Star Excursion Balance Test

The Star Excursion Balance Test (SEBT) is a dynamic balance assessment requiring strength, flexibility, and proprioception. It is used to evaluate dynamic balance, identify functional deficits, and predict injury risk in the lower extremity, particularly among athletes and physically active individuals¹. The test is widely recognized for its application in rehabilitation after musculoskeletal injuries, especially chronic ankle instability, as well as for assessing functional limitations in individuals with knee osteoarthritis².

Purpose and Principle

The purpose of the SEBT is to maintain balance on one leg while reaching the opposite leg as far as possible in eight different directions: anterior, anteromedial, medial, posteromedial, posterior, posterolateral, lateral, and anterolateral³.

Test setup:

• Athletic tape is placed on the floor in a star pattern with 45° between each line

• The patient balances on one leg at the center while reaching in each of the eight directions with the opposite leg

• Reach distances are measured precisely

Reduced reach distance in one or more directions—particularly posteromedial—may indicate functional instability and increased risk of injuries such as sprains or ligament ruptures⁴.

Execution of the Test

1. Prepare the floor with athletic tape in a star pattern

2. The patient stands barefoot on one leg in the center of the star

3. The opposite leg reaches as far as possible along one of the eight directions without losing balance

4. Measure the distance from the center to the point where the foot touches the ground

5. Repeat for all eight directions and both legs

6. Calculate results as a percentage of leg length for standardized scoring⁵

Interpretation and Evidence

• Reliability:

  • High intra-rater reliability (ICC 0.67–0.97)

  • Moderate to good inter-rater reliability (ICC 0.35–0.93)

  • Accurate setup and measurement are essential for consistency⁶

• Clinical use:

  • Commonly applied in rehabilitation and return-to-play decisions after ankle and knee injuries

  • Research shows that reduced reach distance in the anterior, posteromedial, and posterolateral directions can predict lower extremity injury risk, especially in athletes⁷

  • Despite its widespread use, further research is recommended to validate SEBT in specific injured populations, such as those with patellofemoral pain syndrome⁸

Summary

The Star Excursion Balance Test (SEBT) is a validated and reliable dynamic balance test used in both sports and clinical settings. It assesses functional performance, predicts injury risk, and supports rehabilitation decision-making. While highly useful, results should be interpreted with caution in specific patient populations until further validation studies are available.

Sources:

1. Advanced fitness assessment and exercise prescription. Heyward V. Human kinetics, 6th edition: 303 (5)

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 American journal of sports physical therapy: NAJSPT. 2009 May;4(2):92.

3. Pollock, Kristen M. The star excursion balance test as a predictor of lower extremity injury in high school football players. Diss. University of Toledo, 2010.

4. Picot B, Terrier R, Forestier N, Fourchet F, McKeon PO. The star excursion balance test: an update review and practical guidelines. International Journal of Athletic Therapy and Training. 2021 Jul 20;26(6):285-93. BibTeXEndNoteRefManRefWorks

5. Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. Journal of athletic training. 2002 Oct;37(4):501.

6. TheProactiveAthlete. Star Excursion Balance Test. Available from: https://www.youtube.com/watch?v=UxDbm7_CWec [last accessed 25/10/2012]

7. Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. Journal of Orthopaedic & Sports Physical Therapy. 2006 Dec;36(12):911-9.

8. 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 May;47(3):339-57.

9. Hardy L, Huxel K, Brucker J, Nesser T. Prophylactic ankle braces and star excursion balance measures in healthy volunteers. Journal of athletic training. 2008 Jul;43(4):347-51.

10. Chaiwanichsiri D, Lorprayoon E, Noomanoch L. Star excursion balance training: effects on ankle functional stability after ankle sprain. JOURNAL-MEDICAL ASSOCIATION OF THAILAND. 2005 Sep;88:S90.

11. Kanko LE, Birmingham TB, Bryant DM, Gillanders K, Lemmon K, Chan R, Postic M, Giffin JR. The star excursion balance test is a reliable and valid outcome measure for patients with knee osteoarthritis. Osteoarthritis and Cartilage. 2019 Apr 1;27(4):580-5.