This study was conducted to analyze the alignment of various collegiate dancers’ ankles in order to strengthen the muscles surrounding the ankle joint and improve balance. The research was conducted using a pre and post-test consisting of the Star Excursion Balance test and the Stork test. Participants from the Texas A&M dance program that did not have any lower extremity injuries in the six months prior to the study were randomly assigned to either the Pilates intervention group, balance board intervention group, or a control group who continued their regular training regimen. The participants met three times a week for five weeks to go through the intervention exercises. After the intervention period, a post test was conducted to collect data from the same tests used for the pre-test. It was predicted that the balance board group would have the greatest improvement because the exercises were fully weight bearing and challenged their balance more than the reformer group

Bergeron, Chloe

Dardeau, Madeleine

Gerwig, Olivia

Schraer, Danielle Sara

English

Texas A&M University

EFFECTIVENESS OF ANKLE STRENGTHENING USING PILATES  
REFORMER VS. BALANCE BOARD TO IMPROVE BALANCE IN  
DANCERS 
 
 
An Undergraduate Research Scholars Thesis 
by 
CHLOE BERGERON, MADELEINE DARDEAU, OLIVIA GERWING and DANIELLE  
SCHRAER 
 
 
Submitted to the Undergraduate Research Scholars program at  
Texas A&M University 
in partial fulfillment of the requirements for the designation as an 
 
 
UNDERGRADUATE RESEARCH SCHOLAR 
 
 
Approved by Research Advisors:  Christine Bergeron 
Carisa Armstrong 
 
May 2019 
 
Major: Dance Science 
TABLE OF CONTENTS 
 
Page 
ABSTRACT .................................................................................................................................. 1 
ACKNOWLEDGMENTS  ........................................................................................................... 2 
NOMENCLATURE  .................................................................................................................... 3 
CHAPTER  
I. INTRODUCTION ...................................................................................................... 4 
II. METHODS  ................................................................................................................ 6 
Participants  ........................................................................................................... 6 
Testing Protocol  ................................................................................................... 6 
Intervention  .......................................................................................................... 8 
 
III. RESULTS  ................................................................................................................ 10 
IV. DISCUSSION  .......................................................................................................... 12 
V. CONCLUSION  ........................................................................................................ 14 
REFERENCES  .......................................................................................................................... 15 
 
  
1 
ABSTRACT 
Effectiveness of Ankle Strengthening using Pilates Reformer vs. Balance Board to Improve 
Balance in Dancers 
 
 
Chloe Bergeron, Madeleine Dardeau, Olivia Gerwing, and Danielle Schraer 
Department of Health and Kinesiology 
Texas A&M University 
 
 
Research Advisor: Christine Bergeron 
Department of Health and Kinesiology 
Texas A&M University 
 
 
Research Advisor: Carisa Armstrong 
Department of Health and Kinesiology 
Texas A&M University 
 
 
 This study was conducted to analyze the alignment of various collegiate dancers’ ankles  
in order to strengthen the muscles surrounding the ankle joint and improve balance. The research 
was conducted using a pre and post-test consisting of the Star Excursion Balance test and the  
Stork test. Participants from the Texas A&M dance program that did not have any lower  
extremity injuries in the six months prior to the study were randomly assigned to either the 
Pilates intervention group, balance board intervention group, or a control group who continued 
their regular training regimen. The participants met three times a week for five weeks to go 
through the intervention exercises. After the intervention period, a post test was conducted to 
collect data from the same tests used for the pre-test. It was predicted that the balance board 
group would have the greatest improvement because the exercises were fully weight bearing and 
challenged their balance more than the reformer group. 
  
2 
ACKNOWLEDGEMENTS  
 
We would like to thank our faculty advisors, Christine Bergeron and Carisa Armstrong, 
for their support and guidance throughout this research project. We would also like to thank the 
College of Education - Health and Kinesiology Department at Texas A&M University for 
allowing us the opportunity to conduct our research. Lastly, we would like to thank the TAMU 
dance department for allowing us to use their students as our subjects and our participants for 
making our research possible. 
  
3 
NOMENCLATURE  
 
SEBT  Star Excursion Balance Test 
ST  Stork Test 
  
4 
CHAPTER I 
INTRODUCTION 
 
Balance and ankle stability are essential components for dancers to perform movements 
with correct alignment and to help prevent injury. Consequently, finding a way to increase ankle 
stability and improve balance time in dancers is important for their overall success. In general, 
“balance training is believed to be one of the principal constituent of rehabilitating an athlete 
with functional ankle instability.” (Davlin, 2004) Mhatre, Vilares, Stibb, Albert, Pickering, 
Marciniak, Kording and Toledo found that balance board in dancers, cross training is essential to 
keep the body in shape to perform. It is thought that “Regular technique class… does not always 
provide a sufficient conditioning program for prevention of injuries or skeletal imbalances often 
associated with the performance and rehearsal.” (Ahearn, 2006) This raises the question, what is 
the best method of cross training for dancers to improve ankle stability and balance? In search 
of the most effective training method, this study investigated two forms of common training 
methods for dancers, Pilates reformer and balance board. Based upon current research the “use of 
proprioceptive balance board program is effective” (Verhagen, van der Beek, Twisk, Bouter, 
Bahr & van Mechelen, 2004) in preventing ankle sprains. Although “there is weak support for 
the effectiveness of Pilates . . . this weakness is related to the lack of sound research methods 
employed in the published research.” (Bernardo & Nagle, 2006) Since Pilates is used as a 
training method by many athletes and more research is needed to determine its effectiveness on 
balance, exploring the potential benefits on the strength and stabilization of the ankle in 
comparison to another training method is useful.  
5 
The limited research raises many questions about the impact of cross training protocols 
on dancers’ ankle stability and balance.  Balance board training has been proven to increase 
balance and assist with ankle stability in some populations, but the research is non-existent in 
dancers. Currently, Pilates research does not support an improvement on balance in dancers. 
(Amorim, Sousa, Machado & Santos, 2011) However as stated by Bernardo and Nagle, this may 
be due to a lack in methods rather than a flaw in the Pilates method.  These two training methods 
have not been compared in published research in regard to improving ankle stability and balance 
in dancers. Therefore, the goal for this study is to investigate which training method may 
increase overall balance in collegiate dancers.  
 
  
6 
CHAPTER II 
METHODS 
 
Participants 
Initially, this study consisted of 22 of participants ranging from age 18-24 years old from 
a collegiate level dance program.  Five subjects withdrew from the study due to missed training 
or intervention session and one was withdrawn from the study due to a foot injury, which 
occurred outside of the study.  This left a total of 16 participants who completed the study. 
Participants were required to be enrolled in a ballet and/or modern technique class which met 
three times a week. Study participants also had to be free from a lower extremity injury in the 
past six months. An IRB committee approved this research and all participants signed a consent 
form.  
Testing Protocol 
The remaining participants were randomly divided into three groups; a balance board 
intervention group (n=4), a Pilates reformer intervention group (n=5), and a control group (n=7). 
The intervention groups performed exercises on the balance board or the Pilates reformer, which 
aimed at strengthening the ankles, and were geared towards a skill level for trained collegiate 
dancers. The control group continued their normal exercise regimen without any intervention or 
additional balance training. Before intervention began, a pre-test was conducted with the Star 
Excursion Balance Test (SEBT) in parallel and the Stork Test (ST) in parallel and external 
rotation for all three groups. For the SEBT, the subject stood on one leg in parallel on flat foot at 
the center of a taped star with their hands on their hips throughout the test. The subjects were 
expected to maintain balance and proper alignment of the standing leg as they reached the 
7 
gesture leg to the end of each arm of the star. Each participant started with a score of 10 for the 
SEBT test and received -0.5 for each infraction that totaled up for their final score. Infractions 
during the SEBT included losing balance such as hopping, hands dropping from the hips, 
touching the foot to the ground or pronating or supinating the standing ankle. For the ST, the 
subjects stood on one leg with the other leg in a passé position. The subject stood on a flat-foot 
as long as possible in parallel and external rotation for a maximum of thirty seconds. If the 
participants had an infraction while balancing, the time was recorded when the infraction 
occurred. Infractions could have been a break of the toe from the standing knee, losing balance 
and the toe touching the ground or a hop.   
                       
Figure 1. Participants on a balance board.        Figure 2. Participant on Pilates reformer. 
 
 
 
8 
Intervention 
The Pilates reformer group (n=5) and balance board group (n=4) did one week of training 
to learn the exercises they would be doing during the 4-week intervention study. The balance 
board group used a balance board, which is a circular board with half a sphere as the base to 
allow for movement in all directions and to challenge balance while the participant is standing 
upright, fully weight bearing (Figure 1). The Pilates reformer is a gliding bed that uses resistance 
springs to strengthen different parts of the body while the participant exercises in various 
positions (Figure 2).  
Participants were taught the exercises and instructed on the mechanics, proper alignment 
and muscular engagement of the exercises. The training sessions lasted 15-20 minutes and were 
conducted three times over a one-week period. Following the one-week training session, 
participants performed 4 weeks of intervention. Each group followed the same exercise format 
including a Pilates movement principle mat warm up, exercises on the either the reformer or the 
balance board and ending the session with a single balance in parallel passé (Tables 1 and 
2).  The timing of the exercises for both groups were controlled using a metronome set at 25 bpm 
at 2/4 time. Intervention sessions were conducted by the same qualified instructor who lead the 
subjects through the exercises and ensured participants maintained proper alignment throughout.  
 
 
 
 
 
 
9 
Table 1. Balance Board Exercises 
 
Warm 
Up: 
Plié in parallel (5x), plié external rotation (first position) (5x), plié roll up forced arch (5x), 
plié relevé (5x) 
Exercise: Clockwise circles (5x), counter-clockwise circles (5x), single leg side-to-side (10x), passé relevé 
(10x) 
 *(metronome set at 25 beats per minute in a 2/4 time) 
Balance: Parallel balance (30 sec), externally rotated balance (30 sec) 
Intensify:  Did last set of balances without touching the barre. 
 
 
Table 2. Pilates Reformer Exercises 
 
 
Warm 
Up: 
Plié in parallel (5x), plié external rotation (first position) (5x), plié roll up forced arch 
(5x), plié relevé (5x) 
Exercise: Footwork [parallel toes (10x), externally rotated toes (10x), single leg heel raises (10x), 
prancing (20x)] 
*(metronome set at 25 beats per minute in a 2/4 time) 
Balance: Parallel balance (30 sec), externally rotated balance (30 sec) 
Intensify: Added pulses to each exercise.  
 
 
  
10 
CHAPTER III 
RESULTS 
 
The data from this study was analyzed with IBM SPSS software using ANOVA 3-way 
analysis with a p-value of <0.05 being utilized for the dependent variables in each test. There 
was a significant difference found in overall time for all participants from the pretest to the post-
test in the stork test in external rotation on the left side (p = 0.002) as seen in graph 1 below and 
the stork test in parallel on the right side (p = 0.042) as seen in graph 2 below. However, there 
were no differences found between the balance board group, Pilates reformer group, or the 
control group from the pretest to the post-test for the stork test in parallel on the right (p = 0.263) 
or left side (p = 0.987) or the stork test in external rotation on either the right (p = 0.772) or the 
left side (p = 0.259). There was also no significant difference in overall balance time in the stork 
test in parallel on the left side (p = 0.095), and the stork test in external rotation on the right side 
(p = 0.724). The star test also showed no significant difference between the three groups on 
either the right (p = 0.129) or the left side (p = 0.791) from the pretest to the post-test. 
 
 
11 
 
Graph 1: Pre/Post Left Side External  Graph 2: Pre/Post Right Side Parallel 
Graph 1. Results of stork test in external  Graph 2. Results of stork test in parallel on  
rotation on left side, comparing balance time  right side, comparing balance time between  
between the pre- and post-tests.    the pre- and post-tests.  
  
12 
CHAPTER IV  
DISCUSSION 
 
Balance is crucial to a dancer’s success in training and performance not only aesthetically 
or functionally but also to help prevent injuries. Determining a training method to improve 
balance would be beneficial to a dancer’s overall achievements. In this study, participants in all 
three groups (balance board, Pilates reformer, and control) improved in their overall balance time 
in the ST in parallel on the right side and the ST in external rotation on the left side. After 
comparing pre and post test scores, all three groups showed improvement however, no 
improvement was shown between the control group or either of the intervention groups. The 
only variable that all participants had in common were the required technique class they took 
part in throughout the study. This result could imply that perhaps through ballet and/or technique 
classes one can improve ankle stability and balance. Further research will need to be done to 
inspect the overall impact that technique classes has on balance and if this is the most effective 
way to improve balance in collegiate level dancers. 
Dance technique focuses on the use of the legs in parallel and external rotation. The ST 
test used in this study was performed in parallel and rotation however the SEBT test was only 
executed in parallel. In addition, both tests were executed on flat foot rather than on relevé. If the 
study was repeated, the researchers would include the SEBT in external rotation and perform 
both tests in parallel and relevé to imitate a more traditional dance balance.  It would be useful to 
see how those results impact overall outcomes. 
Balance board training and Pilates encompass a large variety of exercises that can be used 
in the training process. Perhaps greater difference in ankle stability and balance would be seen 
13 
between the intervention groups and the control if there were a variance in the training protocol. 
Pilates also uses various pieces of equipment including the exo-chair, the cadillac and spine 
corrector as well as numerous props for mat work. Perhaps the use of the cadillac in Pilates 
training could have a larger impact on the strength of the lower leg muscles thus increasing ankle 
stability and balance. Extended research is required in order to address the number of variables 
available with these two training methods and how that can influence a dancer’s training and 
performance. Furthermore, statistical data was limited due to a small sample size, so it is far to 
question if the results would be different with a larger subject pool.  
  
14 
CHAPTER V 
CONCLUSION 
 
Although significance was seen pre and post testing in some aspects of overall balance 
there was no significant difference seen between the balance board, Pilates or control groups. 
Consequently, it can be determined that neither balance board nor Pilates reformer training has 
an impact on improving balance. Since overall balance improvement was seen in all three 
groups, dance training over a four-week period does appear to improve ankle stability and 
balance. Additional testing is warranted to determine if dance training is the most effective way 
to increase balance in dancers.    
15 
REFERENCES 
 
Ahearn, E. (2006). The Pilates Method and Ballet Technique: Applications in the Dance Studio. 
 Journal of Dance Education, 6, 92-99. 
 
Amorim, T., Sousa, F., Machado, L., & Santos, J. (2011). Effects of Pilates training on muscular 
 strength and balance in ballet dancers. Journal of Sport Sciences, 11 (2), 147-150. 
 
Bernardo, L., & Nagle, E. F. (2006). Does Pilates Training Benefit Dancers? An Appraisal of 
 Pilates Research Literature. Journal of Dance Medicine & Science, 10, 46-50.  
 
Davlin, C. D. (2004). Dynamic Balance in High Level Athletes’. Perceptual and Motor Skills, 
 1171-1176. 
 
Oliver, G. D., & Brezzo, R. (2009). Functional Balance Training in Collegiate Women Athletes. 
 Journal of Strength and Conditioning Research, 23 (7), 2124-2129. 
 
Olmsted, L. C., Carcia, C. R., Hertel, J., & Shultz, S. J. (2002, December). Efficacy of the Star 
 Excursion Balance Tests in Detecting Reach Deficits in Subjects with Chronic Ankle 
 Instability. Journal of Athletic Training, 37(4), 501-506. Retrieved from PUBMed. 
 
SUNDARAGANESH K., MOHANDAS K., KIRUBAKARAN K. G., & VIKRAM M. (2015). 
 Effect of Wobble Board Balance Training Program among Athletes with Functionally 
 Unstable Ankle Joint. Medicine & Health (Universiti Kebangsaan Malaysia), 10(1), 17–
 22. Retrieved from 
 http://ezproxy.library.tamu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=
 true&db=asn&AN=117754994&site=ehost-live  
 
Verhagen, E., der Beek, A. van, Twisk, J., Bouter, L., Bahr, R., & Mechelen, W. van. (2004). 
 The Effect of a Proprioceptive Balance Board Training Program for the Prevention of 
 Ankle Sprains: A Prospective Controlled Trial. The American Journal of Sports 
 Medicine, 32(6), 1385–1393. https://doi.org/10.1177/0363546503262177 
 


Effectiveness of Ankle Strengthening using Pilates Reformer vs. Balance Board to Improve Balance in Dancers

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Effectiveness of Ankle Strengthening using Pilates Reformer vs. Balance Board to Improve Balance in Dancers

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