Donald Shrump's poster on assessing risk of lower extremity injury using the

y-balance test lower quadrant

Shrump, Donald  Jr.

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Background and Purpose Assessing Risk of Lower Extremity Injury:  Y-Balance Test™ Lower Quadrant Donald D. Shrump Jr., CSCS University of Bridgeport College of Chiropractic University of Bridgeport, Bridgeport, CT Background – • Utility of functional testing has become increasingly popular by clinicians in an effort to assess injury risk, baseline deficits from injury, and improvement after treatment. 1, 2,3,4,5  • Previous injuries may lead to subtle deficits in neuromuscular control, dynamic posture control, strength, and flexibility. 3,4  • Y-Balance Test™ lower quadrant (YBT-LQ) provides quantitative data for the effectiveness rehabilitative modalities.6  • Evidence supporting YBT-LQ has provided many clinicians with  criterion for decision making in treatment modalities.    Purpose –  • The purpose of this presentation was to demonstrate the usefulness of employing YBT-LQ into chiropractic rehabilitation practice. References 1. Plisky P, Rauh M, Kaminski T, Underwood F. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36:911-919. 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. North Am J Sports Phys Ther 2009;4(2):92. 3. Nadler SF, Malanga GA, Feinberg JH, Rubanni M, Moley P, Foye P. Functional performance deficits in athletes with previous lower extremity injury. Clin J Sport Med. 2002;12(2):73-78. 4. Lehr ME, Plisky PJ, Kiesel KB, Butler RJ, Fink M, Underwood FB. Y Balance Test Predicts Non-Contact Lower Extremity Injury in Collegiate Football Players. Sports Health. (In Review)  5. 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 Aug;23(4):e225-32. 6. de Noronha M, França LC, Haupenthal A, Nunes GS. Intrinsic predictive factors for ankle sprain in active university students: A prospective study. Scand J Med Sci Sports. 2012. 7. Paterno MV, Myer GD, Ford KR, Hewett TE. Neuromuscular training improves single-limb stability in young female athletes. J Orthop Sports Phys Ther. 2004 Jun;34(6):305-16. 8. Wassinger CA, Rockett A, Pitman L, Murphy MM, Peters C. Acute effects of rearfoot manipulation on dynamic standing balance in healthy individuals. Man Ther. 2013 Nov 10.   Methods • Prior to balance testing, lower extremity length is measured from the anterior superior iliac spine (ASIS) to the medial malleolus on all patients to standardize reach distances.  • Following familiarization with the YBT-LQ protocols, dynamic standing balance can be quantified by measuring lower extremity reach distances anteriorly (A), posteromedially (PM), and posterolaterally (PL) from 3 successful attempts.    • Initial results of the reach distances may be compared for left to right asymmetries.  • Composite score (CS) can be calculated by the sum of three reach directions divided by three times lower limb length (cm), then multiplied by 100.      ( A  +  PM  +  PL )     (3 x Limb Length)  • Using the composite score, a clinician could utilize the injury risk algorithm by Move2Perform for pre-participation physical screenings and to assist with return to sport decisions.5  • Various treatment modalities can be tested for effectiveness.7,8      Results and Conclusions Methods Treatments • Composite scores below cut off points (i.e. college football = 89%) increased probability of injury by 37.7% to 68.1 %.4  • Subjects with anterior asymmetry > 4 cm were 2.5 times more likely to sustain a injury. Additionally, females in the bottom1/3 of the composite score cut off had a 6 times risk of injury.1  • Subjects with a composite score under 80 for PL have 48% greater risk of suffering an ankle sprain. In contrast, participants who were able to reach a distance equivalent to 90% of their limb length or higher, had a significantly lower incidence of sprains.5  • Neuromuscular training and rearfoot distraction manipulation significantly improve YBT-QL scores.7,8  • Future studies using YBT-LQ should evaluate effectiveness of various chiropractic manipulation treatments. Results X 100 = CS www.ybalancetest.com/ Fig. 1 – Anterior Reach www.ybalancetest.com/ Fig. 2 – Posteromedial Reach www.ybalancetest.com/ Fig. 3 – Posterolateral Reach Fig. 4 – Move2Perform algorithm creates cut off points for age, gender, and  sport.  Fig. 5 - Survival curves for Star Excursion Balance Test posterolateral direction (SEBT PL) according to Cox regression model. 6 Table 1. Sample neuromuscular exercise progressions from the balance and hip/pelvis/trunk strengthening protocol for single leg stability.7 Initial Phase (Weeks 1-2) Intermediate Phase  (Weeks 3-4) Late Phase  (Weeks 5-6) Stable surface progression: • Broad jump, stick landing • Box drop, stick landing • Single-leg, stick landing • Box drop medicine ball catch • Single-leg crossover, stick landing • Box drop 180° medicine ball catch Unstable surface (BOSU) progression: • Double-leg balance  • Double-knee balance • Single-leg balance • Single-knee balance (Fig. 6) • Single-leg balance (perturbation/     sport-specific) • Hip-side balance Targeted hip/pelvis/trunk strengthening: • Abdominal crunch BOSU abdominal crunch • Lower back superman’s • BOSU abdominal crunch • BOSU lower back superman’s • BOSU abdominal V-sit/toe touch • Back hyperextensions Wassinger et al 2013 Fig. 7 - Rearfoot Distraction Manipulation8 Paterno et al 2004 Fig. 6 - Neuromuscular training7  

Assessing Risk of Lower Extremity Injury

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Assessing Risk of Lower Extremity Injury

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