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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.