Proprioception, Motor Control and Injury Risk on Female Wrestlers

Effects of a 4-Week Neuromuscular Balance Training Program on Knee Proprioception, Functional Performance, and Landing Errors in Elite Female Wrestlers: A Randomized Controlled Trial

This study aimed to examine the effect of a 4-week neuromuscular balance-based training program on landing mechanics as reflected by the Landing Error Scoring System-Real Time (LESS-RT), together with associated changes in knee proprioception (JPS), force sense (FSET), static balance (SLST), and single-leg functional performance in elite female wrestlers.

Study Overview

• Status: Completed
• Conditions: Anterior Cruciate Ligament; Postural Balance; Proprioception; Female Athletes; Neuromuscular Training; Landing Mechanics
• Intervention / Treatment: Other: Exercise

• Study Type: Interventional
• Enrollment (Actual): 22
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Yalova
    • Yalova, Yalova, Turkey (Türkiye), 77100
      • Yalova University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• • Not having suffered a knee injury or undergone surgery within the last 6 months,

  • Not having a known neurological, vestibular, or rheumatological disease,
  • Committing to regular participation in planned training sessions throughout the study period.

Exclusion Criteria:

• not being a volunteer

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group; proprioceptive exercise application. The intervention process will be planned as individualized sessions, 3 days a week, for 30 minutes each, over a period of 4 weeks, and will be conducted under the supervision of a physiotherapist.	Other: Exercise; Single-leg balance and squats on a soft surface (balance pad); Static and dynamic balance exercises with eyes closed; Closed and open kinetic chain knee exercises with Theraband; Landing and jumping control on a mini trampoline
No Intervention: Control group; no additional intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Landing Error Scoring System (LESS)	The Landing Error Scoring System (LESS) is an observational assessment tool used to evaluate lower extremity biomechanics during a jump-landing task. Participants perform a standardized jump from a platform and land while their movements are recorded and analyzed based on specific criteria. Higher LESS scores indicate a greater number of movement errors and an increased risk of lower extremity injury, particularly anterior cruciate ligament (ACL) injury. A commonly used cut-off score is ≥5, indicating a higher risk of lower extremity injury, particularly ACL injury.	t0: baseline t1: at 4 weeks (post-intervention, after 12 sessions)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Joint Position Sense (JPS)	With their eyes closed, the participant is seated with their knee passively brought to a 45° flexion, held for 5 seconds, and then returned to the starting position. The participant is then asked to actively reproduce the same angle. Three repetitions are performed for each leg, and the average absolute angular error (degrees) is calculated. Measurement will be done using a goniometer. There is no universally established cut-off value; higher repositioning error values indicate impaired proprioception.	t0: baseline t1: at 4 weeks (post-intervention, after 12 sessions)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment of Strength Sensation with Barometric Cuff	This innovative method will assess force perception and motor sensitivity. A barometric cuff (e.g., DHD-3®, Biometrics Ltd.) is placed at the tibial plateau, and the participant is asked to compress the cuff during knee extension until a target pressure value is reached. They are then asked to repeat the same movement with their eyes closed. The difference in approach to the target pressure (absolute error, mmHg) is analyzed as the average of 3 repetitions. There is no standardized cut-off value; greater deviation from the target pressure reflects reduced force sense accuracy	t0: baseline t1: at 4 weeks (post-intervention, after 12 sessions)
Single-Leg Hop Test Battery	The Single Leg Hop Test Battery is a functional performance assessment used to evaluate lower extremity strength, power, and dynamic stability. It typically includes a series of hop tests such as the single hop for distance, triple hop for distance, crossover hop, and timed hop performed on one leg. Performance is quantified based on distance or time, and results are often expressed as a limb symmetry index to assess side-to-side differences. A limb symmetry index (LSI) of <90% is generally considered indicative of functional asymmetry and increased injury risk.	t0: baseline t1: at 4 weeks (post-intervention, after 12 sessions)
Lower Extremity Functional Scale	The Lower Extremity Functional Scale (LEFS) is a self-reported questionnaire used to assess functional status in individuals with lower extremity conditions. It consists of 20 items evaluating difficulty in performing daily activities, each scored on a 5-point scale. Higher total scores indicate better functional ability and lower levels of disability. A cut-off score of <60 points is often interpreted as the presence of significant functional limitation in the lower extremities.	t0: baseline t1: at 4 weeks (post-intervention, after 12 sessions)

Collaborators and Investigators

• Sponsor: University of Yalova

Study record dates

Study Major Dates

• Study Start (Actual): June 30, 2025
• Primary Completion (Actual): September 30, 2025
• Study Completion (Actual): November 20, 2025

Study Registration Dates

• First Submitted: March 18, 2026
• First Submitted That Met QC Criteria: March 25, 2026
• First Posted (Actual): April 1, 2026

Study Record Updates

• Last Update Posted (Actual): April 1, 2026
• Last Update Submitted That Met QC Criteria: March 25, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Female Athletes; Neuromuscular Training; Proprioception; Postural Balance; Anterior Cruciate Ligament Injury Risk; Landing Mechanics
• Additional Relevant MeSH Terms: Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Exercise
• Other Study ID Numbers: 2025/221

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No