Star Excursion Balance Test Anterior Asymmetry is Associated with Injury Status in Division I Collegiate Athletes
Stiffler MR, Bell DR, Sanfilippo JL, Hetzel SJ, Pickett KA, Heiderscheit BC. J Orthop Sports Phys Ther. 2017; 29:1-27.
Take Home Message: A clinician could use Star Excursion Balance Test anterior asymmetries to possibly differentiate collegiate athletes at greater risk for non-contact knee or ankle injury.
Clinicians use the Star Excursion Balance Test (SEBT) to identify athletes at risk for lower extremity injury. However, athletes’ performance on SEBT has been inconsistent across populations. Factors such as sex and type of sport the athlete plays may contribute to this discrepancy. It is unclear if these factors affect the relationship between SEBT score and risk of injury. Therefore, the authors retrospectively evaluated whether preseason SEBT scores from 147 healthy athletes were related to who experienced a non-contact knee or ankle injury during a season, while controlling for sport, sex, and athletic exposure (starter vs. non starter). Injury was defined as any acute, non-contact, musculoskeletal condition at the knee or ankle sustained during sport participation and required the athlete to be removed for at least 1 day. Among 147 athletes 29 of them experienced an injury. The authors found that dominant limb of the injured group on average had lower reach distances in the anterior direction and a lower composite score (average of the 3 reach directions) compared with the uninjured group. All non-dominant limb reach scores were lower in injured group compared to uninjured. When the authors evaluated the side-to-side asymmetry measures they found that the anterior reach distance was different between groups. However, when accounting for sex, sport, and athletic exposure only the anterior direction asymmetry discriminated between athletes who would or would not develop an injury.
These findings are noteworthy as these authors are one of the first to determine that the SEBT, especially the anterior reach side-to-side asymmetry measure, may be a robust screening method to discriminate between athletes at risk for lower extremity injury. The author’s primary finding was that side-to-side asymmetry in the anterior reach direction (absolute or normalized limb length) was associated with non-contact knee or ankle injury independent of sport, sex, or athletic exposure. More prospective research needs to be conducted to confirm these findings and ascertain a specific cut point for high risk versus low risk athletes. Also, it should be noted that the only excluding factor related to injury history was surgical intervention. They did not exclude anyone with previous ankle sprains, which could also alter results based on previous research, which indicated the SEBT can differentiate those at risk for chronic ankle instability. Finally, it would be valuable to know if sex, sport, starting status, or chronic ankle instability modify the association between SEBT scores and injury risk. For example, the SEBT score may predict who is at risk among soccer players but not among softball players. In the meantime, medical professionals can use the SEBT as one aspect of their screening to help identify athletes at risk for non-contact lower extremity injuries.
Question for Discussion: Do you use SEBT as part of a screen to detect athletes at risk for non-contact lower extremity injuries? If so, has it been helpful? What other screening tools do you currently use?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban