Upper Quarter Y-Balance Test

Most of us have used the Y-Balance Test for lower quarter injury risk assessment, but have you used it for the upper quarter? In today’s mentoring minutes with Dr. Jordan Cossin we look at how to use the Y-Balance Test as a functional measure for your upper extremity patients! Take a look at the video and notes below!

Notes:

• Significant difference in performance between patients with shoulder impingement syndrome & healthy controls.

  • Shoulder impingement syndrome performed worse in medial & inferolateral directions.

• Youth athletes perform significantly better than untrained youth control.

• Fair to moderate correlation with core stability & upper extremity functional tests.

  • No significant difference between dominant & non dominant limbs.

• Excellent test-retest reliability.

• Moderate agreement between commercial Y-Balance Test apparatus and DIY version.

How to Perform:

• Upper limb length measurement

  • Shoulder abducted to 90 deg

  • Tape measure from spinous process of C7 to longest digit

• General cardio warm-up (5 min)

• Push up position (Feet 12 in. apart)

• Ulnar/thumb side of stable arm placed on center block/line

• Test specific warm-up (3 sub maximal reaches in each direction)

  • Medial, superolateral, inferolateral

• 3 practice trials (1 minute rest between each)

• 3 data collection trials (1 minute rest between each)

Data Collection:

• Average of 3 trials scored

• Sum of all 3 directions taken for total excursion score

  • Composite score = total excursion score / 3x upper limb length (#1 on how to perform)

• Compare bilaterally

DIY Upper Quarter Y-Balance Test:

• 3 cloth tape measures

• Athletic tape

• Goniometer

  • 90 deg

  • 135 deg (x2)

• x3 2x4x8 wood blocks

References:

Cramer, J., Quintero, M., Rhinehart, A., Rutherford, C., Nasypany, A., May, J., & Baker, R. T. (2017). Exploration of score agreement on a modified upper quarter y-balance test kit as compared to the upper quarter y-balance test. International Journal of Sports Physical Therapy, 12(1), 117.

Hazar, Z., Ulug, N., & Yuksel, I. (2014). Upper Quarter Y-Balance Test Score of Patients with Shoulder Impingement Syndrome. Orthopaedic Journal of Sports Medicine, 2(11_suppl3), 2325967114S00275.

Schwiertz, G., Beurskens, R., & Muehlbauer, T. (2020). Discriminative validity of the lower and upper quarter Y balance test performance: a comparison between healthy trained and untrained youth. BMC Sports Science, Medicine and Rehabilitation, 12(1), 1-8.

Westrick, R. B., Miller, J. M., Carow, S. D., & Gerber, J. P. (2012). Exploration of the y-balance test for assessment of upper quarter closed kinetic chain performance. International journal of sports physical therapy, 7(2), 139.

Training Load Progression (Return to Sport/Activity)

Difficulty knowing how much, how fast, or how soon to progress your patient’s? Whether you’re working with a high-level athlete or the average jane/joe understanding how to minimize injury risk while enhancing performance is key! Watch Dr. Jordan Cossin’s video below to learn more on today’s mentoring minutes!

Notes: 

• 5 Ways to ensure patients are well prepared for demands

  1. Maintain adequate training load during offseason &/or while injured

     • Raises “floor”

     • Avoid “basement”

     • Improves athletes’ ability to tolerate load during pre-season & return to sport

  2. Identify ceiling & ensure training load is proportionate to competition

     • Need to know what the athlete is going back to

       • Wearable & video technologies

       • Sport-specific literature

  3. Assess individual difference in training tolerance

     • Age

     • Injury hx

     • Poor training hx

     • Musculoskeletal deficiencies

     • Strength deficits

     • Poor aerobic fitness

     • Psychosocial factors

  4. Identify & prepare for most demanding parts of the sport

     • Do not just train for average demands of competition, but prepare for the highest demand

       • If not may result in: inability to perform at higher intensities when needed, may be at greater risk of injury during these times

  5. Understanding of the physical demands of the sport, physical capacities required to perform activities, & factors that limit performance (individual)

     • Time to progress from “floor” to “ceiling”

     • Progressive, gradual, & systematic increases in training load 

“Floor”: patient/athlete’s current capacity

“Ceiling”: capacity needed to perform specific task/sport

“Time”: time allotted to get from floor to ceiling

“Basement”: deconditioning/injury resulting in capacity below the “floor”

“Penthouse”: capacity above the need for specific task/sport

References:

Gabbett, T. J. (2020). How much? How fast? How soon? Three simple concepts for progressing training loads to minimize injury risk and enhance performance. journal of orthopaedic & sports physical therapy, 50(10), 570-573.

Balance in Elderly

Welcome to PhysioU’s Mentoring Minutes! Each episode of Mentoring Minutes directly applies a clinical approach with relevant research for effective results.

Notes: 

• Muscle power (force x velocity) declines earlier & faster with age than strength or endurance.

  • Elderly fallers in community & nursing homes show less power in lower limbs than non-fallers.

• 10-weeks of power training improves balance in healthy elderly adults.

• High speed resistance training improves functional performance and quality of life in healthy elderly females.

• Low load power training (20% 1RM) demonstrates greatest improvement in balance when compared to higher loads. 

  • Power improves to the same degree across load ranges.

• Power training shows low amount of adverse events in healthy elderly adults (it’s safe)

• Cluster sets demonstrate better outcomes for functional performance measures than traditional sets.

  • Cluster set: 30 sec rest after 2 consecutive reps (total of 8 reps per set). 

  • Traditional set: 150 sec rest after 8 consecutive reps. 

References:

Orr, R., De Vos, N. J., Singh, N. A., Ross, D. A., Stavrinos, T. M., & Fiatarone-Singh, M. A. (2006). Power training improves balance in healthy older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(1), 78-85.

Ramirez-Campillo, R., Alvarez, C., Garcìa-Hermoso, A., Celis-Morales, C., Ramirez-Velez, R., Gentil, P., & Izquierdo, M. (2018). High-speed resistance training in elderly women: effects of cluster training sets on functional performance and quality of life. Experimental gerontology, 110, 216-222.

Mentoring Minutes: Lack of DF and Kinematic Changes Up The Chain

We take a deep into how dorsiflexion can have a significant impact on the rest of the kinetic chain. Dr. LeMoine breaks down functional tests that can be used for assessments AND treatments. He also discusses common movement faults that a clinician should be aware of when viewing the patient from various angles during functional testing.

Hand Held Dynamometer: Quad & Lower Extremity Muscles

We look at alternative ways to test max strength of various lower extremity muscles. Dr. LeMoine breaks down the current research and demonstrates the set up when using a hand held dynamometer for the LE in the clinic. He explains how it compares to the gold standard and stresses the importance of using it with all patients.

References:

• Diagnostic Accuracy of Handheld Dynamometry and 1-Repetition-Maximum Tests for Identifying Meaningful Quadriceps Strength Asymmetries

• Hip Strength Deficits in People With Symptomatic Knee Osteoarthritis: A Systematic Review With Meta-analysis

• Persons With Chronic Hip Joint Pain Exhibit Reduced Hip Muscle Strength