excursion balance test

Star Excursion Balance Test

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 physically active individuals.

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 (e.g. chronic ankle instability), to identify athletes at greater risk for lower extremity injury, as well as during the rehabilitation of orthopedic injuries in healthy active adults (1)

Research has suggested to use this test as a screening tool for sport participation as well as a post-rehabilitation test to ensure dynamic functional symmetry. 

Figure (physiopedia)

How to perform The SEBT:

Conducting the Test (science for sport)

• The athlete should be wearing lightweight clothing and remove their footwear. After doing so, they are the required to stand in the centre of the star, and await further instruction.
• When using the right foot as the reaching foot, and the left leg to balance, the athlete should complete the circuit in a clockwise fashion. When balancing on the right leg, the athlete should perform the circuit in an anti-clockwise fashion.
• With their hands firmly placed on their hips, the athlete should then be instructed to reach with one foot as far as possible and lightly touch the line before returning back to the starting upright position.
• With a pencil, the test administrator should mark the spot at which the athlete touched the line with their toe. This can then be measured from the centre spot after the test to calculate the reach distance of each reach direction. Reach distances should be recorded to the nearest 0.5cm (22).
• They should then repeat this with the same foot for all reach directions before changing foot.
• After they have completed a full circuit (every reach direction) with each foot, they should then repeat this process for a total of three times per leg. For example, they should have three anterior reach performances for both their right and left leg.
• Once the athlete has performed 3 successful reaches with each foot in all directions, they are then permitted to step away from the testing area.
• The test administrator should have recorded the reach distance of each successful attempt, with a pencil, in order to calculate the athlete’s SEBT score after the test.

Scoring System

With the test complete and all performances measured and recorded, the test administrator can then calculate the athlete’s SEBT performance scores using the following simple equations:

• Average distance in each direction (cm) = Reach 1 + Reach 2 + Reach 3 / 3
• Relative (normalised) distance in each direction (%) = Average distance in each direction / leg length * 100

These calculations should be performed for both the right and left leg in each direction, providing you with a total of 16 scores per athlete.

 Normative data

Figure ( Miller, T., 2012).

• According to Hertel, Miller, and Deneger (2000), the reliability of the SEBT ranges between r = 0.85-0.96
• According to Plisky et al (2006), the reliability of this test ranges between 0.82-0.87 and scores 0.99 for the measurement of limb length
• Chaiwanichsiri et al (2005) concluded that the Star Excursion Balance training was more effective than a conventional therapy program in improving functional stability of a sprained ankle
• Plisky et al (2009) concluded that the intra-rater reliability of the SEBT as being moderate to good (ICC 0.67- 0.97) and inter-rater reliability as being poor to good (0.35-0.93) [2]

Supporting Articles/text

Advanced fitness assessment and exercise prescription. Heyward V. Human kinetics, 6th edition: 303 (5)

Miller, T. (2012). National Strength and Conditioning Association. Test and Assessment. Human Kinetics. Champagne, IL.

Bressel E, Yonker JC, Kras J, Heath EM. Comparison of Static and Dynamic Balance in Female Collegiate Soccer, Basketball, and Gymnastics Athletes. Journal of Athletic Training 2007;42(1):42–46.

Chaiwanichsiri D., Lorprayoon E., Noomanoch L. (2005). Star Excursion Balance Training : Effects on Ankle Functional Stability after Ankle Sprain. Journal of Medical Association Thailand 88(4): 90-94 (1B)

Plisky P., Rauh M., Kaminski T., Underwood F (2006) Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players. Journal of Orthopaedic and Sports Physical Therapy. 36 (12) (1B)

Plisky P et al. (2009). The Reliability of an Instrumented Device for Measuring Components of the Star Excursion Balance Test.  American Journal of Sports Physical Therapy. 4(2): 92–99. (2B)

Star Excursion Balance Test

The Star Excursion Balance Test (SEBT) is a simple, but time intensive, test used to measure dynamic balance/dynamic postural control.

By Owen Walker Last updated: February 29th, 2024 8 min read

Contents of Article

What is the Star Excursion Balance Test?

Why is balance important in sports, how do you conduct the star excursion balance test, what is the star excursion balance test scoring system, is the star excursion balance test valid and reliable, further reading.

• About the Author

The Star Excursion Balance Test was developed to be a reliable measure of dynamic stability. Since then, it has proven to be a sensitive indicator of lower limb injury risk in a variety of populations. To add to this, the Star Excursion Balance Test has been shown to have high levels of intra-rater test-retest reliability , though no validity coefficients have been studied.

The Star Excursion Balance Test (SEBT) is a relatively simple, but somewhat time-intensive, test used to measure dynamic balance, otherwise known as dynamic postural control (1). It measures dynamic balance by challenging athletes to balance on one leg and reach as far as possible in eight different directions (2). Though the SEBT is very similar to the Y Balance Test TM , it is important to understand that these are in fact different, with the Y Balance Test TM being a newer and condensed version of the SEBT.

Performance on the SEBT has been shown to differentiate between individuals with lower limb conditions such as chronic ankle instability (3-10), patellofemoral pain (11), and anterior cruciate ligament reconstruction (12). To add to this, the SEBT is even capable of assessing improvements in dynamic balance following training interventions (13, 14).

Perhaps the SEBT’s greatest talent is its ability to identify athletes with a higher risk of lower limb injury. For example, an anterior reach asymmetry of greater than 4cm during the SEBT has been suggested to predict which individuals are at higher risk of lower limb injury (15). However, other researchers have found that only female athletes with a composite score of less than 94 % of limb length were at greater risk of injury (15). More recent research in collegiate American football players has shown that athletes with a composite score of less than 90 % are 3.5 times more likely to sustain an injury (16).

All of this information suggests that each sport and population (e.g. gender) appear to have their own injury risk cut-off point (15, 16).

Balance, otherwise known as ‘postural control’, can be defined statically as the ability to maintain a base of support with minimal movement, and dynamically as the ability to perform a task while maintaining a stable position (17, 18). In a chaotic sporting environment, the ability to maintain a stable position is vital not only for successful application of the skill but to also reduce the likelihood of injury (15, 16, 19).

As dynamic balance is an integral part of performance, and poor balance is related to a higher risk of injury (20, 21, 15), then it may be of great interest to test and monitor an athlete’s dynamic stability.

It is important to understand that whenever fitness testing is performed, it must be done so in a consistent environment (e.g. facility) so it is protected from varying weather types, and with a dependable surface that is not affected by wet or slippery conditions. If the environment is not consistent, the reliability of repeated tests at later dates can be substantially hindered and result in worthless data.

Required Equipment Before the start of the test, it is important to ensure you have the following items:

• Reliable and consistent testing facility (minimum 2×2 metres (m)).
• Test administrator(s)
• Sticky tape (minimum 8m)
• Measuring tape
• Performance recording sheet

Test Configuration Video 1 displays the test configuration for the SEBT. This setup must be adhered to if accurate and reliable data is desired. The test administrator should stick four 120 cm lengths of sticky tape onto the floor, intersecting in the middle, and with the lines placed at 45°   angles (2).

Participants should thoroughly warm up prior to the commencement of the test. Warm-ups should correspond to the biomechanical and physiological nature of the test. In addition, sufficient recovery (e.g. 3-5 minutes) should be administered following the warm-up and prior to the commencement of the test.

Conducting the test

• The athlete should be wearing lightweight clothing and remove their footwear. After doing so, they are then required to stand in the centre of the star and await further instruction.
• When using the right foot as the reaching foot, and the left leg to balance, the athlete should complete the circuit in a clockwise fashion. When balancing on the right leg, the athlete should perform the circuit in an anti-clockwise fashion.
• With their hands firmly placed on their hips, the athlete should then be instructed to reach with one foot as far as possible and lightly touch the line before returning back to the starting upright position.
• With a pencil, the test administrator should mark the spot at which the athlete touched the line with their toe. This can then be measured from the centre spot after the test to calculate the reach distance of each reach direction. Reach distances should be recorded to the nearest 0.5cm (22).
• They should then repeat this with the same foot for all reach directions before changing foot.
• After they have completed a full circuit (every reach direction) with each foot, they should then repeat this process for a total of three times per leg. For example, they should have three anterior reach performances for both their right and left leg.
• Once the athlete has performed three successful reaches with each foot in all directions, they are then permitted to step away from the testing area.
• The test administrator should have recorded the reach distance of each successful attempt, with a pencil, in order to calculate the athlete’s SEBT score after the test.

NOTE: Failed attempts include the following:

• The athlete cannot touch their foot down on the floor before returning back to the starting position. Any loss of balance will result in a failed attempt.
• The athlete cannot hold onto any implement to aid their balance.
• The athlete must keep their hands on their hips at all times throughout the test.
• The athlete must lightly touch their toe on the reach line whilst staying in full control of their body. Any loss of balance resulting in a heavy toe/foot contact with the floor should be regarded as a failed attempt.

With the test complete and all performances measured and recorded, the test administrator can then calculate the athlete’s SEBT performance scores using the following simple equations (17):

• Average distance in each direction (cm) = Reach 1 + Reach 2 + Reach 3 / 3
• Relative (normalised) distance in each direction (%) = Average distance in each direction / leg length * 100

These calculations should be performed for both the right and left leg in each direction, providing you with a total of 16 scores per athlete.

Though no validity coefficients are available for the SEBT, authors (23) have provided evidence that the SEBT is sensitive for screening various musculoskeletal injuries (17). Furthermore, high intratester reliability has been found for the SEBT (intraclass correlation coefficients = 0.78 – 0.96) (24).

We suggest you now check out this article on The Landing Error Scoring System (LESS).

All information provided in this article is for informational and educational purposes only. We do not accept any responsibility for the administration or provision of any testing conducted, whether that results in any positive or negative consequences. As an example, we do not take any responsibility for any injury or illness caused during any test administration. All information is provided on an as-is basis.

• Nelson, Brian D., “Using the Star Excursion Balance test as a predictor of lower extremity injury among high school basketball athletes” (2012).Theses and Dissertations. Paper 389. [Link]
• Gribble PA, Kelly SE, Refshauge KM, Hiller CE. Interrater Reliability of the Star Excursion Balance Test. Journal of Athletic Training 2013;48(5):621–626. [PubMed]
• Akbari M, Karimi H, Farahini H, Faghihzadeh S. Balance problems after unilateral lateral ankle sprains. J Rehabil Res Dev. 2006;43(7): 819–824. [PubMed]
• Gribble PA, Hertel J, Denegar CR. Chronic ankle instability and fatigue create proximal joint alterations during performance of the Star Excursion Balance Test. Int J Sports Med. 2007;28(3):236–242. [PubMed]
• Gribble PA, Hertel J, Denegar CR, Buckley WE. The effects of fatigue and chronic ankle instability on dynamic postural control. J Athl Train. 2004;39(4):321–329. [PubMed]
• Hale SA, Hertel J, Olmsted-Kramer LC. The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. J Orthop Sport Phys Ther. 2007;37(6):303–311. [PubMed]
• Hertel J, Braham RA, Hale SA, Olmsted-Kramer LC. Simplifying the Star Excursion Balance Test: analyses of subjects with and without chronic ankle instability. J Orthop Sport Phys Ther. 2006;36(3):131– 137. [PubMed]
• Martinez-Ramirez A, Lecumberri P, Gomez M, Izquierdo M. Wavelet analysis based on time-frequency information discriminate chronic ankle instability. Clin Biomech (Bristol, Avon). 2010;25(3): 256–264. [PubMed]
• Nakagawa L, Hoffman M. Performance in static, dynamic, and clinical tests of postural control in individuals with recurrent ankle sprains. J Sport Rehabil. 2004;13(3):255–268. [Link]
• Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the Star Excursion Balance Tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train. 2002;37(4):501–506. [PubMed]
• Aminaka N, Gribble PA. Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. J Athl Train. 2008;43(1):21–28. [PubMed]
• Herrington L, Hatcher J, Hatcher A, McNicholas M. A comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls. Knee. 2009;16(2):149–152. [PubMed]
• McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008; 40(10):1810–1819. [PubMed]
• McLeod TC, Armstrong T, Miller M, Sauers JL. Balance improvements in female high school basketball players after a 6- week neuromuscular-training program. J Sport Rehabil. 2009;18(4): 465–481. [PubMed]
• Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36(12):911–919. [PubMed]
• Butler RJ, Lehr ME, Fink ML, Kiesel KB, Plisky PJ. Dynamic balance performance and noncontact lower extremity injury in college football players: an initial study. Sports Health. 2013;5(5): 417–422. [PubMed]
• Bressel E, Yonker JC, Kras J, Heath EM. Comparison of Static and Dynamic Balance in Female Collegiate Soccer, Basketball, and Gymnastics Athletes. Journal of Athletic Training 2007;42(1):42–46. [PubMed]
• Winter DA, Patla AE, Frank JS. Assessment of balance control in humans. Med Prog Technol. 1990;16:31–51. [PubMed]
• Zazulak B, Cholewicki J, and Reeves NP. Neuromuscular control of trunk stability: Clinical implications for sports injury prevention. J Am Acad Orthop Surg 16: 497–505, 2008. [PubMed]
• de Noronha M, Franca LC, Haupenthal A, Nunes GS. Intrinsic predictive factors for ankle sprain in active university students: a prospective study [published online January 20, 2012]. Scan J Med Sci Sports. doi:10.1111/j.1600-0838.2011.01434. [PubMed]
• McGuine T. Sports injuries in high school athletes: a review of injury-risk and injury-prevention research. Clin J Sports Med. 2006;16:488-499. [PubMed]
• Shaffer SW, Teyhen DS, Lorenson CL, Warren RL, Koreerat CM, Straseske CA, Childs JD. Y-Balance Test: a reliability study involving multiple raters. Mil Med. 2013;178(11):1264-70. [PubMed]
• Olmstead L, Carcia C, Hertel J, Shultz S. Efficacy of star excursion balance test in detecting reach deficits in subjects with chronic ankle instability. Journal of Athletic Training. 2002;37(4):501-507. [PubMed]
• Hertel J, Miller S, Denegar C. Intratester and intertester reliability during the star excursion balance test. Journal of Sport Rehabilitation. 2000;9(1):104-116. [Link]

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Home > Fitness Testing > Tests > Balance > Star Excursion

Star Excursion Balance Test (SEBT)

The Star Excursion Balance Test (SEBT) is a test of dynamic balance, using in a single-leg stance that requires strength, flexibility, core control and proprioception. The test requires participants to balance on one leg and reach as far as possible in eight different directions. The similar Y-Balance Test was derived from this test.

purpose : To assess active balance and core control

equipment required: A flat, smooth, non-slip surface, measuring tape, marking tape. To prepare for the test, four 120cm lengths of marking tape are placed on to the floor, intersecting in the middle, and with the lines placed at 45-degree angles.

pre-test: Explain the test procedures to the subject. Perform screening of health risks and obtain informed consent. Prepare forms and record basic information such as age, height, body weight, gender, test conditions. Perform an appropriate warm-up. See more details of pre-test procedures .

procedure: The subject should be wearing lightweight and non-restrictive clothing and no footwear. The subject stands on one foot in the center of the star with their hands on their hips. They then reach with one foot as far as possible in one direction and lightly touch the line before returning back to the starting position. The support foot must stay flat on the ground. This is repeated for a full circuit, touching the line in every reach direction. The assessor should mark the spot on the line where the subject was able to reach. The test should be repeated three times for each foot. The trial is invalid if the subject cannot return to the starting position, the foot makes too heavy of a touch, or if the subject loses balance. see video .

Scoring : After the test all the reached distances are recorded to the nearest 0.5cm. Calculate Average distance in each direction (average of the three measurements) and Relative (normalised) distance in each direction (%) (average distance in each direction / leg length * 100). These calculations should be performed for both the right and left leg in each direction, providing a total of 16 scores per athlete.

Comments: this test has been used as an indicator of lower limb injury risk in a variety of populations

advantages: this is a simple test to perform with simple and inexpensive equipment.

disadvantages: the test can be time-consuming if it needs to be performed on a large group of individuals.

The Test in Action

• See a video description of the star excursion balance test

Similar Tests

• A similar test, the y-balance test

Related Pages

• See a video about the Y Balance test
• About balance testing
• Other balance tests

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Star Excursion Balance Test | Postural Control | Return to Play

• Assessment E-Book

The Star Excursion Balance Test, abbreviated as SEBT consists of a series of reaching tasks with the lower extremity in eight directions. According to a study by Gribble et al. (2013) , the SEBT has excellent inter-rater reliability between 0.86 to 0.92 and has been shown to be able to differentiate individuals with lower limb conditions like chronic ankle instability, Patellofemoral pain, and ACL reconstructions. For this reason, we consider the SEBT as a test with a high clinical value in practice.

In order to conduct the test, first, place 6 strips of tape on the ground at an angle of 45°. Before the actual test is started, 4-6 practice trials in each direction are required after which your patient can rest for 5 minutes.

For the actual test, the patient has 3 official measured test moments. To start, have your patient stand barefoot on one limb with his hands on the hips and ask him to try to reach as far as possible along with each tape. The tape measure should be touched lightly with the most distal portion of the reaching foot without shifting weight to or coming to rest on the foot of the reaching limb and the examiner marks the most distal point of contact on the measuring tape.

A trial is not considered complete if the participant touched heavily, came to rest at touchdown, had to make contact with the ground with the reaching foot to maintain balance, or lifted or shifted any part of the foot of the stance limb during the trial.

After each a trial in a direction, the patient returns his reaching limb to the starting position at the apex of the grid resuming a bilateral stance again. Then, repeat the same procedure with the same limb in another direction. A full circuit is done for one limb if all directions have been covered. Then switch legs and complete another full circuit. At the end of the Star Excursion Balance Test, the patient should have completed 3 full circuits with both legs and the distance of each trial should be measured.

Scoring: To score the SEBT, first calculate the average reach distance in each direction in centimeters, by dividing the sum of all 3 trials per leg through 3. So you should have 16 values. Then, calculate the relative (or normalized) distance in each direction as a percentage by taking the average distance in each direction, divided by the patient’s leg length, and multiplied by 100. If you now compare the legs with each other, this enables you to identify athletes with a higher risk of injury. For example, Plisky et al. (2006) found that an anterior reach asymmetry of greater than 4cm during the SEBT predicted individuals at higher risk for lower limb injuries in basketball players.

Pollock et al. (2010) found that Collegiate American football players with a composite score of less than 90% are 3.5 times more likely to sustain an injury.

Of course, these are only samples of two sport-specific cohorts which is why it is important to mention that the application and the generalization of the SEBT should be carefully considered for each sport and sex, as there is a huge variance in SEBT performance and injury risk between sports and sexes!

LEARN TO OPTIMIZE REHAB & RTS DECISION MAKING AFTER ACL RECONSTRUCTION

Other useful performance tests that you might be interested in are:

• Y-Balance Test
• Drop Jump Test
• Hop Test Cluster

Butler RJ, Lehr ME, Fink ML, Kiesel KB, Plisky PJ. Dynamic balance performance and noncontact lower extremity injury in college football players: an initial study. Sports health. 2013 Sep;5(5):417-22.

Bressel E, Yonker JC, Kras J, Heath EM. Comparison of static and dynamic balance in female collegiate soccer, basketball, and gymnastics athletes. Journal of athletic training. 2007 Jan;42(1):42.

Gribble PA, Kelly SE, Refshauge KM, Hiller CE. Interrater reliability of the star excursion balance test. Journal of athletic training. 2013;48(5):621-6.

Hubbard TJ, Kramer LC, Denegar CR, Hertel J. Contributing factors to chronic ankle instability. Foot & ankle international. 2007 Mar;28(3):343-54.

Plisky PJ, Gorman PP, Butler RJ, Kiesel KB, Underwood FB, Elkins B. The reliability of an instrumented device for measuring components of the star excursion balance test. North American journal of sports physical therapy: NAJSPT. 2009 May;4(2):92.

Robinson RH, Gribble PA. Support for a reduction in the number of trials needed for the star excursion balance test. Archives of physical medicine and rehabilitation. 2008 Feb 1;89(2):364-70.

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Star Excursion Balance Test & Dynamic Postural Control

• Anterior (ANT), posteromedial (PM) and posterolateral (PL) lines.
• Stand on the central point.
• Hands on hips. 
• Reach as far as you can along the line and gently tap the line.
• Do not come to rest on the line.
• Do not transfer your body weight onto the reaching leg.

FACTORS AFFECTING PERFORMANCE 

• Vastus medialis is most active in anterior reach. 
• Vastus lateralis is least active in lateral reach.
• Medial hamstring is most active during anterolateral reach.
• Bicep femoris was most active during posterior and posterolateral reach. 

WHAT DOES THE SEBT TELL US?

Chronic ankle instability (cai):.

• In CAI, all three directions have the ability to identify reach deficits in participants compared to healthy controls, however, the PM is the most representative of the overall performance (Hertel, Braham, Hale & Olmsted-Kramer., 2006). 
• Anterior reach is more impacted by dorsiflexion ROM and plantar cutaneous sensation, meaning that mechanical restrictions and sensory deficits impact this movement.
• DF ROM is best evaluated with the knee to wall weight bearing lunge test compared to non weight bearing AROM (Dill et al., 2014). 
• Posteromedial and posterolateral reach is more impacted by eversion strength and balance control. 
• De la Motte, Arnold & Ross (2015) studied the movement pattern differences in trunk rotation and found that patients with CAI are more likely to use increased trunk flexion during anterior reach which suggests a compensation strategy for reduced ankle control is to manipulate the pelvis and trunk. 

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION (ACLR):

• The same authors (De la Motte, Arnold & Ross., 2015, p.358) also studied trunk movements in ACL patients and found that following an ACLR, when reaching forward, patients are more likely to rotate their trunk away (backwards) from the reach leg and externally rotate the pelvis on the stance leg. 
• In a different study following ACLR, researchers found that when looking above the ankle and at the knee, patients with reduced quadricep strength have reduced reach capacity in the anterior directions (Clagg, Daterno, Hewett & Schmitt., 2015). 
• These same authors also found that hip abductions strength impacts all 3 directions, telling us that dynamic balance has contributions from the foot, ankle, knee, hip and trunk and our assessment of movement patterns should try consider all these areas too. 

PATELLOFEMORAL PAIN SYNDROME (PFPS):

IMPLEMENTATION INTO REHAB

REFERENCES:

Erson Religioso III, DPT, FAAOMPT

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The Star Excursion Balance Test: An Update Review and Practical Guidelines

2021, International Journal of Athletic Therapy and Training

The Star Excursion Balance Test (SEBT) is a reliable, responsive, and clinically relevant functional assessment of lower limbs’ dynamic postural control. However, great disparity exists regarding its methodology and the reported outcomes. Large and specific databases from various population (sport, age, and gender) are needed to help clinicians when interpreting SEBT performances in daily practice. Several contributors to SEBT performances in each direction were recently highlighted. The purpose of this clinical commentary is to (a) provide an updated review of the design, implementation, and interpretation of the SEBT and (b) propose guidelines to standardize SEBT procedures for better comparisons across studies.

Related Papers

Physical education of students

Background and Study Aim: Balance control has been regarded as a crucial factor in sports and indicated as an important element to be examined for the risks of injury. But it is unknown whether the dynamic balance changes according to the player positions in professional soccer players. To determine whether there were differences in the dynamic balance performance of the different positions of Turkish professional soccer players from within one squad. Material and Methods: Twenty-four professional soccer players were divided into 4 groups by the coach, including goalkeepers (n = 3), midfielders (n = 6), defenders (n = 7) and forwards (n = 8). Prior the competition season, anthropometric characteristics of players were measured. Then, players were tested Y Balance Test (YBT) for the anterior (ANT), posteromedial (PM), and posterolateral (PL) reach distances and limb lengths bilaterally. Results: The goalkeepers were heavier compared with the midfielders. Furthermore, the BMI of the g...

Physical Treatments: Specific Physical Therapy Journal (PTJ)

Purpose: Recently, the Functional Movement Screen (FMS) and Y Balance Tests are used to assess the key movement patterns, dynamic stability and to identify individuals at high risk of injury. But, there are few studies to assess the relationship between the FMS test and Y Balance Test. This study aimed to assess the relationship between dynamic stability and the FMS test. Methods: The subjects of this study were 95 students (Mean±SD age=26.7±3.13 y, Mean±SD height=177.4±6.9 cm, Mean±SD weight=72.02±6.91 kg, and Mean±SD BMI=22.93±0.41 kg/ m2) from a university complex. All subjects were evaluated prior to the onset of training. Y Balance Test was used to evaluate dynamic stability and FMS test for evaluating the movement patterns of the subjects. Results: The Pearson correlation coefficient was used to assess the relationship between variables. The results showed a significant association between the FMS score and the aggregate Y score (r=0.205, P=0.04). Also, there was a weak correlation between FMS and normalized posteromedial reach (r=0.27, P=0.04). However, the correlation between FMS and normalized anterior reach and posterolateral reach was not statistically significant (P>0.05). Conclusion: These findings demonstrate partial correspondence between the two tests. However, the relationship is not strong enough to consider them interchangeable. Thus, dynamic postural control is not a large component of the aggregate FMS score.

Journal of Functional Morphology and Kinesiology

Dynamic postural control is challenged during many actions in sport such as when landing or cutting. A decrease of dynamic postural control is one possible risk factor for non-contact injuries. Moreover, these injuries mainly occur under loading conditions. Hence, to assess an athlete’s injury risk properly, it is essential to know how dynamic postural control is influenced by physical load. Therefore, the study’s objective was to examine the influence of maximal anaerobic load on dynamic postural control. Sixty-four sport students (32 males and 32 females, age: 24.11 ± 2.42, height: 175.53 ± 8.17 cm, weight: 67.16 ± 10.08 kg) were tested with the Y-Balance Test before and after a Wingate Anaerobic Test on a bicycle ergometer. In both legs, reach distances (anterior) and composite scores were statistically significantly reduced immediately after the loading protocol. The values almost returned to pre-load levels in about 20 min post-load. Overall, findings indicate an acute negative...

International Journal of Sports Physical Therapy

Brice PICOT

Background Lower extremity injuries among young female handball players are very common. The modified Star Excursion Balance Test (mSEBT) is a valid clinical tool to assess dynamic postural control and identify athletes with higher risk of injury. However, its interpretation is difficult since performance on this test is highly sport dependent. No normative values on the mSEBT exist in handball. Purpose The aim of this investigation was to establish normative ranges of mSEBT performance in young, healthy female handball players to help practitioners when interpreting risk estimates. Study design Cross-Sectional Study Methods Athletes from 14 elite teams were recruited during a national tournament and performed 3 trials in the anterior (ANT), posteromedial (PM), posterolateral (PL) directions of the mSEBT. Means, standard deviations and 95% confidence intervals (95%CI) of normalized reached distances were calculated for each direction and the composite score (COMP). Level of asymmetr...

Ariel S Mandelblum

Humans are creatures of habit, and once the chain has been severed, our routines become horribly disrupted affecting every large & small detail of our lives. Injuries affect both the body and the mind, and without one, the other cannot thrive or hope to recover. Identified on this board are four of the most commonly known postural control assessments, as well as can be utilized to identify injuries as a means of pre-participation screening for athletes. The NCAA (National Collegiate Athletic Association), along with sports psychologists attest to the notion of training the mind even if the body cannot due to an injury. The purpose of this report is to identify which of the four examination protocols presents the highest degree of reliability, and validity towards identifying lower extremity injuries (ankle, knee, hip).

Riley Kenney

Kenney, Riley, MAT, May 2017 Athletic Training REVIEWING THE USE OF INJURY SCREENING ASSESSMENTS AND IDENTIFYING RISK OF INJURY Lower extremity injures account for over half of reported sports related injuries with the ankle and knee being the most commonly injured joints. The majority of non-contact injuries related to these two joints can potentially be prevented through individualized prevention programs. Biomechanical injury screening has the potential to identify the risk factors associated with injury and allows the implementation of targeted rehabilitation strategies to combat the identified deficits. There is substantial need for screening assessments that are practical and accurate for the clinical athletic trainer. This literature reviewed examined the dorsiflexion lunge test, Functional Movement Screen (FMS), Y-Balance, Star Excursion Balance Test and the lower extremity strength assessment as preseason screening tools and their ability to predict future injury of primari...

Dr. YOUSEF ALSHEHRE , Khalid Alkhathami

Background: Individuals with chronic low back pain (CLBP) may demonstrate reduced ability to perform dynamic tasks due to fear of additional pain and injury in response to the movement. The Y-balance test (YBT) is a functional and inexpensive test used with various populations. However, the reliability and validity of the YBT used for assessing dynamic balance in young adults with CLBP have not yet been examined. Purpose: To determine the inter-rater reliability of the YBT and to compare dynamic balance between young adults with CLBP and an asymptomatic group. Study Design: Reliability and validity study. Methods: Fifteen individuals with CLBP (≥ 12 weeks) and 15 age- and gender-matched asymptomatic adults completed the study. Each group consisted of 6 males and 9 females who were 21-38 years of age (27.47 ± 5.0 years). The YBT was used to measure participant’s dynamic balance in the anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions. The scores for each participant were independently determined and recorded to the nearest centimeter by two raters. Both the YBT reach distances and composite scores were collected from the dominant leg of asymptomatic individuals and the involved side of participants with CLBP and were used for statistical analysis. Results: The YBT demonstrated excellent inter-rater reliability, with intraclass correlation coefficients ranging from 0.99 to 1.0 for the YBT scores of both asymptomatic and CLBP groups. The CLBP group had lower scores than those of the asymptomatic group in the reach distances of the ANT (p = 0.023), PM (p < 0.001), and PL (p = 0.001) directions, and the composite scores (p < 0.001). Conclusions: The results demonstrated excellent inter-rater reliability and validity of the YBT for assessing dynamic balance in the CLBP population. The YBT may be a useful tool for clinicians to assess dynamic balance deficits in patients with CLBP.

The Journal of orthopaedic and sports physical therapy

Cailbhe Doherty

Study Design Controlled laboratory study. Objective To utilize kinematic and stabilometric measures to compare dynamic balance during performance of the Star Excursion Balance Test (SEBT) between persons 6-months post first-time lateral ankle sprain (LAS) and a non-injured control group. Background Biomechanical evaluation of dynamic balance in persons following first-time LAS during SEBT performance could provide insight into the mechanism(s) by which individuals proceed to recover fully, or develop chronic ankle instability. Methods Sagittal-plane kinematics of the lower extremity and the center of pressure (COP) path during the performance of the anterior (ANT), posterior-lateral (PL) and posterior-medial (PM) reach directions of the SEBT were obtained from 69 participants, 6 months following first-time acute LAS. Data also were obtained from 20 non-injured controls. Results The LAS group displayed lower normalized reach distances in all 3 reach directions compared to control par...

German Journal of Exercise and Sport Research

Dynamic postural control is one of the essential factors in situations where non-contact injuries mainly occur, i.e., landing, cutting, or stopping. Therefore, testing of dynamic postural control should be implemented in injury risk assessment. Moreover, non-contact injuries mainly occur under loaded conditions when the athlete is physically stressed. Therefore, risk factors and mechanisms of these injuries should also be regarded under loading conditions and not only when the athlete is recovered. Current studies examining the influence of physical load on risk factors, such as dynamic postural control, often use cycling protocols to stress the participants. Nevertheless, most types of sports require running as a central element and the induced internal load after cycling might not be the same after running. Therefore, the current study aimed to examine the influence of a running and a cycling protocol on dynamic postural control and to determine the potential injury risk under rep...

Journal of sport rehabilitation

Mary Ireland

The Y-Balance Test was developed as a test of dynamic postural control and has been shown to be predictive of lower extremity injury. However, the relationship between hip strength and performance on the Y-Balance Test has not been fully elucidated. The goal of this study was to identify the relationship between components of isometric hip strength and the Y-Balance Test, to provide clinicians better guidance as to specific areas of muscle performance to address in the event of poor performance on the Y-Balance Test. Laboratory Study. Biomechanics Laboratory. Seventy-three healthy participants, 40 males and 33 females, volunteered for this study. None. Participants completed the Y-Balance Test on the right leg. We then measured peak isometric torque in hip external rotation, abduction, and extension. Correlations were calculated between torque measurements, normalized for mass, and Y-Balance Test performance. Significant relationships were used in linear regression models to determi...

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Star Excursion Balance Test

My favourite dynamic postural control objective outcome measure.

Firstly, thanks for checking out the video. I hope that it was helpful and if you are not already using the Star Excursion Balance Test you will now.  This is the information that I felt was too ‘nitty gritty’ to include in the video.

Reliability of the Star Excursion Balance Test

The reliability of the SEBT components utilised (i.e. the anterior, posteromedial and posterolateral) ranged from 0.82 to 0.87 (ICC3,1) (Plisky et al. 2006). To put this in perspective, it is of similar reliability to assessing knee flexion ROM with a universal goniometer (Brosseau et al. 1997).

Clinical Implications of This Measure

Assessing Intervention Effectiveness: as a reliable measure, you can use it to gauge an athletes improvements in dynamic postural control over time.

Injury Prediction: Plisky et al. (2006) showed that athletes with anterior left/right reach differences greater than 4 cm were 2.5 times more likely to sustain a lower limb injury over the course of a season. They also found that female athletes with a composite reach distance less than 94.0% of their limb length (measured from ASIS to lateral malleolus) were 6.5 times more likely to have a lower extremity injury!

Relevant to Athletic Population: the SEBT is sensitive enough to show dynamic postural control in a number of athletic populations including ACL deficient and Chronic Ankle Instability patients (Herrington et al. 2009; Hertel et al. 2006).

Conclusions

My conclusion is that is a sweet test. If you want to objectively assess an athlete’s responses to neuromuscular and postural control training (and honestly why would you not) this is your go-to. This can be a massive motivational tool, and also proves how helpful your exercises are. Also, if you want to “pre-screen” for injury this can also be used as a helpful predictor and should be a component of your assessment.

Go set it up right now, and enjoy your new favourite outcome measure.

Brosseau L, Tousignant M, Budd J, Chartier N, Duciaume L, Plamondon S, O’Sullivan JP, O’Donoghue S, Balmer S. Intratester and intertester reliability and criterion validity of the parallelogram and universal goniometers for active knee flexion in healthy subjects. Physiotherapy Research International 1997; 2(3):150-166

Herrington L, Hatcher J, Hatcher A,  McNicholas M. A comparison of Star Excursion Balance Test reach distances between ACL defiient patients and asymptomatic controls. The Knee 16 (2009) 149–152

Hertel J, Braham RA, Hale SA, Olmsted Kramer LC. Simplifying the Star Excursion Balance Test: Analyses of Subjects With and Without Chronic Ankle Instability. J Orthop Sports Phys Ther 2006;36:131-137.

Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players. J Orthop Sports Phys Ther 2006;36(12):911-919

Related Posts

hey fellow profession,

im a brazilian academic of physiotherapy and my work of completion of course is about a star test balance in injury of ACL and I don’t have found articles about SEBT, so you can send me your references on this post???

i really need… thanks

Natália Goulart ( [email protected] )

Hi Natália,

Thanks for your interest. Unfortunately, I am not able to distribute PDF documents of articles given this is digital piracy. You can, however, access these articles via each Journal’s website e.g. Journal of Orthopaedic Sports and Physical Therapy: http://www.jospt.org/ .

Hope this helps you out!

I currently using SEBT for my dissertation and I am at the point of putting the results into microsoft excel. What I wanted to know was what is the correct equation for measuring the composite scores?

Hope you can answer this Thanks

Seti ( [email protected] )

[…] This post was mentioned on Twitter by The Sports PT, The Sports PT. The Sports PT said: My favourite dynamic postural control measure – The Star Excursion Balance Test. http://bit.ly/9Eo7GN #physiotherapy #physicaltherapy […]

Support for a reduction in the number of trials needed for the star excursion balance test

Affiliation.

• 1 Department of Kinesiology, University of Toledo, Toledo, OH, USA.
• PMID: 18226664
• DOI: 10.1016/j.apmr.2007.08.139

Robinson RH, Gribble PA. Support for a reduction in the number of trials needed for the Star Excursion Balance Test.

Objective: To determine the number of trials necessary to achieve stability in excursion distance and stance leg angular displacement for the 8 directions of the Star Excursion Balance Test (SEBT).

Design: One-way repeated-measures analysis of variance.

Setting: Athletic training laboratory.

Participants: Twenty participants (10 men, 10 women) without any known musculoskeletal injuries or neurologic deficits that could have negatively affected their dynamic balance volunteered for the study.

Intervention: Participants completed 6 practice and 3 test trials in each of the 8 reach directions of the SEBT.

Main outcome measures: Excursion distances of the reaching leg normalized to leg length and angular displacement at the hip and knee of the stance leg in all 3 planes of movement were determined.

Results: There were significant increases in excursion distance, hip flexion, and knee flexion for 7, 4, and 5 of the 8 reach directions, respectively.

Conclusions: For the majority of the reach directions, maximum excursion distances and stance leg angular displacement values achieved stability within the first 4 practice trials, thus justifying a reduction in the recommended number of practice trials from 6 to 4 and supporting the trend toward simplifying SEBT administration.

• Analysis of Variance
• Biomechanical Phenomena
• Hip Joint / physiology
• Knee Joint / physiology
• Postural Balance / physiology*
• Research Design

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• v.14(2); 2019 Apr

THE MODIFIED STAR EXCURSION BALANCE AND Y-BALANCE TEST RESULTS DIFFER WHEN ASSESSING PHYSICALLY ACTIVE HEALTHY ADOLESCENT FEMALES

The modified Star Excursion Balance Test (mSEBT) and Y-Balance Test (YBT) are two common methods for clinical assessment of dynamic balance. Clinicians often use only one of these test methods and one outcome factor when screening for lower extremity injury risk. Dynamic balance scores are known to vary by age, sex and sport. The physically active adolescent female is at high risk for sustaining lower extremity injuries, specifically to the anterior cruciate ligament (ACL). Thus clarity regarding the use of dynamic balance testing results in adolescent females is important. To date, no studies have directly compared the various outcome factors between these two dynamic balance tests for this population.

To determine if there was an association between the mSEBT and YBT scores for measured reach distances, calculated composite score and side-to-side limb asymmetry in the ANT direction in physically active healthy adolescent females.

Study Design

Cross-sectional study.

Twenty-five healthy, physically active female adolescents (mean age, 14.0 ± 1.3 years) participated. Reach distances, a composite score and side-to-side limb asymmetry for the mSEBT and YBT, for each limb, were compared and examined for correlation.

There were significant differences and moderate to excellent relationships between the measured reach directions between the mSEBT and the YBT. Injury risk classification, based on limb asymmetry in the anterior reach direction, differed between the tests. However, the calculated composite scores from the two tests did not differ.

Conclusions

Performance scores on a particular reach direction should not be used interchangeably between the mSEBT and YBT in physically active adolescent females, and should not be compared to previously reported values for other populations.

Level of Evidence

Introduction.

Clinicians often use dynamic balance tests as a functional screen to identify athletes at-risk of injury, assess deficiencies following injury, and monitor rehabilitation progress. 1 The Star Excursion Balance Test (SEBT) 2 , 3 and Y-Balance Test (YBT) 4 , 5 are two reliable methods commonly used to clinically assess dynamic balance of the lower extremity. The time consuming eight-reach direction SEBT is often modified (mSEBT) to use only three reach directions: Anterior (ANT), Posteromedial (PM) and Posterolateral (PL). 6 - 8 The commercially available YBT apparatus (Move2Perform, Evansville, IL) is an instrumented version of the mSEBT, designed to improve repeatability and standardize test procedures. 4 Both the mSEBT and YBT simultaneously assess range of motion, flexibility, neuromuscular control and strength. 9 Within each test, there are a number of factors that can be reported and analyzed to assess lower extremity injury risk, such as the maximal reach distance measured in specific reach directions, a calculated composite score and side-to-side asymmetries in the anterior reach direction. Normative dynamic balance performance scores vary depending on the age, sex or specific sport played of the population. 10 - 16 Ankle injuries have been linked to a reduced reach distance in the PM direction in recreationally active college students, 17 while ankle sprains in high school and college football athletes were linked to a reduced reach distance in the ANT direction. 18 Normalized composite scores of less than 94% on the mSEBT in high-school female basketball players 14 and less than 86.5% in college football players 10 on the YBT indicate a significant risk of lower extremity injury. The likelihood of sustaining a noncontact lower limb injury is also increased with ANT reach distance asymmetry between limbs of greater than 4 cm in high school basketball players for the mSEBT 14 and Division I athletes for the YBT. 19

Although the tests are very similar in nature, there are differences in the neuromuscular demands associated with each test. Within a healthy adult population reach distances and kinematic profiles differ between the mSEBT and YBT suggesting that the values between tests should not be used interchangeably. 20 , 21 With the variability in performance between subjects of different ages, sexes, and sport participation, 13 , 22 it has been suggested that normative data, and injury risk thresholds or cut-off scores should only be utilized for comparison with the specific test and participant population from which they were developed. 23

Several investigations of adults and collegiate populations have noted differences within and between the SEBT and YBT, 20 , 21 however the literature lacks information regarding clinical dynamic balance tests for healthy active adolescent females. Although the relationship between the two dynamic balance scores for the adolescent female population is currently not known, it is of particular interest as this demographic carries a high-risk of sustaining lower extremity injuries, specifically to the anterior cruciate ligament (ACL) of the knee. Active adolescent females are four to six times more likely than males to sustain an ACL injury when participating in the same sports. 24 Additionally, young female athletes who return to sport following an ACL injury have the highest rate of re-injury (ipsilateral and contralateral) and are at 30-40 times greater risk of ACL injury compared to uninjured adolescents. 25 Clinicians may be incorrectly classifying young female athletes by inadvertently interchanging indices of performance between the mSEBT and YBT, or using injury-risk thresholds that have been established for a different population.

The purpose of the current study was to determine if there was an association between the mSEBT and YBT scores for measured reach distances, calculated composite score and side-to-side limb asymmetry in the ANT direction in physically active healthy adolescent females. As there are reported inconsistencies between the tests in an adult population, it was hypothesized that measured reach distances, a calculated composite score and side-to-side limb asymmetry for the ANT reach direction will differ between the mSEBT and YBT for physically active healthy adolescent females.

Participants

Following approval from the University of Manitoba's Health Research Ethics Board (H2014:302), 25 recreationally active adolescent females with no recent trauma to the lower extremity were recruited from the community to participate in this laboratory-based study. An a priori power analysis using data from a previous study of healthy recreationally active adults indicated that 22 subjects would be adequate to assess the mSEBT. 15 , 26 Inclusion criteria stated that volunteers were required to be female, 12-18 years of age, with no history of a lower limb musculoskeletal injury or concussions in the prior six months. Participants were excluded if they failed a standardized screening criteria protocol by having knee joint effusion, being unable to fully flex and extend the knee joint, demonstrating quadriceps lag with an active straight-leg raise, having quadriceps strength less than 75% of the unaffected leg on manual muscle testing or being unable to perform 10 consecutive pain free hops 27 . Informed consent was obtained from parents and participants prior to initiation of study activities.

Testing Protocol

Demographic information, such as age, leg dominance (based on the leg preference for kicking a ball) and sport participation were collected. Maturation status was determined using the self-reported pubertal maturation observational scale (PMOS). 28 The Physical Activity Questionnaire for Adolescents (PAQ-A) assessed physical activity level as a score of 1-5, 1 indicates a subject is minimally active and 5 extremely active. 29 Anthropometric data including height and weight were measured. The mSEBT and the YBT were completed according to previously described protocols, 4 , 9 and required subjects to perform testing while barefoot, maintaining their hands on their hips. For the mSEBT, subjects performed a series of single-limb squats using the non-stance limb to touch a point a maximum distance along designated lines on the ground ( Figure 1 ). The mSEBT has been established as a reliable measure of dynamic balance in adolescents, with intra-rater intraclass correlation coefficients (ICCs) ranging from 0.82 to 0.87 and coefficients of variation ranging from 2.0% to 2.9%. 14 Lab pilot study results indicated inter rater ICCs ranged from 0.69 to 0.95 for the YBT reach directions and from 0.59 to 0.75 for the SEBT reach directions.

Modified star excursion balance test (mSEBT) for the left stance limb. a: Anterior reach direction; b: Posteromedial reach direction; c:Posterolateral reach direction .

The YBT (Move2Perform, Evansville, IL) is a commercially available, instrumented product that is used to evaluate the same three reach directions as the mSEBT ( Figure 2 ). Subjects maintain a one-legged stance on an elevated stance platform from which three pieces of plastic pipe extend in the specific ANT, PM and PL directions. With the non-stance foot, participants push an indicator to a maximum distance along the pipe, marked with 0.5 cm increments. A previous study indicated that the YBT is a reliable method for assessing dynamic balance; within session inter-rater ICCs 0.54 to 0.82 and typical error values of 5.9% in children. 15

Y-balance test (YBT) for the left stance limb. a: Anterior reach direction; b: Posteromedial reach direction; c: Posterolateral reach direction .

For both tests, subjects performed the recommended four practice trials, in each direction prior to completing the three test trials on each limb. 4 , 8 A standardized order of testing was utilized, the right stance limb was measured first in the order of ANT, PM and PL. Testing was repeated in the same order for the left stance limb. If the subject removed their hands from their hips, lost their balance or rested their reaching foot on the ground (mSEBT), kicked the reach-indicator plate to gain more distance (YBT), made contact with the ground on the reach or return to bilateral stance to gain balance, or lifted or shifted any part of the stance foot the trial was considered incomplete, and was repeated. The distance of the toe touch reached along each direction was marked and subsequently measured by an investigator for the mSEBT, while the most proximal edge of the reach indicator from the apex of the YBT was recorded.

The average of three successful test trails for each reach direction was used for data analysis. Limb length (LL) was measured from the anterior superior iliac spine to the most distal aspect of the ipsilateral medial malleolus in supine lying. 2 All reach distances were normalized as a percentage of the stance limb length using the formula [% = (excursion distance/LL) × 100]. A composite score, which is an average of all three reach distances, [Comp = ((ANT+PM+PL)/(3 × LL)) × 100] was also calculated for each limb. The absolute difference in the anterior reach direction distance (centimeters) between limbs was calculated to assess side-to-side asymmetry. 23

Statistical Analysis

Descriptive data for both the mSEBT and YBT were calculated. Student paired t-tests were used to test the differences in reach distance scores between limbs and between the mSEBT and YBT. For the measured reach distance scores of the mSEBT differences of at least 6-8% are needed to feel confident that a clinical change in performance has occurred 26 . A Bonferroni correction alpha level of p <0.004 (0.05/12) was used to compare the right and left limb because of the standardized test order of mSEBT followed by YBT, with the right limb reach directions always tested prior to the left limb. An alpha level of p < 0.05 was set for all other comparisons. 20 Effect sizes (Cohen's d) for the differences between the mSEBT and YBT scores were calculated with values less than 0.2, 0.21 to 0.79, and above 0.80 considered to represent weak, moderate and strong effects, respectively 30 . Pearson correlations and Bland-Altman assessments of agreement were used to compare performance on all three reach directions and the composite score for the mSEBT and YBT. 20 , 21 , 31 Correlation coefficients (r) of 0.25-0.49, 0.50-0.74, and 0.75-1.0 were considered to represent weak, moderate and excellent relationships, respectively. 32 The absolute difference in the anterior reach distance (centimeters) between limbs was assessed with Student paired t-tests, and compared with the established absolute side-to-side asymmetry injury risk cut-off value of greater than 4 cm. 14 , 19

Demographic information and anthropometric data for participants are presented in Table 1 . Results indicate that participants were predominantly post-pubertal adolescents with a normal BMI, right leg dominant and participated in a variety of sport activities. Separate 1-way analysis of variance based on maturation status and activity level indicated that these factors had no significant impact on dynamic balance reach direction scores, thus all subjects were grouped together for comparison of the tests. Comparison between the right and left limb indicated that there were no statistically or clinically significant between limb differences for either the mSEBT or the YBT. Statistically and clinically significant differences were observed between the mSEBT and YBT for all three measured reach directions. However, no significant differences were noted between the two procedures for the calculated composite scores or absolute asymmetry in the anterior direction ( Table 2 ). Effect size calculations indicated that results were moderate to strong for all three measured reach distances, but weak for the composite score and absolute asymmetry. Pearson product-moment correlation coefficients between the mSEBT and YBT indicated a moderate to excellent relationship for all the measured reach directions, except the left limb in the anterior direction and the right limb in the posterolateral direction which both had a weak relationship ( Table 3 ). Bland-Altman assessments of agreement between the mSEBT and YBT indicated that there was a bias between the three reach directions, however the calculated composite scores showed good agreement ( Table 4 ). Two subjects had a greater than 4 cm absolute asymmetry in the anterior direction for the mSEBT and a different two subjects for the YBT ( Figure 3 ).

Absolute side-to-side difference in the anterior reach direction .

Participant demographic and anthropometric information, reported as mean ± SD, (95% confidence interval) .

BMI = body mass index; PAQ-A = physical activity questionnaire for adolescents

Measured reach distances, calculated composite scores and absolute side-to-side asymmetry for the mSEBT and YBT, reported as mean ± SD, (95% confidence interval)] .

mSEBT = modified star excursion balance test; YBT = Y-Balance Test

Correlation ( r ) between reach distances for the mSEBT and the YBT .

Abbreviations: mSEBT, modified star excursion balance test; YBT, y-balance test

Bland-Altman assessments for agreement between the mSEBT and the YBT .

D = mean difference; SD diff = standard deviation of the difference

This is the first report to compare the results from the mSEBT and YBT with a healthy physically active female adolescent population that is at significant risk for lower extremity injury. The main finding of this investigation was that measured participant scores for the three reach directions differ between the mSEBT and YBT. The anterior reach distance was greater for the mSEBT than the YBT, interestingly the posteromedial and posterolateral distances were less for the mSEBT than the YBT. In contrast, the opposing skewness of the measured reach directions resulted in similar values for the calculated composite scores for the tests. Also the established injury risk cut-off score of greater than 4 cm absolute asymmetry in the anterior direction identified different subjects at-risk of injury depending on the test method. As a consequence, caution should be used when comparing the results from the mSEBT and the YBT for a healthy physically active adolescent female population. When comparing these scores to the reported values for other populations within the literature, the test scores should remain exclusive to their specific population and test method. 20 , 21 , 23

Demographic data confirmed that participants were young, physically active individuals engaged in a wide range of sporting activities. This finding is important as it serves to extend the findings of other investigations on the YBT and mSEBT which focused on sport specific populations (such as basketball or soccer), 14 , 16 age specific populations (i.e., college-aged or young adults), 6 , 12 , 26 or specific competitive levels within sport (i.e., Division I or elite athletes). 11 , 19 Data presented are representative of a typical adolescent female population that participates in a variety of sporting activities and is nearing or has recently reached physical maturation. Anthropometric data also help to confirm that our adolescent females were representative of a healthy population that included individuals with various body types (tall/short; thin/muscular, etc.). Again, this finding serves to enhance the overall generalizability of our results to a broad population of adolescent females. Clinical measures of dynamic balance are a critical component of pre-participation screening in this population. If clinicians can accurately identify healthy adolescent female athletes who may be at an increased risk of sustaining lower extremity injuries, they can then advise and implement intervention strategies to address the factors associated with the epidemic of lower extremity injuries (especially to the ACL) seen in this population.

Two previous studies compared performance on the SEBT versus YBT for healthy active male and female adult populations. For reach in the anterior direction, both studies found a difference between the SEBT and YBT. 20 , 21 One suggested that disparities in posture control strategies may be responsible for the differences between the tests, and hypothesized that the SEBT predominately relies on a feed-forward control strategy until contact is made with the toe touch. 20 By comparison the same report suggested that during the YBT, constant proprioceptive feedback is received as the reach-foot toe remains in contact with the reach-indicator throughout the excursion (feedback control). 20 Additionally, while the stance platform is relatively low, the slight elevation in stance position maintained during the YBT may also contribute to the decreased reach distance. 20 The other study 21 reported that the performance of the SEBT and YBT differed in relation to dynamic neuromuscular demands, as evident by the difference the anterior reach distances and associated kinematic profiles. For anterior reach, there was a negative correlation between reach distance and hip-joint sagittal-plane angular displacement for the SEBT (i.e., as hip joint flexion increased, reach distance decreased). In contrast, there was a positive relationship between reach distance and hip-joint sagittal plane angular displacement during performance of the YBT (i.e., as hip joint flexion decreased, reach distance decreased). 21

In addition to anterior direction differences, the results indicate that the reach distances for the posteromedial and posterolateral directions also differed between the mSEBT and the YBT. This is not consistent with the findings of the two reports noted above. 20 , 21 The sensorimotor system that regulates balance and postural awareness relies on information from the visual, vestibular and somatosensory subsystems. 33 When reaching in the anterior direction subjects receive visual feedback on their performance. However, in the posteromedial and posterolateral directions visual awareness is lower, which places a greater reliance on the non-visual somatosensory system. Coughlan et al. 20 reported that the reach distance achieved in the anterior direction was less for the YBT compared to the SEBT. When visual awareness was decreased in the posterior directions, a similar score was achieved between the SEBT and YBT. Their report suggested this increase in YBT performance relative to SEBT was due to the increased somatosensory feedback for the YBT due to the constant toe contact with the reach-indicator. 20 An important difference between the previous studies and the present investigation is the demographic characteristics of participants. Subjects in that study were healthy adult males 22.5 ± 3.05 years of age while this investigation assessed healthy adolescent females. Pubertal growth is reported to inhibit the sensorimotor functions of the lower extremity; thus, during dynamic postural control tasks adolescents heavily rely on visual cues. 34 The impaired non-visual somatosensory systems in adolescents may be the reason why the same increase in YBT performance relative to the SEBT is not demonstrated in our population. This may explain why performance in the posterior reach directions of the mSEBT and YBT were different for subjects in this investigation, yet were the same in an adult population. 20 Protocol variations in which testing in this investigation occurred during one session while these other two studies 20 , 21 conducted each dynamic balance test a week apart may have also contributed to the differences observed in the posterior reach directions. The present results indicate that female adolescent subjects performed differently on both the SEBT and YBT assessment methods when compared to an adult population. Caution should be used when interpreting and comparing reach distance performance for adolescents to those achieved by adults.

In addition to the measured reach directions, a composite score was calculated for both the mSEBT and YBT. Bland-Altman analysis of the data indicated that for the anterior reach direction, the mSEBT distance was greater than YBT. However, the mSEBT reach distances were less than the YBT for both the posteromedial and posterolateral reach directions. Thus, when the composite score was calculated, the positively and negatively skewed reach values resulted in a value which was similar between the two tests. The inherent scoring differences in different reach directions, and possible differences in overall dynamic balance, are concealed when the assessment only includes the composite score values. Therefore, it is recommended that when assessing dynamic balance, participant performance on the individual reach directions should be analyzed, in conjunction with the calculated composite scores, as results of this investigation indicates that examination of only the composite score may not accurately reflect the true differences in dynamic balance performance for each test. Composite score values alone are often used in the literature to assess sport-specific risk of injury. A normalized SEBT composite score of less than 94.0% was shown to indicate the risk of a lower extremity injury in high school basketball players. 14 College football players who score less than 89.4% on the normalized YBT composite score are also at an increased risk of injury. 10 The average composite scores for our subjects were above both of these cut-off values for both the mSEBT and the YBT. Based on the above reported values for injury risk, mSEBT results indicated that five of the subjects were vulnerable to a lower extremity injury. For the YBT, only four subjects were at an increased risk of injury. Furthermore, only one individual was identified as susceptible to injury via both test cut-off values. The remaining at-risk individuals identified in the mSEBT were different from those identified in the YBT, once again highlighting that a difference between the tests exists. This suggests that the sport-specific injury risk dynamic balance composite score cut-off values for high school basketball and college football players may not be accurate for physically active adolescent females. 13 Determination of such injury risk cut-off values for physically active adolescent females was beyond the scope of this study, and would be very useful for future application.

Asymmetries between limbs is also often used as a screening tool to determine those who may be at increased risk of sustaining an injury. 10 , 14 A difference in the raw anterior reach distance of more than 4cm between limbs for either the mSEBT 14 or the YBT 19 is clinically significant, and suggests a greater likelihood of sustaining a noncontact lower limb injury. 5 , 6 , 14 , 15 , 26 Recently, Stifler et al. 23 found that in Division I collegiate athletes’ side-to-side asymmetry in the anterior reach direction of the SEBT was associated with injury. As dynamic balance scores vary based on age, sex and sport 13 it is unknown if this established injury risk cut-off value is appropriate for female adolescent athletes. This is the first report to compare injury risk classification based on limb asymmetry between the SEBT and YBT for the recreationally active female athlete. Analysis of raw anterior scores indicated that two subjects using the mSEBT and a different two subjects using the YBT had asymmetries of more than 4cm. Once again, results indicate that there is a difference between the two test methods for the specific population in this investigation. Further investigations of this population with a larger sample size are required to assess healthy and injured subjects to determine an appropriate cut-off value for each of the test methods.

Typically, clinicians will only complete one dynamic balance test as part of an evaluation. Both the mSEBT 14 and YBT 15 are reliable; as such, either test would be appropriate to assess dynamic balance in adolescent females, however the tests should not be used interchangeably. Each test protocol has its own strengths and limitations. The mSEBT does not require costly equipment and allows an evaluator to assess five reach directions in addition to the three used for the modified protocol. However the toe touch is harder to quantify and control in the mSEBT. The instrumented YBT may provide quicker and more standardized measurements, it is limited to assessing only the anterior, posteromedial and posterolateral reach directions and may not be financially feasible for all clinicians. The goal of the present study was not to assess whether one test is superior to the other in assessing dynamic balance. The purpose was to evaluate whether the outcome factors of reach distance, composite scores and side-to-side limb asymmetry in the ANT direction of the mSEBT were interchangeable with those of the YBT, and to determine if previously reported thresholds determined in other populations would be accurate when classifying adolescent female athletes at-risk of injury. Although most test scores were found to have a moderate positive correlation between the two test methods based on Pearson product-moment correlations, t-test results showed that the absolute values of the mSEBT reach directions are not interchangeable with the absolute reach values of the YBT. This means that if a subject had a high reach distance on the mSEBT, they would also have a high score when performing the same reach direction on the YBT. But a reach distance score of 94% on the mSEBT, was not the same as a reach distance of 94% on the YBT. Subjects are inconsistently classified as at-risk for an injury when using the previously established cut-off value of greater than 4 cm asymmetry in the anterior reach direction. Researchers and clinicians should be aware of these inherent differences when interpreting and implementing these dynamic balance tests.

It is important to acknowledge that this study did have several limitations, primarily related to the specific population which limits the external validity, but addresses an important deficiency in the literature regarding clinical dynamic balance tests for this population. While several sport-specific reports examined the mSEBT and YBT in female athletes, the diverse group of sporting activities of subjects in this investigation allows commentary on a more broad-based population of athletes. This population is of particular interest to clinicians as athletically active adolescent females are at a high-risk of sustaining lower extremity injuries. A priori power analysis indicated that our sample size was appropriate to assess the measured reach distances of dynamic balance tests, 15 , 26 however sample size was a limitation for the composite score and absolute side-to-side limb asymmetry. While future studies will need a larger sample size to establish normative values for both healthy and injured physically active adolescent females, this investigation is the first to report dynamic balance scores for a recreationally active adolescent female population, drawn from a diverse sporting population. Importantly, placement of the stance limb foot varies between the mSEBT and YBT: in the mSEBT, the heel is aligned to the center of the mSEBT grid, 1 and for the YBT, the toes of the stance limb are aligned to the center of the grid. Differences in the anterior reach distances between the tests may be directly related to this variation. In future studies comparing the test procedures, the mSEBT should adapt the standardized foot position of the YBT.

The results of this study suggest that although both the mSEBT and YBT can be used clinically to measure dynamic balance, performance scores on a particular reach direction should not be used interchangeably between the mSEBT and YBT in this population. Since administration of the mSEBT and YBT protocols varies within the literature, specific detailed methodology should be carefully reviewed by clinicians and researchers when interpreting dynamic balance scores and using cut-off values to classify individuals at-risk of injury. Further research is clearly needed in order to establish normative values for the SEBT and YBT in the adolescent female population, and determine the limits of reliability for dynamic balance testing in healthy and ACL-injured individuals.

• Open access
• Published: 13 August 2024

Enhancing physical attributes and performance in badminton players: efficacy of backward walking training on treadmill

• Omkar Sudam Ghorpade 1 ,
• Moattar Raza Rizvi 2 , 8 ,
• Ankita Sharma 1 , 9 ,
• Harun J. Almutairi 3 ,
• Fuzail Ahmad 4 ,
• Shahnaz Hasan 5 ,
• Abdul Rahim Shaik 5 ,
• Mohamed K. Seyam 5 ,
• Shadab Uddin 6 ,
• Saravanakumar Nanjan 6 ,
• Amir Iqbal 7 &
• Ahmad H. Alghadir 7  

BMC Sports Science, Medicine and Rehabilitation volume  16 , Article number:  170 ( 2024 ) Cite this article

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Metrics details

Badminton, a dynamic sport, demands players to display exceptional physical attributes such as agility, core stability, and reaction time. Backward walking training on a treadmill has garnered attention for its potential to enhance physical attributes and optimize performance in athletes while minimizing the risk of injuries.

By investigating the efficacy of this novel approach, we aim to provide valuable insights to optimize training regimens and contribute to the advancement of sports science in badminton.

Methodology

Sixty-four participants were randomized into a control group ( n  = 32) and an experimental group ( n  = 32). The control group received routine exercise training, while the experimental group received routine exercise training along with additional backward walking training on the treadmill. Pre- and post-intervention measurements were taken for core stability using the Plank test, balance using the Star Excursion Balance test, reaction time using the 6-point footwork test, and agility using the Illinois Agility test.

The results showed that the experimental group demonstrated significant improvements in core stability ( p  < 0.001), balance ( p  < 0.001), reaction time ( p  < 0.05), and agility ( p  < 0.001) compared to the control group. The backward walking training proved to be effective in enhancing these physical attributes in badminton players.

Incorporating backward walking exercises into the training regimen of badminton players may contribute to their overall performance.

Peer Review reports

Introduction

Badminton is a popular and widely practiced racket sport that has gained immense popularity worldwide [ 1 ]. It is a fast-paced and highly dynamic game, requiring players to demonstrate a combination of technical skills, physical fitness, and mental acuity [ 2 ]. With its roots in ancient China and India, badminton has grown to become the national sport of several Asian countries, with a strong presence in both professional and recreational circles [ 3 ]. In the past few decades, badminton has gained global recognition as one of the fastest racket sports, attracting a diverse and ever-growing community of enthusiasts.

For winning the games and performing better the players must utilize a wide range of shot variations, including smashes, clears, drops, and drives, to outmaneuver their opponents and secure a competitive advantage [ 4 ]. The game’s rapid and dynamic nature necessitates a high level of physical fitness, making strength, endurance, power, reaction time, agility, speed, adaptability, balance, and coordination essential attributes for successful players [ 5 ]. To excel in badminton, athletes need to combine sound technical skills with a strong physical foundation to execute precise and powerful shots while maintaining fluid movement across the court [ 6 ].

Agility is a paramount attribute in badminton that significantly affects a player’s overall performance on the court [ 7 ]. Exceptional agility allows players to cover the court more efficiently, reach the shuttlecock in time, and execute shots accurately from various positions. In the dynamic and fast-paced nature of badminton, players must execute rapid body movements with precision and speed, making agility a critical factor in maintaining a competitive edge [ 8 ].

Reaction time is an essential characteristic for badminton players, as it has a significant impact on their ability to respond quickly and effectively to the dynamic and fast-paced nature of the game. Rapid shot return, anticipation, defensive skills, net play, drop shots, net kills, rally control, footwork and court coverage, deception and strategy, competitive edge, and mental agility are indispensable [ 9 ]. On the badminton court, training and enhancing reaction time through specific maneuvers and exercises can enhance a player’s performance and contribute to their success [ 10 , 11 ].

Another critical aspect of a badminton player’s physical preparation is core strength and stability [ 12 ]. Core muscles play a crucial role in stabilizing the spine, transferring force between the upper and lower extremities, and controlling the body’s center of gravity. They facilitate fluid movement and efficient power transfer during various game actions, such as lunges, jumps, and swings [ 13 ]. Core strength training has been extensively utilized not only to prevent lower back and lower limb injuries but also to optimize player performance in badminton and other sports [ 14 ].

Furthermore, posture and balance are key factors contributing to a player’s performance on the court. Maintaining proper body control and posture during rapid and complex movements is essential to execute shots accurately and efficiently [ 15 ]. The ability to control joint movement and position dynamically is crucial for swift changes in direction, evasive maneuvers, and quick responses to opponent shots. Badminton players with superior agility and balance tend to outperform their peers and are less prone to injuries resulting from incorrect footwork or unstable landing postures [ 16 , 17 ].

Backward walking, also known as retro walking, has gained popularity as an easy, cost-effective exercise that promotes health and quality of life. In the context of rehabilitation, backward walking training on treadmill has shown promising results in improving muscle action and lower extremity strength through increased motor unit recruitment, benefiting lower limb muscles [ 18 , 19 ]. Additionally, it has demonstrated positive effects on foot posture and alignment in long-distance runners. Moreover, backward walking has been associated with improvements in body balance and stability in adolescents [ 20 ]. Backward walking training has been widely utilized in various sports and has demonstrated its effectiveness in improving balance, stability, agility, coordination, and footwork skills. It has been particularly valuable in sports that require rapid changes of direction [ 21 , 22 ].

In this context, the present study aims to investigate the efficiency of backward walking training on treadmill on core stability, balance, agility, and reaction time in badminton players. While core strength training has been widely explored, the potential impact of backward walking on these specific aspects of physical performance remains relatively unexplored. Badminton involves quick, explosive movements and shuttlecock tracking which require exceptional lower limb strength, balance, and fast reaction times. Backward walking training is hypothesized to particularly enhance these abilities by improving proprioception and muscular coordination in ways that are directly translatable to badminton’s rapid on-court movements.

Understanding the benefits of backward walking on trunk stability, balance, agility, and reaction time can inform coaches and athletes on the optimal integration of this training approach to enhance performance and reduce the risk of injuries. By combining the sport’s rich history and global significance with cutting-edge research, this study endeavors to elevate the standard of badminton training and contribute to the development of well-rounded and resilient athletes.

Participants and methods

Study design.

The study design was a two-tailed experimental study. This type of study design was commonly used in scientific research to explore relationships and causality between variables. In this design, two groups were compared, and the hypothesis was formulated as a two-tailed (non-directional) hypothesis. The sampling method employed for participant selection was convenience sampling.

Study participants

The participants were selected based on their easy accessibility and availability to the researchers. The study included participants who were badminton players performing at the district level and above, and who had been actively practicing badminton for a period of more than 6 months in two badminton academies in Delhi NCR. The study focused specifically on participants of the both the genders within the age group of 18 to 26 years. Participants with recent knee and ankle injuries, recent fractures, or those currently on medication or supplements to improve performance were not included in the research. Additionally, individuals with neurological conditions were also excluded to ensure that the study sample comprised individuals without such conditions, thereby maintaining a more homogeneous group for analysis.

Ethical consideration

This study received ethical approval from the Ethical Committee of the Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research and Studies. The approval reference number is MRIIRS/FAHS/PT/2022-23/S-008 dated 7th January 2023. The study design adhered to the guidelines outlined in the revised Helsinki Declaration of Biomedical Ethics, ensuring the ethical treatment of participants and the protection of their rights. Additionally, to ensure transparency and accountability, the study protocol was registered in the clinical trial registry at https://www.ctri.nic.in/ with the identifier CTRI/2023/05/052750. The registration date was 17th May 2023.

Sample size calculation

G*Power (version 3.1.9.2, Heinrich Heine-University, Düsseldorf, Germany) was used to calculate the sample size. An a priori power analysis using t-test to compare differences between two independent means, with a desired statistical power of 80%, a significance level of 5%, and an effect size of 0.72 resulted in a sample size of 64. The effect size was derived from a previous study [ 23 ], where the mean of the outcome variable “dynamic balance following backward walking” was used.

Study Procedure

In this study, 64 participants voluntarily took part after receiving detailed explanations and providing informed consent. The participants were divided into two groups: the control group and the experimental group, based on their eligibility determined by inclusion and exclusion criteria. The control group involved individuals undergoing routine exercise training, while the experimental group received routine exercise training combined with backward walking training. The outcome measures like core stability, balance, reaction time and agility were assessed at both pre- and post-training. To ensure unbiased results, the participants were blinded to their group assignment, while the outcomes assessor remained aware of the groupings for accurate evaluation. The randomization procedure was carried out using a double-blinded trial methodology. This rigorous methodology helps to minimize potential biases and enhances the validity and reliability of the research findings. This study conforms to the Consolidated Standards of Reporting Trials (CONSORT) guidelines for reporting randomized controlled trials. We have included a completed CONSORT checklist as an additional file to provide a comprehensive overview of our trial’s design, analysis, and interpretation. Furthermore, a CONSORT flow diagram (Fig.  1 .) depicts the study procedures, including enrollment, randomization, pre-assessment, intervention, post-assessment, and data analysis.

Prior to the initiation of the actual study, all participants underwent two familiarization sessions to ensure they were adequately prepared and understood the tests involved in the study. During these sessions, participants were introduced to the equipment and detailed procedures for each test, which included the Plank test, Star Excursion Balance Test (SEBT), 6-point footwork test, and Illinois Agility Test. Each participant had the opportunity to practice under supervision, which helped standardize the test administration and ensure accurate, reliable results. These sessions were not included as the part of intervention and baseline data was collected after these sessions only.

A CONSORT flow diagram is depicting the study procedures

Outcome measures

The Illinois Agility Test was utilized to assess the agility of badminton players. The methodology was adopted in a previous study [ 24 ]. This widely recognized test involves positioning 8 cones in a specific pattern on a flat surface to create a zigzag course. The badminton players were instructed to navigate through the course, executing rapid and accurate directional changes. The test’s validity and reliability were established in the study, making it an effective tool for evaluating agility among athletes.

Core stability and strength

To assess core stability and strength, participants underwent the plank test [ 25 ]. Detailed instructions were provided to each participant before the test. The plank test required participants to assume a prone lying position with their elbows supported on the ground, lifting their bodies while keeping their hands pronated and parallel to the floor. Participants were instructed to maintain a straight bodyline off the ground, with their ankles in a neutral position, supported on their toes. A neutral head position, facing the ground, was also emphasized during the test. The stopwatch was started as soon as the subject assumed the correct plank position. Each participant’s performance was then measured continuously, recording the time they were able to maintain the plank position until they reached their limit or experienced loss of balance. This process was repeated three times for each participant, and the average of the three readings was used for analysis.

• Reaction time

The reaction time of the badminton players was assessed using the randomized six-point footwork drill as describe previously [ 11 ]. Results of the reliability analysis indicated the visual reaction system using the stopwatch had excellent Intraclass Correlation Coefficient (ICC) for both tests (ICC = 0.95).This drill was conducted on the badminton court, with six cones strategically placed at different locations, including the forehand front corner, backhand front corner, forehand side, backhand side, forehand backcourt corner, and backhand backcourt corner. The purpose of this training exercise was to enhance the players’ agility, speed, and footwork by replicating real-game scenarios that require quick reactions and precise foot movements. The players were instructed to move rapidly between these designated points in a random order, simulating the unpredictability of actual game situations. To objectively measure their performance, a stopwatch was used to record the time taken by each player to complete the drill. Each participant performed three repetitions of the test with a resting time of 5 min after every repetition to ensure the best performance every time. The reaction times were recorded for each trial, with data being noted for the best (maximum) times achieved across the trials.

Balance assessment

The study utilized the Star Excursion Balance Test (SEBT) as a clinical tool to evaluate dynamic balance and postural control in participants [ 26 ]. The test involved creating a star-like pattern on the floor using tape, with eight distinct directions marked: anterior, anteromedial, anterolateral, medial, lateral, posterior, posteromedial, and posterolateral. Before commencing the test, participants received clear instructions and a detailed explanation of the procedure. They were asked to stand in a single-leg stance, with the tested limb placed at the center of the star pattern. During the test, participants lifted their non-tested leg and reached as far as possible along each marked direction, maintaining balance throughout each reach and returning to the starting position after each trial. Three trials were conducted for each direction, and the average reach distance achieved was recorded. To account for individual variations in leg length, the reach distance for each direction was normalized by dividing it by the participant’s limb length. The utilization of normalized units allowed for standardized measurements of balance performance, ensuring meaningful and comparable assessments across participants [ 16 ]. The SEBT was performed in a clockwise direction to maintain consistency in the testing procedure.

Interventions

Routine training.

Participants in the control group received routine training, which consisted of three sessions per week for six weeks. The training program included dynamic warm-ups with activities such as jogging, leg swings, and arm circles to prepare the body for more strenuous activities and prevent injuries. Strength training focused on building muscle strength and endurance through exercises like squats, lunges, push-ups, and planks. Agility drills involved ladder drills and cone drills to improve quick directional changes and overall agility. Core stability exercises such as the Russian twist, bird-dog, and bridge were incorporated to strengthen core muscles, vital for balance and efficient movement patterns. Endurance training was performed through longer duration, moderate-intensity cardiovascular activities like running or cycling. Each session concluded with a cool-down phase involving static stretching targeting all major muscle groups to aid in recovery and decrease muscle stiffness. The intensity and repetitions of these exercises were individually adjusted based on each athlete’s Perceived Rate of Exertion (PRE), ensuring the training was challenging yet manageable, optimizing the training program’s effectiveness tailored to individual fitness levels and recovery needs.

Backward walking training on treadmill

Participants in the experimental group were instructed about the training regimen, which incorporates a ball hanging in front of the treadmill to encourage the participants to maintain a forward-facing gaze during the exercise. The training session began with a 4-minute session of forward walking on the treadmill, followed by a 1-minute rest period. After the rest, the participants switch to backward walking on the treadmill for another 4-minute session, followed by another 1-minute rest period. This sequence was repeated for a total of 12 min of exercise. The training protocol was scheduled to be performed three times a week, continuously for a duration of 6 weeks [ 27 ]. Throughout the training period, participants maintain a constant walking speed of 3 km/hr. Backward training regimen aimed to enhance participant’s walking skills and proprioception, promoting balance and coordination during backward movement.

Statistical analysis

The statistical analysis was performed using SPSS (version 24.0, IBM Corp., Armonk, NY, USA). Descriptive statistics, including mean and standard deviation (SD), were calculated to summarize the characteristics of the study variables. The normal distribution of the data was assessed by, the Shapiro-Wilk test. To calculate within-group comparisons, paired t-tests was used to examine the differences between pre and post-intervention measurements for trunk stability, balance, reaction time, and agility. Independent t-tests was used to compare the control and experimental groups at the baseline. To see the effects of the intervention over time, repeated measures analysis of variance (ANOVA) was used, considering the factors of time (pre and post) and group (control and experimental). The significance level was set at p  < 0.05 for all statistical tests in the thesis.

The study was conducted on 64 badminton players divided equally in control and experimental groups. The control group consisted of a higher proportion of male participants compared to females, while a similar pattern was observed in the experimental group. The average age of participants in the control group was slightly higher than that of the experimental group. Heights were comparable in both groups, with the experimental group showing a slightly higher average. Average weight was similar in both groups, and the control group had a slightly higher BMI compared to the experimental group. Right-hand dominance was prevalent in most participants in both the control and experimental groups. Specifically, in the control group, a larger percentage of participants were right-handed, whereas the experimental group also had a higher number of right-handed participants. In both the control and experimental groups, a higher percentage of male participants had more than 5 years of badminton experience compared to females (Table  1 ).

Upon reviewing the participant characteristics presented in the provided data, it is clear that conducting a gender-based study for the comparison of outcome variables may not be feasible due to the limited number of female participants in both the control and experimental groups. Additionally, when comparing hand dominances, it is apparent that the majority of participants in both groups were right-hand dominant. As a result, we did not plan to present the results based on gender and hand dominance in the study, as the sample sizes for these subgroups were not sufficient for meaningful statistical comparisons. Instead, our primary focus was on comparing the outcome variables between the control and experimental groups and evaluating the impact of the intervention on the specified measures.

Table  2 presents the results of the independent t-test were used to assess differences between two independent groups at each time point—pre and post-intervention for agility, core stability, reaction time and balance. For the agility test, there was a significant improvement in the experimental group from pre (17.08 ± 0.43) to post (15.32 ± 0.34) with a mean difference of 1.75 (t = 21.28, p  < 0.001, 95% CI [1.58, 1.92]), whereas the control group showed no significant difference (t=-0.13, p  = 0.89, 95% CI [-1.09, 0.95]). Similarly, for the core stability, the experimental group showed a significant improvement from pre (3.44 ± 0.41) to post (5.39 ± 0.42) with a mean difference of -1.94 (t=-18.51, p  < 0.001, 95% CI [-2.16, -1.73]), while the control group had no significant change (t=-0.98, p  = 0.32, 95% CI [-0.26, 0.08]). Finally, for reaction time, the experimental group demonstrated a significant improvement from pre (17.93 ± 1.03) to post (15.02 ± 0.41) with a mean difference of 2.91 (t = 14.09, p  < 0.001, 95% CI [2.49, 3.33]), while the control group had no significant difference (t = 0.05, p  = 0.95, 95% CI [-0.51, 0.54]).

The independent t-test results for the SEBT measurements between pre and post-intervention showed significant improvements in the experimental group for various reach directions (Table  3 ). Notably, the experimental group displayed significant enhancements in anterior reach for both the right (MD= -6.87, p  < 0.001) and left legs (MD= -8.21, p  < 0.001), anterolateral reach for the right leg (MD = 10.40, p  < 0.001), lateral reach for the right leg (MD = 9.46, p  < 0.001), posterolateral reach for both the right (MD = 9.37, p  < 0.001) and left legs (MD= -8.87, p  < 0.001), and posteromedial reach for the right leg (MD = 9.18, p  < 0.001). In contrast, the control group had no significant changes in most reach directions. However, both groups showed significant improvements in posterior reach for both legs.

Paired t-tests was conducted to compare the pre and post-intervention measurement within each group for the agility, core stability, reaction time and balance (Fig.  2 ). For the agility, the experimental group showed a significant improvement from pre (17.08 ± 0.43) to post (15.32 ± 0.34) with a mean difference of 1.75 (t = 21.28, p  < 0.001, 95% CI [1.58, 1.92]), whereas the control group had no significant change (t = 0.88, p  = 0.38, 95% CI [-0.62, 1.57]). Further, the core stability in the experimental group demonstrated a significant improvement from pre (3.44 ± 0.41) to post (5.39 ± 0.42) with a mean difference of -1.94 (t= -18.51, p  < 0.001, 95% CI [-2.16, -1.73]), while the control group had no significant change (t= -0.23, p  = 0.88, 95% CI [-0.40, -0.06]). Similarly, for the reaction time, the experimental group showed a significant improvement from pre (17.93 ± 1.03) to post (15.02 ± 0.41) with a mean difference of 2.91 (t = 14.09, p  < 0.001, 95% CI [2.49, 3.33]), while the control group had no significant difference (t = 0.10, p  = 0.92, 95% CI [-0.51, 0.54]). As a whole, the experimental group showcased significant enhancements in balance, exemplified by marked improvements across diverse reach directions. In contrast, the control group exhibited minimal alterations in SEBT performance, underscoring the distinct disparity between the two groups. (Table  4 ).

The repeated measures ANOVA was conducted to assess changes in performance measures (agility test, core stability, and the reaction time) over time within each group (Table  5 ). For the agility, there was a significant time effect (F = 16.87, p  < 0.001, η² p  = 0.21), indicating that performance improved from pre to post within both the experimental and control groups. However, the group effect (F = 5.03, p  = 0.03, η² p  = 0.08) and time x group interaction (F = 5.57, p  = 0.02, η² p  = 0.08) were not significant, suggesting that the improvement in performance did not differ significantly between the two groups. For the core stability and reaction time, there were significant time effects (core stability: F = 262.06, p  < 0.001, η² p  = 0.81; reaction time: F = 199.77, p  < 0.001, η² p  = 0.76), indicating performance improvements from pre to post within both groups. Additionally, significant group effects (core stability: F = 220.04, p  < 0.001, η² p  = 0.78; reaction time: F = 49.07, p  < 0.001, η² p  = 0.44) and time x group interactions (core stability: F = 161.15, p  < 0.001, η² p  = 0.72; reaction time: F = 171.9, p  < 0.001, η² p  = 0.73) were found for both core stability and reaction time, suggesting that the improvement in performance differed significantly between the experimental and control groups.

Pre and Post comparison of illinois agility test, plank test, and 6-point forward test between control and experimental group

The aim of the study was to investigate the efficiency of backward walking on agility, core stability, reaction time, and balance in badminton players. To assess these variables, the researchers employed specific outcome measures, including the Illinois agility test for agility, Plank test for core stability, the 6-point footwork test for reaction time, and the Star Excursion Balance Test (SEBT) for balance in the badminton players. The study included a total of 64 participants, with 32 individuals in each group (control and experimental).

Badminton is physically demanding, requiring athletes to possess high levels of aerobic and anaerobic fitness [ 28 ]. The ability to swiftly change direction, accelerate, and decelerate is essential for reaching the shuttlecock and maintaining court coverage effectively. The aerodynamics of a shuttlecock play a crucial role in badminton. Researchers investigate the factors influencing shuttlecock trajectory, spin, and speed, taking into account factors such as air resistance, drag, and shuttlecock design [ 29 ]. This knowledge helps players anticipate and react to shots more effectively. Backward walking training on treadmill offers a unique and innovative approach to enhancing the physical performance of athletes. By incorporating such exercises into their training regimen, players can improve their agility, balance, and proprioception, which are crucial attributes in badminton. By adding backward training to their training routines, badminton players can enhance their physical attributes, ultimately contributing to improved performance and reduced injury risk during competitive play [ 30 ].

In the present study, the control group received routine exercise training focusing on improving sports performance, whereas the experimental group received routine exercise training along with backward walking training. Pre and post-intervention assessment were taken to measure core stability using plank test, balance using the SEBT, reaction time using the 6-point footwork test and agility using the Illinois agility test. The experimental group demonstrated significant improvement in core stability, balance, reaction time, and agility as compared to the group following only regular exercise protocol.

There were significant difference in stability between the control and experimental groups. The improved core strength enhances dynamic balance, and agility in adolescent badminton players [ 14 ]. The six weeks of backward walking training leads to enhanced core strength, as evidenced by the outcomes of the plank test. This improvement in core strength could potentially contribute to the observed enhancements in agility and balance. These findings align with findings of previous studies which demonstrated that backward walking has the potential to enhance balance and stability among badminton players [ 31 ]. Notably, their study revealed the most significant improvements within the short-term duration of 4 weeks of training.

Backward training targets specific muscle groups involved in maintaining stability and generating power during quick movements on the court, such as the quadriceps, hamstrings, and calf muscles. Strengthening these muscles through backward training can help prevent injuries and improve overall lower body strength and stability. Additionally, backward training challenges players’ motor skills by requiring them to perform movements in reverse, leading to increased motor unit recruitment and improved coordination [ 32 ]. The focus on core stability during backward training can also benefit badminton players in maintaining a strong and balanced stance while executing shots and moving swiftly on the court [ 16 ].

Further, the control group did not show a significant difference in agility, whereas the experimental group of backward training exhibited a significant improvement in agility. These findings suggest that incorporating backward walking training can be effective in enhancing agility. Studies in the past shows that repeated backward running training (RBRT) can have positive effects on various measures of physical fitness in youth male soccer players and netball players [ 17 , 21 , 22 ]. Within-group analysis revealed that RBRT improved all performance variables, including speed, agility, power and other physical fitness measures.

In this study, there was no significant difference in the control group of the six-point footwork test, whereas there was a significant difference in the experimental group that underwent backward training. The backward training helped improve backward running when the shuttle was behind and helped maintain balance with control. A previous study reported discovered that a twelve-week intervention focused on agility training, utilizing the Visual Reaction Time technique with a foundation in six-point footwork and T-footwork, yielded significant differences in the recorded reaction and action times for the fixed-light-mode six-point footwork test [ 11 ]. Additional research has corroborated the notion that engaging in recurrent backward running exercises can enhance diverse aspects of physical fitness among adolescent male football players and netball players. These improvements encompass enhanced speed, agility, power, and other pertinent physical fitness indicators. The inclusion of backward training in conditioning and skills training regimens has the potential to yield positive outcomes in terms of improving physical fitness among adolescent male football and netball athletes [ 21 , 22 ].

The improved balance improves footwork performance in adolescent competitive badminton players also the visual reaction training improves the six-point footwork [ 15 ]. The improved footwork has also been associated with enhanced reaction time and agility [ 11 ]. Another study has shown the significant differences in short-sprint speed and power measures were observed in adolescent athlete after backward running training shows the effectiveness of backward training [ 17 ]. Balance training has been identified as an effective approach to mitigate the risk of falls during backward running, offering benefits during gameplay when players need to respond to the shuttle being behind them, thereby preventing potential falls and enhancing performance.

Backward walking training on treadmill offers a unique and innovative approach to enhancing the physical performance of athletes. By incorporating such exercises into their training regimen, players can improve their agility, balance, and proprioception, which are crucial attributes in badminton. By adding backward training to their training routines, badminton players can enhance their physical attributes, ultimately contributing to improved performance and reduced injury risk during competitive play.

While this study provides valuable insights into the effects of backward walking on trunk stability, balance, agility, and reaction time in badminton players, there are some limitations to consider. The six-week duration of the intervention may not fully capture the long-term effects. The study did not control for external factors that could influence the outcomes, such as participants’ training regimens or nutrition. Additionally, the lack of long-term follow-up limits our understanding of the durability of the observed improvements. There may also be unaccounted confounding variables that could influence the results. Future research should address these limitations to enhance the validity and broader applicability of the findings.

Despite the limitations, this study opens avenues for future research. Firstly, investigations could focus on exploring the optimal duration and frequency of backward walking training to maximize its effectiveness in improving trunk stability, balance, agility, and reaction time. Additionally, further studies could examine the underlying mechanisms through which backward walking influences these physical attributes, such as changes in muscle activation patterns or proprioceptive feedback. Moreover, investigations could extend beyond laboratory settings and explore the real-world application of backward walking training in badminton players during their actual game performance. Lastly, future research could explore the potential benefits of combining backward walking with other training modalities or interventions to enhance overall athletic performance in badminton players.

This study demonstrates that a six-week intervention of backward walking has the potential to improve trunk stability, balance, agility, and reaction time in badminton players. The experimental group showed significant and clinically relevant improvements as compared to the control group. The findings suggest that incorporating backward walking into training regimens may be an effective strategy for enhancing athletic performance in badminton players. However, further research is needed to validate the results in larger and more diverse populations, consider longer intervention duration, and address potential confounding factors to establish the full benefits and applicability of backward walking as a training modality.

Data availability

All data generated or analyzed during this study will be available upon a reasonable request from the corresponding author.

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Acknowledgements

The authors extend their appreciation to the Deanship of Scientific Research,  King Saud University for funding through Vice Deanship of Scientific Research Chairs; Rehabilitation Research Chair.

This study was funded by King Saud University, Deanship of Scientific Research, Vice Deanship of Scientific Research Chairs; Rehabilitation Research Chairs. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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O.S.G. M.R.R. A.S. S.H. F.A. A.H.A. and A.I. proposed the study concept and design. O.S.G. M.R.R. and A.S. planned the methodology. O.S.G. and A.S. collected data. H.J.A. A.I., A.H.A., and F.A. contributed to the data analysis. F.A. S.H. A.R.S. M.K.S. S.U. S.N. A.H.A. and A.I. contributed to the data interpretation. O.S.G. A.S. M.R.A. F.A. S.H. and A.I. prepared the manuscript’s initial draft. O.S.G. M.R.R. A.S. F.A. S.H. A.R.S. M.K.S. S.U. S.N. A.H.A. and A.I. critically reviewed and edited the manuscript for intellectual content. All authors have read, understood, reviewed, and approved the manuscript’s final version to be submitted or published and take responsibility for the intellectual content of the same manuscript.

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Ghorpade, O.S., Rizvi, M.R., Sharma, A. et al. Enhancing physical attributes and performance in badminton players: efficacy of backward walking training on treadmill. BMC Sports Sci Med Rehabil 16 , 170 (2024). https://doi.org/10.1186/s13102-024-00962-x

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Received : 17 April 2024

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DOI : https://doi.org/10.1186/s13102-024-00962-x

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