Hand Reach Star Excursion Balance Test as a Measure of

Joint Mobility

O. Eriksrud

, J. Cabri

and P. Federolf

Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway

Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria

1 OBJECTIVES

Joint range of motion (ROM) is commonly

measured using goniometry with accepted reference

values such as American Academy of Orthopedic

Surgeons (AAOS) (Greene and Heckman, 1994).

The procedures of obtaining these measures are

based on unidirectional and uniplanar passive testing

of isolated joint motions in supine, prone or seated

positions.

The relationship of such ROM measures to

performance have been found to be variable (Craib

et al., 1996; Menz et al., 2006). Utilizing tests of the

full kinematic chain from an upright standing

position that involve the concurrent use of multiple

joints, directions and planes of motion might be one

solution to the shortcomings of the traditional ROM

testing procedures. Full kinematic chain tests have

the advantage of greater specificity to most human

movements such as athletic performance.

The Star Excursion Balance Test (SEBT) is a

widely accepted test of dynamic postural control and

balance (Gribble et al., 2012) that challenges

coordination, mobility, and strength (Hubbard et al.,

2007). However it does not challenge all joint

movements at and above the hip (Delahunt et al.,

2013), but it offers a platform from which a whole-

body mobility and balance test can be created. In the

current study we propose a Hand Reach Star

Excursion Balance Test (HSEBT), which combines

a systematic use of unilateral and bilateral hand

reaches, thus also challenging mobility in hip and

upper body joints.

The purposes of this study were to (1) provide

joint movement reference data for HSEBT; and (2)

compare the 22 elicited joint movements of the

ankle, knee, hip and spine elicited by HSEBT to

ROM reference values and joint movements elicited

by SEBT.

2 METHODS

Twenty-eight healthy male subjects without

musculoskeletal dysfunction in the past 6 months

volunteered for the study. HSEBT was performed on

a testing grid that featured nine concentric circles at

10 cm intervals with eight vectors projecting from

the centre of the mat at 45° intervals and marked at

one centimetre intervals. The vectors were used as

reference for the horizontal reach tests (HR) and

named as follows: 1) Anterior (A0). 2) Left 45

(L45). 3) Right 45 (R45). 4) Left 90 (L90). 5)

Right 90 (R90). 6) Left 135 (L135). 7) Right 135

(R135) and 8) Posterior (P180). All HR are

measured in centimetres (cm). The rotational reaches

(RR) were measured in degrees () using the outer

concentric circle with degrees identified at 5

intervals. When performing overhead or rotational

reaches a plumbline was used to project reach

distance to the mat. All subjects performed 20 hand

reaches, 10 on each leg, in the same order without

warming up.

Movements of the participants were captured

using 58 reflective markers and fifteen Oqus

cameras (ProReflex®, Qualisys Inc., Gothenburg,

Sweden) recording at 480 Hz to create the foot, leg,

thigh, pelvis, thorax and upper arm segment. Data

analysis was performed using Visual 3D® (C-

Motion Inc., Rockwille MD, USA).

Three-dimensional joint movements of the foot,

knee, hip and trunk (=

max

-

start

) triggered by

different hand reach tests were calculated from

starting (

start

= mean

frames 5-100

) and maximum reach

position (

max

) of the fifth metacarpal marker of the

reaching hand(s). The maximum reach position was

defined to reflect the maximum HR and RR scores.

Descriptive statistics were then calculated for all

joint movements and hand reach performance.

Eriksrud, O., Cabri, J. and Federolf, P..

Hand Reach Star Excursion Balance Test as a Measure of Joint Mobility.

Table 1: HSEBT joint movement comparison to selected ROM reference values.

Joint Plane Motion Test

Result () ROM reference values ()

Foot Sag DF R45 29.2±6.0

11-27 (Lindsjo et al., 1985; Mudge et al., 2013)

Sag PF LROT 0.4±4.6 36-56 (Boone and Azen, 1979; Lindsjo et al., 1985)

Front Ev R90 18.1±3.2

13-34 Schwarz, 2011 #1564;Macedo, 2009 #1567}

Front Inv L90 7.8±4.4 21-43 (Macedo and Magee, 2009; Schwarz et al., 2011)

Trans Abd RROT 14.2±3.5 NR

Trans Add LROT 16.9±5.1 NR

Knee Sag Flex A0 94.3±22.4 132-149 (Macedo and Magee, 2009; Roach and Miles, 1991)

Sag Ext RROT 7.9±12.8 -2 -4 (Boone and Azen, 1979; Mudge et al., 2013)

Front Abd LROT 5.5±2.4

frontal plane movement arch of 13° at 20° of knee flexion

(Levangie and Norkin, 2011).

Front Add R45 18.2±6.9

Trans IR LROT 15.7±3.7

15 (Almquist et al., 2002)

Trans ER RROT 24.4±5.2

20 (Almquist et al., 2002)

Hip Sag Flex R45 109.0±8.2 113-133 (Macedo and Magee, 2009; Sankar et al., 2012)

Sag Ext L135 30.5±6.9

3-19 (Moreside and McGill, 2011; Roach and Miles, 1991)

Front Abd L90 18.2±7.4 34-60 (Macedo and Magee, 2009; Sankar et al., 2012)

Front Add R90 28.3±5.3

14-31 (Roaas and Andersson, 1982; Sankar et al., 2012)

Trans IR LROT 27.2±5.3

27-58 (Moreside and McGill, 2011; Mudge et al., 2013)

Trans ER RROT 32.2 ±5.4

32-48 (Mudge et al., 2013; Roach and Miles, 1991)

Trunk Sag Flex A0 58.1±9.0 Lumbar: 40-60 Thoracic: 20-45 (Magee, 2006)

Sag Ext P180 35.1±7.8 Lumbar: 20-35 Thoracic: 25-40

(Magee, 2006)

Front Lat Flex L90/R90 38.1±6.7

1, 2

Lumbar: 15-20 Thoracic: 20-40

(Magee, 2006)

Trans Rot LROT/RROT 33.1±4.3

Lumbar: Rot: 3-18 Thoracic: 35-50

(Magee, 2006)

= kinematic average of two tests

= within or greater than range of ROM reference values

Abbreviations: NR=None Reported; L=Left; R=Right; B=Bilateral; DF=Dorsiflexion; PF=Plantarflexion; Ev=Eversion; Inv=Inversion;

Abd=Abduction; Add=Adduction; Flex=Flexion; Ext=Extension; IR=Internal Rotation; ER=External Rotation; Lat Flexion= Lateral

flexion; Rot=Rotation

3 RESULTS

Twenty-eight healthy male subjects (age 23.8  2.2

years; height 181  6.0 cm; weight = 78.3  9.2 kg)

completed all 20 tests. The HSEBT test that elicited

the greatest joint movement, plane and direction, of

the ankle, knee, hip and spine is identified in Table

1. HSEBT elicited eleven out of twenty-two joint

movements within or greater than goniometric ROM

reference values.

4 DISCUSSION

Dorsiflexion (29.2±6.0°) is greater than ROM

reference values. However, more appropriate

comparisons can be made to the weight bearing

modified lunge test (38,2) (Menz et al., 2003). Foot

eversion (18.1±3.2°) is within ROM reference

values and similar to the test found to elicit

maximum ankle eversion in the SEBT (16.41.9°)

(Doherty et al., 2015). Inversion (7.8±4.4°) is not

within range of ROM reference values, however,

similar to what has been found for SEBT (7.11.9)

(Kang et al., 2015). To the authors’ knowledge no

goniometric ROM for abduction and adduction exist,

however the joint movements obtained is similar to

stance phase of running (Freedman et al., 2015).

Maximum knee flexion (94.3±22.4) is below

ROM reference values, but greater than in the SEBT

(66.3°-68.9°) (Doherty et al., 2015; Kang et al.,

2015). Knee internal rotation is within the range

while external rotation is greater, (7.8°-26.6°) and

(5.3±14.7°) respectively, when compared to SEBT

(Doherty et al., 2015; Kang et al., 2015). The frontal

plane arch (23°) obtained in this study is greater than

the ROM reference values (Table 1), but similar to a

functional task such as a jump-stop unanticipated cut

(27) (Ford et al., 2005)

HSEBT is eliciting more hip flexion than the

SEBT (72.0°-77.0°) (Doherty et al., 2015; Kang et

al., 2015). Hip extension is greater than ROM

reference values, but closer to what have been

observed in activities thought to require hip

extension such as sprint running (22°) (Kivi et al.,

2002) and football kick (25°) (Smith and Gilleard,

2015). In comparison, SEBT does not challenge hip

extension. Both hip internal and external rotation are

at the lower end of ROM reference values. The

rotational values are greater than the internal (4.3°-

8.0°) and external rotation (5.2°-23.5°) values

reported for the SEBT (Doherty et al., 2015; Kang et

al., 2015; Robinson and Gribble, 2008). Hip

adduction is within ROM reference values and

greater than what has been found with the SEBT

(15) (Doherty et al., 2015). Hip abduction is less

than ROM reference values, but similar to SEBT

(15) (Robinson and Gribble, 2008).

Spine movements elicited by the HSEBT are

representative of both lumbar and thoracic spine

movement. The HSEBT is able to elicit flexion and

lateral flexion within, and extension, and rotation

just outside range of ROM reference values (Magee,

2006). SEBT do not elicit spine movements within

ROM reference values. However, selected

movements do predict reach distance (Kang et al.,

2015), which might indicate their importance in

balance and postural adjustments.

HSEBT elicits unique combinations of

movements in ankle joint complex, knee, hip and

spine. Observed joint movements, nine of twenty-

two possible, were within the ranges of goniometric

ROM reference values, while two (ankle

dorsiflexion and hip extension) where greater. In

comparison to the SEBT, the HSEBT elicits similar

or lower values for the ankle, but greater values for

the knee, hip and spine. In addition, hip extension

and spine movements are elicited by the HSEBT and

not SEBT. HSEBT offers a new and promising

approach to functional mobility testing that

integrates the full kinematic chain.

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