Dynamic Leap and Balance Test: Ability to Discriminate Balance Deficits in Individuals With Chronic Ankle Instability

in Journal of Sport Rehabilitation
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Context: The Dynamic Leap Balance Test (DLBT) is a new dynamic balance task that requires serial changes in base of support with alternating limb support and recovery of dynamic stability, as compared with the Y modification of the Star Excursion Balance Test (Y-SEBT), which assesses dynamic stability over an unchanging base of support. Objectives: To assess the dynamic balance performance in 2 different types of dynamic balance tasks, the DLBT and the SEBT, in subjects with unilateral chronic ankle instability (CAI) when compared with matched controls. The authors hypothesized that the DLBT score would significantly differ between the CAI involved and uninvolved limbs (contralateral and healthy matched) and demonstrate a modest (r = .50) association with the SEBT scores. Design: Case-control. Setting: Controlled laboratory. Participants: A total of 36 physically active adults, 18 with history of unilateral CAI and 18 without history of ankle injury, were enrolled in the study. CAI subjects were identified using the Identification of Functional Ankle Instability questionnaire. Interventions: The DLBT and the SEBT were performed in a randomized order on a randomly selected limb in CAI and healthy subjects. Main Outcome Measures: Time taken to complete the DLBT and the reach distances performed on the SEBT were compared between the CAI and the healthy subjects. Results: There were no statistically significant differences (P < .05) in SEBT reach distances between groups. The DLBT time was greater (P < .01) for unstable ankles compared with the stable ankle. The authors found no correlation (P > .05) between DLBT time and any of the SEBT reach distances suggesting that the DLBT provides unique information in the assessment of patients with CAI. Conclusion: The DLBT challenges the ability to maintain postural control in CAI subjects differently than the SEBT. There is a need of more dynamic balance assessment tools that are functional and clinically relevant.

Jaffri is with Exercise and Sport Injury Laboratory, Department of Kinesiology, University of Virginia, Charlottesville, VA, USA. Jaffri, Newman, Smith, Vairo, Buckley, and Miller are with the Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA. Vairo is also with the Department of Orthopedics and Rehabilitation, The Pennsylvania State University, Regional Campus, University Park, PA, USA. Denegar is with the Department of Kinesiology, University of Connecticut, Storrs, CT, USA.

Jaffri (ahj8uw@virginia.edu) is corresponding author.
  • 1.

    Tsigilis N, Zachopoulou E, Mavridis T. Evaluation of the specificity of selected dynamic balance tests. Percept Mot Skills. 2001;92(3, pt 1):827–833. doi:

  • 2.

    Wegener L, Kisner C, Nichols D. Static and dynamic balance responses in persons with bilateral knee osteoarthritis. J Orthop Sports Phys Ther. 1997;25(1):13–18. PubMed ID: 8979171 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Blackburn T, Guskiewicz KM, Petschauer MA, Prentice WE. Balance and joint stability: the relative contributions of proprioception and muscular strength. J Sport Rehabil. 2000;9(4):315–328. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Gambetta V, Gray G. Everything in balance. Train Cond. 1995;2(2):15–18.

  • 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. J Athl Train. 2002;37(4):501–506. PubMed ID: 12937574

    • Search Google Scholar
    • Export Citation
  • 6.

    Wikstrom EA, Fournier KA, McKeon PO. Postural control differs between those with and without chronic ankle instability. Gait Posture. 2010;32(1):82–86. PubMed ID: 20418101 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Delahunt E, Coughlan GF, Caulfield B, Nightingale EJ, Lin C, Hiller CE. Inclusion criteria when investigating insufficiencies in chronic ankle instability. Med Sci Sports Exerc. 2010;42(11):2106–2121. PubMed ID: 20351590 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Mulligan I, Boland M, Payette J. Prevalence of neurocognitive and balance deficits in collegiate football players without clinically diagnosed concussion. J Orthop Sports Phys Ther. 2012;42(7):625–632. PubMed ID: 22531476 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Tsai LC, Yu B, Mercer VS, Gross MT. Comparison of different structural foot types for measures of standing postural control. J Orthop Sports Phys Ther. 2006;36(12):942–953. PubMed ID: 17193872 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Docherty CL, McLeod TCV, Shultz SJ. Postural control deficits in participants with functional ankle instability as measured by the Balance Error Scoring System. Clin J Sport Med. 2006;16(3):203–208. PubMed ID: 16778539 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Wikstrom EA, Tillman MD, Chmielewski TL, Borsa PA. Measurement and evaluation of dynamic joint stability of the knee and ankle after injury. Sports Med. 2006;36(5):393–410. PubMed ID: 16646628 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Ross SE, Guskiewicz KM. Examination of static and dynamic postural stability in individuals with functionally stable and unstable ankles. Clin J Sport Med. 2004;14(6):332–338. PubMed ID: 15523204 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Bernier JN, Perrin DH, Rijke A. Effect of unilateral functional instability of the ankle on postural sway and inversion and eversion strength. J Athl Train. 1997;32(3):226–232. PubMed ID: 16558454

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Ross SE, Guskiewicz KM, Yu B. Single-leg jump-landing stabilization times in subjects with functionally unstable ankles. J Athl Train. 2005;40(4):298–304. PubMed ID: 16404451

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Basnett CR, Hanish MJ, Wheeler TJ, et al. Ankle dorsiflexion range of motion influences dynamic balance in individuals with chronic ankle instability. Int J Sports Phys Ther. 2013;8(2):121–128. PubMed ID: 23593550

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Martinez-Ramirez A, Lecumberri P, Gomez M, Izquierdo M. Wavelet analysis based on time–frequency information discriminate chronic ankle instability. Clin Biomech. 2010;25(3):256–264. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Pionnier R, Découfour N, Barbier F, Popineau C, Simoneau-Buessinger E. A new approach of the Star Excursion Balance Test to assess dynamic postural control in people complaining from chronic ankle instability. Gait Posture. 2016;45:97–102. PubMed ID: 26979889 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Fullam K, Caulfield B, Coughlan GF, Delahunt E. Kinematic analysis of selected reach directions of the Star Excursion Balance Test compared with the Y-Balance Test. J Sport Rehabil. 2014;23(1):27–35. PubMed ID: 23945793 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Gribble PA, Hertel J, Denegar CR, Buckley WE. The effects of fatigue and chronic ankle instability on dynamic postural control. J Athl Train. 2004;39(4):321–329. PubMed ID: 15592604

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Sefton JM, Hicks-Little CA, Hubbard TJ, et al. Sensorimotor function as a predictor of chronic ankle instability. Clin Biomech. 2009;24(5):451–458. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Jaffri AH, Newman TM, Smith BI, Miller SJ. The Dynamic Leap and Balance Test (DLBT): a test–retest reliability study. Int J Sports Phys Ther. 2017;12(4):512–519. PubMed ID: 28900556

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2014;48:1014–1018. PubMed ID: 24255768 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Hambly K. The use of the Tegner Activity Scale for articular cartilage repair of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):604–614. PubMed ID: 21076815 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Konor MM, Morton S, Eckerson JM, Grindstaff TL. Reliability of three measures of ankle dorsiflexion range of motion. Int J Sports Phys Ther. 2012;7(3):279–287. PubMed ID: 22666642

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36(12):911–919. PubMed ID: 17193868 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Gribble PA, Hertel J. Considerations for normalizing measures of the Star Excursion Balance Test. Meas Phys Educ Exerc Sci. 2003;7(2):89–100. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Finnoff JT, Peterson VJ, Hollman JH, Smith J. Intrarater and interrater reliability of the Balance Error Scoring System (BESS). PM R. 2009;1(1):50–54. PubMed ID: 19627872 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    McKeon P, Ingersoll C, Kerrigan DC, Saliba E, Bennett B, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008;40(10):1810–1819. PubMed ID: 18799992 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Hoch MC, Staton GS, McKeon PO. Dorsiflexion range of motion significantly influences dynamic balance. J Sci Med Sport. 2011;14(1):90–92. PubMed ID: 20843744 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Terada M, Harkey MS, Wells AM, Pietrosimone BG, Gribble PA. The influence of ankle dorsiflexion and self-reported patient outcomes on dynamic postural control in participants with chronic ankle instability. Gait Posture. 2014;40(1):193–197. PubMed ID: 24768526 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    van der Harst JJ, Gokeler A, Hof AL. Leg kinematics and kinetics in landing from a single-leg hop for distance. A comparison between dominant and non-dominant leg. Clin Biomech. 2007;22(6):674–680. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Orishimo KF, Kremenic IJ. Effect of fatigue on single-leg hop landing biomechanics. J Appl Biomech. 2006;22(4):245–254. PubMed ID: 17293621 doi:

  • 33.

    Kulmala J-P, Avela J, Pasanen K, Parkkari J. Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers. Med Sci Sports Exerc. 2013;45(12):2306–2313. PubMed ID: 23748735 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Nunns M, House C, Fallowfield J, Allsopp A, Dixon S. Biomechanical characteristics of barefoot footstrike modalities. J Biomech. 2013;46(15):2603–2610. PubMed ID: 24054331 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Williams DS, McClay IS, Manal KT. Lower extremity mechanics in runners with a converted forefoot strike pattern. J Appl Biomech. 2000;16(2):210–218. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Seebauer CJ, Bail HJ, Rump JC, Hamm B, Walter T, Teichgräber UK. Ankle laxity: stress investigation under MRI control. AJR Am J Roentgenol. 2013;201(3):496–504. PubMed ID: 23971441 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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