and tears: Current opinion. Open Access J Sports Med 2016; 7: 33-42.

Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep 2008; 7(1): 39-44.

Gribble PA, Hertel J, Denegar CR, Buckley WE. The effects of fatigue and chronic ankle instability on dynamic postural control. J Athl Train 2004; 39(4): 321-9.

Rojhani Shirazi Z, Shafaee R, Afarandide M. Survey on the effects of balance training on proprioception of knee and ankle joints and equilibrium time in single leg in healthy female students. J Rafsanjan Univ Med Sci 2012; 10(4): 289-98. [In Persian].

Moradi K, Minoonejad H, Rajabi R. The immediate effect of core stability exercises on postural sway in athletes with functional ankle instability. Rehabilitation Medicine 2015; 4(3): 103-12. [In Persian].

Sahranavard M, Aghayari A, Motealleh A, Farhadi A. The effect of core stability exercises on dynamic balance of athletes with chronic ankle sprain. J Res Rehabil Sci 2015; 11(3): 228-37. [In Persian].

Gaedtke A, Morat T. TRX suspension training: a new functional training approach for older adults - development, training control and feasibility. Int J Exerc Sci 2015; 8(3): 224-33.

Weiss T, Kreitinger J, Wilde H, Wiora C, Steege M, Dalleck L, et al. Effect of functional resistance training on muscular fitness outcomes in young adults. J Exerc Sci Fit 2010; 8(2): 113-22.

Milton D, Porcari J, Foster C, Gibson M, Udermann B. The effect of functional exercise training on functional fitness levels of older adults. Gundersen Med J 2008; 5(1): 4-8.

Tomljanovic M, Spasi-ç M, Gabrilo G, Uljevic O, Foretic N. Effects of five weeks of functional vs. traditional resistance training on anthropometric and motor performance variables. Kinesiology 2011; 43(2): 145-54.

Dawes J, Melrose D. Resistance characteristics of the TRX™ suspension training system at different angles and distances from the hanging point. J Athl Enhancement 2015; 4(1): 1000184.

Gaedtke A, Morat T. Effects of two 12-week strengthening programmes on functional mobility, strength and balance of older adults: Comparison between TRX suspension training versus an elastic band resistance training. Cent Eur J Sport Sci Med 2016; 13(1): 49-64.

Delahunt E, Coughlan GF, Caulfield B, Nightingale EJ, Lin CW, Hiller CE. Inclusion criteria when investigating insufficiencies in chronic ankle instability. Med Sci Sports Exerc 2010; 42(11): 2106-21.

Fong SS, Tam YT, Macfarlane DJ, Ng SS, Bae YH, Chan EW, et al. Core muscle activity during TRX suspension exercises with and without kinesiology taping in adults with chronic low back pain: implications for rehabilitation. Evid Based Complement Alternat Med 2015; 2015: 910168.

Demeritt KM, Shultz SJ, Docherty CL, Gansneder BM, Perrin DH. Chronic ankle instability does not affect lower extremity functional performance. J Athl Train 2002; 37(4): 507-11.

Plisky PJ, Gorman PP, Butler RJ, Kiesel KB, Underwood FB, Elkins B. The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sports Phys Ther 2009; 4(2): 92-9.

Hale SA, Hertel J, Olmsted-Kramer LC. The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. J Orthop Sports Phys Ther 2007; 37(6): 303-11.

McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc 2008; 40(10): 1810-9.

Bliss LS, Teeple P. Core stability: The centerpiece of any training program. Curr Sports Med Rep 2005; 4(3): 179-83.

Colston MA. Core stability, part 1: Overview of the concept. Int J Athl Ther Train 2012; 17(1): 8-13.

Mok NW, Yeung EW, Cho JC, Hui SC, Liu KC, Pang CH. Core muscle activity during suspension exercises. J Sci Med Sport 2015; 18(2): 189-94.

Hangai M, Kaneoka K, Hinotsu S, Shimizu K, Okubo Y, Miyakawa S, et al. Lumbar intervertebral disk degeneration in athletes. Am J Sports Med 2009; 37(1): 149-55.

Kleim JA, Barbay S, Nudo RJ. Functional reorganization of the rat motor cortex following motor skill learning. J Neurophysiol 1998; 80(6): 3321-5.

Janot J, Heltne T, Welles C, Riedl J, Anderson H, Howard A, et al. Effects of TRX versus traditional resistance training programs on measures of muscular performance in adults. Journal of Fitness Research 2013; 2(2): 23-38.

Filipa A, Byrnes R, Paterno MV, Myer GD, Hewett TE. Neuromuscular training improves performance on the star excursion balance test in young female athletes. J Orthop Sports Phys Ther 2010; 40(9): 551-8.

Samson KM, Sandrey MA, Hetrick A. A Core stabilization training program for tennis athletes. Int J Athl Ther Train 2007; 12(3): 41-6.

Paquette MR, Li Y, Hoekstra J, Bravo J. An 8-week reactive balance training program in older healthy adults: A preliminary investigation. J Sport Health Sci 2015; 4(3): 263-9.

Zech A, Hubscher M, Vogt L, Banzer W, Hansel F, Pfeifer K. Balance training for neuromuscular control and performance enhancement: A systematic review. J Athl Train 2010; 45(4): 392-403.

Tantawi SS. Effect of core stability training on some physical variables and the performance level of the compulsory kata for karate players. World J Sport Sci 2011; 5(4): 288-96.

Mohammadi V, Alizadeh MH, Gaieni A. The effects of strength, balance and combined (strength and balance) exercise programs on the dynamic balance of young male athletes. J Res Rehabil Sci 2013; 9(1): 113-23. [In Persian].

Hermens HJ, Freriks B, Merletti R, Stegeman DF, Blok JH, Rau G, et al. European recommendations for surface electromyography: Results of the SENIAM Project. Enschede, Netherlands: Roessingh Research and Development; 1999.

Hall EA, Docherty CL, Simon J, Kingma JJ, Klossner JC. Strength-training protocols to improve deficits in participants with chronic ankle instability: A randomized controlled trial. J Athl Train 2015; 50(1): 36-44.


  • There are currently no refbacks.

Postal Address: Journal of Research in rehabilitation Sciences, 2nd floor, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

P.O.Box: 81745-164

Telephone: 009831-37925008

Fax: 009831-36691663 

Creative Commons Attribution-NonCommercial 4.0

This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/). Noncommercial uses of the work are permitted, provided the original work is properly cited.