Stance foot alignment and hand positioning alter star excursion balance test scores in those with chronic ankle instability: What are we really assessing?

Physiother Theory Pract. 2017 Apr;33(4):316-322. doi: 10.1080/09593985.2017.1302028. Epub 2017 Mar 31.


Objective: The literature has consistently shown that the Star Excursion Balance Test (SEBT) is a reliable and valid tool to anticipate the risk of lower extremity injury, assess dynamic postural control differences among groups, and assess the effectiveness of balance training programs in both healthy individuals and people with lower extremity injuries. However, there is no standard administration technique for the SEBT in research, clinical practice, or performance settings. Therefore, the purpose of this investigation was to compare six different combinations (3 different foot alignments × 2 hand positions) on the SEBT performance in those with chronic ankle instability (CAI).

Design: Repeated Measures Design.

Setting: University Research Laboratory.

Participants: Twenty-five university students with CAI (12 males, 13 females; age: 20.3 ± 2.4 years, height: 172.7 ± 7.4 cm, weight: 77.5 ± 15.3 kg.

, bmi: 25.9 ± 4.0 kg/m2) voluntarily participated in the study.

Methods: Six different SEBT positions were used to assess dynamic postural control. Three foot positions: 1) Foot centered; 2) Toe fixed; and 3) Toe-heel changing and two hand placements: 1) Hands free and 2) Hands on the hips were used in this study. After 6familiarization trials for each condition, three Star Excursion Balance Test scores were recorded.

Main outcome measures: Normalized reach distance (% of leg length) in the anterior, posteromedial, and posterolateral directions as well as a composite reach score quantified dynamic postural control.

Results: Both foot alignment and hand position significantly altered normalized SEBT reach distance in the anterior (p < 0.003), posteromedial (p < 0.001), posterolateral (p < 0.001), and composite reach scores (p < 0.001).

Conclusion: Different foot alignments and hand constraints significantly altered normalized reach distances and the composite score in individuals with CAI. These results do not suggest that any combination of foot alignments and/or hand constraints is superior. However, changing the toe/heel position, while maintaining hands on the hips, may provide the best standardization for clinicians and researchers.

Keywords: Ankle sprains; dynamic postural control; methodology.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Ankle Joint / physiopathology*
  • Biomechanical Phenomena
  • Chronic Disease
  • Female
  • Foot*
  • Hand*
  • Humans
  • Joint Instability / diagnosis*
  • Joint Instability / physiopathology
  • Male
  • Patient Positioning*
  • Physical Examination / methods*
  • Postural Balance*
  • Predictive Value of Tests
  • Range of Motion, Articular
  • Reproducibility of Results
  • Young Adult