Lower-Limb Strength and Balance Asymmetries in Adolescent Female Basketball Players
DOI:
https://doi.org/10.35469/ak.2026.567Keywords:
lower-limb symmetry, basketball, isokinetic strenght testing, functional performance testing, Y balance testAbstract
Purpose: Adolescent female basketball players experience increased risk of lower-limb injury, particularly during periods of rapid growth and maturation. Lower-limb strength and balance asymmetries are recognized contributors to injury risk and are commonly assessed after injury, yet they are less frequently evaluated as part of preventive screening in healthy athletes.
Methods: Twenty-two female U18 basketball players (mean age, 16.2 ± 1.2 years) underwent preventive assessment of lower-limb symmetry. Isokinetic knee flexor and extensor strength were measured at angular velocities of 60°/s, 180°/s, and 240°/s, with peak torque and hamstring-to-quadriceps (H:Q) ratios analysed. Dynamic balance was assessed using the Y-Balance Test (YBT), with reach distances normalized to limb length. Limb Symmetry Index (LSI) was calculated for all measures. Clinically relevant asymmetry was defined as LSI >10% or an anterior YBT reach difference >4 cm.
Results: At the group level, lower-limb symmetry appeared generally acceptable, with mean LSI values below 10% for isokinetic strength, H:Q ratios, and YBT performance. However, in most of the tested parameters, 25% of athletes demonstrated strength asymmetries exceeding 10%. On the YBT, 32% of participants exhibited LSI >10% in at least one reach direction, and 36% of athletes demonstrated anterior reach asymmetry greater than 4 cm, indicating potential functional imbalance.
Conclusion: Although group-level findings suggest good symmetry, a substantial proportion of healthy adolescent female basketball players display clinically meaningful individual asymmetries in strength and dynamic balance. These asymmetries may represent neuromuscular profiles relevant to lower-limb injury risk and support the use of preventive screening to identify athletes who may benefit from targeted injury-prevention strategies.
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Acar, N. E., Umutlu, G., Gencer, Y. G., Güven, E., & Taşman, G. A. (2025). Strength asymmetries and their impact on landing dynamics during countermovement jump and drop jump tests in professional female basketball players. BMC Sports Science, Medicine and Rehabilitation, 17(1), 282. https://doi.org/10.1186/s13102-025-01352-7
Adachi, N., Nawata, K., Maeta, M., & Kurozawa, Y. (2008). Relationship of the menstrual cycle phase to anterior cruciate ligament injuries in teenaged female athletes. Archives of Orthopaedic and Trauma Surgery, 128(5), 473–478. https://doi.org/10.1007/s00402-007-0461-1
Agresta, C., Church, C., Henley, J., Duer, T., & O’Brien, K. (2017). Single-leg squat performance in active adolescents aged 8–17 years. Journal of Strength and Conditioning Research, 31(5), 1187–1191. https://doi.org/10.1519/JSC.0000000000001617
Amado, B. L., De Lira, C. A. B., Vancini, R. L., Forte, P., Costa, T., Weiss, K., … Santos Andrade, M. (2023). Comparison of knee muscular strength balance among pre- and post-puberty adolescent swimmers: A cross-sectional pilot study. Healthcare, 11(5), 744. https://doi.org/10.3390/healthcare11050744
Andrade, M. S., Junqueira, M. S., Andre Barbosa De Lira, C., Vancini, R. L., Seffrin, A., Nikolaidis, P. T., … Knechtle, B. (2021). Age-related differences in torque in angle-specific and peak torque hamstring to quadriceps ratios in female soccer players from 11 to 18 years old: A cross-sectional study. Research in Sports Medicine, 29(1), 77–89. https://doi.org/10.1080/15438627.2020.1742713
Andreoli, C. V., Chiaramonti, B. C., Biruel, E., Pochini, A. de C., Ejnisman, B., & Cohen, M. (2018). Epidemiology of sports injuries in basketball: Integrative systematic review. BMJ Open Sport & Exercise Medicine, 4(1), e000468. https://doi.org/10.1136/bmjsem-2018-000468
Arboix-Alió, J., Buscà, B., Peralta-Geis, M., Montalvo, A., & Fort-Vanmeerhaeghe, A. (2025). The relationship between change-of-direction performance indicators and inter-limb asymmetries in elite youth female basketball players. Journal of Human Kinetics, 96, 235–246. https://doi.org/10.5114/jhk/202104
Barber-Westin, S. D., Noyes, F. R., & Galloway, M. (2006). Jump-land characteristics and muscle strength development in young athletes. : A Gender Comparison of 1140 Athletes 9 to 17 Years of Age. The American Journal of Sports Medicine, 34(3), 375–384. https://doi.org/10.1177/0363546505281242
Bishop, C., Turner, A., & Read, P. (2018). Effects of inter-limb asymmetries on physical and sports performance: A systematic review. Journal of Sports Sciences, 36(10), 1135–1144. https://doi.org/10.1080/02640414.2017.1361894
Borowski, L. A., Yard, E. E., Fields, S. K., & Comstock, R. D. (2008). The epidemiology of U.S. high school basketball injuries, 2005–2007. The American Journal of Sports Medicine, 36(12), 2328–2335. https://doi.org/10.1177/0363546508322893
Clifton, D. R., Hertel, J., Onate, J. A., Currie, D. W., Pierpoint, L. A., Wasserman, E. B., … Kerr, Z. Y. (2018). The first decade of web-based sports injury surveillance: Descriptive epidemiology of injuries in U.S. high school girls’ basketball (2005–2006 through 2013–2014) and National Collegiate Athletic Association women’s basketball (2004–2005 through 2013–2014). Journal of Athletic Training, 53(11), 1037–1048. https://doi.org/10.4085/1062-6050-150-17
Coto Martín, R., Pérez Mallada, N., Martínez Beltrán, M. J., Cuéllar Marín, L., Borrás Luján, P. J., Arroyo, O. O., … Arribas-Marín, J. M. (2025). Differences in strength, muscle work, and hamstring/quadriceps ratio in professional and junior elite basketball players according to sex. Journal of Functional Morphology and Kinesiology, 10(2), 204. https://doi.org/10.3390/jfmk10020204
DiCesare, C. A., Montalvo, A., Barber Foss, K. D., Thomas, S. M., Ford, K. R., Hewett, T. E., … Myer, G. D. (2019). Lower extremity biomechanics are altered across maturation in sport-specialized female adolescent athletes. Frontiers in Pediatrics, 7, 268. https://doi.org/10.3389/fped.2019.00268
Ford, K. R., Shapiro, R., Myer, G. D., Van Den Bogert, A. J., & Hewett, T. E. (2010). Longitudinal sex differences during landing in knee abduction in young athletes. Medicine & Science in Sports & Exercise, 42(10), 1923–1931. https://doi.org/10.1249/MSS.0b013e3181dc99b1
Fort-Vanmeerhaeghe, A., Benet-Vigo, A., Montalvo, A., Arboix, A., Buscà, B., & Arboix-Alió, J. (2022). Relationship between performance and inter-limb asymmetries using flywheel resistance device in elite youth female basketball players. Biology, 11(6), 812. https://doi.org/10.3390/biology11060812
Fousekis, K., Tsepis, E., & Vagenas, G. (2010). Lower limb strength in professional soccer players: Profile, asymmetry, and training age. Journal of Sports Science & Medicine, 9(3), 364–373.
Guan, Y., Bredin, S. S. D., Taunton, J., Jiang, Q., Wu, N., & Warburton, D. E. R. (2022). Association between inter-limb asymmetries in lower-limb functional performance and sport injury: A systematic review of prospective cohort studies. Journal of Clinical Medicine, 11(2), 360. https://doi.org/10.3390/jcm11020360
Heinert, B. L., Collins, T., Tehan, C., Ragan, R., & Kernozek, T. W. (2021). Effect of hamstring-to-quadriceps ratio on knee forces in females during landing. International Journal of Sports Medicine, 42(3), 264–269. https://doi.org/10.1055/a-1128-6995
Lambert, C., Pfeiffer, T., Lambert, M., Brozat, B., Lachmann, D., Shafizadeh, S., … Akoto, R. (2020). Side differences regarding the limb symmetry index in healthy professional athletes. International Journal of Sports Medicine, 41(11), 729–735. https://doi.org/10.1055/a-1171-2548
Leister, I., Mattiassich, G., Kindermann, H., Ortmaier, R., Barthofer, J., Vasvary, I., … Kulnik, S. T. (2018). Reference values for fatigued versus non-fatigued limb symmetry index measured by a newly designed single-leg hop test battery in healthy subjects: A pilot study. Sport Sciences for Health, 14(1), 105–113. https://doi.org/10.1007/s11332-017-0410-5
Leppänen, M., Pasanen, K., Kannus, P., Vasankari, T., Kujala, U., Heinonen, A., … Parkkari, J. (2017). Epidemiology of overuse injuries in youth team sports: A 3-year prospective study. International Journal of Sports Medicine, 38(11), 847–856. https://doi.org/10.1055/s-0043-114864
Mehl, J., Diermeier, T., Herbst, E., Imhoff, A. B., Stoffels, T., Zantop, T., … Achtnich, A. (2018). Evidence-based concepts for prevention of knee and ACL injuries. 2017 guidelines of the ligament committee of the German Knee Society (DKG). Archives of Orthopaedic and Trauma Surgery, 138(1), 51–61. https://doi.org/10.1007/s00402-017-2809-5
Moseid, C. H., Myklebust, G., Slaastuen, M. K., Bar‐Yaacov, J. B., Kristiansen, A. H., Fagerland, M. W., … Bahr, R. (2019). The association between physical fitness level and number and severity of injury and illness in youth elite athletes. Scandinavian Journal of Medicine & Science in Sports, 29(11), 1736–1748. https://doi.org/10.1111/sms.13498
Myer, G. D., Ford, K. R., Khoury, J., Succop, P., & Hewett, T. E. (2011). Biomechanics laboratory-based prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury. British Journal of Sports Medicine, 45(4), 245–252. https://doi.org/10.1136/bjsm.2009.069351
Nagai, T., Bates, N., McPherson, A., Hale, R., Hewett, T., & Schilaty, N. D. (2021). Effects of sex and age on quadriceps and hamstring strength and flexibility in high school basketball athletes. International Journal of Sports Physical Therapy, 16(5), 1302–1312. https://doi.org/10.26603/001c.27986
National Federation of State High School Associations. (n.d.). High school sports participation hits record high in 2024–25. Retrieved December 28, 2025, from NFHS
Parry, G. N., Williams, S., McKay, C. D., Johnson, D. J., Bergeron, M. F., & Cumming, S. P. (2024). Associations between growth, maturation and injury in youth athletes engaged in elite pathways: A scoping review. British Journal of Sports Medicine, 58(17), 1001–1010. https://doi.org/10.1136/bjsports-2024-108233
Plisky, P. J., Gorman, P. P., Butler, R. J., Kiesel, K. B., Underwood, F. B., & Elkins, B. (2009). The reliability of an instrumented device for measuring components of the star excursion balance test. North American Journal of Sports Physical Therapy, 4(2), 92–99.
Plisky, P. J., Rauh, M. J., Kaminski, T. W., & Underwood, F. B. (2006). Star excursion balance test as a predictor of lower extremity injury in high school basketball players. Journal of Orthopaedic & Sports Physical Therapy, 36(12), 911–919. https://doi.org/10.2519/jospt.2006.2244
Shultz, S. J., Cruz, M. R., Casey, E., Dompier, T. P., Ford, K. R., Pietrosimone, B., … Taylor, J. B. (2022). Sex-specific changes in physical risk factors for anterior cruciate ligament injury by chronological age and stages of growth and maturation from 8 to 18 years of age. Journal of Athletic Training, 57(9–10), 830–876. https://doi.org/10.4085/1062-6050-0038.22
Urbančič, Š. & Tomc Žargi, T. (2026). Lower-Limb Strength and Balance symmetries in Adolescent Female Basketball Players [Data set]. Zenodo. https://doi.org/10.5281/zenodo.20341333
Wilk, K. E., Romaniello, W. T., Soscia, S. M., Arrigo, C. A., & Andrews, J. R. (1994). The relationship between subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed knee. Journal of Orthopaedic & Sports Physical Therapy, 20(2), 60–73.
Zuckerman, S. L., Wegner, A. M., Roos, K. G., Djoko, A., Dompier, T. P., & Kerr, Z. Y. (2018). Injuries sustained in National Collegiate Athletic Association men’s and women’s basketball, 2009/2010–2014/2015. British Journal of Sports Medicine, 52(4), 261–268. https://doi.org/10.1136/bjsports-2016-096005
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