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What is the Y Balance Test?

The Y Balance Test is a dynamic clinical assessment developed as a modified version of the Star Excursion Balance Test. This dynamic test aims to gauge the balance and stability of a person’s legs. It is primarily conducted on athletes, especially those injured and on their way to a full recovery. This test gauges a person’s balance by attempting to identify any signs of postural control deficits resulting from injuries in their lower extremities, such as ankle sprains or instability, or some other lower extremity condition that affects their ability to maintain balance.

The Y Balance Test is always conducted on a flat surface. This surface has a Y marked on it by tape. The patient taking this test will have to stand in the middle of the Y and reach for every end of the Y with one leg while maintaining their balance with the other. Whether they can accomplish this or not, they will alternate the role of their legs so that the previous one used to maintain their balance will reach each end of the Y. The previous leg that was used to reach for each end will be used to maintain their standing balance.

Check out this video to see how the Y Balance Test is performed:

How to conduct the Y Balance Test

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

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. The posteromedial and posterolateral strips should have a 45 degree-angle between them.

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

• First, they must pick one of their legs to use as the standing leg.
• Tell them to get into standing position with their chosen leg in the middle of the Y and have them place their hands on their hips.
• 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.
• They must do this three times for each leg.

This test has fail 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 these instructions are clear to the patient, give them a trial run for both legs before proceeding with the actual test. Technically, they will do this test four times in one session.

How to interpret the findings of the Y Balance Test

While the patient is performing this test, you will need to measure their reach for each direction using the measuring tape. The measurement will be in centimeters, and 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.

You need to measure 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%

Do note that there is not enough research to fully determine the Y Balance Test’s accuracy, but it depends on certain factors. Currently, the baseline for being at risk of injury and loss of balance is if a patient has a Composite Reach Distance below 89%. This is in the context of collegiate athletes. High school athletes are at risk of injury and loss of balance if they get a Composite Reach Distance below 94%.

You can use 89% or 94% as your baseline if you treat collegiate/professional athletes and high school athletes respectively. Just remember that the factors might depend on their age and sport. Given this, you might want to use other balance-related tests 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.

‍Y Balance Test Example

Now that you know what the Y Balance Test is about, how it’s performed and what you need to conduct it, and how to calculate the scores, it’s time to see what it looks like on paper. Normally, this test doesn’t come with a sheet to record your findings and calculate scores, so we at Carepatron took the liberty to create a template for you that will allow you to jot down your scores and comments! Here is what it looks like:

‍Download this Y Balance Test Example (Sample) here:

If you like what you see, then feel free to download a Y Balance Test PDF from our platform! The test comes with sections where you can input your calculations, plus, there’s an additional comments box where you can write down your thoughts on the patient, the test, and whatever decisions you have for them regarding their treatment and recovery. You can print it if you would rather fill it out with a pen, or you can go paperless and just write using the editable fields of the PDF!

When is it best to conduct the Y Balance Test?

To reiterate, the Y Balance Test is, more often than not, a test conducted for athletes, especially if they are in the recovery phase after getting treated for an injury or during their training.

Those who take this test usually play team sports where balance is essential, like basketball or soccer! These sports require balance and dynamic postural control, so the Y Balance Test is usually conducted during the early stages of athletic training to gauge players in terms of their balance and potential balance deficits.

The results will help coaches and trainers construct specific programs that will work with their current level of balance and set benchmarks for them to keep improving. This is so they can minimize the risk of injury and falling if the Y Balance Test results indicate that certain players are at risk of falling and sustaining an injury.

Suppose an athlete or a non-athlete gets injured and sustains an ankle sprain, an injury, some other type of trauma in the lower extremities, or a neurological condition (which is likely to affect their balance). In that case, this test can be used during their recovery or rehabilitation phase to check if they are regaining their postural control, no matter how slow. The results should help professionals determine what goes into their treatment.

Who can conduct the Y Balance Test?

Since the Y Balance Test is a dynamic physical examination that gauges the capability of the legs to maintain balance, it is best conducted by healthcare professionals who have been trained and are experienced when dealing with musculoskeletal problems, especially those in the lower extremities. These professionals include:

• Orthopedists
• Physical therapists
• Occupational therapists
• Rehabilitation specialists

Since this test is often used in sports settings, athlete physicians, trainers, and coaches can also conduct this test as part of training and rehabilitation.

Now, remember our point about this test having a lack of research when it comes to the accuracy of the test? Well, given that lack of research, it is best that the aforementioned professionals conduct this test because they have the know-how when it comes to conducting tests like this, plus, they can interpret the results well enough that you can trust their judgment regarding the scores and whatever decisions they might have for the patient.

Another point that we’d like to reiterate is the part about including the Y Balance Test as part of a comprehensive examination. We recommend that you do that to get and consider the results of other assessments, especially those that have already been established to be reliable. One assessment that is perfect for this is the Short Physical Performance Battery (SPPB). It’s an assessment composed of three tests, all of which have something to do with balance.

It’s also best to conduct similar tests to get the best picture of your patient’s balance.

What are the benefits of the Y Balance Test?

It can help determine ways to prevent injury from falling.

Athletes are prone to falling if they don’t get enough training or get too tired while playing a sport and keep pushing themselves beyond their limits. If their lower extremities are injured, then their risk of falling increases. The Y Balance Test can properly assess the current level of balance or what balance deficits an athlete has, especially while recovering from an injury. Trainers and coaches can use this test to help them create a training program that accounts for an athlete’s current level of balance to help prevent accidents during training as well as to help improve their capability to maintain balance. They can keep at this until they hit certain benchmarks before making new adjustments to accommodate the improvements.

It can help guide treatment decisions.

Just as trainers and coaches can develop tailor-fitted training programs for athletes, recovering or not, clinicians who conduct this test can also use this test to assess elderly patients and those with balance issues caused by neurological conditions. By properly interpreting the results based on the Y Balance Test scores, the clinician’s observations, and the results of other balance tests, they can create tailor-fitted treatment plans and rehabilitation programs for non-athletic patients to help improve their quality of life and see if they need assistance with activities of daily living.

It can be used to monitor patients down the line.

Suppose your team developed a treatment or rehabilitation plan for your patient with balance issues, and you’ve implemented this plan. In that case, naturally, you’d want to know if the plan is working and if the patient is improving in maintaining their balance. If you want to find out, you can schedule routine check-ups with them and repeat this test. If their reach increases and they’re maintaining their balance well, your treatment/rehabilitation plan is working! Cool! If not, then you might want to make some adjustments or overhaul it, then see if the changes will do the trick.

Why use Carepatron for physical therapy-related work?

If you happen to be a physical therapist or an adjacent healthcare professional, then we recommend that you take the time to browse around the Carepatron platform! We’re sure you’ll find something that will tickle your fancy and benefit your work.

One of our features that we suggest you look at is our treasure trove of clinical resources. We have a massive collection of worksheets, assessments (including this Y Balance Test), survey templates, general treatment plans, progress note templates, and much more! It even covers numerous healthcare fields, including physical therapy, orthopedics, etc.

Since one of the points that we’ve mentioned a few times is to include the Y Balance Test in a comprehensive examination, we’d like you to know that we have other assessments that you can include as part of it, just like the Short Physical Performance Battery, the Straight Leg Raise Test, 30-second Sit-to-Stand Test, the Tinetti Balance Test, and more! We even have the parent version of the Y Balance Test, which is the Star Excursion Balance Test, so if you think that including that might help, feel free to download our template! With our roster of assessments, we’re sure you’ll have more than enough to conduct.

That’s not all! We also have an awesome storage system that will allow you to store your clinical documentation with us in a HIPAA-compliant manner. You can store filled-out PDF copies with us if you downloaded our Y Balance Test template! Doing so is the equivalent of making backups of your files. If you lose your physical copies, you can simply access the storage, download the files, and reprint them! You can even choose who gets to access these files besides you! We recommend giving access to your teammates so you can share results easily.

We at Carepatron are committed to helping healthcare professionals with their work, so take advantage of our platform so we can find ways to streamline your workflows and help you preserve your work!