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Star Excursion Balance Test

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Dieter Schuddinck and Rachael Lowe  

Contents

Purpose

The Star Excursion Balance Test (SEBT) is a dynamic test that requires strength, flexibility, and proprioception. It is a measure of dynamic balance that provides a significant challenge to athletes and people who are physically active. The test can be used to assess physical performance but can also be used to screen deficits in dynamic postural control due to musculoskeletal injuries like chronic ankle instability. It could be used to identify athletes at greater risk for lower extremity injury. It is also possible to use the test during the rehabilitation of orthopedic injuries in healthy, physically active adults [1] [2].

The SEBT could be used to compare balance ability among different sports and to assess physical performance. Research have suggested to use the SEBT as a screening tool for sport participation on the one hand and as a post-rehabilitation test to ensure dynamic functional symmetry on the other hand. It’s also been showed that the performance of SEBT improves after training. [2]

It is important, that the test capture the greatest amount of information of instability in the shortest amount of time [2].

Technique

Before the test is performed, there is a set up needed. You need to use 4 strips of athletic tape with a length of 6-8 foot. Then you should form a ‘+’. After this is done, you have to use 4 strips of athletic tape of the same length but this time you are going to form an ‘x’. It is important that all the different lines are separated from each other by an angle of 45° [3].
The goal of the SEBT is to maintain single leg stance on one leg while reaching as far as possible with the contra lateral leg [2]. The person performing this test must maintain a base of support on one leg, while using the other leg to reach as far as possible in 8 different directions. This person (standing on his left leg for example) must reach in 8 different positions, once in every of the following directions : anterior, anteromedial, medial, posteromedial, posterior, posterolateral, lateral and anterolateral [3]. The anterior, posteromedial and posterolateral directions appear to be important to identification individuals with chronic ankle instability and athletes at greater risk of lower extremity injury [2].


When the person demonstrates a significantly decreased reach while standing on the injured limb compared to standing on the healthy limb, the Star Excursion Balance Test has shown his ability to point out a loss of dynamic postural control [3]. There is a similar test like the Star Excursion Balance Test, but this test is not performed in the shape of a star, but in ‘Y-form’, called the Y-test.
The test originally incorporated reaching in eight directions while standing on each foot, but factor analysis indicated that one reach direction (posteromedial) was able to accurately identify individuals with chronic ankle instability as well as performing all eight directions [2].


1. Anterior
2. Anteromedial
3. Medial
4. Posteromedial
5. Posterior
6. Posterolateral
7. Lateral
8. Anterolateral

For knowing how to perform the Star Excursion Balance Test, you can watch the next clip :
http://www.youtube.com/watch?v=wHv2YDfoWoE

Evidence

There have been different studies that have investigated the evidence of the Star Excursion Balance Test. First, an overview of the reliability.

  1. According to the study of Hertel, Miller and Deneger (2000) the reliability of the SEBT ranges between r = 0,85 and 0,96 [1]
  2. According to the prospective cohort study ‘Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players’ (Plisky P. et al – 2006) the reliability of this test ranged between 0.82 and 0.87 and scored 0.99 for the measurement of limb length [4]
  3. In two other studies, Kinezey SJ et al (1998) and Hardy L et al 2008), the reliability of the Star Excursion Balance test has been determined with an intra-class correlation coefficients ranging from 0,67 tot 0,87 [5][6]
  4. 4. The study ‘Star Excursion Balance Training : Effects on Ankle Functional Stability after Ankle Sprain’ (Chaiwanichsiri D et al – 2005) concluded that the Star Excursion Balance training was more effective than the conventional therapy program in improving functional stability of the sprained ankle [7]
  5. 5. The study of Plisky P. et al (2009) concluded: the intra-rater reliability of the SEBT has been reported as moderate to good (ICC 0.67- 0.97) and inter-rater reliability has been reported as poor to good (0.35-0.93).[2]

The SEBTs appears to be an effective means for determining reach deficits both between and within subjects with unilateral chronic ankle instability [3]. It can also be used to determine deficits and asymmetries in individuals, as well to assist in the return to play decision-making process [2].

To discuss the validity of this test in certain injured populations, such as patellofemoral pain syndrome, further research is still recommended [3]

Resources

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Recent Related Research (from Pubmed)

References

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  1. 1.0 1.1 Advanced fitness assessment and exercise prescription. Heyward V. Human kinetics, 6th edition: 303 (5)
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 The Reliability of an Instrumented Device for Measuring Components of the Star Excursion Balance Test. Plisky P et al. Am J Sports Phys Ther. 2009 May; 4(2): 92–99. (2B)
  3. 3.0 3.1 3.2 3.3 3.4 Efficacy of the Star Excursion Balance Tests in Detecting Reach Deficits in Subjects With Chronic Ankle Instability. Olmsted L., Caria C., Hertel J., Shultz S. Journal of Athletic Training 2002;37(4):501–506 (1B)
  4. Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players. Plisky P., Rauh M., Kaminski T., Underwood F. Journal of Orthopaedic & Sports Physical Therapy 2006; 36 (12) (1B)
  5. The reliability of the star-excursion test in assessing dynamic balance. Kinzey SJ., Armstrong CW., et al. J Orthop Sports Phys Ther. 1998;27(5): 365-360 (1B)
  6. Prophylactic Ankle Braces and SEBT Measures in Healthy Volunteers. Hardy L., Huxel K., Brucker J., Nesser T. Journal of Athletic Training 2008;43(4):347–351 (2C)
  7. Star Excursion Balance Training : Effects on Ankle Functional Stability after Ankle Sprain. Chaiwanichsiri D., Lorprayoon E., Noomanoch L. J Med Assoc Thai 2005; 88(4): 90-94 (1B)

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