Y Balance Test and Ice Hockey

Although many of us are familiar with the Y Balance Test, I really haven't spoken to many individuals who actually use it. Most of the professionals I have spoken with (that utilize the Functional Movement Systems) only use the FMS and/or SFMA.

To me, the YBT may just be the FM Systems' secret weapon.

As per the YBT website,
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"The Y Balance Test...is a thoroughly researched, yet easy way to test a person's risk for injury as well as demonstrate functional symmetry. The Y Balance Test Protocol was developed through years of research in lower extremity injury prevention using the Star Excursion Balance Test. This device and protocol is highly accurate and can be used for measuring pre and post rehabilitation performance, improvement after performance enhancement programs, dynamic balance for fitness programs, and return to sport readiness."

To give you an overview, the YBT is a two part test, consisting of both upper and lower extremity components.

The Y Balance Test Lower Quarter (YBT-LQ) is a dynamic test performed in single-leg stance that requires strength, flexibility, core control and proprioception. It has been used to assess physical performance, identify chronic ankle and ACL instability, and identify athletes at greater risk for lower extremity injury. The YBT-LQ incorporates three movement directions (anterior, posteromedial and posterolateral). The goal of this test is to maintain single-leg stance on a leg while reaching as far as possible with the contralateral leg.

The Y-Balance Test Upper Quarter (YBT-UQ) is a dynamic measure of trunk control. Mobility and stability are both maximally challenged during the test. Stability of the stance arm, shoulder girdle and trunk is challenged at the same time mobility of the reach arm, shoulder girdle and trunk is challenged. During each reach component, scapular stability, mobility, thoracic rotation and core stability are combined as you encourage the client to reach as far as possible without losing balance. By reaching as far as possible outside of a narrow base of support, the client is required to use balance, proprioception, strength and full motion.

This test is designed to test a client’s trunk and upper extremity while in a pushup position. The goal of the test is to maintain a pushup position while on the center platform of the YBT device and push the reach indicator with one hand as far medially and diagonally across the body in the inferolateral and superolateral directions. (YBT Test Instructions)
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Over the last year, I have had the opportunity to utilize this testing method (YBT-LQ) in several different pre-season settings, particularly in ice hockey where groin, hip and lower abdominal injuries relatively frequent the "non-contact injury" column. Aside from other testing procedures, I felt that it was time to incorporate the YBT into my protocols. My first live exposure to the test was at the SFMA internship last July and while I got certified immediately following the internship, I will admit that it wasn't until I actually started administering the test that I realized its true value.
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As mentioned above, the YBT-LQ is comprised of three different reaches: Anterior, Posteromedial and Posterolateral (see the image above). To be brief, the key variables you aim to examine are asymmetry in reach in each of the three directions and the total composite score as compared to the existing normative data.

The cutoff for asymmetry is 4 cm, so anyone with 4 or above is deemed asymmetrical. Those right at 4 cm, I generally am not as concerned with and simply keep these individuals in the back of my head. I always make sure to look a little deeper into players with greater than 10 cm of asymmetry. *Note, for some reason I like breaking the rules.

The Composite Score is essentially a final score [(AR+PM+PL) / (3xlimb length)] x 100. Typically this is used to compare to the norm. It is based on a body relative (compared to their own limb length) score. As an example, currently the cutoff score for football players is 89, so I generally highlight players who score less than 89. I do not know the cutoff score for hockey or soccer.

Unlike the FMS or SFMA, this testing procedure is technically based on quantity not quality. However, I'd say that I'm relatively confident in my assessment skills so I generally try to analyze how they athlete looks while performing the tests. I mentioned earlier that I think the YBT is the FM Systems' secret weapon and the reason I say this is because it takes end range control and stability in a single-limb stance in order to perform the test well.  It is dynamic and multiplanar...and it is a test under load. Not external load but whenever you go into a single-leg squat, that's (internal) load!

Some of the things I look for when testing the athletes are dynamic valgus, trunk control and positioning, and the ability to dissociate the contralateral limbs. And having tested players at elite levels, I have come up with several hypotheses for low scores on each of the tests.

As the Anterior Reach is basically a "pistol-like" squat, those athletes that score low may be doing so due to less than optimal eccentric triplanar control of the stance hip (especially sagittal), valgus collapse of the knee, limited dorsiflexion mobility, and poor core control.

The Posteromedial Reach looks almost exactly like a skating stride. I have found that those athletes who incorporate Rear Foot Elevated ("Bulgarian") Split Squats generally do very well on this test. Those athletes that score low on this test too may be doing so due to poor multiplanar control of the stance hip and a lack of core stability. I would also suggest that anterior and medial chain restrictions may be contributing factors as well.

Limitations in Posterolateral Reach (similar to a crossover), in addition to the above, seem to also result from restriction in full extension of the stride leg as well as closed chain ankle dorsiflexion and hip internal rotation mobility restrictions of the stance leg.

As with all single leg activities, my biggest concern is whether or not each joint complex is doing its job neuromuscularly. That is, if the stance hip isn't contributing to movement control, the body may look to the opposite side of the lumbopelvic complex for stability. As a result, movement excursion restrictions may be perceived and scores may be limited.

​For those of you in the hockey scene who have yet to utilize the Y Balance Test, I encourage you to do so. It's may just be an excellent complement to your current testing protocols and hopefully will provide you with greater insight into not only who may be at risk for injury, but also who may end up being your better skaters.