Walk into any gym, and you’ll likely find a variety of balance equipment stacked on racks or strewn about the floor, like wobble boards, BOSU balls, and foam pads. But how effective is balance training for improving athletic performance and injury recovery? Let’s see what the research says.
Strength and power
A 2015 systematic review and meta-analysis reported that unstable surface training can improve muscle strength, power, and balance among healthy teens and young and older adults, based on 22 studies. There was no data for middle-aged adults.
However, among teens and young adults, the researchers Behm et al. wrote that unstable training has “no consistent advantage” over stable training for maximal strength improvement. In other words, any benefits of unstable training were small and are just as good as stable training.
In some cases, the effects ranged from zero to medium, but overall, unstable training still provided “an adequate stimulus to increase maximal strength in seniors,” similar to younger people.
Behm et al. wrote that unstable training is often linked to “lower force and power outputs” and “decreased movement velocity and range of motion,” which can limit how much strength people gain.
They wrote that while proponents of unstable training argue that it should lead to better strength and performance because it closely matches “unstable task demands,” (based on the SAID principle), Behm et al. found that most strength tests were done on stable surfaces, such as the squat, bench press, and jump tests. So even if unstable training improves balance on an unstable surface, those adaptations don’t fully transfer to stable strength tests in laboratory settings.
Behm et al. pointed out that different studies yield different results. One study found “no significant differences” in muscle activity during a chest press on a Swiss ball compared to a bench. However, they pointed out the research inconsistency, citing another study that found “significantly higher trunk muscle activity” during squats on an unstable surface.
Because of the small sample sizes and just three studies of older adults, the researchers considered the results “preliminary” and more research is needed to better understand how effective unstable training really is compared to other types of strength training.
ACL injury risk
Research on balance training and ACL injury risk is conflicting due to different experimental protocols, lack of differentiating types of ACL injuries, and sampling bias (e.g. gender, age).
A 2013 systematic review found that anterior cruciate ligament (ACL) rehab programs that emphasize unstable surface training have a higher risk of an ACL injury than other types of exercises, such as state stretching and explosive training. Researchers Taylor et al. wrote that statistical tests showed doing balance training longer increased the odds ratio of injury and their results are similar to a 2009 South Korean meta-analysis where programs without balance training “showed a statistically significant [odds ratio] lowering injury risk.”
“Similarly, Sadoghi et al. found no evidence of effectiveness from the use of a balance board during prevention programmes,” they added.
However, Taylor et al. pointed out that their finds contradict an earlier study that found a positive relationship between balance training and ACL injury risk.
After they investigated the study’s balance training protocols, they reported that they had “appreciably higher durations and intensities…when compared with balance training components of ACL prevention programmes…prevention programmes may need to intensify their balance training prescription.”
While Taylor et al. did not describe how or why balance training may increase the risk of ACL injuries, further studies found different results:
- Similar to Taylor et al.’s study, a 2015 system review and meta-analysis found both ACL injury groups that did or did not do balance training had lower risk of injury than those that did nothing. However, the group without balance training had a slightly lower injury rate than the group with balance training in both categories.
On the surface, this may suggest balance training is less effective, but the research reported p-value for balance training for ACL injuries was 0.5142, which is far above the significance value of p=0.05. Therefore, the data show balance training does not prevent or increase the risk of having an ACL injury. - A 2017 review reported some studies did not find a significant reduction of ACL injury risk with balance training, while some randomized controlled trials have shown balance training “might be efficacious” in preventing other lower body injuries, such as ankle ligaments. The researchers also reported balance training has a 41% reduction of ACL injury risk while programs without balance training have a 66% reduction rate.
Despite the mixed results, the researchers “recommend that balance training be done in conjunction but not alone to prevent ACL injuries.” - A 2025 systematic review and meta-analysis of eight studies found that injury reduction programs that include balance training can reduce the risk of ACL injuries by 58% in soccer players, particularly female players. The researchers identified several factors why women have higher benefits than men, including having lower baseline levels of lower body strength and power than men and having anatomical and biomechanical differences, such as the Q-angle.
Ankle instability
A 2024 systematic review by Liu et al. found unstable surface training has “potential benefits in improving balance” in people with chronic ankle instability “but has no significant effect on hop function.” The researchers reported significant improvements in six outcomes, including the posterolateral, posteromedial, anteriomedial, and medial directions of the Star Excursion Balance Test (SEBT), along with the time-in-balance test and foot-lift test.
However, they found no significant benefits in the anterior direction of the SEBT, the side-hop test, or the figure-of-8 hop test.
Based on nine studies with 308 participants who were primary college students, athletes, and recreationally active individuals. The studies used a variety of balance tools, such as wobble boards, BOSU balls, and balance shoes and balls Control groups received either no intervention, resistance training, or vibration training.
The authors wrote their findings are “preliminary and should not be considered conclusive.”
Originally published Nov 18, 2015. Updated May 3, 2026.
Nick Ng, BA
Nick Ng is the editor of Massage & Fitness Jounal and the managing editor for My Neighborhood News Network.
An alumni from San Diego State University with a bachelor’s degree in graphic communications, Nick had completed his massage therapy training at International Professional School of Bodywork in San Diego in 2014. In 2021, he earned an associate’s degree in journalism at Palomar College.
When he gets a chance, he enjoys weightlifting at the gym, salsa dancing, and exploring new areas in the Puget Sound area in Washington state.
