Y Balance Test

How to conduct the Y Balance Test

To conduct the Y Balance Test for your clients, follow these steps:

Step 1: Prepare the materials of a Y Balance Test kit

Before you start conducting the Y Balance Test, you need to make sure that you have the following equipment:

• A flat surface (2x2 meters)
• Sticky tape
• Measuring tape
• Performance-recording sheet

Step 2: Mark the Y on the floor

Once you have these ready, make a Y using the sticky tape. Make sure that each direction is six to eight feet long. These directions are the anterior, posteromedial, and posterolateral. The posteromedial and posterolateral strips should be positioned 135 degrees from the anterior strip and have a 45-degree angle between them.

Step 3: Demonstrate the test

Once the Y has been marked, demonstrate the following instructions to them:

1. First, they must pick one of their legs to use as the standing leg.
2. Tell them to get into a standing position (the starting position) with their chosen leg in the middle of the Y and have them place their hands on their hips.
3. Once they are standing, they will reach as far as they can within the range of each direction of the Y but without planting their reaching foot on the floor. They will reach for each direction using their big toe.
4. They must do this three times for each leg.

Things to note

This test has failed states, by the way. Here are things that they shouldn't do while performing the Y Balance Test:

• They can't hold onto something for balance.
• They should not lose their balance and fall.
• They can't remove their hands from their hips.
• They can't plant their reach foot on the floor.
• The heel of their standing foot should not rise or move at all.

Once the patient understands these instructions, give them a trial run for both legs before proceeding with the test. Technically, they will do this test four times in one session.

Calculating and interpreting Y Balance Test scores

While the patient is performing this test, you must measure their reach for each direction using the measuring tape. The measurement will be in centimeters; you must record to the nearest 0.5cm. For example, if their reach is 3.6, that counts as 3.5. If it's 3.89, then it's 4.0cm.

The measuring components are the anterior, posteromedial, and posterolateral directions. Since the first set is a trial, it won't count in the scoring. Here are the calculations:

1. (Reach 1 + reach 2 + reach 3) ÷ 3 = average distance in each direction (cm)
2. (Average distance in each direction ÷ leg length) x 100 = relative (normalized) distance in each direction (%)
3. (Normalized anterior + normalized posteromedial + normalized posterolateral) ÷ 3 = composite reach distance (%)

Example for 1 & 2 using anterior direction:

1. (57cm + 58cm + 59cm) ÷ 3 = 58cm
2. (58cm ÷ 73cm) x 100 = 79.5%

Example for composite reach distance:

3. (79.5% + 77% + 78.5%) ÷ 3 = 78%

Currently, the composite score baseline for being at risk of injury and losing balance is if a patient has a composite reach distance below 89% (Butler RJ et al., 2013). This is in the context of collegiate athletes. High school athletes risk injury and loss of balance if they get a composite reach distance below 94%.

Plisky et al. (2009) also concluded in a paper in the J Sports Phys Ther journal that the Y Balance Test is a reliable test for "measuring single limb stance excursion distances while performing dynamic balance testing in collegiate soccer players."

If you treat collegiate/professional athletes or high school athletes, you can use 89% or 94% as your baseline. Just remember that the factors might depend on their age and sport. Given this, you might want to use other balance and lower extremity-related tests as part of a comprehensive examination. Doing so will likely give you more accurate results and a better picture of your patient.

When is it best to conduct the Y Balance Test?

The Y Balance Test, a variation of the Star Excursion Balance Test (SEBT), is a valuable tool for assessing dynamic balance and identifying potential risk factors for lower extremity injuries. Its application is most appropriate in sports health.

Pre-season screening for athletes

Conduct the Y Balance Test during pre-season evaluations for high school basketball players and college football players. This timing allows practitioners to establish a baseline for dynamic balance performance, enabling monitoring changes throughout the season.

Injury risk assessment

Utilize the Y Balance Test for injury risk assessments, especially for collegiate athletes with a history of noncontact lower extremity injuries or chronic ankle instability. Identifying balance deficits can inform targeted interventions to mitigate injury risk.

Incorporation into comprehensive movement screens

Integrate the Y Balance Test into comprehensive movement screens, such as the Functional Movement Screen (FMS). This approach provides a more holistic understanding of an individual's movement patterns, combining static and dynamic balance assessments to enhance the overall evaluation.

Post-injury rehabilitation

Implement the Y Balance Test during rehabilitation for athletes with previous injuries. Tracking changes in dynamic balance, particularly in the anterior reach direction, can guide rehabilitation strategies and ensure a safe return to play.

Monitoring progress in dynamic balance

Periodically conduct the Y Balance Test throughout the season to monitor an athlete's dynamic balance progress. Regular assessments can help identify emerging imbalances and allow timely interventions to optimize performance and reduce injury risk.

Integration with lower extremity functional scale

Combine the Y Balance Test with the Lower Extremity Functional Scale to obtain a more comprehensive profile of an individual's lower extremity function. This dual approach addresses subjective and objective measures, aiding in a more nuanced understanding of a person's risk for lower extremity injuries.

Adjusting for anatomical variations

When conducting the Y Balance Test, consider a person's leg length and anterior superior iliac spine height. This adjustment accounts for individual anatomical differences, ensuring a more accurate assessment of dynamic balance capabilities.

Identification of asymmetries

Attention should be paid to balance test reach asymmetry, especially in the anterior direction. Asymmetries in dynamic balance may indicate an increased risk of lower extremity injuries, so addressing these imbalances through targeted interventions is crucial.

By strategically incorporating the Y Balance Test at different stages of an athlete's journey, practitioners can proactively manage and enhance dynamic balance, ultimately contributing to improved sports performance and reduced risk of lower extremity injuries.

References

Butler, R. J., Lehr, M. E., Fink, M. L., Kiesel, K. B., & Plisky, P. J. (2013). Dynamic balance performance and noncontact lower extremity injury in college football players. Sports Health a Multidisciplinary Approach, 5(5), 417–422. https://doi.org/10.1177/1941738113498703

Plisky, P. J., Gorman, P. P., Butler, R. J., Kiesel, K. B., Underwood, F. B., & Elkins, B. (2009). The reliability of an instrumented device for measuring components of the star excursion balance test. PubMed. https://pubmed.ncbi.nlm.nih.gov/21509114