Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 1

The information contained herein is not intended to be a substitute for professional medical advice, diagnosis or treatment in any
manner. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any
medical condition or before engaging in any physical fitness plan. All rights reserved. Printed in the United States of America using
recycled paper. No part of this manual may be reproduced or transmitted in any form whatsoever without written permission from the
author or publisher, with the exception of the inclusion of brief quotations in articles or reviews.
Copyright 2010 Functional Movement Systems, Gray Cook and Phil Plisky.
Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 2
Table Of Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

The Y Balance Test – Lower Quarter (YBT-LQ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

The Y Balance Test - Upper Quarter (YBT-UQ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

How It Started?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Why Do We Need YBT?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

What is Unique?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

In What Populations is the Y Balance Test Useful?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Y Balance Test-Lower Quarter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Description. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Reach Directions And Testing Order. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Test Faults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Practice Trials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Measuring Lower Limb Length. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

What do we look for on the YBT-LQ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Dorsiflexion Clearing Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Interpreting Results of Dorsiflexion Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Tips For Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Verbal Instructions For the Lower Quarter Y Balance Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Y Balance Test Lower Quarter Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Reliability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Injury Prediction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Lower Quarter Y Balance Test Relationship to UCL Injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Use as Return to Sport Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Lower Quarter Examples. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Lower Quarter FAQ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 1
Y Balance Test Upper Quarter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Description. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

What Do We Look For On The YBT-UQ?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Reach Directions And Testing Order. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Reading The Measure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Test Faults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Practice Trials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Measuring Upper Limb Length. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Tips for Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Y Balance Test - Upper Quarter Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Verbal Instructions For The Upper Quarter Y Balance Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Upper Quarter Examples. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Upper Quarter FAQs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Appendix A - Test Performance Standards Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Appendix B - Scoresheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

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Y Balance Test
Introduction
The Y Balance Test Overview
As an integral part of Functional Movement Systems, the Y Balance Test is a thoroughly researched, yet easy way to test a
client’s motor control as well as demonstrate functional symmetry.

The Y Balance Test allows us to quarter the body and look at how the core and each extremity function under body weight
loads. The Y Balance Test Protocol was developed through years of research in injury prevention and identification of
motor control changes that occur after injury. This device and protocol are highly accurate and can be used for measuring
pre and post rehabilitation performance, improvement after performance enhancement programs, dynamic balance for
fitness programs, and return to sport readiness. The Y Balance Test is divided into two components - the Lower Quarter
and Upper Quarter:

The Y Balance Test – Lower Quarter (YBT-LQ) is a dynamic test performed in single leg stance that requires adequate
strength, flexibility, core control, and proprioception at the limit of the client’s stability. This test requires most, if not all,
of the components of motor control – an essential component of proper function.

The Y Balance Test - Upper Quarter (YBT-UQ) is a dynamic upper quadrant test performed in a single arm push up
position at the limit of stability. This test requires shoulder girdle and core stability, as well as adequate shoulder and
thoracic mobility in the closed kinetic chain.

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The Y Balance Test – Lower Quarter (YBT-LQ)
The YBT-LQ is a simplified version of the Star Excursion Balance Test (SEBT) in which only 3 reach directions (instead of
the original 8 directions of the SEBT) are performed using a specific testing protocol and device to improve reliability and
ease of administration of the SEBT. In a systematic review and subsequent prospective cohort studies of the SEBT and
YBT-LQ, researchers concluded that they are reliable tests of dynamic balance, predictive of injury, able to identify balance
deficits after injury, and modifiable. Researchers have suggested including one of these tests in screening prior to activity
participation.

The goal of the YBT-LQ is to maintain single limb stance while reaching as far as possible with the contralateral leg.
Because limb length is a small, but significant factor in how far someone reaches, limb length needs to be measured. Prior
to administering the test, 6 practice trials are first performed. Next, 3 trials in each of the 3 directions for each foot are
collected and the maximum reach in each direction is used for analysis.

The predictive ability of the Y Balance Test have been examined by Plisky et al, Butler et al., Smith et al, and Teyhen et al.
These authors found that high school and collegiate athletes and military personnel with asymmetries of greater than 4
cm between the right and left reach distance in the anterior direction and/or a composite score below the age, sex, and
sport/activity risk cut-off had an increased risk of lower extremity injury. A person is at risk of losing time from activity
if there is a side to side asymmetry in reach distance or decreased performance compared to the person’s peer group. In
addition, by combining the results of the Functional Movement Screen, injury history, and sport/gender specific Y Balance
Test results into the Move2Perform algorithm, researchers were able to accurately predict time loss from sport (Lehr et al
2014).

The composite score gives a snapshot of the client’s overall performance and is relative to his body. The composite score
is the sum of the greatest reach in each of the three reach directions (anterior, posteromedial, posterolateral) divided
by three times the limb length, and then multiplied by 100. Boys and girls high school basketball players with anterior
asymmetry of greater than 4 cm were at increased risk of injury and girls with a composite score below 94% (in the bottom
third of their peers) were 6 times more likely to get injured. In collegiate football, players with a composite score of less
than 89% (note that the composite risk cut-point needs to be based on age, sex, and sport) were more likely to get injured.
Thus, since the injury risk cut point is different in each population, the composite score should not be less than the cut
points that are specific for the age, sex, and sport/activity of the client. Finally, improving the SEBT can reduce injury risk.
In a randomized controlled trial with 226 youth female soccer players, researchers found that if performance on the SEBT
is improved, injury risk is reduced.

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The Y Balance Test - Upper Quarter (YBT-UQ)
The YBT-UQ is performed by starting the athlete in the up position of a push up with feet shoulder width apart. Closed
kinetic chain motor control is measured by reaching in the following three directions: medial, inferolateral, and
superolateral. Following a warm up trial, the best of three attempts are recorded for each reach direction. The composite
score is calculated in a similar way as the YBT-LQ by taking the sum of all three reach directions, dividing by the upper
extremity limb length and multiplying by 100. This composite score can be compared to the injury risk cut score for each
population as determined by age, sex, and sport/activity.

Two published studies (Gorman et al 2012, Westrick et al 2012) found the YBT-UQ to be reliable. In addition, both studies
found there was no difference in YBT-UQ performance between dominant and non-dominant limbs. This indicates that
YBT-UQ performance serves as a good measure in return to sport testing when rehabilitating shoulder, upper limb,
and spine injuries. In our current research, we are also finding right/left symmetry on the YBT-UQ in professional and
collegiate baseball players (including pitchers).

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How It Started?
The Y Balance Test has been developed through years of research and field-testing, but was originally created out of a
frustration with the outcomes of our pre-participation physicals. Fifteen years ago, we began testing hundreds of athletes
each year, but it nagged us as researchers and clinicians that effective injury prevention was not occurring.

An efficient and effective test, built and backed by high quality research, was needed to identify those who would lose time
from their sport. At this time, there was some injury prediction research coming out for athletes. But either the testing
took hours to perform or was only related to one type of injury (e .g. ACL tears). A gap existed between injury prediction
research and the real world.

We hypothesized that balance was related to injury, but wanted a more challenging measure than static unilateral stance.
Researchers were starting to use the Star Excursion Balance Test for identifying people who had chronically unstable
ankles. However, because it had 8 different reach directions it didn’t meet the criteria of being time efficient. We analyzed
the research and reduced it to the 3 directions that would give us the most information in the shortest period of time.

At the beginning of the season, nearly 300 basketball players were measured at 8 high
schools. Crawling around on the floor marking reach distances on tape measures
didn’t look very professional and was uncomfortable. Accuracy was lacking as well. The
athletes were tracked for injuries over the course of the season. We found the test to be
predictive, but also found areas that the reliability could be improved.

This led to the development of a protocol and test kit to boost the reliability and
ease of administration of the test. Since it was developed, a normative database of
over 60,000 tests has been accumulated. The database includes school age children,
athletes of all levels, military personnel and even older adults after total joint replacement surgery. The database ranges
in age from ages 6 to 88.

We also recognized that a body relative test was needed to look at the upper quadrants
of the body, which led to the development of the Y Balance Test - Upper Quarter. A
decade later, the Y Balance Test has been validated by multiple research studies, and
can be performed efficiently in any setting.

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Why Do We Need The YBT?
When a student takes a math or reading test in school, it establishes a baseline, assists in academic planning for the
child, identifies competence in an area, and can show progress. But most importantly, testing can identify and lead to
the resolution of problems that the student may have that could impact their learning and future success. Similarly,
in training or rehabilitation, the Y Balance Test sets a baseline and can show progress or competence as a part of
comprehensive return to activity testing.

Remember, a test gauges a person’s ability and is a measurement that does not require interpretation. A comprehensive
functional test would examine a client’s ability across multiple domains and give a precise numerical rating that
corresponds with aptitude in those domains. This is what the Y Balance Test does. It acts as a "functional goniometer"
by allowing precise quantification of a client’s body relative movement by simultaneously requiring strength, flexibility,
neuromuscular control, core stability, range of motion, balance, and proprioception.

What is Unique?
Comparison to other tests
Compared to static balance tests or plank tests, the Y Balance Test requires dynamic motor control at the limit of stability.
This is where the deficit is magnified. Right and left asymmetry is better identified and the composite score can be
compared to others in the same population. To illustrate, a collegiate soccer player may be able to stand on one leg or
plank for 30 seconds and so will most of his teammates. Since the Y Balance Test requires the player to reach at their limit
of stability, differences between limbs and other players will become apparent in the presence of motor control deficits.

How is it used with the Functional Movement Screen?

The Functional Movement Screen separates movement patterns. The Y Balance Test brings all the patterns back together
in tri-planar movement. In the Y Balance Test, mobility and stability within multiple planes of movement are challenged.
The movements of the Y Balance Test require range of motion, strength, stability and coordination in multiple joints. Any
one or a combination of multiple deficits can cause a failure of the test. Think about all of the areas that can cause a
problem in the Y Balance Test Lower Quarter:

▪▪ Stability or mobility problems in the foot, ankle, knee, hip and spine
▪▪ Strength deficits anywhere in the limb or spine
▪▪ Coordination problems anywhere in the limb or spine

Therefore, the Y Balance Test is an excellent test for finding deficits in multiple systems in multiple areas of the body. That
makes it a powerful test, but it does not help to identify where the problem lies. Our data indicate that approximately 20%
of people who have a normal Functional Movement Screen score fail the Y Balance Test (and vice versa) . The Functional
Movement Screen is extremely useful in identifying what movement pattern is dysfunctional. The Y Balance Test is the
precise gauge that can measure the severity of motor control deficit found with the Functional Movement Screen. Thus
both complement each other perfectly and are most powerful used in combination. If the client has pain or injury, the
Selective Functional Movement Assessment can provide even greater detail by specifically identifying the location of the
mobility or stability problem.

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In What Populations is the Y Balance
Test Useful?
The Y Balance Test has been effectively used in multiple populations from 1st graders to 85 year olds. While the Y Balance
Test originated in sports and has become widely used in all major professional sports teams, it has been utilized widely in
research and the field throughout the lifespan around the world.
Because the Y Balance Test has the unique ability to identify motor control deficits it has been used to test 1st through 5th
graders to determine if they have dynamic motor control which is an essential foundation for higher level performance
and skill acquisition.

In the military it has been extensively used both in the special forces (Army Rangers and Navy Seals), combat personnel,
as well as support personnel. On the other end of the spectrum, the Y Balance Test has been used in numerous research
studies involving older adults who underwent balance training programs or as an outcome measure after total hip, knee,
or ankle replacement.

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Y Balance Test-Lower Quarter
Purpose
The Lower Quarter Y Balance Test (YBT-LQ) is a dynamic test that requires stability, strength,
flexibility, and proprioception of the lower quadrant of the body. This dynamic task requires
the person to perform at his/her limit of stability.

It has been used to assess physical performance, identify chronic ankle and ACL instability,
and identify athletes and military personnel at greater risk for lower extremity injury.
Researchers have suggested including these tests in screening for activity participation.
The YBT-LQ incorporates three movement directions (anterior, posteromedial and
posterolateral). The goal of this test is to maintain single-leg stance on one leg while
reaching as far as possible with the contralateral leg.

Starting Position
Description
After giving the testing procedure instructions, have the client perform six practice trials in each of the three directions
prior to formal testing. Start by having the client stand with the foot on the center foot plate, with the most distal aspect of
the toes just behind the red starting line. While maintaining a single-limb stance, have the client reach with the free limb
in one of three directions (anterior, posteromedial or posterolateral), and then return to the starting position.

Once ready to complete the formal testing, have the participant start with the right foot on the center of the foot plate and
perform three attempts while reaching in one of the three directions. Then the participant will place the left foot on the
center foot plate and repeat with the opposite limb. Alternating stance legs between trials will ensure adequate rest for
accurate results.

Figure 1 Figure 2 Figure 3

The maximal reach distance is measured by reading the tape measure at the edge of the reach indicator, at the point
where the most distal part of the foot reached in half centimeters (e.g. 68.5, 69.0, 69.5 cm). Three trials in each direction
for each foot will be collected and the maximal reach in each direction will be included for analysis. If there are failed
attempts, perform a maximum of six trials in a single direction. If the participant has more than four failed attempts, a
zero should be recorded for that trial.

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Reach Directions And Testing Order
The leg that is being measured is the stance leg. This simply represents the pattern and does not imply the functional
ability of a body part or side. Reach is named in terms of directional relationship to the stance leg.

Once you are ready to complete the formal testing, have the client start with the right foot on the center of the foot plate
and perform three attempts while reaching anteriorly. The best of the three reach attempts is recorded as the score for the
right anterior reach. Then the participant will place the left foot on the center foot plate and repeat with the opposite limb.
Alternating stance legs between trials will ensure adequate rest for accurate results.
The specific testing order is—

1. Right anterior reach (3 trials)

2. Left anterior reach (3 trials)
3. Right posteromedial reach (3 trials)
4. Left posteromedial reach (3 trials)
5. Right posterolateral reach (3 trials)
6. Left posterolateral reach (3 trials)

Three trials in each direction for each foot will be collected and the maximal reach in each direction will be included for
analysis.

Test Faults
Any of the following test faults invalidate a reach attempt:
▪▪ kicking push box
▪▪ not returning to starting position under control
▪▪ touching down during reach
▪▪ foot on top of stance plate

Practice Trials
After you give the testing procedure instructions, have the client perform six practice trials in each of the three directions
prior to formal testing. This is because the Y Balance Test is a novel movement for most and it takes multiple trials for the
client’s learning effect to maximize.

Measuring Lower Limb Length

Determine the client’s limb length by measuring the distance from the Anterior Superior Iliac Spine (ASIS) to the most
distal aspect of the medial malleolus. Have the individual lie supine on a table, without socks and shoes. Start with both
knees bent, feet flat on the table as if standing. Ask the client to raise the hips off the table, and return to the resting
position. Straighten the individual’s knees to fully extended. Pull on the legs at the malleoli to ensure legs are fully
extended. On the client’s right limb, palpate the most inferior distal surface of the ASIS and align it with the "0" zero line
of a cloth tape measure. While holding the tape on the ASIS, extend the tape to the inferior distal surface of the medial
malleolus of the right ankle. Record the measurement to the nearest 0.5 cm.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 10
What do we look for on the YBT-LQ?
Researchers indicate that there should not be greater than four centimeter right and left reach distance difference in
the anterior reach direction. There should not be greater than a six cm. reach distance difference in the posteromedial
and posterolateral directions. Also, the composite score—the sum of three reach directions divided by three times limb
length, then multiplied by 100—should not be less than the cut points specific for the age, gender and sport/activity of the
individual.

Dorsiflexion Clearing Test

Starting Position:
1. Client will remove shoes for testing. Subject starts kneeling on one knee and the other foot aligned on
the edge the stance plate of the YBT kit.
2. Align border of foot being tested (1st metatarsal to calcaneus) with the edge of the YBT stance plate.
3. A phone with the TiltMeter app or bubble inclinometer is placed 2 finger breadths under the tibial
tuberosity
4. The subject will bring the knee forward and keep the knee over the 4th ray. Contact with the heel must
be maintained and the client is directed to replace heel down if it does come up.
5. The degree measurement of the tibial angle is recorded at the maximum excursion of the tibia over the
toe with the heel down.

Interpreting Results of Dorsiflexion Test

Optimal closed kinetic chain dorsiflexion is 40 degrees or greater. A minimum passing score is 35 degrees. Even more
important than total angle, is asymmetry. There should be no greater than a 5 degree difference between the left and right
closed kinetic chain dorisflexion measure.

Tips For Testing

▪▪ Shoes are off for Y Balance Testing.
▪▪ The leg that is being measured is the stance leg. This simply represents the pattern and does not imply
the functional ability of a body part or side.
▪▪ Six practice trials on each leg in each direction should be performed prior to testing.
▪▪ Client must maintain unilateral stance on the platform.
▪▪ Be sure the client starts with toe up to, but behind the line and checking this position after each trial.
▪▪ Client must maintain reach foot contact with the reach indicator on the target area while it is motion (i.e.
cannot kick the reach indicator). Foot must contact the red target area of the box.
▪▪ Client cannot use the reach indicator for stance support (i.e. place the foot on top of reach indicator).
▪▪ Client must return the reach foot to the starting position under control (i.e. return the reach foot to the
floor behind the angle, next to the stance platform).
▪▪ The reach foot can return to the floor between reaches, but only returning to the starting position under
control.
▪▪ Do not coach the movement; simply repeat the instructions if needed.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 11
Verbal Instructions For the Lower Quarter Y Balance Test
The following is a script to use while administering the Lower Quarter Y Balance Test. For consistency throughout all
testing, this script should be used during each test.

Please let me know if there is any pain while performing any portion of the test.

Please remove your shoes while performing the test.

Place your _______foot on the center of the foot plate with your toes just behind the starting line.

While maintaining the foot on the platform, push the reach indicator in the red target area as far as possible with the
opposite leg.

The reach foot must maintain contact with the reach indicator on the target area while it is motion (i.e. cannot kick
the reach indicator).

Do not use the reach indicator for stance support (i.e. place foot on top of reach indicator).

Return the reach foot to the starting position under control (i.e. return the reach foot to the floor behind the angle,
next to the stance platform).

Do you understand the instructions?

The participant will perform each movement three times before alternating the supporting foot in the same direction.
Once completed in the same direction for both feet, continue with the next direction.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 12
Y Balance Test Lower Quarter Research
Reliability
The Y Balance Test has been shown to produce repeatable and consistent testing results demonstrated by multiple
studies. In a military mass screening setting researchers found good reliability of the Y Balance Test Lower Quarter with
1
multiple raters (e.g. testing 50 service members per hour). The raters were trained and tested with live demonstration as
well the online Y Balance Test certification course. The authors found Interrater test–retest reliability of the maximal reach
had intraclass correlation coefficients (2,1) of 0.80 to 0.85 with a standard error of measurement ranging from 3.1 to 4.2 cm
2
for the 3 reach directions (anterior, posteromedial, and posterolateral). In two other studies, Plisky et al and Faigenbaum
3
et al reported good to excellent test re-test as well as interrater reliability in soccer players and grade school children.

The Y Balance Test can be performed reliability in single participant as well as large group testing settings with raters
having minimal experience (with standardized training). The online course with certification examination as well as a live
proficiency check-off by an experienced tester is recommended prior to testing large groups.

Injury Prediction 4
The predictive ability of the Y Balance Test Lower Quarter was first examined by Plisky et al when the number of reach
directions from the Star Excursion Balance Test were reduced from 8 to 3. Boys and girls high school basketball players
were measured on the Y Balance Test Lower Quarter at the beginning of the season and then monitored for lower extremity
injury throughout the season. These researchers found that high school basketball players with asymmetry of greater
than 4 cm between the right and left reach distance in the anterior direction as well as a composite score below the age,
4
sex, and sport risk cut-off had an increased risk of time loss lower extremity injury.

In another prospective cohort study of 59 college football players, researchers found that those players who scored below
5
89.6% composite reach on the YBT-LQ were 3.5 times more likely to get injured. While this study adds to the body of
literature that the Y Balance Test is predictive of lower extremity injury in collegiate football players, it is important to note
that the high school basketball player injury risk cut point was 94%, but collegiate football player cut point was 89.6%.
This emphasizes the need to use risk cut points that are age, gender, and sport specific. In a similar prospective study of
100 male and female collegiate soccer players, players with an anterior reach asymmetry were almost 6 times more likely
to sustain a lower extremity injury.

In another study, researchers prospectively performed the Y Balance Test Lower Quarter on 184 collegiate athletes from
6
13 collegiate sports and followed them for injuries through their competitive seasons. They found that the "ROC curves
determined asymmetry > 4 cm (Sensitivity=59%; Specificity=72%) as the optimal cut-point for predicting injury. Only
anterior asymmetry was significantly associated with non-contact injury (odds ratio=2.33, 95% confidence interval
6
[1.15-4.76])." Similar to previous studies, anterior reach asymmetry of greater than 4cm was a risk factor for injury in
collegiate athletes. The authors also found that you cannot apply one composite score risk cut point across multiple
sports. Specifically, it is known that the mean composite Y Balance Test score varies among groups, the risk cut point for
each sport and each gender in this sample should have been used for each sub group. In this study, one composite risk
cut point was applied to men’s basketball (n=9), women’s basketball (n=2), men’s cross country running (n=13), women’s
cross country running (n=17), men’s football (n=68), women’s golf (n=3), men’s track and field (n=7), women’s track and
field (n=3), men’s tennis (n=5), women’s tennis (n=5), women’s volleyball (n=8), women’s soccer (n=27), and women’s
6
swim/dive (n=17). The authors found that one cut point was not predictive which further emphasizes the need to use the
age, gender, sport/activity specific cut points found in the Move2Perform software.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 13
Since injury risk is multifactorial, current trends in injury prevention are to categorize individuals using multiple risk
7
factors. Lehr et al screened Division III college athletes in the pre participation physical exam and followed them for an
entire competitive season. At the start of the season, 183 collegiate athletes across multiple sports (including soccer)
were interviewed about their injury history and tested on the YBT-LQ and FMS. Scores were entered into the Move2Perform
7
algorithm to classify the athlete into one of four risk categories. The Move2Perform algorithm calculated and weighted
the composite FMS score, individual FMS test scores, results of FMS clearing tests, presence of asymmetry on any of the
five bilateral FMS movements, pain during testing, previous injury, YBT-LQ asymmetry, and YBT-LQ composite score below
the risk threshold for the individual athlete. The YBT-LQ composite score risk threshold was determined by the software
4,5,7
based on competition level (i.e., junior high, high school, college, and professional), sport, and sex of the athlete. If
athletes were in the moderate or substantial risk category, they were 3.4 times (95% CI, 2.0 to 6.0) more likely to get injured
during that season. Not one athlete in the normal category got injured; in a subsequent unpublished analysis, there were 4
7
non-contact ACL injuries (3 in the high-risk group and 1 in the slightly increased risk group).

A military study using an algorithmic approach to injury prevention measured numerous variables previously shown
to be related to injury in attempt to find the fewest, yet most robust combination of risk factors related to preventable
musculoskeletal injury in service members. 922 soldiers were measured and then followed prospectively for 1 year. The
researchers found prior history of injury, prior work restrictions, lower perceived recovery from prior injury, asymmetrical
ankle dorsiflexion, decreased or asymmetrical performance on the YBT-LQ or YBT-UQ, and pain with Functional Movement
Screen or hop testing were associated with time loss injury. The odds ratio was 5.7 (95% CI: 4.1 to 7.9), relative risk was 2.5
(95% CI: 2.1 to 2.9), and an area under the curve was 0.73. Presenting with 2 or less variables resulted in a sensitivity of 0.87
(95% CI:0.84 to 0.90) and having 6 or more resulted in a specificity of 0.91 (95% CI:0.89 to 0.94).
The Y Balance Test Lower Quarter has been shown to be predictive in high school and collegiate athletes as well as in
military personnel. Even greater injury prediction can be obtained by using the Move2Perform injury prediction software
that combines previous injury history with multiple tests, including the Y Balance Test and Functional Movement Screen.

Lower Quarter Y Balance Test Relationship to UCL

Injuries 8
Garrison et al found that Y Balance Test Lower Quarter in athletes who had an ulnar collateral ligament injury in the elbow
was lower than healthy controls. The authors hypothesized that the poor dynamic balance as measured by the Y Balance
Test Lower Quarter may indicate an inefficient lower extremity base/motor control that could alter throwing and pitching
mechanics, which could cause increase stress to the shoulder and elbow and lead to upper body injury. In a subsequent
study, the researchers found that the Y Balance Test Lower Quarter was normalized after comprehensive rehabilitation
9
following Ulnar Collateral Ligament reconstruction.

Use as Return to Sport Test

10 11
Mayer et al and Boyle et al tested athletes at 6 and 9 months post op ACL reconstruction on the YBT-LQ and FMS. The
test results indicated that many displayed deficits with testing even though many of the athletes had been "cleared" to
12
return to sport. Based on this research, Sun et al reported that the Functional Movement Screen (FMS) and the Lower
Quarter Y Balance Test (YBT-LQ) are "possible objective tools for evaluating a patient’s readiness to return to sports after
ACL reconstruction. The results suggest that many patients clinically cleared continue to have measurable functional
deficits and that both FMS and YBT-LQ may be used as additional tools for return to sports clearance." Further, Garrison et
al found that an athlete’s performance on the anterior reach of the Y Balance Test Lower Quarter correlated with functional
13
performance when they returned to sport.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 14
Thus, because the Y Balance Test Lower Quarter is predictive of injury and can identify the motor control changes that
occur after injury, it is imperative that it is included as part of the return to play criteria for athletes and discharge criteria
for all patients.

Researchers have found that limb length is a small, but significant factor in how far someone reaches on the Y Balance
Test. Therefore, limb length needs to be measured (from most inferior aspect of the anterior superior iliac spine to the
14
inferior distal surface of the medial malleolus of the right ankle to the nearest 0.5 cm).

Researchers have also found that there is a learning effect with the test which is why 6 practice trials are first performed
and then 3 trials in each of the 3 directions for each foot (for a total of 9 trials on each limb). In the Y Balance Test
research, the greatest reach (not the average reach) is used for for analysis.

References
1. Shaffer SW, Teyhen DS, Lorenson CL, et al. Y balance test: a reliability study involving multiple raters. Military
medicine. 2013;178(11):1264-1270.
2. 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. N Am J Sports Phys Ther. 2009;4(2):92-99.
3. Faigenbaum AD, Myer GD, Fernandez IP, et al. Feasibility and reliability of dynamic postural control measures in
children in first through fifth grades. International journal of sports physical therapy. 2014;9(2):140-148.
4. 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.
5. 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.
6. Smith CA, Chimera NJ, Warren M. Association of y balance test reach asymmetry and injury in division I athletes.
Medicine and science in sports and exercise. 2015;47(1):136-141.
7. Lehr ME, Plisky PJ, Butler RJ, Fink ML, Kiesel KB, Underwood FB. Field-expedient screening and injury risk algorithm
categories as predictors of noncontact lower extremity injury. Scand J Med Sci Sports. 2013;23(4):e225-232.
8. Garrison JC, Arnold A, Macko MJ, Conway JE. Baseball players diagnosed with ulnar collateral ligament tears
demonstrate decreased balance compared to healthy controls. J Orthop Sports Phys Ther. 2013;43(10):752-758.
9. Hannon J, Garrison JC, Conway J. Lower extremity balance is improved at time of return to throwing in baseball
players after an ulnar collateral ligament reconstruction when compared to pre-operative measurements.
International journal of sports physical therapy. 2014;9(3):356-364.
10. Mayer SW, Queen RM, Taylor D, et al. Functional Testing Differences in Anterior Cruciate Ligament Reconstruction
Patients Released Versus Not Released to Return to Sport. Am J Sports Med. 2015;43(7):1648-1655.
11. Boyle MJ, Butler RJ, Queen RM. Functional Movement Competency and Dynamic Balance After Anterior Cruciate
Ligament Reconstruction in Adolescent Patients. J Pediatr Orthop. 2016;36(1):36-41.
12. Sun L, Lin DE, Fan J, Gill TJ. Editorial: Functional testing in the assessment of return to sports after anterior cruciate
ligament reconstruction. Ann Transl Med. 2015;3(16):225.
13. Garrison JC, Bothwell JM, Wolf G, Aryal S, Thigpen CA. Y Balance Test Anterior Reach Symmetry at Three Months Is
Related to Single Leg Functional Performance at Time of Return to Sports Following Anterior Cruciate Ligament
Reconstruction. International journal of sports physical therapy. 2015;10(5):602-611.
14. Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and
outcomes in lower extremity injury: a literature and systematic review. Journal of athletic training. 2012;47(3):339-
357.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 15
Lower Quarter Examples
EXAMPLE 1
Name: Mike Jones For questions about this report contact:
Date of Birth: 03/02/1970 Jim Smith, CSCS
Test Date: 12/22/2015 ProRehab, PC
Report ID: R23354C3 812 492 4444

Summary Report
Wellness Screening

Lower Quarter Y Balance Test

Left Right Difference Standard
Anterior: 64 57.5 6.5 Below
Posteromedial: 120 117.5 2.5 Optimal
Posterolateral: 118 111 7 Below
Composite: 107.1 101.1 Optimal

Upper Quarter Y Balance Test

Left Right Difference Standard
Medial: 94 91 3 Optimal
Inferolateral: 84 79 5 Below
Superolateral: 82 79.5 2.5 Optimal
Composite: 94.2 90.2 Optimal

Here are your results compared to other 45 year old Moderate Fitness individuals.

Interpreting the YBT-LQ results requires a look at each of the four test standards. This includes examining for the presence
asymmetry in each of three reach directions as well as looking at the composite score compared to the client’s peer group.

In this example, there is 6.5 cm difference in the anterior reach direction and a 7 cm posterolateral asymmetry. Based on
research, this is considered dysfunctional. The composite score is above the cut point for a 45 year old male involved in
moderate level fitness activities. Therefore, his composite score is optimal.

It is important to note on the YBT-LQ that all four standards are components of testing motor control and determining
injury risk (i.e. need to examine asymmetry in each direction and composite score).

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 16
EXAMPLE 2

Name: Maria Wilson For questions about this report contact:

Date of Birth: 05/23/1995 Joe Smith, PT
Test Date: 12/22/2015 ProRehab, PC
Report ID: B57E94C8 812 492 4444

Summary Report
Pre-Season Physicals

Lower Quarter Y Balance Test

Left Right Difference Standard
Anterior: 55.5 57 1.5 Optimal
Posteromedial: 99 98 1 Optimal
Posterolateral: 101.5 106 4.5 Pass
Composite: 91.4 93.5 Below

Upper Quarter Y Balance Test

Left Right Difference Standard
Medial: 77.5 79 1.5 Optimal
Inferolateral: 66.5 70 3.5 Pass
Superolateral: 69 72 3 Optimal
Composite: 76.8 80.1 Below

Here are your results compared to other College Football (Soccer) athletes.

In this example, asymmetries are not present in any of the three reach directions. However, the composite score of
91.4 is below standard for female collegiate soccer players. This means that when the best reaches in all directions
were averaged and normalized for limb length, the composite score on one or both limbs was less than the cut point
determined specifically for the age, gender and sport or activity (in this case, collegiate soccer).

An individual can have asymmetries in any or all of the three reach directions, but may still do very well on the composite
score. Alternatively, asymmetries may be absent in all three reach directions, but the composite score may be below
standard. Keep in mind that all four standards are very important and a below standard score in any of them will affect
the plotting on the curve as well as the injury risk category on the Move2Perform report.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 17
Lower Quarter FAQ
Q: Can the heel come up on the stance leg during the YBT-LQ?
A: The heel of the stance foot can come up during the test as long as the other criteria for a valid test are met. (The reach
foot stays in contact with the red target area of the box, the reach foot does not touch down until the reach/return is
completed, there is control when returning to the starting position and the toe is just behind the red line on the stance
foot.)

Q: Do the hands have to remain on the hips during the reach attempts?
A: No. The participant is allowed to reach with the arms in any direction during the reach attempts.

Q: What does it mean to "return under control" after a reach attempt?

A: Returning to the starting position under control means that the client has little sway or loss of balance while
completing the reach attempt or returning to the start. Single leg stance is maintained without the need to set the foot
down immediately upon returning to the starting position to maintain balance. If you have a question if the client is
returning under control, you can require the client to maintain the single leg stance position for 1 second after returning
from a reach attempt.

Q: What is the reliability of YBT-LQ testing in children?

A: Faigenbaum et al found that the Y Balance Test can be used reliably in children 1st-5th grade.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 18
Y Balance Test Upper Quarter
Purpose
The Upper Quarter Y Balance Test (YBT-UQ) is a dynamic test where upper quarter mobility and stability are both
maximally challenged. Stability of the stance arm, shoulder girdle and trunk is challenged at the same time that mobility
of the reach arm, shoulder girdle and trunk is challenged. During each reach component, scapular stability, mobility,
thoracic rotation and core stability are combined as you encourage the client to reach as far as possible without losing
balance. By reaching as far as possible outside of a narrow base of support, the client is
required to use balance, proprioception, strength and full motion.

This test is designed to test an individual’s trunk and upper extremity while in a pushup
position. The goal of the test is to maintain a pushup position while on the center platform
of the YBT device and push the reach indicator with one hand as far medially and diagonally
Starting Position
across the body in the inferolateral and superolateral directions.

Description
Once you have given the client testing instructions, have the client perform two practice trials of all three reach directions
sequentially on each arm prior to formal testing. The test will be completed with shoes off.

Start by having the participant place the right thumb just behind and parallel to the red line in a pushup position with
feet shoulder-width apart and hands directly under the shoulders. The participant will push the reach indicator with the
left hand in the red target area to the left as far as possible. While maintaining the same position, have the client push
the inferolateral box as far as possible, and finally, push the superolateral box as far as possible without setting the reach
hand down. Read the reach distances while the client rests, and then repeat the test two more times with the right hand
on the stance plate. The client will then complete three trials in the same manner with the opposite limb. Unlike the lower
quarter YBT, all three reach directions are performed sequentially, one right after another without setting the reach hand
down between reach directions. When rested, the client will return to the starting position to perform the next trial.

Medial Reach Inferolateral Reach Superolateral Reach

Once ready to complete the formal testing, have the participant start with the right hand on the center plate and perform
all three trials while reaching in the three directions in the specific testing order. Measure the maximal reach distance by
reading the tape measure at the edge of the reach indicator, at the point where the most distal part of the hand reached
in half centimeters (e.g. 68.5, 69.0, 69.5 cm). Three trials in each direction for each arm will be collected and the maximal
reach in each direction will be included for analysis. If there are failed attempts, a maximum of six trials will be performed
for any stance arm in a single direction. If the participant has more than four failed attempts, record a zero for that trial.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 19
What Do We Look For On The YBT-UQ?
There should not be a greater than four centimeter right and left reach distance difference in the medial, inferolateral and
superolateral reach directions. Also, the composite score—the sum of three reach directions is divided by three times limb
length, then multiplied by 100—should not be less than the cut points that are specific for the age, gender and sport of the
individual. This can be obtained by using the Move2Perform software available at www.move2perform.com.

Reach Directions And Testing Order

The upper extremity that is being measured is the stance arm. This simply represents the pattern and does not imply the
functional ability of a body part or side. Reach is named in terms of directional relationship to the stance arm.

Start by having the participant place the right thumb just behind and parallel to the red line in a pushup position with
feet shoulder-width apart and hands directly under the shoulders. The participant will push the reach indicator with the
left hand in the red target area to the left as far as possible. While maintaining the same position, have the client push
the inferolateral box as far as possible, and finally, push the superolateral box as far as possible. Read the reach distances
while the client rests, and then repeat the test two more times with the right hand on the stance plate. The client will then
complete three trials in the same manner with the opposite limb. Unlike the lower quarter YBT, all three reach directions
are performed sequentially, one right after another without a break.

The specific testing order follows—

1. Right medial reach; right inferolateral reach; right superolateral reach
2. Left medial reach; left inferolateral reach; left superolateral reach

Reading The Measure

Measure the maximal reach distance by reading the tape measure at the edge of the reach indicator, at the point where
the most distal part of the hand reached in half centimeters (e.g. 68.5, 69.0, 69.5 cm). Three trials in each direction for each
arm will be collected and the maximal reach in each direction will be included for analysis. If there are failed attempts,
a maximum of six trials will be performed for any stance arm in a single direction. If the participant has more than four
failed attempts, record a zero for that trial.

Test Faults
▪▪ Shoving push box
▪▪ Not returning to starting position under control
▪▪ Touching down with reach hand before all three reach directions are completed
▪▪ Hand on top of stance plate
▪▪ Not maintain both feet in contact with the floor

Practice Trials
Once you have given the client the testing instructions, have the client perform two practice trials, two with each arm in
each of the three directions prior to formal testing. The test will be completed with shoes off.
Note: Only two practice trials are performed for the Upper Quarter Y Balance Test due to the high demand of the test and fatigue
becoming factor a,

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 20
Measuring Upper Limb Length
First, determine the client’s arm length in standing by measuring the distance from the Cervical 7 (C7) spinous process—
most bony prominence at the base of the neck—to the distal tip of the third digit to the nearest half centimeter with the
arm elevated to 90 degrees—out to side. If you are unable to determine the location of the C7 spinous process, have the
participant flex and extend the neck; the C7 spinous process will remain prominent throughout. Only measure the right
arm.

Tips for Testing

▪▪ The test is performed with the shoes off.
▪▪ The arm that is being measured is the stance arm. This simply represents the pattern and does not
imply the functional ability of a body part or side.
▪▪ Two practice trials for each arm in each direction should be performed prior to testing.
▪▪ Client must maintain unilateral stance on the platform.
▪▪ Client must maintain reach hand contact with the reach indicator on the target area while it is motion
(i.e. cannot shove the reach indicator).
▪▪ Client cannot use the reach indicator for stance support (i.e. place hand on top of reach indicator).
▪▪ Client must keep both feet in starting position throughout the test.
▪▪ The three directions must follow this pattern: medial, inferolateral and superolateral directions.
▪▪ Client must return the reach hand to the starting position under control.
▪▪ Do not coach the movement; simply repeat the instructions if needed.
▪▪ The stance arm elbow may bend during the test.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 21
Y Balance Test - Upper Quarter Research
Reliability, Baseline and Return to Sport Testing
Researchers have found the Y Balance Test Upper Quarter to have good reliability with ICC coefficients ranging from 0.80
1-4
to 1.0 for test-retest as well as intrarater reliability. In addition, multiple studies found there was no difference in YBT-
UQ performance between dominant and non-dominant limbs in professional and collegiate baseball players (including
1-4
pitchers), collegiate swimmers, and the general population. This indicates that YBT-UQ performance is a good measure
in return to sport testing when rehabilitating shoulder and arm and back injuries or getting baseline measurements.
4
Westrick et al stated:

"Similarity on the UQYBT between dominant and non-dominant limbs indicates that performance on this test using a
noninjured UE may serve as a reasonable measure for "normal" when testing an injured UE."

A Unique Measure of UE CKC Ability

When compared to other upper extremity tests such as the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST)
and the One Armed Hop Test researchers found that the YBT-UQ requires stability at the person’s limit of stability in a
one-arm push up position. The stability required during the YBT-UQ is unlike planks, side bridges, trunk flexor/extensor
4
endurance tests and the CKCUEST. Westrick et al reported:

"There was a significant fair to moderate association between performance on the UQYBT and the CKCUEST, LTET, and
push-ups. These results suggest the tests are interrelated but do not necessarily assess equal components of UE CKC
ability."

Injury Prediction
A military study used the Y Balance Test Upper Quarter as part of an injury prediction algorithm. The researchers found
prior history of injury, prior work restrictions, lower perceived recovery from prior injury, asymmetrical ankle dorsiflexion,
decreased composite score or asymmetrical performance on the YBT-LQ or YBT-UQ, and pain with Functional Movement
Screen or hop testing were associated with time loss injury in soldiers over a year period.

Thus, the Y Balance Test Upper Quarter is a reliable and valid means to determine a person’s upper quarter functional
symmetry for intake or return to sport/activity testing. Similar to the Y Balance Test Lower Quarter, the composite score
needs to be compared to the age, gender, and sport/activity cut points which are found in the Move2Perform software.

References
1. Butler R, Arms J, Reiman M, et al. Sex differences in dynamic closed kinetic chain upper quarter function
in collegiate swimmers. Journal of athletic training. 2014;49(4):442-446.
2. Butler RJ, Myers HS, Black D, et al. Bilateral differences in the upper quarter function of high school aged
baseball and softball players. International journal of sports physical therapy. 2014;9(4):518-524.
3. Gorman PP, Butler RJ, Plisky PJ, Kiesel KB. Upper Quarter Y Balance Test: reliability and performance
comparison between genders in active adults. Journal of strength and conditioning research / National
Strength & Conditioning Association. 2012;26(11):3043-3048.
4. Westrick RB, Miller JM, Carow SD, Gerber JP. Exploration of the Y balance test for assessment of upper
quarter closed kinetic chain performance. International journal of sports physical therapy. 2012;7(2):139-
147.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 22
Verbal Instructions For The Upper Quarter Y Balance Test
The following is a script to use while administering the Upper Quarter Y Balance Test. For consistency throughout all
testing this script should be used during each test. Equipment needed: Y Balance Test kit and cloth tape measure

Instructions

Please let me know if there is any pain while performing any portion of the test.

Please remove your shoes while performing the test.

Place your _______ hand on the center of the stance plate with your thumb just behind and parallel to the red
starting line with the other hand on top of the reach indicator.

While maintaining the ________ hand on the platform, push the reach indicator in the red target area as far as
possible with the opposite hand out to the side, then under and across, and finally over and across without resting
between directions.

The reach hand must maintain contact with the reach indicator on the target area while it is motion (i.e.. cannot shove
the reach indicator).

Do not use the reach indicator for stance support (i.e. don’t place hand on top of reach indicator).

Return the reach hand to the starting position under control.

Repeat two more times and then use the opposite arm in the same three directions.

Do you understand the instructions?

Have the participant perform each movement three times before alternating the supporting arm in the same
direction.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 23
Upper Quarter Examples
EXAMPLE 1
Name: Kyle Howard For questions about this report contact:
Date of Birth: 08/25/1987 Joe Smith, PT
Test Date: 12/22/2015 ProRehab, PC
Report ID: G43990BD 812 492 4444

Comprehensive Report
Pre-Season Physicals

Lower Quarter Y Balance Test

Left Right Difference Standard
Anterior: 69.5 71 1.5 Optimal
Posteromedial: 106 109 3 Optimal
Posterolateral: 109.5 111 1.5 Optimal
Composite: 100.7 103.2 Pass

Upper Quarter Y Balance Test

Left Right Difference Standard
Medial: 79 83 4 Pass
Inferolateral: 80 85 5 Below
Superolateral: 66.5 72 5.5 Below
Composite: 81.5 87 Pass

Here are your results compared to other Professional Baseball athletes.

Interpreting the YBT-UQ results requires a look at each of the four test standards. This includes examining for the
presence asymmetry in each of three reach directions as well as looking at the composite score compared to the client’s
peer group.

In this example, there is a 5 cm difference in the inferolateral reach direction and a 5.5 cm asymmetry in the superolateral
reach. Based on research, this is considered dysfunctional. The right and left composite scores are above the cut point
established for professional baseball players, therefore his composite score is in the passing standard.

It is important to note on the YBT-UQ that all four standards are components of testing motor control and determining
functional symmetry (i.e. you need to examine asymmetry in each direction and composite score).

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 24
EXAMPLE 2

Name: Maria Wilson For questions about this report contact:

Date of Birth: 05/23/1995 Joe Smith, PT
Test Date: 12/22/2015 ProRehab, PC
Report ID: B57E94C8 812 492 4444

Summary Report
Pre-Season Physicals

Lower Quarter Y Balance Test

Left Right Difference Standard
Anterior: 55.5 57 1.5 Optimal
Posteromedial: 99 98 1 Optimal
Posterolateral: 101.5 106 4.5 Pass
Composite: 91.4 93.5 Below

Upper Quarter Y Balance Test

Left Right Difference Standard
Medial: 77.5 79 1.5 Optimal
Inferolateral: 66.5 70 3.5 Pass
Superolateral: 69 72 3 Optimal
Composite: 76.8 80.1 Below

Here are your results compared to other College Football (Soccer) athletes.

In this example, asymmetries are not present in any of the three reach directions. However, the composite score of
76.8 is below standard for female collegiate soccer players. This means that when the best reaches in all directions
were averaged and normalized for limb length, the composite score on one or both limbs was less than the cut point
determined specifically for the age, gender and sport or activity (in this case, collegiate soccer).

An individual can have asymmetries in any or all of the three reach directions, but may still do very well on the composite
score. Alternatively, asymmetries may be absent in all three reach directions, but the composite score may be below
standard. Keep in mind that all four standards are very important and a below standard score in any of them will affect
the plotting on the curve as well as the injury risk category on the Move2Perform report.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 25
Upper Quarter FAQs
Q: Do you have expected normative data (published) for YBT-LQ and UQ for any age group/etc? If yes, are there
published cut-off scores (or proposed scores) related to injury risk, etc?
A: The risk cut points are based on multiple published studies as well as studies presented at scientific meetings
(specifically Butler 2013, Plisky 2006, Lehr 2013). When risk cut points for a specific group are not published, an algorithm
is used to establish the cut point based on the database of over 60,000 tests. This method of establishing risk cut points
was validated by Lehr et al 2013 in collegiate athletes. The cut points can be accessed on an individual client basis by
using the Move2Perform software.

Q: I currently use the Y Balance Test in my practice. Is it possible to get the cut points without buying the software?
A: No. The cut points are specific for each age, gender and sport. Given the complexity of the injury risk algorithm (which
utilizes the Y Balance Test Injury Risk cut points), you need to use the Move2Perform software to take full advantage of the
latest research in return to sport/activity and pre-participation testing.

Q: When analyzing Y Balance Test results, why are cut points necessary for age, gender, sport/activity level?
A: The Y Balance Test is predictive of injury and is frequently used in pre-participation and return to sport decision making.
However, researchers have found that a specific risk cut point MUST be used for each population:

▪▪ High school basketball player injury risk cut point was 94% (Plisky 2006)
▪▪ Collegiate football player cut point was 89% (Butler 2013)
▪▪ To best predict injury in collegiate athletes, a Y Balance Test composite score risk cut point was used
based on age, gender and sport for 10 different sports across both genders (Lehr 2013)
▪▪ Professional soccer players score better than professional basketball players on the Y Balance Test
(Plisky 2011 ACSM)
▪▪ Collegiate and Professional Soccer players performed better on the Y Balance Test than high school
soccer players (Butler 2012)

Each age, gender, and sport/activity level has a different average composite score as well as a different injury risk
cut point. In addition, remember that in 3 studies the injury risk cut points were different in high school vs. collegiate
athletics and that the 2013 Lehr et al study validated using Y Balance Test risk cut points based on age, gender and sport.

How do we apply this information? When determining an athlete’s readiness for return to sport or testing dynamic
balance, we need to use population specific risk cut points and normative data for analyzing Y Balance Test results. The
population specific risk cut points and normative database are applied by using the Move2Perform software.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 26
Appendix A
TEST PERFORMANCE STANDARDS CHECKLIST
Y Balance Test Lower Quarter

Measuring Limb Length

▪▪ The subject’s right limb, measured in centimeters from the anterior superior iliac spine to the most
distal portion of the medial malleolus with a cloth tape measure in supine.
▪▪ Be sure to get into soft tissue area under ASIS and hook under ASIS and go past medial malleolus and
measure at most distal tip.

Testing Order
▪▪ Right Anterior, Left Anterior; Right Posteriomedial, Left Posteriomedial; Right Posteriolateral, Left
Posteriolateral.

Starting Position
▪▪ With socks and shoes off, have person stand on the stance platform with the right foot, tip of big toe at
the start line. Reach leg is slightly touched down in triangular area formed by posterior pole and stance
plate.
▪▪ Note foot placement after each trial (foot frequently moves or get repositioned, need to reset prior to
next trial).

Reading the measure

▪▪ Read in half centimeters (69.0, 69.5, 70.0). If the reach indicator is over the number, it is that number. If
the whole number is showing, it is that number plus a half. If the reach indicator is over the next number,
it is that next whole number.

Identifying a Failed Reach Trial

▪▪ Failure to maintain unilateral stance on the platform (e.g. touched down to the floor with the reach foot
or fell off the stance platform).
▪▪ Failure to maintain reach foot contact with the reach indicator on the target area while it was in motion
(e.g. kicked the reach indicator).
▪▪ Using the reach indicator for stance support (e.g. placed foot on top of reach indicator).
▪▪ Failure to return the reach foot to the starting position under control.
▪▪ Failure to perform a successful trial in 6 attempts.
▪▪ Reports of pain during any trial.

Greatest or average reach?

▪▪ Greatest reach distance of three successful trials, for each direction, for each limb.

Do the hands need to be on the hips during the test?

▪▪ No

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 27
What is returning under control?
▪▪ If you are questioning whether or not the client is returning under control, require the client to maintain
the single leg stance position for one second after returning from the reach attempt.

Does the heel have to stay down?

▪▪ No

What is the reliability of YBT-LQ testing in children?

▪▪ Faigenbaum et al found that the Y Balance Test can be used reliably in children 1st-5th grade.

Closed Kinetic Chain Dorsiflexion

Starting Position
▪▪ With the individual in a lunge position kneeling on the left knee and right foot out in front. Right ankle,
knee and hip are at 90 degree angles; left knee and hip aligned under the shoulders and left foot
dorsiflexed.

Reading the Measure

▪▪ While the individual is in the starting position place the bubble goniometer over the While the individual
is in the starting position place the bubble goniometer over the tibial tuberosity of the lower leg (or two
finger widths below tibial tuberosity if using phone inclinometer). Next, have the individual lunge forward
bringing the right knee over the toes as far as they can without losing heel contact with the surface, read
and record the degrees of motion at this point. Repeat on the other side. Be sure the knee tracks forward
over the 4th ray and the heel maintains in contact with the surface. Next, have the individual lunge
forward bringing the right knee over the toes as far as possible without losing ground contact with the
right heel, read and record the degrees of motion at this point. Repeat on the other side.

Key Points
▪▪ Have foot straight forward (not externally rotated)
▪▪ Keep knee aligned over the 4th ray (typically person will deviate medially)
▪▪ Palpate between heel and kit (or ground) to determine when heel starts to lift off ground (pressure on
finger gets less)

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 28
Y Balance Test Upper Quarter
Measuring Limb Length
▪▪ The subject’s right limb, measured in centimeters from C7 to the most distal portion of the longest
phalanx with a cloth tape measure.
▪▪ Have the subject look down chin to chest to palpate and identify the C7 vertebrae and then measure
from C7 to the most distal tip of the longest finger.

Testing Order
▪▪ Right Medial, Right Inferolateral, Right Superolateral in succession for three (3) attempts. Then Left
Medial, Left Inferolateral, Left Superolateral for three (3) attempts.

Starting Position
▪▪ With socks and shoes off, have the athlete begin by assuming a pushup position with feet shoulder
width apart, right hand on the stance platform with the Right thumb along the start line. Left hand on
the medial reach indicator at shoulder width.
▪▪ Shoulder Width: Place feet shoulder width apart by aligning the inside edge of the foot with the crease of
the armpit

Reading the measure

▪▪ Read in half centimeters (69.0, 69.5, 70.0). If the reach indicator is over the number, it is that number. If
the whole number is showing, it is that number plus a half. If the reach indicator is over the next number,
it is that next whole number. When recording the scores, the stance arm indicates the limb being tested.

Identifying a Failed Reach Trial

▪▪ Failure to maintain unilateral stance on the platform (e.g. touched down to the floor with the reach hand
or fell off the stance platform).
▪▪ Failure to maintain reach hand contact with the reach indicator on the target area while it was in motion
(e.g. shoved the reach indicator).
▪▪ Using the reach indicator for stance support (e.g. placed fingers on top of reach indicator).
▪▪ Failure to return the reach hand to the starting position under control.
▪▪ Failure to perform a successful trial in 3 attempts.

SHOES ARE OFF IN YBT – UQ!

The feet need to stay in contact with ground
Unlike the Y Balance Test Lower Quarter, all three reach directions are performed sequentially without touching down or a
break. A break is allowed between trials.
Can the elbow be bent or remain straight during the YBT-UQ?
▪▪ The elbow can bend during the YBT-UQ
Greatest or average reach?
▪▪ Greatest reach distance of three successful trials, for each direction, for each limb.

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 29
Appendix B
SCORE NAME:____________________________________________

SHEET DATE:____________/____________/____________

Lower Quarter: Right LE Limb Length: _______cm (Distal ASIS to Distal Medial Malleolus)

DIRECTION GREATEST RIGHT GREATEST LEFT

Anterior
Posteromedial
Posterolateral

Upper Quarter: Right UE Limb Length: _______cm (C7 to tip of Longest Finger)

DIRECTION RIGHT TRIAL 1 RIGHT TRIAL 2 RIGHT TRIAL 3

Medial
Inferolateral
Superolateral

LEFT TRIAL 1 LEFT TRIAL 2 LEFT TRIAL 3

DIRECTION GREATEST RIGHT GREATEST LEFT

Medial
Inferolateral
Superolateral

Composite Right Score: Upper__________________ Lower__________________

Composite Left Score: Upper__________________ Lower__________________

Composite Reach Distance:

Composite score = ((sum of the greatest reach in each direction) / (3 x Limb Length)) x 100.
Calculate the composite scores for left and right separately.

Research validated composite score cut points for age, gender, and sport/activity are available through
the Move2Perform software www.move2perform.com

Copyright 2015 Functional Movement Systems, Gray Cook and Phil Plisky 30