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Steele C, Valentin S. Intrinsic and extrinsic variables impacting upper quarter Y-balance test scores in sporting cohorts: A systematic review. J Bodyw Mov Ther 2024; 39:183-194. [PMID: 38876624 DOI: 10.1016/j.jbmt.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/05/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION The upper quarter y-balance test (YBT-UQ) is a functional screening tool used to detect musculoskeletal injury risk, aid rehabilitation, and monitor dynamic function, strength and control, yet little is currently known about intrinsic and extrinsic factors that influence reach scores. OBJECTIVES This systematic review aimed to determine if age, sex, or interventions influenced reach scores and whether between-limb differences were common in non-injured sporting populations, with a secondary aim to identify if sport impacted YBT-UQ reach. METHODS Web of Science, PubMed, and SportDiscus were systematically searched from January 2012 to November 16, 2023, revealing twenty-three studies satisfying inclusion criteria of published in English between 2012 and 2023, healthy participants of any age including both males and females, athletic populations, YBT-UQ use to assess upper limb mobility/stability, report normalised reach scores, and peer-reviewed full-texts. Methodological quality was evaluated via National Institutes of Health (NIH) quality assessment tools for controlled interventions, observational cohort and cross-sectional designs, and pre-post with no control group. RESULTS Age, sex, sport, and fatigue were influencing factors; greater reach scores were achieved in older athletes (i.e. >18 years), males, and in a well-rested state. Between-limb differences were not common in sporting populations; therefore, asymmetries may be useful for practitioners to aid injury risk identification. CONCLUSION This is the first systematic review investigating YBT-UQ influencing factors and thereby provides context for clinicians regarding characteristics that impact reach scores in sporting populations, from which normative values could be determined and further aid clinical decisions or areas to improve regarding injury risk.
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Affiliation(s)
- Charlotte Steele
- Sport and Physical Activity Research Institute, University of the West of Scotland, Glasgow, UK
| | - Stephanie Valentin
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.
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Footwear Type and Testing Environment Do Not Affect Baseline Modified Balance Error Scoring System Performance Among Middle School Athletes. J Sport Rehabil 2023; 32:9-13. [PMID: 35894918 DOI: 10.1123/jsr.2021-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT Limited evidence exists to demonstrate the effect of extrinsic factors, such as footwear worn or the testing environment, on performance of the modified balance error scoring system (mBESS) in the middle school age (10-14 y) population. Therefore, the purpose of our study was to investigate the effect of footwear types and testing environments on performance of the mBESS by middle school athletes. DESIGN Cross-sectional. METHODS In total, 2667 middle school athletes (55.9% boys and 44.1% girls; age = 12.3 [0.94] y) were administered the mBESS while wearing their self-selected footwear (barefoot, cleats, or shoes) either indoors (basketball court) or outdoors (football field or track). The number of errors committed (range = 0-10) during the double-leg, single-leg, and tandem stances of the mBESS were summed to calculate a total score (range = 0-30). Kruskal-Wallis tests were used to assess for differences among the footwear groups for each mBESS stance and the total score. Mann-Whitney U tests with calculated nonparametric effect sizes (r) were used to assess for differences between the footwear groups and testing environments when appropriate. RESULTS There were significant differences for the number of committed errors among the footwear groups in the single-leg (P < .001) and tandem (P < .001) stances of the mBESS and mBESS total scores (P < .001). Significantly fewer errors (better) were committed while wearing shoes compared with other footwear in the single-leg and tandem stances of the mBESS (Ps ≤ .032, r = .07-.13). Participants assessed indoors committed significantly fewer errors than those assessed outdoors in each stance of the mBESS (Ps ≤ .022, r = .04-.14). Lower (better) mBESS total scores were observed for participants while wearing shoes (Ps ≤ .002, r = .10-.15) or assessed indoors (P = .001, r = .14). CONCLUSIONS Although our data suggest that the type of footwear worn and the testing environment have a significant effect on mBESS scores of middle school athletes, the magnitudes of these differences are negligible.
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Ikuta Y, Nakasa T, Fujishita H, Obayashi H, Fukuhara K, Sakamitsu T, Ushio K, Adachi N. An association between excessive valgus hindfoot alignment and postural stability during single-leg standing in adolescent athletes. BMC Sports Sci Med Rehabil 2022; 14:64. [PMID: 35410244 PMCID: PMC9004062 DOI: 10.1186/s13102-022-00457-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diminished balance is associated with the incidence of ankle and lower extremity injuries in adolescents. Although flexible flatfoot is a common foot condition in pediatric and adolescent populations, the association between balance control and foot morphology remain unclear in adolescent athletes. METHODS Rearfoot angle in the double-limb standing position, body mass index (BMI), and isometric muscle strength related to the knee joint were retrospectively reviewed in 101 adolescent athletes (75 boys and 26 girls) with a mean age of 14.0 years (range 12-17). Postural stability during single-leg standing on static and dynamic platforms was investigated using Balance System SD in 119 feet without functional ankle instability. The participants were divided according to their rearfoot angle into control (less than 7°) and valgus (greater than or equal to 7°) groups. The measured parameters were compared between the control and valgus groups using Welch's t-test, and P values < 0.05 were considered statistically significant. Multiple regression analysis was conducted to identify the factors that significantly influenced postural control. RESULTS The average rearfoot angle was 4.6° in all participants. An excessive valgus rearfoot angle was detected in 53 feet (26.2%). No significant difference was found between the groups in terms of BMI and isometric knee muscle strength. Although no statistical differences were observed in postural stability on the static platform between the control and valgus groups, the valgus group demonstrated poorer postural stability for single-leg standing on the dynamic platform. Multiple regression analysis revealed that BMI and rearfoot angle were significantly associated with a poor postural control on the dynamic platform. CONCLUSIONS Our findings suggest that excessive rearfoot valgus specifically contributes to the deterioration of postural stability in adolescent athletes, and that rearfoot alignment should be evaluated for the adolescent population to prevent sports-related lower extremity injury.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan. .,Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan.
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan.,Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Hiromune Obayashi
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Kouki Fukuhara
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Kai Ushio
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan.,Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan
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Stoddard CA, Wang-Price S, Lam SE. Limb Dominance Does Not Affect Y-Balance Test Performance in Non-Athlete Adolescents. Int J Sports Phys Ther 2022; 17:164-173. [PMID: 35136685 PMCID: PMC8805098 DOI: 10.26603/001c.30996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Lower Quarter Y-Balance Test (YBT-LQ) has been shown to be reliable for assessing dynamic balance in children and adolescents. However, limited research is available about the effects of leg dominance on YBT-LQ performance in adolescents. In addition, there is no consensus on the use of maximum reach or mean reach distance being a better measure of YBT-LQ performance. HYPOTHESIS/PURPOSE The purposes of this study were to determine if there is a difference in the YBT-LQ performance between the dominant and non-dominant limbs in non-athlete adolescents, and to compare the reliability of the maximum reach scores to that of the mean reach scores in this population. STUDY DESIGN Prospective cohort study. METHODS Twenty-six healthy non-athlete adolescents (13.6 ± 1.0 years, 22 girls, 4 boys) performed the YBT-LQ on two separate days while the same investigator scored their performance. Paired t-tests were used to compare reach distances on dominant and non-dominate stance limbs. Intraclass correlation coefficients (ICC3,1) were calculated for the maximum and mean reach distances for three directions (anterior, posterolateral, posteromedial) and the composite scores on each limb. RESULTS There was no significant difference in YBT-LQ performance between dominant and non-dominant stance limbs (p > 0.05). Overall, the between-day intra-rater reliability for maximum reach and mean reach scores was moderate-to-good for both limbs (ICC3,1 = 0.59 - 0.83), but was poor for the composite score on the dominant limb (ICC3,1 = 0.42) and maximum anterior reach on non-dominant limb (ICC3,1 = 0.48). CONCLUSION Limb dominance does not seem to be a factor for YBT-LQ performance in this population. The YBT-LQ appears to be a reliable tool for dynamic balance assessment in non-athlete adolescents using the individual score of each direction. The use of mean reach measures seems to slightly improve reliability, specifically the anterior reach direction, in this population. LEVEL OF EVIDENCE Level 2b.
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Lisman P, Hildebrand E, Nadelen M, Leppert K. Association of Functional Movement Screen and Y-Balance Test Scores With Injury in High School Athletes. J Strength Cond Res 2021; 35:1930-1938. [PMID: 30844987 DOI: 10.1519/jsc.0000000000003082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Lisman, P, Hildebrand, E, Nadelen, M, and Leppert, K. Association of functional movement screen and Y-Balance Test scores with injury in high school athletes. J Strength Cond Res 35(7): 1930-1938, 2021-The purpose of this study was to determine the association between functional movement screen (FMS) and Y-Balance Test (YBT) performance and lower extremity injury in a sample of male high school athletes. A total of 124 high school football (n = 89), lacrosse (n = 25), and baseball (n = 10) players underwent FMS and YBT before the start of their competitive seasons. Time loss lower extremity injury incidence data were tracked by each team's certified athletic trainer and used for analysis. Receiver operating characteristic (ROC) curves were calculated to determine the optimal cutpoints for FMS composite score (CS) and YBT measures, including CS and reach distance asymmetry for anterior, posteromedial, and posterolateral directions, for predicting injury. No cutpoints on the ROC curves maximized sensitivity and specificity; therefore, FMS CS and YBT measures (CS and asymmetry) were analyzed as continuous variables. Logistic regression models adjusted for age and sport revealed no significant associations between FMS CS and lower extremity injury (odds ratio [OR] = 0.99; 95% confidence interval [CI] = 0.83-1.20). Similar findings were found for YBT asymmetry in all directions (ORs ranged from 0.98 to 1.08) and CS (OR = 0.99; 95% CI = 0.95-1.04). There were also no significant associations between the presence of asymmetry and low score (score of 1) on any individual FMS test and injury. Overall, FMS and YBT were not associated with increased risk of lower extremity injury in this sample of high school athletes. These findings do not support the use of FMS and YBT as stand-alone injury risk assessments in high school athletes.
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Affiliation(s)
- Peter Lisman
- Department of Kinesiology, Towson University, Towson, Maryland
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Bulow A, Bellemare A, Anderson JE, Leiter JRS, MacDonald PB, Peeler JD. Lower Extremity Kinematics of the Y-Balance Test in Healthy and ACL Injured Adolescent Females. Int J Sports Phys Ther 2021; 16:381-392. [PMID: 33842034 PMCID: PMC8016411 DOI: 10.26603/001c.21529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adolescent females are at significant risk for sustaining an ACL injury. The Y-Balance Test (YBT) is frequently used to evaluate neuromuscular control and lower extremity function. However, few studies have quantified 2D lower extremity kinematics during performance of the YBT, and there is an absence of kinematic data specific to at-risk adolescent females. PURPOSE To examine lower extremity joint kinematics during execution of the YBT by healthy and ACL-injured adolescent females. STUDY DESIGN Prospective cohort. METHODS Twenty-five healthy and ten ACL-injured (mean time from injury 143 days) adolescent females were assessed using the YBT. Sagittal and frontal plane knee and ankle motion was video recorded during execution of the YBT anterior reach movement. Ankle dorsi-flexion, knee flexion, and knee valgus angles were quantified via kinematic analysis. ANOVAs with a post hoc Bonferroni correction were used to compare YBT scoring (%LL) and kinematic data between groups. Pearson product-moment correlations determined the relationship between kinematic data and YBT scoring. RESULTS Healthy and ACL-injured subjects demonstrated similar YBT scores and lower extremity kinematic data. Healthy subjects demonstrated a weak positive correlation between ankle dorsiflexion and YBT scoring, and a weak negative correlation between knee valgus and YBT scoring. These relationships did not exist for ACL-injured subjects. Kinematic data for both groups also demonstrated a large degree of variability, regardless of YBT score. CONCLUSIONS Adolescent females frequently utilize a variety of lower extremity movement strategies when performing a functional movement task, and scoring on the YBT offers limited insight regarding lower extremity joint kinematics and ACL-injury risk in a physically active adolescent female population. LEVEL OF EVIDENCE Level 3.
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Muehlbauer T, Schwiertz G, Brueckner D, Kiss R, Panzer S. Limb Differences in Unipedal Balance Performance in Young Male Soccer Players with Different Ages. Sports (Basel) 2019; 7:sports7010020. [PMID: 30641997 PMCID: PMC6359298 DOI: 10.3390/sports7010020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
In soccer, the dominant leg is frequently used for passing and kicking while standing on the non-dominant leg. Consequently, postural control in the standing leg might be superior compared to the kicking leg and is further enhanced with increasing age (i.e., level of playing experience). Unfortunately, leg differences in postural control are associated with an increased risk of injuries. Thus, we examined differences between limbs in unipedal balance performance in young soccer players at different ages. Performance in the Lower Quarter Y Balance Test (YBT-LQ) of the dominant and non-dominant leg and anthropometry was assessed in 76 young male soccer players (under-13 years [U13]: n = 19, U15: n = 14, U17: n = 21, U19: n = 22). Maximal reach distances (% leg length) and the composite scores were used for further analyses. Statistical analyses yielded no statistically significant main effects of leg or significant Leg × Age interactions, irrespective of the measure investigated. However, limb differences in the anterior reach direction were above the proposed cut-off value of >4 cm, which is indicative of increased injury risk. Further, statistically significant main effects of age were found for all investigated parameters, indicating larger reach distances in older (U19) compared to younger (U13) players (except for U15 players). Although reach differences between legs were non-significant, the value in the anterior reach direction was higher than the cut-off value of >4 cm in all age groups. This is indicative of an increased injury risk, and thus injury prevention programs should be part of the training of young soccer players.
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Affiliation(s)
- Thomas Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, 45141 Essen, Germany.
| | - Gerrit Schwiertz
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, 45141 Essen, Germany.
| | - Dennis Brueckner
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, 45141 Essen, Germany.
| | - Rainer Kiss
- Department of Health and Social Affairs, FHM Bielefeld-University of Applied Sciences, 33602 Bielefeld, Germany.
| | - Stefan Panzer
- Institute of Sport Science, Saarland University, 66123 Saarbrücken, Germany.
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Functional movement screen and Y-Balance test scores across levels of American football players. Biol Sport 2018; 35:253-260. [PMID: 30449943 PMCID: PMC6224853 DOI: 10.5114/biolsport.2018.77825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/26/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Few studies have investigated differences in functional movement assessment performance across scholastic levels of competition. This study examined Functional Movement Screen (FMS) performance in middle school (MS), high school (HS) and collegiate (COL) American football players and Y-Balance test (YBT) scores in MS and HS players. Functional movement measurements were collected for MS (N = 29; age = 12.8 ± 0.7 years), HS (N =52; age = 15.7 ± 1.2 years), and COL (N =77; age = 19.9 ± 1.4 years) football players prior to each group’s competitive season. Differences in composite FMS and YBT measurements were examined using Welch’s ANOVA and Mann-Whitney U-tests, respectively. Chi-square analyses examined normality of score distributions for individual FMS tests. The MS group displayed a lower composite FMS (12.9 ± 1.9) than both HS (14.0 ± 1.7) and COL (14.1 ± 2.1) groups (p = 0.019). COL players scored significantly lower on the Shoulder Mobility (SM) but higher on the Deep Squat (DS), In-line Lunge (ILL), Active Straight-Leg Raise (ASLR) and Push-Up (PU) than both HS and MS groups. No differences were found between MS and HS groups for any YBT normalized reach distances and side-to-side reach distance differences. FMS performance varied with football competition level whereas YBT performance did not. The results suggest that football competition levels normative data and injury-risk thresholds should be established when using FMS scores to guide performance and injury prevention programming.
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Tocci N, Howell DR, Sugimoto D, Stracciolini A, Morse J, Meehan WP. Physical activity outside of organised sports is associated with functional performance. Acta Paediatr 2017; 106:825-830. [PMID: 28160518 DOI: 10.1111/apa.13776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/12/2017] [Accepted: 01/31/2017] [Indexed: 12/25/2022]
Abstract
AIM The purpose of this study was to determine whether high levels of strenuous physical activity outside of organised sports are associated with better functional test performance. METHODS Youth athletes (n = 445, mean = 14.2 ± 2.5 years) reported their frequency of strenuous physical activity outside of organised sports. The functional performance tests: vertical jump height, pro agility test time, estimated maximal oxygen uptake (VO2 max), front plank time and postural stability were measured and compared between groups. RESULTS Athletes in the five or more times a week group demonstrated faster pro agility times (5.37 ± 0.43 seconds) than the never group (5.59 ± 0.56 seconds; p = 0.002) and the 1-4 times a week group (5.52 ± 0.47 seconds; p = 0.005). The five or more times a week group demonstrated higher mean vertical jump height (42.9 ± 13.3 vs. 40.3 ± 10.8 cm; p = 0.009) and higher estimated VO2 max (48.1 vs. 45.6 mL/kg/minute; p = 0.001) than the 1-4 times a week group. CONCLUSION Youth athletes who engaged in strenuous physical activity outside of organised sports five or more times a week performed best on functional performance tests.
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Affiliation(s)
- Noah Tocci
- The Micheli Center for Sports Injury Prevention; Waltham MA USA
- Colby College; Waterville ME USA
| | - David R. Howell
- The Micheli Center for Sports Injury Prevention; Waltham MA USA
- Division of Sports Medicine; Department of Orthopaedics; Boston Children's Hospital; Boston MA USA
- Brain Injury Center; Boston Children's Hospital; Boston MA USA
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention; Waltham MA USA
- Division of Sports Medicine; Department of Orthopaedics; Boston Children's Hospital; Boston MA USA
- Department of Orthopaedic Surgery; Harvard Medical School; Boston MA USA
| | - Andrea Stracciolini
- The Micheli Center for Sports Injury Prevention; Waltham MA USA
- Division of Sports Medicine; Department of Orthopaedics; Boston Children's Hospital; Boston MA USA
- Department of Orthopaedic Surgery; Harvard Medical School; Boston MA USA
| | - Jen Morse
- The Micheli Center for Sports Injury Prevention; Waltham MA USA
| | - William P. Meehan
- The Micheli Center for Sports Injury Prevention; Waltham MA USA
- Division of Sports Medicine; Department of Orthopaedics; Boston Children's Hospital; Boston MA USA
- Brain Injury Center; Boston Children's Hospital; Boston MA USA
- Department of Orthopaedic Surgery; Harvard Medical School; Boston MA USA
- Department of Pediatrics; Harvard Medical School; Boston MA USA
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