Using the Star Excursion Balance Test to Assess Dynamic Postural-Control Deficits and Outcomes in Lower Extremity Injury: A Literature and Systematic Review

Context: A dynamic postural-control task that has gained notoriety in the clinical and research settings is the Star Excursion Balance Test (SEBT). Researchers have suggested that, with appropriate instruction and practice by the individual and normalization of the reaching distances, the SEBT can be used to provide objective measures to differentiate deficits and improvements in dynamic postural-control related to lower extremity injury and induced fatigue, and it has the potential to predict lower extremity injury. However, no one has reviewed this body of literature to determine the usefulness of the SEBT in clinical applications. Objective: To provide a narrative review of the SEBT and its implementation and the known contributions to task performance and to systematically review the associated literature to address the SEBT's usefulness as a clinical tool for the quantification of dynamic postural-control deficits from lower extremity impairment. Data Sources: Databases used to locate peer-reviewed articles published from 1980 and 2010 included Derwent Innovations Index, BIOSIS Previews, Journal Citation Reports, and MEDLINE. Study Selection: The criteria for article selection were (1) The study was original research. (2) The study was written in English. (3) The SEBT was used as a measurement tool. Data Extraction: Specific data extracted from the articles included the ability of the SEBT to differentiate pathologic conditions of the lower extremity, the effects of external influences and interventions, and outcomes from exercise intervention and to predict lower extremity injury. Data Synthesis: More than a decade of research findings has established a comprehensive portfolio of validity for the SEBT, and it should be considered a highly representative, noninstrumented dynamic balance test for physically active individuals. The SEBT has been shown to be a reliable measure and has validity as a dynamic test to predict risk of lower extremity injury, to identify dynamic balance deficits in patients with a variety of lower extremity conditions, and to be responsive to training programs in both healthy people and people with injuries to the lower extremity. Clinicians and researchers should be confident in employing the SEBT as a lower extremity functional test.

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Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(08)70053-9 ◽

2007 ◽

Vol 2007 ◽

pp. 50-51

Author(s):

T. Rowland

Keyword(s):

High School ◽

Lower Extremity ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Basketball Players ◽

Balance Test ◽

Star Excursion Balance Test

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Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2006.2244 ◽

2006 ◽

Vol 36 (12) ◽

pp. 911-919 ◽

Cited By ~ 515

Author(s):

Phillip J. Plisky ◽

Mitchell J. Rauh ◽

Thomas W. Kaminski ◽

Frank B. Underwood

Keyword(s):

High School ◽

Lower Extremity ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Basketball Players ◽

Balance Test ◽

Star Excursion Balance Test

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Y-Balance test asymmetry is greater in collegiate athletes with a history of concussion

Neurology ◽

10.1212/01.wnl.0000550655.96792.92 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S26.1-S26

Author(s):

Hoch Matthew ◽

Curry Nicole ◽

Hartley-Gabriel Emily ◽

Heebner Nicholas ◽

Hoch Johanna

Keyword(s):

Lower Extremity ◽

Injury Risk ◽

Collegiate Athletes ◽

Lower Extremity Injury ◽

Absolute Difference ◽

Group Differences ◽

Extremity Injury ◽

Balance Test ◽

Increased Risk ◽

History Of

Athletes with a history of concussion (HC) are at an increased risk of sustaining lower extremity injuries. It is unclear if these individuals exhibit dynamic postural control deficits associated with lower extremity injury risk. The purpose of this study was to determine if collegiate athletes with a HC demonstrate differences in Y-Balance Test (YBT) performance compared to athletes with no history of concussion (NHC). A total of 116 varsity and club athletes from a Division-I university participated. Forty participants reported a HC (female/male: 31/9, age: 20.0 ± 1.4 years, height: 169.3 ± 13.1 cm, mass: 68.4 ± 14.0 kg) while 76 reported NHC (female/male: 60/16, age: 20.0 ± 1.7 years, height: 168.5 ± 12.9 cm, mass: 68.7 ± 14.6 kg). Individuals with a current concussion or lower extremity injury, or a history of lower extremity surgery were excluded. Participants completed the YBT anterior reach direction barefoot on both limbs. The YBT was completed by maximally reaching anteriorly, maintaining balance, and returning to the starting position without errors. Participants completed 4 practice trials and 3 test trials. Reach distances were averaged and normalized to leg length. Between-limb asymmetry was calculated as the absolute difference between the left and right limbs. Separate independent t-tests examined group differences in normalized reach distances and asymmetry. The proportion of participants in each group with >4 cm of asymmetry was compared using a χ2 test. Alpha was set at 0.05 for all analyses. No group differences were identified in normalized reach distances for the left (HC: 61.4% ± 9.2%, NHC: 60.8% ± 6.2%, p = 0.88, ES = 0.08) or right (HC: 61.4% ± 6.2%, NHC: 60.2% ± 6.8%, p = 0.51, ES = 0.17) limbs. However, a greater proportion of HC participants demonstrated >4 cm asymmetry (HC: 40.0%, NHC: 19.7%; p = 0.02) and these participants exhibited greater asymmetry (HC: 3.87 ± 3.69 cm, NHC: 2.40 ± 2.13 cm, p = 0.03; ES = 0.53). Athletes with a HC exhibited greater asymmetry compared to athletes with NHC. Anterior reach asymmetries of >4 cm are associated with greater lower extremity injury risk. The YBT may provide a clinical technique to further explore the relationship between concussion and lower extremity injury.

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Dynamic Balance Performance and Noncontact Lower Extremity Injury in College Football Players

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738113498703 ◽

2013 ◽

Vol 5 (5) ◽

pp. 417-422 ◽

Cited By ~ 72

Author(s):

Robert J. Butler ◽

Michael E. Lehr ◽

Michael L. Fink ◽

Kyle B. Kiesel ◽

Phillip J. Plisky

Keyword(s):

Lower Extremity ◽

Dynamic Balance ◽

College Football ◽

Lower Extremity Injury ◽

Football Players ◽

Extremity Injury ◽

Balance Performance

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Sustained Improvements in Dynamic Balance and Landing Mechanics After a 6-Week Neuromuscular Training Program in College Women’s Basketball Players

Journal of Sport Rehabilitation ◽

10.1123/jsr.2014-0323 ◽

2016 ◽

Vol 25 (3) ◽

pp. 233-240 ◽

Cited By ~ 12

Author(s):

Kate R. Pfile ◽

Phillip A. Gribble ◽

Gretchen E. Buskirk ◽

Sara M. Meserth ◽

Brian G. Pietrosimone

Keyword(s):

Lower Extremity ◽

Injury Prevention ◽

Outcome Measures ◽

Dynamic Balance ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Basketball Players ◽

Landing Mechanics ◽

Women's Basketball ◽

Over Time

Context:Epidemiological data demonstrate the need for lower-extremity injury-prevention training. Neuromuscularcontrol (NMC) programs are immediately effective at minimizing lower-extremity injury risk and improving sport-related performance measures. Research investigating lasting effects after an injury-prevention program is limited.Objective:To determine whether dynamic balance, landing mechanics, and hamstring and quadriceps strength could be improved after a 6-wk NMC intervention and maintained for a season.Design:Prospective case series.Setting:Controlled laboratory.Participants:11 Division I women’s basketball players (age 19.40 ± 1.35 y, height 178.05 ± 7.52 cm, mass 72.86 ± 10.70 kg).Interventions:Subjects underwent testing 3 times, completing the Star Excursion Balance Test (SEBT), Landing Error Scoring System (LESS), and isometric strength testing for the hamstrings and quadriceps muscles. Pretest and posttest 1 occurred immediately before and after the intervention, respectively, and posttest 2 at the end of the competitive season, 9 mo after posttest 1. Subjects participated in eighteen 30-min plyometric and NMC-training sessions over a 6-wk period.Main Outcome Measures:The normalized SEBT composite score, normalized peak isometric hamstrings:quadriceps (H:Q) ratio, and the LESS total score.Results:The mean composite reach significantly improved over time (F2,10 = 6.96, P = .005) where both posttest scores were significantly higher than pretest (70.41% ± 4.08%) (posttest 1 73.48% ± 4.19%, t10 = –3.11, P = .011) and posttest 2 (74.2% ± 4.77%, t10 = –3.78, P = .004). LESS scores significantly improved over time (F2,10 = 6.29, P = .009). The pretest LESS score (7.30 ± 3.40) was higher than posttest 1 (4.9 ± 1.20, t10 = 2.71, P = .024) and posttest 2 (5.44 ± 1.83, t10 = 2.58, P = .030). There were no statistically significant differences (P > .05) over time for the H:Q ratio when averaging both legs (F2,10 = 0.83, P = .45).Conclusions:A 6-wk NMC program improved landing mechanics and dynamic balance over a 9-mo period in women’s basketball players. NMC adaptations can be retained without an in-season maintenance program.

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USING MOVEMENT SCREENING TESTS AND BIOMECHANICAL ANALYSIS TO DIFFERENTIATE POST-CONCUSSION PEDIATRIC SOCCER ATHLETES FROM HEALTHY CONTROLS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00142 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0014

Author(s):

Scott O. Burkhart

Keyword(s):

Lower Extremity ◽

Biomechanical Analysis ◽

Screening Tests ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Balance Test ◽

Increased Risk ◽

Movement Screening ◽

Deep Squat ◽

Study Participants

Background: Recently, 2 controlled prospective studies of collegiate student-athletes identified 1.6 to 2.5 increased risk of subsequent lower extremity injury following concussion (Books et al., 2016; Lynall et al., 2015). The purpose of the study is to determine the potential clinical utility and application of the Functional Movement Screen (FMS), Y Balance Test (YBT), Tuck Jump Assessment (TJA), and Landing Error Scoring System (LESS) in a sample of post-concussion soccer athletes and a sample of healthy age and gender matched soccer athlete controls to identify differences. Differentiation was defined as significance in raw score performance on the FMS, YBT, TJA, LESS. Prospective data was collected on lower extremity injury within 6-months post-concussion. Methods: The study participants were administered the FMS, YBT, TJA, and LESS in successive order by a licensed athletic trainer. All measures were administered in a biomechanical lab setting. Post-concussion soccer athletes were administered the FMS, YBT, TJA, and LESS after receiving formal medical clearance from a licensed physician. Post-concussion soccer athletes were matched with healthy soccer athlete controls by age, gender, and years of participation. All study participants were administered screening measures at rest. All demographic and raw data were summarized using descriptive statistics with point estimates and 95% confidence intervals calculated for all end points. Independent sample t-tests were performed at <0.05 to measure significant differences between groups. Results: 50 (17 female, 33 male; mean age=14.1; mean years of participation=6.8) post-concussion soccer athletes and 50 (17 female, 33 male; mean age=14.3; mean years of participation=6.7) matched soccer athlete controls were administered the FMS, YBT, TJA, and LESS. Significant differences were observed between the post-concussion and control groups on FMS Deep Squat ( t=-9.76, p=<0.001), Inline Lung ( t=-8.43, p=<0.001), and LESS total score (t=-9.21, p=<0.001). No other significant differences were observed. Conclusions: The current study identified the FMS, YBT, TJA, and LESS as potential movement screening tests in which differences could be observed in a sample of post-concussion and healthy control soccer athletes. Results from the current study identified specific differences between groups with respect to movement screening test performance on the FMS Deep Squat, Inline Lunge, and LESS total score. Further research is warranted to clearly define the observed differences. Clinicians should consider these findings when providing recommendations and discussing recovery in concussion patients.

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Does the Y-Balance test Predict Lower Extremity Injury among Volleyball Players?

Research Journal of Pharmacy and Technology ◽

10.5958/0974-360x.2018.00295.0 ◽

2018 ◽

Vol 11 (4) ◽

pp. 1584

Author(s):

Veena S Kirthika ◽

K. Padmanabhan ◽

Selvaraj Sudhakar ◽

S. Ramanathan ◽

Mustafa Murtuza ◽

...

Keyword(s):

Lower Extremity ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Balance Test ◽

Volleyball Players

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Laboratory Measures of Postural Control During the Star Excursion Balance Test After Acute First-Time Lateral Ankle Sprain

Journal of Athletic Training ◽

10.4085/1062-6050-50.1.09 ◽

2015 ◽

Vol 50 (6) ◽

pp. 651-664 ◽

Cited By ~ 36

Author(s):

Cailbhe Doherty ◽

Chris M. Bleakley ◽

Jay Hertel ◽

Brian Caulfield ◽

John Ryan ◽

...

Keyword(s):

Lower Extremity ◽

Postural Control ◽

Ankle Sprain ◽

Control Group ◽

Injured Limb ◽

Balance Test ◽

Lateral Ankle Sprain ◽

Lateral Ankle ◽

Star Excursion Balance Test ◽

First Time

Context No researchers, to our knowledge, have investigated the immediate postinjury-movement strategies associated with acute first-time lateral ankle sprain (LAS) as quantified by center of pressure (COP) and kinematic analyses during performance of the Star Excursion Balance Test (SEBT). Objective To analyze the kinematic and COP patterns of a group with acute first-time LAS and a noninjured control group during performance of the SEBT. Design Case-control study. Setting University biomechanics laboratory. Patients or Other Participants A total of 81 participants with acute first-time LAS (53 men, 28 women; age = 23.22 ± 4.93 years, height = 1.73 ± 0.09 m, mass = 75.72 ± 13.86 kg) and 19 noninjured controls (15 men, 4 women; age = 22.53 ± 1.68 years, height = 1.74 ± 0.08 m, mass = 71.55 ± 11.31 kg). Intervention Participants performed the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the SEBT. Main Outcome Measure(s) We assessed 3-dimensional kinematics of the lower extremity joints and associated fractal dimension (FD) of the COP path during performance of the SEBT. Results The LAS group had decreased normalized reach distances in the ANT, PL, and PM directions when compared with the control group on their injured (ANT: 58.16% ± 6.86% versus 64.86% ± 5.99%; PL: 85.64% ± 10.62% versus 101.14% ± 8.39%; PM: 94.89% ± 9.26% versus 107.29 ± 6.02%) and noninjured (ANT: 60.98% ± 6.74% versus 64.76% ± 5.02%; PL: 88.95% ± 11.45% versus 102.36% ± 8.53%; PM: 97.13% ± 8.76% versus 106.62% ± 5.78%) limbs (P < .01). This observation was associated with altered temporal sagittal-plane kinematic profiles throughout each reach attempt and at the point of maximum reach (P < .05). This result was associated with a reduced FD of the COP path for each reach direction on the injured limb only (P < .05). Conclusions Acute first-time LAS was associated with bilateral deficits in postural control, as evidenced by the bilateral reduction in angular displacement of the lower extremity joints and reduced reach distances and FD of the COP path on the injured limb during performance of the SEBT.

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