Balance error scoring
system stances that identify division I athletes with chronic ankle instability
most in need of rehabilitation

B., White A., Linens S. Athl Train Sports Health Care. 2015; 7(5): 190-196

Take Home Message: Single-leg
and tandem stances on a foam surface may be a quick and inexpensive screening
tool for athletes who need a preventative ankle rehabilitation program.

ankle sprains negatively impact a patient’s life. Screening tools for chronic
ankle instability could lead to improved interventions. Many sports medicine clinics
have little equipment or time to establish a screening assessment for every
joint. However, many medical professionals use the balance error scoring system (BESS) test,
which could serve a dual purpose for concussion assessment and ankle screening.
Therefore, the authors had 51 Division I collegiate athletes (32 with reported chronic
ankle instability and 19 healthy participants) perform the BESS test to determine
which stances athletes with chronic ankle instability were more likley to
perform poorly. The athletes performed the BESS test based on a concussion testing
protocol except that all the trials were recorded using a video camera. The
athletic trainer scored the errors by reviewing the video at a later time. The
authors found that the single leg stance on a foam surface or the tandem leg
stance on a foam surface were most effective at correctly identifying those
with or without chronic ankle instability. The authors also identified the
number of errors that would ideally identify those with chronic ankle
instability: single leg stance on foam surface (more than 5 errors) and tandem
leg stance on foam surface (more than 3 errors).

the authors found that the single-leg and tandem stances on a foam surface may
be an accurate screen for Division I athletes with chronic ankle instability.
These patients may  need preventative
ankle rehabilitation to decrease risk of ankle re-injury. The results make
sense, if you decrease the base of support and alter the surface; someone with
ankle instability is going to have trouble balancing. Further research is
necessary in a larger cohort with a wider array of athletes to further validate
the cut-off, which should be conducted with an evaluator that is blinded to
whether the athlete reported chronic ankle instability or not. It is important
to note that the BESS scoring used a video recording. This adds some cost to
conducting the BESS test but an advantage is that the athletic trainer could
review the video at their convenience and rewind the video if needed. This
could be a time efficient strategy for using the BESS test as part of a
prescreening protocol. Ultimately, these authors provide evidence that medical
professionals could use the BESS test, particularly the two stances, to screen
for athletes that need ankle rehabilitation.

Questions for Discussion:
Would you use the BESS to screen for chronic ankle instability? Do you think
results would be similar for those with knee instability?

by: Jane McDevitt, PhD
by: Jeff Driban


Differences Among Sports and Teams on Baseline Concussion Performance

Dobo, B., White, A., & Linens, S. (2015). Balance Error Scoring System Stances That Identify Division I Athletes With Chronic Ankle Instability Most in Need of Rehabilitation Athletic Training & Sports Health Care, 7 (5), 190-196 DOI: 10.3928/19425864-20150831-04