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ENFCLI 1093 1---7 ARTICLE IN PRESS
1 Enferm Clin. 2019;xxx(xx):xxx---xxx
2

www.elsevier.es/enfermeriaclinica

3 The effects of eccentric strengthening exercises on

4 foot alignment change, malleolus height and agility
5 level of junior badminton players in Makassar
6 Q2 Hermilasari ∗ , Irianto, Adi Ahmad Gondo

7 Physiotherapy Study Program, Faculty of Nursing, Hasanuddin University, Makassar, Indonesia

8 Received 29 May 2019; accepted 15 July 2019

9 KEYWORDS Abstract
10 Foot alignment; Objective: This study aims to determine the effect of the eccentric strengthening exercises on
11 Height malleolus; changes in foot alignment, height, and agility level malleolus of junior athletes.
12 Agility; Method: This study used a pre-experimental time-series design. A total of 30 junior badminton
13 Eccentric athletes were recruited to participate. The age ranged from 11 to 15 years old. Data collection
14 strengthening is done through the primary retrieval of data through the measurement instrument of foot
15 exercise; alignment, malleolus height, and agility.
16 Badminton Results: From the results of the SPSS Obtained a significant value of p = 0.0001 (p < 0.05) after
17 18 times the exercise was given.
18 Conclusion: There is an influence of eccentric strengthening exercise on changes in foot align-
19 ment, height, and agility malleolus in junior-level badminton players in Makassar. malleolus
20 height and agility.
21 © 2019 Elsevier España, S.L.U. All rights reserved.

22

Introduction 23

Badminton has become one of the sports that are very pop- Q3 24

Peer-review of abstracts of the articles is under the responsibility ular in the whole society. To be able to perform, badminton 25

of the Scientific Committee of Universitis Indonesia. Full-text and player could not be separated from the skill and mastery 26

the content of it is under responsibility of authors of the article. of basic techniques such as, how to hold the racket (grips), 27
∗ Corresponding author.
an attitude ready (ready stance or position), leg movements 28
E-mail address: sari.hermila@yahoo.co.id ( Hermilasari). (footwork), and the hit motion (stroke).1 One of the most

https://doi.org/10.1016/j.enfcli.2019.07.045
1130-8621/© 2019 Elsevier España, S.L.U. All rights reserved.

Please cite this article in press as: Hermilasari, et al. The effects of eccentric strengthening exercises on foot
alignment change, malleolus height and agility level of junior badminton players in Makassar. EnfermENFCLI
Clin.1093 1---7
2019.
https://doi.org/10.1016/j.enfcli.2019.07.045
 +Model
ENFCLI 1093 1---7 ARTICLE IN PRESS
2 Hermilasari et al.

Table 1 The results of rearfoot angle measurement data analysis.

Measurement rearfoot angle left

Category Group Mean rank p

Rearfoot angle 3 times exercise Pre test Post test 1 2.072.07 1.000
right 6 times exercise Post test 1 Post test 2 2.07 2.58 0.014
9 times exercise Post test 2 Post test 3 2.583.93 0.0001
12 times exercisePost test 3Post test 4 3.934.73 0.001
15 times exercisePost test 4Post test 5 4.735.82 0.0001
18 times exercisePost test 5Post test 6 5.82 6.80 0.0001
Friedman 0.0001

Measurement rearfoot angle left

Measurement(N = 30) Group Mean rank p

Rearfoot angle left 3 times exercise pre test Post test 1 2.172.17 1.000
6 times exercise Post test 1 Post test 2 2.172.55 0.020
9 times exercise Post test 2 Post test 3 2.553.90 0.0001
12 times exercisePost test 3Post test 4 3.904.77 0.001
15 times exercisePost test 4Post test 5 4.775.68 0.0001
18 times exercisePost test 5Post test 6 5.686.77 0.0001
Friedman test 0.0001

29 fundamental skills in the game of badminton is footwork injury and limb surgery, and not participating in another 61

30 (movement of feet) one of the most common movements exercise program other than the exercise given in this study. 62

31 in footwork is the lunge movement where the move was as General information about the characteristics of the sub- 63

32 much as 15% in the game of badminton. The lunges pat- jects, including name, age, medical history, and the injury 64

33 terns can affect limb kinematics inferior.2 In doing footwork was obtained through direct interview. Body mass index 65

34 required high agility, requiring the coordination of joint (BMI) of respondents was taken by measuring the weight 66

35 motion, muscle contraction as well as mastery of technique. and height of subjects. Furthermore, the initial data collec- 67

36 By him, that mastery of all these aspects became an impor- tion is done through pre-test rearfoot angle measurement, 68

37 tant point that must be owned badminton players to support malleolus height, and agility. 69

38 skills while playing to avoid sport injury.3 Giving strengthening eccentric exercise performed three 70

39 From some research shows that the injury most often times a week for six weeks with post-test six times and 71

40 occurs in badminton players there is an injury to the lower recorded each week. 72

41 extremities that is as much as 60% occurred in the knee, Measurement data rearfoot angle, Malleolus height, and 73

42 ankle, gastrocnemius muscle, and soleus muscle, where agility processed using SPSS 22 software using Friedman Test 74

43 players are most at risk of injury is badminton players under for data distribution are not normal and Repeated Measure 75

44 the age of 20 years, Biomechanical changes will occur due ANOVA for normal data distribution to see the effect of pre 76

45 to changes in foot alignment toward overpronation that will and post eccentric strengthening exercises and conducted 77

46 burden the muscles in the knees and legs to work harder to post hoc analysis to see improvement every week. Pearson 78

47 maintain his position in order to stand steady. Overprona- test was also carried out to analyze the relationship between 79

48 tion is a condition that describes the feet are in the prone rearfoot angle, height malleolus, with agility. The results 80

49 position, but it is considered excessive from the normal foot of the data analysis are presented in tables, charts, and 81

50 on general.4 Overpronation can be measured by measuring narration. 82

51 the rearfoot angle and height malleolus.5

Results 83

52 Method The results showed 30 samples of 11---15 years old, junior 84

badminton player male in Avanti and Filawatch club most 85

53 This study was a pre-experiment with time-series design. aged 11 and 13 years. Measurement values malleolus rear- 86

54 This study was conducted in the Mutiara, Soulmate, and Anu- foot angle and height increased for six weeks. Friedman 87

55 grah sports arenas in Makassar. All those sports arenas are Test Results strengthening shows the influence of eccentric 88

56 the practice field of Avanti and Filawatch badminton clubs. exercise to changes in rearfoot angle (p = 0.0001) after 18 89

57 The total of 30 junior athletes, age ranged between 11 times of exercise, and changes can already be seen after 90

58 and 15 years, were recruited to participate in this study. The administration of 6 times the exercise (Table 1). Friedman 91

59 inclusion criteria were male junior badminton player, nor- test results also showed influence strengthening eccentric 92

60 mal body mass index, no history of cardiovascular problems, exercise of the right height change of the lateral malleo- 93

Please cite this article in press as: Hermilasari, et al. The effects of eccentric strengthening exercises on foot
alignment change, malleolus height and agility level of junior badminton players in Makassar. EnfermENFCLI
Clin.1093 1---7
2019.
https://doi.org/10.1016/j.enfcli.2019.07.045
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ENFCLI 1093 1---7 ARTICLE IN PRESS
Q1 The effects of eccentric strengthening exercises 3

Table 2 The results of malleolus height measurement data analysis.

Malleolus height right lateral

Measurement Group Mean rank P

(N = 30)
Malleolus height 3 times exercise
right lateral pre test 2.02 1.000
Post test 1 2.02
6 times exercise
Post test 1 2.02 0.001
Post test 2 3.03
9 times exercise
Post test 2 3.03 0.003
Post test 3 4.07
12 times exercise
Post test 3 4.07 0.005
Post test 4 4.75
15 times exercise
Post test 4 4.75 0.001
Post test 5 5.75
18 times exercise
Post test 5 5.75 0.003
Post test 6 6.37
Friedman test 0.0001

Malleolus height right lateral

Measurement Group Mean rank p

(N = 30)
Malleolus height 3 times exercise
right lateral pre test 2.02 1.000
Post test 1 2.02
6 times exercise
Post test 1 2.02 0.001
Post test 2 3.03
9 times exercise
Post test 2 3.03 0.003
Post test 3 4.07
12 times exercise
Post test 3 4.07 0.005
Post test 4 4.75
15 times exercise
Post test 4 4.75 0.001
Post test 5 5.75
18 times exercise
Post test 5 5.75 0.003
Post test 6 6.37
Friedman test 0.0001

Malleolus height left lateral

Measurement Group Mean rank p

(N = 30)
Malleolus height 3 times exercise
left lateral pre test 2.27 1.000
Post test 1 2.27
6 times exercise
Post test 1 2.27 0.016
Post test 2 2.83

Please cite this article in press as: Hermilasari, et al. The effects of eccentric strengthening exercises on foot
alignment change, malleolus height and agility level of junior badminton players in Makassar. EnfermENFCLI
Clin.1093 1---7
2019.
https://doi.org/10.1016/j.enfcli.2019.07.045
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ENFCLI 1093 1---7 ARTICLE IN PRESS
4 Hermilasari et al.

Table 2 (Continued)

Malleolus height right lateral

Measurement Group Mean rank P

(N = 30)
9 times exercise
Post test 2 2.83 0.003
Post test 3 3.70
12 times exercise
Post test 3 3.70 0.000
Post test 4 5.02
15 times exercise
Post test 4 5.02 0.000
Post test 5 5.60
18 times exercise
Post test 5 5.60 0.002
Post test 6 6.32
Friedman test 0.0001

Malleolus height left medial

Measurement Group Mean rank p

(N = 30)
Malleolus height 3 times exercise
left medial pre test 2.53 1.000
Post test 1 2.53
6 times exercise
Post test 1 2.53 0.034
Post test 2 2.88
9 times exercise
Post test 2 2.88 0.016
Post test 3 3.50
12 times exercise
Post test 3 3.50 0.003
Post test 4 4.53
15 times exercise
Post test 4 4.53 0.001
Post test 5 5.52
18 times exercise
Post test 5 5.52 0.0001
Post test 6 6.50
Friedman test 0.0001

Malleolus height right medial

Measurement Group Mean difference p

(N = 30)
Malleolus height 3 times exercise
right medial pre test 0.0001 NS
Post test 1
6 times exercise
Post test 1 −0.017 0.057
Post test 2
9 times exercise
Post test 2 −0.037 0.094
Post test 3
12 times exercise
Post test 3 −0.093 0.0001
Post test 4

Please cite this article in press as: Hermilasari, et al. The effects of eccentric strengthening exercises on foot
alignment change, malleolus height and agility level of junior badminton players in Makassar. EnfermENFCLI
Clin.1093 1---7
2019.
https://doi.org/10.1016/j.enfcli.2019.07.045
 +Model
ENFCLI 1093 1---7 ARTICLE IN PRESS
The effects of eccentric strengthening exercises 5

Table 2 (Continued)

Malleolus height right lateral

Measurement Group Mean rank P

(N = 30)
15 times exercise
Post test 4 −0.053 0.002
Post test 5
18 times exercise
Post test 5 −0.077 0.0001
Post test 6
Anova repetead 0.0001

94 lus, medial malleolus height left, the left lateral malleolus Meanwhile, the average value of different agility test 100

95 height (p = 0.0001) (Table 2) and Repeated ANOVA results with measurement of rearfoot angle and height malleo- 101

96 at the right height of the medial malleolus showed no lus. The average yield agility declined every week, but 102

97 effect of strengthening eccentric exercise after 18 times this decline is positive because the faster athletes finish 103

98 of exercise, changes can be seen after 6 times giving the agility test. Based on Repeated ANOVA test, agility 104

99 exercise (Table 2). test results show the probability value of 0.0001 (p < 0.05)

Table 3 The results of increase agilty measurement data analysis.

Measurement Group Mean difference p
(N = 30)
Agility 3 times exercise
pre test 2.288 0.0001
Post test 1
6 times exercise
Post test 1 .387 0.158
Post test 2
9 times exercise
Post test 2 0.779 0.001
Post test 3
12 times exercise
Post test 3 .424 0.0001
Post test 4
15 times exercise
Post test 4 0.346 0.016
Post test 5
18 times exercise
Post test 5 .636 0.0001
Post test 6
Anova repetead 0.0001

Table 4 The results of data analysis on measurement rearfoot angle, malleoulus height with agility level.
Group p R r2
Agility Post test 6 Rearfoot right angle .914 −0.021 0.0004
Post test 6 Rearfoot left the angle 0.311 −0.192 0.036
Post test 6 right-lateral malleolus height 0.131 −0.282 0.079
Post test 6 left lateral malleolus height 0.074 −0.331 .109
Post test 6 right medial malleolus height 0.037 −0.383 0.146
Post 6 test left medial malleolus height 0.023 −0.413 .170

Please cite this article in press as: Hermilasari, et al. The effects of eccentric strengthening exercises on foot
alignment change, malleolus height and agility level of junior badminton players in Makassar. EnfermENFCLI
Clin.1093 1---7
2019.
https://doi.org/10.1016/j.enfcli.2019.07.045
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ENFCLI 1093 1---7 ARTICLE IN PRESS
6 Hermilasari et al.

105 (Table 3), which means there is significant strengthening This study showed that changes after administration of 163

106 eccentric exercise on agility. Pearson test was also con- three times eccentric strengthening exercises seen from 164

107 ducted to see the relationship between rearfoot angle, the time it took the respondents to complete the agility 165

108 malleolus height with agility. The results showed that there test were diminished. However, the second week after 166

109 was no relationship between rearfoot angle right, rearfoot six times of exercise increased the time it took much 167

110 angle left, right height lateral malleolus, lateral malleolus longer to complete a test of agility one factor is fatigue 168

111 kit height with agility (p > 0.05) (Table 4). in which the loss of the capacity to develop strength 169

and speed of muscle, resulting from muscle activity,14 and 170

from the third to sixth week, agility respondents increased 171

again to see the lack of time needed to complete the 172

112 Discussion test. 173

Structural malleolus right medial and malleolus medial 174

113 Eccentric exercise strengthening is a model of exercise per- left there is a correlation with increased agility, increase the 175

114 formed by lengthening the contracted muscle to create a navicular bone has an important role to high arch, this can 176

115 viscoelastic change in the muscles. Changing foot alignment affect the height of the malleolus medial because malleolus 177

116 toward overpronation will overload the muscles in the knees medial interconnected with a few bones in the ankle, espe- 178

117 and legs to maintain their positions. Constant pressure expe- cially the navicular bone, when a high increase in the arch 179

118 rienced by the muscle for prolonged abnormal posture and of the foot position overpronate be slowly moving toward 180

119 repetitive movements will alter neurological and biome- normal accompanied by a high increase in medial malleolus 181

120 chanical adaptations and can lead to muscle imbalance.6 are initially lower. This is also consistent with the theory in 182

121 Eccentric strengthening consists of sliding leg curl, heel anatomy book trains who say that there is a body in the fas- 183

122 drops and spread out each used to train and build muscle cia as continuities lines that interconnect with each other, 184

123 tissue structure in the lower extremities, such as the ham- whereby the integrity of the malleolus believed to be the 185

124 string muscles, the gastrocnemius, and intrinsic muscles of main determinant of the stability of the ankle where height 186

125 the superficial back line mutually integrate each other7---10 of the malleolus structure will maintain and facilitate foot in 187

126 Several factors influencing changes in the measurement performing difficult movements, that are not easily injured, 188

127 results (rearfoot angle and malleolus height) in line with and able to keep opponents example when doing footwork 189

128 the given exercise are the positions and how to do the in the game of badminton, So as to support the agility to 190

129 exercises to maximize the effects of such exercises. The change body position for moving quickly and precisely with- 191

130 eccentric strengthening exercise has a positive influence out losing balance while on the move in a row in a quick 192

131 to speed up or optimize muscle strength during contrac- and brief duration followed by strengthening the intrinsic 193

132 tion eccentric occur in the muscles in the superficial back muscles, the gastrocnemius and hamstring which can reduce 194

133 line, such as intrinsic pedis, gastrocnemius, and hamstring the injury rate at the time of sport activities,15 but agility 195

134 muscles. Those effects not only affect muscle hypertrophy is not only influenced by structural lower extremities, but 196

135 and adaptation but also stimulate bone mineralization and the cognitive ability and decision-making by athletes also 197

136 remodeling tendon and optimize performance and increased contribute to agility. 198

137 durability.11 When the eccentric exercises strengthen the

138 sliding leg curl, heel drop and spread out, the transmis-
139 sion of muscle strength occurs in the muscles that are in
140 superficial back line along the myofascial chains such as the Conclusion 199

141 intrinsic muscles, the gastrocnemius, and hamstring. It can

142 provide increased strength in the muscles and the medial The conclusion of this study, that there are differences 200

143 longitudinal arch through the exercise so that it can trans- in rearfoot angle, malleolus height and agility junior bad- 201

144 form into a neutral position on the overpronation pedis so minton players after the eccentric strengthening exercise, 202

145 high medial and lateral malleolus will rise along with the which means that no significant changes after 18 times 203

146 medial longitudinal arcus.10 of exercise. Other than that, there is also a relationship 204

147 Neurophysiological studies show that there are two between the right height of the medial malleolus, the left 205

148 stages of eccentric exercises strengthening. In the first stage medial malleolus height with agility, but there is no rela- 206

149 of 2---3 weeks after the administration, eccentric strength- tionship between rearfoot angle right, rearfoot angle left, 207

150 ening exercise influence motor neuron stimuli that affect right lateral malleolus height and left lateral malleolus with 208

151 the way the activation of muscle fibers. The second stage agility in junior badminton players in Makassar. The results 209

152 begins 4---5 weeks after the workout. Morphological, histo- of this study are expected to junior badminton players can 210

153 chemical, and biochemical changes gradually have occurred apply to strengthen eccentric exercise to support the per- 211

154 that could significantly affect the muscle fibers to produce formance when playing. For further research is expected to 212

155 power.12 Therefore, the result showed that there were some be able to control the variables threatening and using more 213

156 respondents who had experienced an increase in the second sophisticated measurement tools and accurate. 214

157 week after the six times strengthening exercises.

158 Eccentric strengthening exercise with high power pro-
159 duces a specific increase in muscle fiber type II (fast-twitch)
160 after 24 h of exercise and is responsible for improving speed, Conflict of interests 215

161 agility, and strength in the muscles of the lower extremities,

162 thereby increasing agility.13 The authors declare no conflict of interest. 216

Please cite this article in press as: Hermilasari, et al. The effects of eccentric strengthening exercises on foot
alignment change, malleolus height and agility level of junior badminton players in Makassar. EnfermENFCLI
Clin.1093 1---7
2019.
https://doi.org/10.1016/j.enfcli.2019.07.045
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The effects of eccentric strengthening exercises 7

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Please cite this article in press as: Hermilasari, et al. The effects of eccentric strengthening exercises on foot
alignment change, malleolus height and agility level of junior badminton players in Makassar. EnfermENFCLI
Clin.1093 1---7
2019.
https://doi.org/10.1016/j.enfcli.2019.07.045