Star Exursion Balance Test-Lower Quarter Y Balance Test

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The next test in our series on return to sport testing is the Star Excursion Balance Test. While many of you are familiar with the research regarding the test’s utility in predicting injury in the pre-participation setting, it seems to be less commonly implemented in return to sport testing. Remember, we are currently discharging our patients with modifiable risk factors for future injury.

Flux Capacitor from Time Traveling DeLorean from Back to the Future  Is it coincidence that it is in the shape of a Y?

Flux Capacitor from Time Traveling DeLorean from Back to the Future
Is it coincidence that it is in the shape of a Y?

So, how can the Star Excursion/Y Balance Test help us? You may have read the systematic review. But what amazes me  is that in the original paper we reviewed 36 articles extracted from 1998 to 2010, and since then over 30 additional research articles were published in 2011-13 (for a total of over 60 published articles on the Star Excursion/Y Balance Test). Here is a summary of what we know:

  • Reliable (Plisky et al 2009, Shaffer et al 2010, Gribble 2013)
  • Predictive of injury (Plisky 2006, Lehr 2013, de Naronha 2012)
  • Discriminant Validity
    • Identifies chronic ankle and ACL insufficiency (Hubbard 2007, Hertel 2006, Hale 2007, Akbari 2006, Nakagawa 2004 Gribble 2004, Olmstead 2002, Herrington 2009, Delahunt 2013)
    • Differentiates between athletes based on age, sport, gender (Plisky 2009, Thorpe & Ebersole 2008, Bressel et al 2007)
  • Improves after training (Filipa 2010, Fitzgerald 2010, Leavy 2010, Eisen 2010, McKeon 2008, Hale 2007, English 2007, Bouillon 2009, Kahle & Gribble 2009, Rasool & George 2007) even in the elderly! (Khale  et al 2013, Hosseini 2012, Sarvestani  et al 2012)
  • Improving Star Excursion Balance Test scores reduces injury risk (Steffen 2013)

There is no doubt in my mind that the Star Excursion Balance Test/Y Balance Test has the most research behind it compared to any other return to sport test. Most importantly though, it is the ONLY lower quarter test I know of that is reliable, predictive, modifiable AND improving  performance on it reduces injury risk.  Please let me know if I am missing a test that has ALL of those characteristics.

Ok, I agree I should be using Star Excursion Balance Test for return to sport, but what is considered a “passing” test?

Given that the Star Excursion/Y Balance Test is predictive of injury and that one of main goals with return to sport decision making is determining if the athlete is going to get hurt again, we should look at the studies that use the test to predict injury:

High School Basketball players (Plisky 2006)

– Players with anterior asymmetry of greater that 4 cm are at increased risk of injury

– Girls with a composite score (94%) in the bottom third of their peers are 6 times more likely to get injured

Collegiate Football Players (Lehr 2013)

– All injuries occurred in players with a composite score of less than 89% (Note that the composite risk cut point needs to be based on gender, sport, and age.)

Active College Students (de Naronha 2012)

– Posterolateral reach of less than 80% of limb length increase risk of ankle sprain. Interestingly, posterolateral reach of greater than 90% was protective of ankle sprain.

Collegiate Athletes (Lehr 2013)

– Those who had a previous injury and scored below the composite score risk cut point for their age, gender and sport OR had a greater than 4cm anterior reach asymmetry were in the high risk category

Bottom Line: Prior to return to sport (or at LEAST prior to discharge), your patients should demonstrate a symmetrical Star Excursion/Y Balance Test that is above the risk cut point for their peer group.


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Phil Plisky

I want to change peoples lives through dialogue about injury prevention research and return to activity testing.

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