The Y Balance

Test™

Phil Plisky, PT, DSc, OCS,

ATC, CSCS

Star Excursion Balance Test

• First described

by Gary Gray

1995

• Requires 6

practice trials in

each direction

• Then need to

perform 3

measurementsGray 1995, Hertel 2000

Star Excursion Balance Test (SEBT)

• Dynamic

• Requires

• NM control

• ROM/Flexibility

• Strength

Star Excursion Balance Test as a predictor of

lower extremity injury in high school

basketball players

Plisky PJ, Rauh MJ, Kaminski TW,

Underwood FB. JOSPT 2006.

Identifies Athletes at Increased Risk

of LE Injury

• 4 cm right/left anterior reach difference

• (3x more likely)

• Bottom 1/3 of peers

• (Women 6 times more likely to get injured)

Plisky 2006

Identifies Chronic Ankle Instability

• Hubbard 2007

• Anterior, posteromedial, & posterolateral reach distance predicted CAI

• Hertel 2006

• 2-4% side to side difference

• Gribble 2004

• Fatigue amplified side to side difference

• Altered neuromuscular control at knee and hip

• Olmstead 2002

• 2.5-4 cm side to side difference

Improves After Training

• Chaiwanichsiri 2005

• SLST improved after SEBT training

• Plisky & Gorman 2007 (in process)

• SEBT improved after PEP

• Hale 2007

• English 2007

• Improves after Pilates exercise program

• Subjects with & without PFP

• Perform anterior SEBT reach with & without

patellar taping

• PFP group had significantly decreased reach

distance compared to controls

• After taping, PFP group had increased reach

distance

Return to Sport Testing

• Greater than 4 cm right/left difference

in anterior direction

• Identifies Chronic Ankle Instability

• Can be used to demonstrate

functional symmetry

Plisky 2006, Olmsted 2002

Star Excursion Balance Test

Measurement Error

• Touch down?

(support?)

• How far off the

ground?

(1 inch…6 inches?)

• Capture movement

instantaneously?

(marking error?)

Star Excursion Balance Test

• Time consuming

(144 reaches)

• Great variance in

testing protocols

• Wide range of

reliability (0.67-

0.97)

Gray 1995, Hertel 2000

Which Direction Matters?

• Hertel et al

JOSPT

2006

• Plisky et al

JOSPT

2006

Posterolateral Posteromedial

Anterior

Posterolateral

Anterior

Posteromedial

Hertel 2007 & Plisky 2006

A Solution?

• Quick/Efficient

• Portable

• Consistent

• Objective

• Multiple Surface

Applications

The Y Balance Test™

• Less than 3 minutes

per athlete

• Standard Protocol

• Reliability

• Excellent inter and

intrarater

• 0.88-0.99, p ≤ 0.01

Plisky et al 2008

(In Review)

The Y Balance Test™ Practicality

• Pre-participation Physicals

• Injury Prevention Screens

• Pre/Post Measures for Functional

Rehabilitation

• Multi-sport Application

• Return to Sport Testing

The Y Balance Test™ Application

• Greater than 4 cm right/left difference in

anterior direction

• > 2.5 times more likely to be injured

• Decreased overall performance (lowest

1/3 of individual scores) on test (total of

all three directions)

• Women over 6 times more likely to be

injured

Plisky et al 2006

Return to Sport Testing

• Greater than 4 cm right/left

difference in anterior direction

• Identifies Chronic Ankle Instability

• Can be used to demonstrate

functional symmetry

Plisky 2006, Olmsted 2002

References

• Chaiwanichsiri D., Lorprayoon E., Noomanoch L. Star excursion balance training: effects on ankle functional stability after ankle sprain. J Med Assoc Thai. Sep 2005;88 Suppl 4:S90-94.

• Cote K. P., Brunet M. E., Gansneder B. M., Shultz S. J. Effects of Pronated and Supinated Foot Postures on Static and Dynamic Postural Stability. J Athl Train. Mar 2005;40(1):41-46.

• Earl JE, Hertel J. Lower-extremity muscle activation during the Star Excursion Balance Tests. J Sport Rehabil. 2001;10:93-104.

References

• English T., Howe K. The effect of Pilates exercise on trunk and postural stability and throwing velocity in college baseball pitchers: single subject design. NAJSPT. 2007;2(1):8-19.

• Gribble P. A., Hertel J., Denegar C. R., Buckley W. E. The Effects of Fatigue and Chronic Ankle Instability on Dynamic Postural Control. J Athl Train. Dec 2004;39(4):321-329.

• Gray G. Lower Extremity Functional Profile.Adrian, Mi: Wynn Marketing Inc.; 1995.

References

• Gribble PA, Hertel J. Considerations for normalizing measures of the Star Excursion Balance Test. Measurement in Physical Education and Exercise Science. 2003;7(2):89-100.

• Hale SA, Hertel J, Olmsted-Kramer LC. The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2007;37(6):303-311.

• Hertel J, Braham RA, Hale SA, Olmsted LC. Simplifying the Star Excursion Balance Test: analyses of subjects with and without ankle instability. J Orthop Sports Phys Ther. 2006;36:131-137.

References

• Hertel J, Miller SJ, Denegar CR. Intratester and intertester reliability during the Star Excursion Balance Tests. J Sport Rehabil. 2000;9:104-116.

• Hubbard T. J., Kramer L. C., Denegar C. R., Hertel J. Contributing factors to chronic ankle instability. Foot Ankle Int. Mar 2007;28(3):343-354.

• Kinzey SJ, Armstrong CW. The reliability of the star-excursion test in assessing dynamic balance. J Orthop Sports Phys Ther. 1998;27(5):356-360.

References

• Lanning C. L., Uhl T. L., Ingram C. L., Mattacola C. G., English T., Newsom S. Baseline values of trunk endurance and hip strength in collegiate athletes. J Athl Train. Oct-Nov 2006;41(4):427-434.

• Olmsted LC, Carcia CR, Hertel J, Shultz S. Efficacy of the Star Excursion Balance Tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train. 2002;37(4):501-506.

• Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36(12):911-919.