Star Excursion Balance Test | Postural Control | Return to Play
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!
Other useful performance tests that you might be interested in are:
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.
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.
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