Y Balance vs Star Excursion

<collecting some thoughts based off a question on how the Y-Balance Test relates to the Star Excursion-Balance Test that Todd Wright was talking about><this article was crafted with close dialogue with my great friend Dr. Rob Butler from Duke University>  So the Y Balance Test is a potentially simpler version of the Star Excursion Balance Test, which was developed by Gary Gray.  The Star Excursion has 8 lower extremity reaching measures, where the Y Balance has 3 in the Y-lower body version. In 2006, Dr. Phil Plisky's original study validated Gray's Star Excursion, using only the Y-Balance directions, as a valid tool for lower extremity injury prediction.  Plisky's work with Gribble and Hertle, 2 of the other research names you should know on this topic, further support the Star Excursion as a valid tool as per this this Review study.The connection to Austin and Todd Wright is that they are very Gary Gray-influenced in their training methodology.I still can not thank Todd and Logan enough for what I have learned from them over the last several years.It is disappointing that many of his great trainers have moved on from T4TG, and this article and this one too are my experiences over the last several years in learning from Todd and Logan.  It's been complete game changing stuff and their filtered approach to tri-planar movement.Now don't get all excited yet about the Star Excursion just yet.  Because when you look at this study that compared the common directions of the Y-Balance and Star Excursion, you basically get the same information when you use the same motions shared by each test.  So if you can get the same information in less time, 3 motions in Y-Balance vs. 8 motions in Star Excursion, I think there is some fairness to say the Y-Balance is more efficient in terms of time.Of course please do consider my bias as someone that uses the Y-Balance in some settings and supports the Functional Movement System.But same information in less time is not a biased statement.  It's fact.In comparing the Y-Balance and Star Excursion.....1) The Y-Balance has less total repetition for the participant to perform.2) To be consistent, the Y-Balance has equipment, but there is not agreement that it is required or even useful.  Some like the boxes on the dowels; others will put tape on the floor.  Some do the same with the Star Excursion; others use a 360 degree mat when testing.What is known is that you have a lot more rules in the Star Excursion, and this may lead to decreased reliability.3) We don't know that the Y-Balance Upper Body exam informs to upper body injury risk.  There is a study in review that it should be symmetrical in throwing athletes as an injury risk.  There is no upper body measure of Star Excursion.  This isn't good or bad; it's just answering to the Y-Balance vs. Star Excursion question above.4) We also know that when you get better at the Star Excursion, you reduce injuries.Both the Y Balance options and the Star Excursion screen out for if (there is risk).  They're both useful, and measure dynamic balance in a very similar construct.I would ask you to tread lightly if there is some suggestion that because the Star Excursion appears to evaluate more planes of motion that this is somehow better.  This is not the case according to using this tool as an injury predictor. It is better and desirable to train in multiple plains, which again, I refer you to the articles linked above.I also refer you to the suggestion, as I quote Gray Cook, that Function is not what it looks like.  It is what it produces.So where does this take me elsewhere in terms of the big picture?When we use things like the Y-Balance or Star Excursion or even the FMS, these examinations are of fundamental human movement competencies.  Whether they predict injury risk or merely set a standard, the lens that they look through is human, not athletic.  These predictions are also very consistent across multiple practitioners.So when we look at the athletic population, perhaps these excellent tests are not enough in a complete screening and testing approach.When we hear the likes of Dr. Stuart McGill jab at the FMS saying, "Just because you can, it doesn't mean you will," he is 100% correct.We hear many folks say well we have high scores on the FMS, and as soon as we load someone up, they look terrible.  Again, 100% correct.How can we look at movement quality under the presence of increased load?  Is there anything that has norms?  Does it account for quality with force production and force absorption?  Does it account for fatigue?  All of these more physiological factors will affect neurological expressions of movement in the athletic environment.Re-enter the room the over 15-year old Hop and Stop Test.Check out these links from SportsRehabExpert.com and Athlete by Design, which is Jeremy Boone's stuff.As I spoke to Rob Butler about this article and thoughts on this, we talked about my recent time in Toronto at the Women's Canada Basketball Cadet and Juniors camp.  We created a need to look at testing and how to best add  load to movement testing and still be practical and safe.  Most girls are training independently and can't possibly be tested safely with any kind of RM in a squat or clean.  Bottom line though is you can have a great FMS, but then things fall apart in the weight room or court.The Hop and Stop has norms for distance based off height, and it also test for symmetry, which is quite interesting.  The vertical jump is also in the mix for similar reasons, and it certainly has far more grounding as a performance measure as well.  The 3-jump lends to performance and movement control, and 20-jump test may give us a movement profile, power output, cardio expression, and movement under internal load.Maybe there's room for all of the above.Whenever I start to think about Hop and Stop, I'm like why don't we use this more.You can defend Hop and Stop with the 1-leg stuff and symmetry appraisal.  Vertical Jump though is more valid for overall athletic performance and CNS function.Let's just do both.And ultimately, if I use the FMS as a standard of movement, I use the Y-Balance or Star-Excursion as an injury predictor and dynamic balance competency in single-leg stance, and I use the Hop and Stop as a measure of what may or may not happen under load and speed, I have a far more complete view of how we can best modulate the training program.For my dollar, my opinion, I think the FMS can stand alone because we're still training and coaching after the screen is used to look for major problems (1s and pain) and right-left asymmetries.  And even then, if these are inherently motor control issues, smart training renders the program potentially unchanged.  Often smart ass-kicking training, NOT basic correctives, is the right thing to correct the FMS when the individual has all the joint mobility in place.  This is actually a piece that the Anti-FMS crowd doesn't seem to appreciate.  An 11 mobility problem gets on the floor with lots of regressions.  An 11 stability problem might do deadlifts, squats, and pull-ups very quicky.  This is not a difficult road map to unfold after the initial screening.As an aside, if you go certain places with a low FMS, you can expect failure.If you go certain places with a high FMS, you can expect progression.Nothing is guaranteed.  It's just a guide.I don't think the Y-Balance, Hop and Stop, or Vertical Jump can stand alone though.If you have failure in quality or power output, you don't know why.  A power output problem doesn't always have a power output solution.At Nike, it has been interesting to see discrepancies in risk profiles when all the different evaluations don't match up.This is really critical to see that we can not just use 1 tool.Recent case, we've also seen that in doing the OmegaWave Work Capcity test first, and the athletes were miserably out of shape, their FMS measured was down 2-4 points from recent previous scoring.  So cardio counts too.When you look at this amalgamation of data completely and unbiased, it actually makes perfect sense simply on how to we skew training towards weak links in varying stages of competency and/or capacity.Lisman's article here looks at FMS and aerobic testing together, and this is really where my head is at moving forward in looking at movement testing.Everything is connected, which is a big reason to track everything back to the Autonomic Nervous System.  I believe every test listed above tracks back to the ANS in different values.

IF you use the ANS as your guide, I do believe what will appear to be ignoring the FMS will change the FMS.................IF..............the individual has primarily motor control or stability limitations.  This is the concern of the jerks that bag on the FMS without understanding the complete message.  So let me explain 1) why you can't just do the FMS, and 2) why smart training often works out just fine.Under stress, we go to particular patterns of up-regulation where particular muscles gain low-grade, long-term muscle contraction.  We can not deny stress of the training process.  Hopefully most, if not all, of the training process is gearing towards positive adaptations.  But even then recovery is not an option.

If recovery is not ideal, and those up-regulations become chronic, partial pressure of oxygen in the muscle cells are decreased.

And when partial pressure of oxygen is decreased, alpha pro-1 collagen makes scar tissue.

And then movement patterns are stuck.  This is a mobility problem FMS.  And the training box is small(er).

If the adaptations are not chronic yet - Stability FMS problem, you can increase oxygenation uptake through smart training.

THEN you can stave off the changes in the FMS BEFORE they are chronic.But this only works when the individual has the mobility present.  This is where the deeper screening process comes in, and you can't just look at the number that the FMS spits out.  The number just remands if you should look deeper or not and then decide best practice.

As usual I win, and I learned this from Val Nsedkin once he appreciated what the FMS is and isn't.  I'd do his voice, but you wouldn't hear it through the screen.

Everything is connected.Everything matters.Use whatever your training is to beat "these" tests.  Choose wisely and holistically.Bill Hartman actually talked about musculoskeletal assessment under fatigue several years ago. I kinda discarded it as dude, I'm not Coopering someone just to see what happens. I was wrong.If a movement profile, is solid, but pain or power are the limitations, consider this statement.  Make sure you have sound on for this one.