Y-Balance Test Upper Quarter Reliability, Procedure and Normative Data

By Adam Devery, ATC, PTA, CSCS & Phil Plisky, PT, DSc, ATC, OCS, CSCS 

In Upper Extremity Closed Chain Testing Part 1 we discussed a closed-kinetic chain testing series for overhead athletes as well as the general population. In that series, the Y-Balance Test Upper Quarter was identified as a dynamic measure where upper quarter mobility and stability are both required at the person's limit of stability. Stability of the stance arm, shoulder girdle and trunk is challenged while mobility of the reach arm, shoulder girdle and trunk is required.  

During each reach direction, scapular stability, glenohumeral joint mobility, thoracic rotation, and core stability are combined as the person is encouraged to reach as far as possible without loss of balance. By reaching as far as possible outside of a narrow base of support, the person is required to use balance, proprioception, strength, and full motion.

Goal/Purpose of Y Balance Test Upper Quarter

This test is designed to test an individual’s trunk and upper extremity stability while in a push up position. The goal of the test is to maintain a single arm position while on the center platform of the YBT device and push the reach indicator with one hand as far medially as possible, and then, diagonally across the body in the inferolateral and superolateral directions.

For the YBT-UQ, you will need a Y-Balance Testing Kit, and a tape measure. 

To measure the person's upper quarter limb length:

1. Instruct the person to stand facing away from the tester with feet together.
2. Have the person extend the right arm to the side with their palm facing the same direction as the person (90 degrees of abduction).
3. Locate the person's C7 spinous process (most bony prominence at the base of the neck).
4. Measure the distance from the C7 spinous process to the distal tip of the third digit of the person's right hand to the nearest half centimeter.
5. If unable to determine location of C7 spinous process, have the person flex and extend the neck—the C7 spinous process will remain prominent throughout.
6. You will only need to measure the right arm. 

What is the Y Balance Test - Upper Quarter (YBT-UQ) Test Procedure

The YBT-UQ is performed without shoes or socks. The person will have the opportunity to perform 2 practice trials in each direction (3 directions) for both arms.

1.  The person will start by placing their right thumb along the red line in a push up position with their feet shoulder-width apart and hands directly under their shoulders.

2. The person will push the box to the left with the left hand in the red target area as far as possible to the left.  Maintaining the same position, the person will then push the inferior box as far as possible. Finally, the person will push the superior box as far as possible.  Unlike the lower quarter YBT, all 3 reach directions are performed sequentially (one right after another without a break) and returning to the starting position and rest.  When the person is ready to perform the next repetition, the person returns to the starting position and performs the next trial. 

3. The specific testing order is:

   a.  Right Upper Extremity (3 trials)
1. Medial Reach
2. Inferolateral Reach
3. Superolateral Reach

            b. Left Upper Extremity (3 trials)

1. Medial Reach
2. Inferolateral Reach
3. Superolateral Reach

Measurement of Reach Distance

The person places the hand on the platform with thumb along the red line in a push up position with feet shoulder width apart and hands directly under shoulders. The person pushes the reach indicator in the red target area in the direction being tested. 

The maximal reach distance is measured by reading the tape measure at the edge of the reach indicator, at the point where the most distal part of the hand reached in half centimeters (e.g. 68.5, 69.0, 69.5 cm).

Three trials in each direction for each hand are collected and maximal reach in each direction will be included for scoring.

A maximum of 6 trials is performed for each limb.  If the person is unable to complete a reach in all three directions in one good attempt– nothing should be recorded for the failed direction for that trial.  

Reasons for the reach/attempt to be repeated and not counted:

• The person touches down to the floor with the reach hand or falls off the stance platform.

• The person fails to maintain contact with the reach indicator on the target area while the reach indicator is in motion. You can’t shove or push the reach indicator!

• The person uses the reach indicator for support (putting the hand on top of the indicator).

• The person fails to return the reach hand to the starting position under control.  

Normalized Reach Distance: Since reach distance is related to limb length, it is important to normalize the reach to the person's limb length. The equation is maximal reach distance divided by limb length multiplied by 100; calculated for each direction (%). For composite reach distances: Sum of the 3 reach distances, divided by 3 times limb length, multiplied by 100 (%).

 Asymmetry Measures:

• Absolute difference between right and left reach distances (cm) 

What is the reliability of the Upper Quarter Y Balance Test?

 In multiple studies and populations, the Y Balance Test Upper Quarter has good to excellent reliability.

What is the Minimal Detectable Change (MDC) of the Upper Quarter Y Balance Test?

The MDC of the YBT-UQ (Westrick 2012, Gorman 2012) is 

Composite score: 6.5-6.9

Medial: 8.1 cm

Superolateral: 6.4 cm

Inferolateral: 6.1 cm 

The MDC of YBT-UQ composite score in 12-17 year olds (Schwiertz 2019) is 4.8-9.7

What is the Standard Error of Measurement (SEM) of the Upper Quarter Y Balance Test?

The SEM of the YBT-UQ (Westrick 2012, Gorman 2012) is 

Composite score: 2.3-2.5

Medial: 2.9 cm

Superolateral: 2.3 cm

Inferolateral: 2.2

Normative Data for the Y Balance Test Upper Quarter

Researchers have found that Y Balance Test Upper Quarter performance is related to age, gender, and sport/activity (but not limb dominance). Below are tables of published norms in the literature. To get accurate comparison by age, gender, and sport/activity, use the research-backed Move2Perform Software.

About the Author

Adam Devery, ATC, PTA, CSCS

Adam is a minor league professional baseball reconditioning athletic trainer helping return injured players back to sport. He graduated from the University of Evansville with degrees in athletic training and physical therapist assistance. He is also a certified strength and conditioning specialist and has interests in athletic development, injury prevention, and sports rehabilitation. 

References

Bauer, Julian, Marco Hagen, Nelson Weisz, and Thomas Muehlbauer. 2020. “The Influence of Fatigue on Throwing and YBT-UQ Performance in Male Adolescent Handball Players.” Frontiers in Sports and Active Living 2 (July): 81.

Biaggi, Kelsey, Brooke Farmer, Matthew Hobson, Curtis Self, and Terry L. Grindstaff. 2021. “Shoulder Strength and Range of Motion in Healthy Collegiate Softball Players.” Journal of Athletic Training, January. https://doi.org/10.4085/301-20.

Borms, Dorien, and Ann Cools. 2018. “Upper-Extremity Functional Performance Tests: Reference Values for Overhead Athletes.” International Journal of Sports Medicine 39 (6): 433–41.

Butler, Robert, Jennifer Arms, Michael Reiman, Phillip Plisky, Kyle Kiesel, Dean Taylor, and Robin Queen. 2014. “Sex Differences in Dynamic Closed Kinetic Chain Upper Quarter Function in Collegiate Swimmers.” Journal of Athletic Training 49 (4): 442–46.

Butler, Robert J., Heather S. Myers, Douglass Black, Kyle B. Kiesel, Phillip J. Plisky, Claude T. Moorman 3rd, and Robin M. Queen. 2014. “Bilateral Differences in the Upper Quarter Function of High School Aged Baseball and Softball Players.” International Journal of Sports Physical Therapy 9 (4): 518–24.

Chasse, Patrick, Garrett S. Bullock, Abigail C. Schmitt, Barrett A. Little, Lee H. Diehl, and Robert J. Butler. 2018. “THE RELATIONSHIP BETWEEN TRUNK ROTATION, UPPER QUARTER DYNAMIC STABILITY, AND THE KERLAN-JOBE ORTHOPAEDIC CLINIC OVERHEAD ATHLETE SHOULDER AND ELBOW SCORE IN DIVISION I COLLEGIATE PITCHERS.” International Journal of Sports Physical Therapy 13 (5): 819–27.

Degot, M., Y. Blache, L. Neyton, and I. Rogowski. 2019. “Intersession Reliability of the Upper Quarter Y Balance Test Score.” Computer Methods in Biomechanics and Biomedical Engineering. https://doi.org/10.1080/10255842.2020.1714961.

Gorman, Paul P., Robert J. Butler, Phillip J. Plisky, and Kyle B. Kiesel. 2012. “Upper Quarter Y Balance Test.” Journal of Strength and Conditioning Research. https://doi.org/10.1519/jsc.0b013e3182472fdb.

Hazar, Zeynep, Naime Ulug, and Inci Yuksel. 2014. “Upper Quarter Y-Balance Test Score of Patients with Shoulder Impingement Syndrome.” Orthopaedic Journal of Sports Medicine. https://doi.org/10.1177/2325967114s00275.

Kim, Youngwook, Jung-Min Lee, Elizabeth Wellsandt, and Adam B. Rosen. 2020. “Comparison of Shoulder Range of Motion, Strength, and Upper Quarter Dynamic Balance between NCAA Division I Overhead Athletes with and without a History of Shoulder Injury.” Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine 42 (March): 53–60.

Sabau, Elena. 2017. “Differences On The Upper Quarter Y Balance Test Among Young People.” https://doi.org/10.15405/epsbs.2017.06.7.

Schwiertz, Gerrit, Julian Bauer, and Thomas Muehlbauer. 2021. “Upper Quarter Y Balance Test Performance: Normative Values for Healthy Youth Aged 10 to 17 Years.” PloS One 16 (6): e0253144.

Schwiertz, Gerrit, Dennis Brueckner, Simon Schedler, Rainer Kiss, and Thomas Muehlbauer. 2019. “RELIABILITY AND MINIMAL DETECTABLE CHANGE OF THE UPPER QUARTER Y-BALANCE TEST IN HEALTHY ADOLESCENTS AGED 12 TO 17 YEARS.” International Journal of Sports Physical Therapy 14 (6): 927–34.

Teyhen, Deydre S., Scott W. Shaffer, Stephen L. Goffar, Kyle Kiesel, Robert J. Butler, Daniel I. Rhon, and Phillip J. Plisky. 2020. “Identification of Risk Factors Prospectively Associated With Musculoskeletal Injury in a Warrior Athlete Population.” Sports Health 12 (6): 564–72.

Westrick, Richard B., Joseph M. Miller, Scott D. Carow, and J. Parry Gerber. 2012. “Exploration of the Y-Balance Test for Assessment of Upper Quarter Closed Kinetic Chain Performance.” International Journal of Sports Physical Therapy 7 (2): 139–47.

Williamson, Joshua D., Braden L. Lawson, Daniel Sigley, Alan Nasypany, and Russell T. Baker. 2019. “INTRA- AND INTER-RATER RELIABILITY FOR LIMB LENGTH MEASUREMENT AND TRIAL ERROR ASSESSMENT OF THE UPPER QUARTER Y-BALANCE TEST IN HEALTHY ADULTS.” International Journal of Sports Physical Therapy 14 (5): 707–14.