Materials: Y Balance Test Kit.
Methods:
- The patient stands on the center footplate, with the distal aspect of the right foot at the starting line
- While maintaining single leg stance on the right leg, the patient reaches with the free limb (left leg) in the anterior, posteromedial, and posterolateral directions in relation to the stance foot by pushing the indicator box as far as possible
- Participants complete 3 consecutive trials for each reach direction and to reduce fatigue subjects alternate limbs between each direction.
- Attempts are discarded and repeated if: The subject fails to maintain unilateral stance on the platform, Fails to maintain reach foot contact with the reach indicator on the target area while the reach indicator is in motion, Uses the reach indicator for stance support, or Fails to return the reach foot to the starting position under control
- The greatest reach of the three trials in each direction is recorded and the following formula is used to calculate the ‘Composite Score’
Reliability:
| Study | Population | Type | ICC |
| Hannon et al, 2014 | UCL Injured Baseball Players (Average age= 18.5) | Inter-Rater Reliability | 0.86-0.99 |
| Garrison et al, 2013 | UCL Injured & Asymptomatic Baseball Players (Average age= 18.5) | Inter-Rater Reliability | 0.86-0.99 |
| Shaffer et al, 2013 | Military (18-35 years old) | Intra-rater Reliability | 0.85-0.93, 0.80-0.85 |
| Plisky et al, 2009 | Male collegiate soccer players | Intra-rater Reliability | 0.88-0.99 |
Normative Data:
| Study | Population | Study Design | Reference Value |
| de la Motte et al., 2016 | US Army, Navy, Air Force, and Marine Corps | Cross-Sectional | Anterior Reach Difference = 3.1cm, Composite Percentage = 90.9%, Composite Difference = 8.0cm |
| Male US Army, Navy, Air Force, and Marine Corps | Anterior Reach Difference = 3.1cm, Composite Percentage = 91.3%, Composite Difference = 8.1cm | ||
| Female US Army, Navy, Air Force, and Marine Corps | Anterior Reach Difference = 3.0cm, Composite Percentage = 88.7%, Composite Difference = 7.4cm | ||
| Johansson et al., 2016 | Patients with Femoroacetabular Impingement (Symptomatic Limb) | Cross-Sectional | Percent of Leg Length: Ant = 70%, PL = 77.6%, PM= 75.5% |
| Patients with Femoroacetabular Impingement (Asymptomatic Limb) | Percent of Leg Length: Ant = 71.1%, PL = 82.4%, PM= 76.9% | ||
| Individuals without Femoroacetabular Impingement | Percent of Leg Length: Ant = 73.5%, PL = 89.6%, PM= 76.9% | ||
| Hooper et al., 2016 | Individuals with Current Low Back Pain | Cross-Sectional | Ant = 66.2 cm, PL = 94.7 cm, PM= 100.7 cm |
| Individuals with History of Low Back Pain | Ant = 66.4 cm, PL = 94.2 cm, PM= 102.3 cm | ||
| Individuals without Low Back Pain | Ant = 66.4 cm, PL = 105.8 cm, PM= 109.3 cm | ||
| Meardon et al., 2016 | Injured Runners | Case-Control | Percent of Leg Length: Ant = 79%, PL = 83%, PM= 85% |
| Runners with Leg/Ankle/Foot Injuries | Percent of Leg Length: Ant = 82%, PL = 85%, PM= 88% | ||
| Runners with Hip/Thigh/Knee Injuries | Percent of Leg Length: Ant = 75%, PL = 82%, PM= 81% | ||
| Wright et al., 2016 | NCAA Division 1 Athletes | Prospective Cohort | Composite Score: 96.13% |
| Injured NCAA Division 1 Athletes | Composite Score: 96.47% | ||
| Non-Injured NCAA Division 1 Athletes | Composite Score: 95.83% | ||
| Doherty et al., 2015 | Patients with CAI | Descriptive Laboratory Study | Percent of Leg Length: Ant = 61.7%, PL = 93.2%, PM= 100.7% |
| Ankle Sprain Copers | Percent of Leg Length: Ant = 63.0%, PL = 99.8%, PM= 104.6% | ||
| Stiffler et al., 2015 | Collegiate Basketball Players | Descriptive Laboratory Study | Percent of Leg Length: Ant = 64.3%/63.4%, PL = 88.7%/85.7%, PM= 100.2%/101.5 |
| Collegiate Golf Players | Percent of Leg Length: Ant = 69.4%/67.6, PL = 86.5%/85.9, PM= 105.3%/102.2% | ||
| Collegiate Hockey Players | Percent of Leg Length: Ant =66.6/67.0%, PL = 93.1/93.0%, PM= 110.3/113.1% | ||
| Collegiate Soccer Players | Percent of Leg Length: Ant = 66.8/67.4%, PL = 88.7/90.2%, PM= 104.3/105.3% | ||
| Collegiate Softball Players | Percent of Leg Length: Ant = 63.5/63.9%, PL = 87.0/85.3%, PM= 100.7/99.6% | ||
| Collegiate Volleyball Players | Percent of Leg Length: Ant = 66.8/65.3%, PL = 86.6/88.4%, PM= 102.7/102.3% | ||
| Hannon et al, 2014 | UCL Injured Baseball Players, Pre-surgical (Average age= 18.5) | Cross-Sectional | Lead limb Composite: 90.2%, Stance limb: 89.4% |
| UCL Injured Baseball Players, 3 months post-op (Average age= 18.5) | Lead limb Composite: 93.6%, Stance limb: 94.9% | ||
| Garrison et al, 2013 | UCL Injured Baseball Players (Average age= 18.5) | Cross-Sectional | Lead limb Composite: 89.1%, Stance limb: 88.2% |
| Asymptomatic Baseball Players (Average age= 19.0) | Lead limb Composite: 95.8%, Stance limb: 95.4% | ||
| Butler et al, 2012 | Professional Soccer Players | Descriptive Laboratory Study | Percent of Leg Length: Ant = 72.2%, PL = 114.7%, PM= 118.5%, Composite = 101.8% |
| Collegiate Soccer Players | Percent of Leg Length: Ant = 72.8%, PL =114.6% , PM= 115.2%, Composite = 100.9% | ||
| High School Soccer Players | Percent of Leg Length: Ant = 76.2%, PL = 108.2%, PM= 111.0%, Composite = 98.4% |
Injury Prediction:
| Study | Population | Study Design | Cut Point | Sn | Sp | +LR | -LR | AUC | OR |
| Wright et al., 2016 | NCAA Division 1 Athletes | Prospective Cohort | Anterior reach difference ≥ 4cm | 0.46 | 0.69 | 1.45 | 0.79 | 0.55 | – |
| Left Normalized composite reach distance ≤ 94% | 0.16 | 0.80 | 0.82 | 1.04 | 0.52 | – | |||
| Left Normalized composite reach distance < 89% | 0.06 | 0.95 | 1.32 | 0.98 | 0.52 | – | |||
| Right Normalized composite reach distance ≤ 94% | 0.24 | 0.78 | 1.12 | 0.97 | 0.52 | – | |||
| Right Normalized composite reach distance < 89% | 0.06 | 0.90 | 0.55 | 1.05 | 0.52 | – | |||
| Normalized composite reach distance % score ≤ 94% | 0.26 | 0.76 | 1.07 | 0.98 | 0.51 | – | |||
| Normalized composite reach distance % score < 89% | 0.01 | 0.95 | 0.10 | 1.05 | 0.51 | – | |||
| Smith et al, 2014 | NCAA Division 1 Athletes | Prospective Cohort | Anterior right/left reach distance difference > 4 cm | 0.59 | 0.72 | – | – | – | 2.20 |
| PM right/left reach distance difference > 4 cm | – | – | – | – | – | 1.15 | |||
| PL right/left reach distance difference > 4 cm | – | – | – | – | – | 0.57 | |||
| Composite Score | – | – | – | – | – | 1.00 | |||
| Butler et al, 2013 | Collegiate Football Players | Prospective Cohort | 89.6% Composite Score | 1.00 | 0.72 | – | – | – | 3.50 |
| Plisky et al, 2006 | High School Basketball Players | Prospective Cohort | All Players Normalized Composite Right Reach Distance < 94% | – | – | – | – | – | 3.00 |
| All Players Anterior Reach Difference > 4cm | – | – | – | – | – | 2.70 | |||
| Girls Normalized Composite Right Reach Distance < 94% | – | – | – | – | – | 6.50 | |||
| Boys Anterior Reach Distance Difference > 4cm | – | – | – | – | – | 3.00 |
Research:
1. Plisky PJ, et al. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. Journal of Orthopaedic & Sports Physical Therapy. 2006; 36(12): 911-919.
2. Plisky PJ, et al. The reliability of an instrumented device for measuring components of the Star Excursion Balance Test. North American Journal of Sports Physical Therapy. 2009; 4(2): 92-99.
3. Butler RJ, et al. Differences in Soccer Players’ Dynamic Balance Across Levels of Competition. Journal of Athletic Training. 2012; 47(6): 616–620.
4. Butler RJ , et al. Dynamic Balance Performance and Noncontact Lower Extremity Injury in College Football Players: An Initial Study. Sports Health: A Multidisciplinary Approach. 2013; 5(5): 417-422.
5. Garrison JC, et al. Baseball Players Diagnosed With Ulnar Collateral Ligament Tears Demonstrate Decreased Balance Compared to Healthy Controls. Journal of Orthopaedic & Sports Physical Therapy. 2013; 43(10): 752-758.
6. Shaffer SW, et al. Y-Balance Test: A Reliability Study Involving Multiple Raters. Military Medicine. 2013; 178(11): 1264-1270.
7. Hannon J, Garrison JC, Conway J. Lower extremity balance is improved at time of return to throwing in baseball players after an ulnar collateral ligament reconstruction when compared to pre-operative measurements. International Journal of Sports Physical Therapy. 2014; 9(3): 356-364.
8. Smith CA, et al. Association of Y Balance Test Reach Asymmetry and Injury in Division I Athletes. Medicine & Science in Sports & Exercise. 2014. [Epub ahead of print]
9. Butler RJ, Bullock G, Arnold T, Plisky P, Queen R. Competition-Level Differences on the Lower Quarter Y-Balance Test in Baseball Players. Journal of Athletic Training. November 2016. doi:10.4085/1062-6050-51.12.09.
10. Johansson A-C, Karlsson H. The Star Excursion Balance Test: Criterion and divergent validity on patients with femoral acetabular impingement. Manual Therapy. 2016; 26(C): 104-109. doi:10.1016/j.math.2016.07.015.
11. Hooper TL, James CR, Brismée J-M, et al. Dynamic balance as measured by the Y-Balance Test is reduced in individuals with low back pain: A cross-sectional comparative study. Phys Ther Sport. 2016; 22: 29-34. doi:10.1016/j.ptsp.2016.04.006.
12. la Motte de SJ, Gribbin TC, LISMAN P, Beutler AI, Deuster P. The Interrelationship of Common Clinical Movement Screens: Establishing Population-Specific Norms in a Large Cohort of Military Applicants. Journal of Athletic Training. November 2016. doi:10.4085/1062-6050-51.9.11.
13. Meardon S, Klusendorf A, Kernozek T. INFLUENCE OF INJURY ON DYNAMIC POSTURAL CONTROL IN RUNNERS. International Journal of Sports Physical Therapy. 2016; 11(3): 366-377.
14. Wright AA, Dischiavi SL, Smoliga JM, Taylor JB, Hegedus EJ. Association of Lower Quarter Y-Balance Test with lower extremity injury in NCAA Division 1 athletes: an independent validation study. Physiotherapy. 2017; 103(2): 231-236. doi:10.1016/j.physio.2016.06.002.
Continued Reading…
John Snyder, DPT 
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