The effect of neck proprioception neuromuscular facilitation exercises program on dynamic balance and performance of female basketball players

Amir Hossein Barati; Hooman Minoonejad; Homa Naderifar; Hadi Niazi; Bijan Heidari; Amir Hossein Barati; Hooman Minoonejad; Homa Naderifar; Hadi Niazi; Bijan Heidari

ISSN: 2455-5487

Journal of Novel Physiotherapy and Physical Rehabilitation

Research Article Open Access Peer-Reviewed

The effect of neck proprioception neuromuscular facilitation exercises program on dynamic balance and performance of female basketball players

Amir Hossein Barati¹, Hooman Minoonejad², Homa Naderifar^3*, Hadi Niazi⁴ and Bijan Heidari⁵

Author and article information

¹Department of Health and Exercise Rehabilitation, Shahid Beheshti University of Tehran, Iran
²Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
³Vice chancellor for Research and technology, Hamadan University of Medical Sciences, Hamadan, Iran
⁴Department of geography, urban planning geography, Iran
⁵Clinical Research Development Unit of Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran

*Corresponding author: Homa Naderifar, Vice chancellor for Research and technology, Hamadan University of Medical Sciences, Hamadan, Iran, Tel: 00989133028450; Fax: 00988138380063; E-mail: hnaderifar121@gmail.com

DOI: 10.17352/2455-5487.000071

Received: 27 March, 2020 | Accepted: 09 May, 2020 | Published: 11 May, 2020

Keywords: Dynamic balance; Proprioception; Performance

Cite this as

Naderifar H, Minoonejad H, Barati AH, Niazi H, Heidari B (2020) The effect of neck proprioception neuromuscular facilitation exercises program on dynamic balance and performance of female basketball players. J Nov Physiother Phys Rehabil 7(1): 018-022. DOI: 10.17352/2455-5487.000071

Abstract

Background and purpose: Basketball is a dynamic sport that keeping balance is an important factor to improve performance. Therefore, the purpose of this study was to investigate the effect of PNF neck exercises program on dynamic balance and sports performance (penalty throw) of female basketball players.

Materials and methods: 30 basketball players were randomly divided into two intervention-control groups. Athletes in the intervention group participated in the 4-week scheduled program of PNF neck exercises. The control group performed only their daily routine exercises.

Results: The results showed that dynamic balance indicators were decreased and free-throw basketball test in the intervention group was significantly increased after four weeks of PNF neck exercises that these changes were statistically significant in comparison with the control group and before performing exercise protocol (p<0.05).

Conclusion: According to the results, it seems that PNF neck exercises can be beneficial for enhancing dynamic balance and performance of female basketball players.

Main article text

Introduction

Basketball is a dynamic sport in which players are constantly moving and athletes are in a new position at any moment that this change of position requires the re-analysis of visual information received from the new position and balance keep and postural control [1]. Balance is known as an important factor in many sports fields such as Gymnastics, Basketball and Volleyball, and weakness in balancing and postural control when faced with its destructive factors lead to injuries such as instability or pain in the ankle and knee, knee osteoarthritis and acute ankle sprains [1,2]. Also, balance is considered a decisive indicator in investigating the athletes’ functional ability [3]. Keeping postural balance includes sensory perception of body movements, sensory-motor information processing inside the central nervous system, and proper musculoskeletal responses. Somatosensory inputs provide information about the orientation of different parts of the body relative to each other as well as reliance surface of the body [4,5]. Neck afferents play an important role in providing proprioception inputs and this reflects the frequency of neck mechanoreceptors and central connections and reflection in the vestibular, visual and central nervous system. These interactions can produce an effective proprioception input in the upper neck region [6,7]. Neck proprioception information plays an important role in postural keep [7].

In order to know the position of the head in space and on the trunk, not only the information obtained from vestibular and visual systems is need, but also neck proprioception information is needed [8]. Neck function to keep body balance is through the activity of neck proprioception muscle [9]. Neck central core is used as a route for the cerebellum which integrates and organizes the organs of vision, hearing, and proprioception and provides information about the position of the head and body as well as the visual movements and positioning of the objects. There is a high density of tiny and spindly muscles in the upper region of the neck which provide proprioception inputs for the movement of the neck [10,11]. The results of the study by Amer showed that neck muscle fatigue has a negative effect on the position control; so that, neck extensor muscle fatigue is increased and body oscillations is increased [12]. The role of neck proprioception is essential for optimal neck performance and balance in exercise [13]. This neck proprioception has a major role in perception of the movement of the head and neck and had retraining ability and can be improved by exercising [14].

One of the effective exercises program on PNF exercises which is defined as “facilitation of the response to the neuromuscular system by stimulating the pathways and proprioception receptors”. These exercises use specific proprioception receptors and other sensory inputs in order to facilitate the motor reactions and motor learning. Principles of PNF exercises are based on neurophysiological principles associated with tensile reflex. These exercises facilitate and control neuromuscular systems through two mechanisms [15]. Adduction and stretching the articular surfaces while performing exercises stimulate the joints proprioception receptors. Adduction is applied at the beginning of the movements which are performed in the direction of gravity; while, stretching is applied at the beginning of the movements which are performed in the opposite direction of gravity. Also while performing each exercises, the person must look at the organ that is performed on it [13,16]. Considering that neck proprioception plays an important role in the person’s ability to adapt to environmental changes to keep the playing position, no study has been conducted on the effect of neck proprioception neuromuscular facilitation exercises program on dynamic balance and performance of athletes so far. Considering the importance of performance and balance of athletes, it is necessary to investigate the effect of exercises other than the specialized exercises of each sport.

Thus, the purpose of this study was to investigate the effect of four weeks of PNF neck exercises program on dynamic balance and performance (penalty throw) of female basketball players.

Materials and methods

This quasi-experimental clinical trial was conducted in Tehran in 2018. Thirty female basketball players with the age range of 18-24 years old with normal vision and hearing who had at least three years of continuous basketball experience were entered the study [4].

The subjects were randomly divided into two intervention and control groups. After complete knowledge of the subjects with the conditions of the study, the informed consent was obtained for participation in this study. The demographic information of the individuals was recorded in the individual information form. The height and weight of each subject were measured with height and weight scale Seca Model 703. Three individuals were excluded from the study due to lack of cooperation in doing exercises program and three individuals were replaced again. The intervention group participated in the exercises program for six days a week (morning - evening) for four weeks. The protocol of this study was selected based on the study by Soltani [11]. During the study period, the control group maintained their own activity level of exercises program before participating in the study. Biodex Balance System (SD model) was used to measure dynamic balance [17] . The subjects’ position when standing on the Biodex balance system was so that both feet were on the balance sheet and two hands were next to the body. The subjects held their trunk directly; their heads with open eyes opposite the device monitor [18]. Each test was repeated three times for 20 seconds and the rest intervals between each repetition were considered to be 10 seconds [16].

To measure the effect of the exercises program on the performance of athletes, 15 trial penalty throw test was used [19]. This test includes 15 basketball free throws which were executed from the penalty spot in the form of 3 blocks of 5 throws. After each exercise block, the subjects had one minute active rest and then, the next block was completed. The method of scoring the test was in such a way that if the thrown ball is on the top of the basket and hits the basket is score 1, if it hits the basket is score 2, and if the ball hits the sides of the basket or the lack of hit the basket, no score was considered for them.

The overall duration of these exercises was 4 weeks (six days a week in the morning and evening). The individuals did morning exercises at home and did the evening exercises three days at home and three days at the club. The individuals began exercises from three sets of ten. In the first week, athletes were asked to perform a motion pattern, to rest for 5 seconds and then to perform the motion pattern again and to repeat this action 10 times. In the second week, athletes were asked to perform each motion patterns 12 times and to rest for 5 seconds between them. They were asked to do 14 repetitions of these exercises in the third week, and 16 repetitions in the fourth week [11]. During this period, the individuals only dealt with their own specialized sports exercises and theses exercises.

In performing upper limb motion patterns, the individuals were asked to follow the same hand movements with their eyes. Before starting the exercises, all movements were taught to the individual by the researcher. Then, all movements were performed by the individual himself and under the supervision of the researcher Figures 1,2.

Statistical analysis

Mean indices and standard deviation were used to describe the data and shapiro wilk test was used to investigate the groups’ homogeneity. Also, Independent t test was used to analyze the changes in the mean of balance indices and sports performance between the two groups, and Paired t -test to differences within groups.

Results

The characteristics of the groups in terms of age, height and weight are shown in Table 1. Independent t-test analysis indicated no significant differences in the variables age, height and weight of the subjects (p≥0.05).

In Table 2, there was no significant difference between the measured variables before and after of the dynamic balance in the control group (p>0.05), but there was a significant difference between the measured variables of the dynamic balance in the experimental group in the measurements before and after 4 weeks of PNF neck exercises. The findings indicate a significant effect of this exercise program for four weeks on dynamic balance in intervention group subjects (p<0.05).

The results of Table 3 show a significant difference between the results of the functional test of penalty free-throw before and after the exercise program in the experimental group. These findings show the significant effect of PNF on athletic performance (penalty free-throw) of these athletes (p≤0.05). The results showed no significant changes in the control group (p>0.05).

Discussion and conclusion

This study showed that PNF neck exercises program had a significant effect on dynamic balance and penalty throw of athletes in the intervention group. The crucial role of proprioception in balance can be referred to justify these results. One aspect of the role of proprioception in movement and postural control is to design and modify the intrinsic motor commands before and during the execution of a motor command. The motor control system should consider the current and changing state of the joints to estimate the complex mechanical balance resulting from its implementation. In this case, proprioception has the best conditions for providing the information and transmitting them to the central nervous system. Proprioception information plays a crucial role either in maintaining the whole body’s stability or maintaining the stability of topical areas [7].

The results of the study by Ebrahimi can be mentioned as the consistent result with this study, it was shown that balance exercises are effective in improving postural stability and stability range in the intervention group [20]. Today, the high level of balance and use of proprioception in rehabilitation of the injured athlete is taken into consideration. Exercise programs can improve the performance of motor receptor system and the stature control [21]. Neck area like other areas of the spine is exposed to the complications and damages caused by entering the external disturbances due to the multiple segments’ structure [8,9]. About 80% of the postural stability of the head and neck area is provided with the help of neck muscle system and appropriate use of the nervous system strategies on it [6,22]. Neck muscles fatigue affects sensory receptors and proprioception and consequent evidence show that this fatigue of the upper neck muscles leads to increase the fluctuations in stature and impairment of the individuals’ performance [6,13,22]. Muscles proprioception input is considered one of the key sources of information of strategies of stability of stature. Without proper activity of the nervous system strategies in the neck area, this area becomes bending and excessive strain in structures in the presence of very low forces [23]. Pinsault, et al. believe that due to the role of proprioception receptors for neck muscles, exercises lead to shape the brain motor signals in order to keep and maintain the proper position of the head and neck [8]. Minoonejad et al. also showed that neck proprioception neuromuscular facilitation exercises have a significant effect on postural stability to improve the static balance in athletes that the results of this study are consistent with the results of the present study [24]. The study by Gosselin et al. showed that fatigue of the neck muscles leads to an increase in the center of foot pressure displacement of foot in the absence of vision, and the amount of fluctuations in stature is increased with increasing fatigue in the neck muscles, and there is a significant relationship between neck muscles fatigue and postural stability [6]. Neck muscles fatigue has a significant effect on the balance of those with a history of neck pain or history of neck injury [22]. Thus, based on what Soltani et al. reported performing PNF neck exercises can be more appropriate than usual rehabilitation programs to facilitate the rehabilitation of proprioception neck [11].

In the study by Paterno et al, there was a report of reducing the incidence of injuries as well as improving the stability of the anterior-posterior posture balance and consequently performing neuromuscular exercises [21]. The results of the study by Afhami et al. [25]. Showed that neck proprioception exercises can increase the efficiency of postural stability strategies and reduce the fluctuations of head and neck faced with the external disturbances in karate athletes [23]. Cross et al. in their study stated that retraining neck proprioception system in athletes is considered one of the principles of prevention of head and neck injuries in athletes [26]. Yang, et al. [27] examined the effect of 4 weeks of balance exercises on maintaining stability ranges. The results of this study showed that balance exercises significantly improve the control of body condition and thus improve the performance levels in various sports and prevent the incidence of lower limb injuries [27]. Also, the study by Gabriele Boccolini dealt with investigating the effect of balance exercises on the performance of basketball players. This study was conducted on 23 players in two exercise groups (isotonic-balance). The results showed that balance exercises increased the performance of young basketball players (vertical jumping ability) [28]. In fact, given that the player is regularly exposed to different situations and unstable balance conditions in basketball such as accelerations and decelerations, shifting direction and penetration into the defensive environment, these players need to do special exercises to improve their performance. It is notable to consider how these exercises affect the reduction of dynamic balance indices in female basketball players. According to the mechanism of the effect of PNF neck exercises through stimulation of proprioception receptors as well as given that the principles of neuromuscular facilitation exercises techniques are based on neurophysiological principles, it can justify this improvement on postural stability indicators.

Based on the results of this research, the importance of neck proprioception neuromuscular facilitation exercises on the dynamic balance and consequently improvement of sport performance can be emphasized. By improving these factors, it is also possible to reduce the damage caused by dynamic imbalance.

References

Copyright

© 2020 Naderifar H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Table 1: The demographic characteristics of the two groups.
Variable	Groups		p-value
Variable	Control group	Experimental group	p-value
Age	20.35±1.27	20.13±1.54	0.30
Height (Cm)	169.1±1/87	169.1±1.55	0.63
Weight (kg)	62.33±3.71	62.4±3.94	095
BMI(Kg/m2)	21.68±1.31	21.29±1.1	0.45

Table 2: Comparison of changes in the dynamic stability index before and after exercises in between experimental and control groups.
Variable statistics		Groups	Mean square	P- value
Overall stability	Between groups	Experimental group Control group	0/69	0/001*
Media- lateral	Between groups	Experimental group Control group	0/11	0/001*
Anterior- posterior	Between groups	Experimental group Control group	0/90	0/003*

Table 3: Comparison of changes in the performance before and after exercises in the experimental and control groups.
Variable statistics	Groups	Pre- test Mean± SD	After- test Mean± SD	P- value
penalty free-throw	Experimental group Control group	1/60±0/98 1/53±0/50	2/60±0/50 1/66±0/72	0/001* 0/58

Journal of Novel Physiotherapy and Physical Rehabilitation

The effect of neck proprioception neuromuscular facilitation exercises program on dynamic balance and performance of female basketball players