Muscle Strength and Dynamic Balance Stability Tests

  • Frank R. Noyes
  • Sue Barber-WestinEmail author


This chapter reviews common tests used to measure lower extremity muscle strength and dynamic balance stability. Advantages, disadvantages, and normative data are provided to assist the clinician in the selection and interpretation of test results. After major knee surgery, objective muscle strength and dynamic balance tests are used to advance patients through the initial phases of rehabilitation and before return to running and agility training, plyometric and advanced neuromuscular training, and final release to full sports activities. Although muscle strength is commonly evaluated in the clinic with a hand-held dynamometer using isometric resistance, isokinetic testing is preferred because it involves dynamic muscle performance. Correlations between muscle strength measured isokinetically and functional movements have been reported in multiple studies. Isometric testing of muscle strength on an isokinetic dynamometer is a valuable option for patients who have contraindications to isokinetic test protocols. We use this strength measurement early after surgery to protect healing ligament grafts or in cases of patellofemoral pain. If isokinetic or isometric equipment are not available, a 1-repetition single leg maximum leg press is recommended if weight room equipment, an experienced test administrator, and a sufficient amount of time to safely conduct the test are available. A variety of single-leg dynamic balance tests are described, all of which can be conducted in any clinical setting with minimal equipment.


Strength tests Balance tests Isokinetic testing Hop tests ACL testing 


  1. 1.
    Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(12):1697–705. Scholar
  2. 2.
    Gokeler A, Welling W, Zaffagnini S, Seil R, Padua D. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):192–9. Scholar
  3. 3.
    Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–8. Scholar
  4. 4.
    Hamrin Senorski E, Svantesson E, Beischer S, Thomee C, Grassi A, Krupic F, Thomee R, Karlsson J, Samuelsson K. Concomitant injuries may not reduce the likelihood of achieving symmetrical muscle function one year after anterior cruciate ligament reconstruction: a prospective observational study based on 263 patients. Knee Surg Sports Traumatol Arthrosc. 2018;26(10):2966–77. Scholar
  5. 5.
    Jang SH, Kim JG, Ha JK, Wang BG, Yang SJ. Functional performance tests as indicators of returning to sports after anterior cruciate ligament reconstruction. Knee. 2014;21(1):95–101. Scholar
  6. 6.
    Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016. Scholar
  7. 7.
    Muller U, Kruger-Franke M, Schmidt M, Rosemeyer B. Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3623–31. Scholar
  8. 8.
    Palmieri-Smith RM, Lepley LK. Quadriceps strength asymmetry after anterior cruciate ligament reconstruction alters knee joint biomechanics and functional performance at time of return to activity. Am J Sports Med. 2015;43(7):1662–9. Scholar
  9. 9.
    Toole AR, Ithurburn MP, Rauh MJ, Hewett TE, Paterno MV, Schmitt LC. Young athletes cleared for sports participation after anterior cruciate ligament reconstruction: how many actually meet recommended return-to-sport criterion cutoffs? J Orthop Sports Phys Ther. 2017;47(11):825–33. Scholar
  10. 10.
    Welling W, Benjaminse A, Seil R, Lemmink K, Zaffagnini S, Gokeler A. Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sports Traumatol Arthrosc. 2018;26(12):3636–44. Scholar
  11. 11.
    Abrams GD, Harris JD, Gupta AK, McCormick FM, Bush-Joseph CA, Verma NN, Cole BJ, Bach BR Jr. Functional performance testing after anterior cruciate ligament reconstruction: a systematic review. Orthop J Sports Med. 2014;2(1):2325967113518305. Scholar
  12. 12.
    Heckmann TP, Noyes FR, Barber-Westin S. Rehabilitation after ACL reconstruction. In: Noyes FR, Barber-Westin SD, editors. ACL injuries in the female athlete. 2nd ed. New York: Springer; 2018. p. 505–35. Scholar
  13. 13.
    Davies GJ, Riemann B, Ellenbecker T. Role of isokinetic testing and training after ACL injury and reconstruction. In: Noyes FR, Barber-Westin S, editors. ACL injuries in the female athlete: causes, impacts, and conditioning programs. Berlin: Springer; 2018. p. 567–88. Scholar
  14. 14.
    Carvalho HM, Coelho ESMJ, Ronque ER, Goncalves RS, Philippaerts RM, Malina RM. Assessment of reliability in isokinetic testing among adolescent basketball players. Medicina. 2011;47(8):446–52.PubMedCrossRefGoogle Scholar
  15. 15.
    de Araujo Ribeiro Alvares JB, Rodrigues R, de Azevedo Franke R, da Silva BG, Pinto RS, Vaz MA, Baroni BM. Inter-machine reliability of the Biodex and Cybex isokinetic dynamometers for knee flexor/extensor isometric, concentric and eccentric tests. Phys Ther Sport. 2015;16(1):59–65. Scholar
  16. 16.
    Sole G, Hamren J, Milosavljevic S, Nicholson H, Sullivan SJ. Test-retest reliability of isokinetic knee extension and flexion. Arch Phys Med Rehabil. 2007;88(5):626–31. Scholar
  17. 17.
    Tsiros MD, Grimshaw PN, Schield AJ, Buckley JD. Test-retest reliability of the biodex system 4 isokinetic dynamometer for knee strength assessment in paediatric populations. J Allied Health. 2011;40(3):115–9.PubMedGoogle Scholar
  18. 18.
    Whiteley R, Jacobsen P, Prior S, Skazalski C, Otten R, Johnson A. Correlation of isokinetic and novel hand-held dynamometry measures of knee flexion and extension strength testing. J Sci Med Sport. 2012;15(5):444–50. Scholar
  19. 19.
    Ithurburn MP, Paterno MV, Ford KR, Hewett TE, Schmitt LC. Young athletes with quadriceps femoris strength asymmetry at return to sport after anterior cruciate ligament reconstruction demonstrate asymmetric single-leg drop-landing mechanics. Am J Sports Med. 2015;43(11):2727–37. Scholar
  20. 20.
    Loturco I, Pereira LA, Kobal R, Abad CCC, Komatsu W, Cunha R, Arliani G, Ejnisman B, Pochini AC, Nakamura FY, Cohen M. Functional screening tests: interrelationships and ability to predict vertical jump performance. Int J Sports Med. 2018;39(3):189–97. Scholar
  21. 21.
    Newman MA, Tarpenning KM, Marino FE. Relationships between isokinetic knee strength, single-sprint performance, and repeated-sprint ability in football players. J Strength Cond Res. 2004;18(4):867–72. Scholar
  22. 22.
    Rouis M, Coudrat L, Jaafar H, Filliard JR, Vandewalle H, Barthelemy Y, Driss T. Assessment of isokinetic knee strength in elite young female basketball players: correlation with vertical jump. J Sports Med Phys Fitness. 2015;55(12):1502–8.PubMedGoogle Scholar
  23. 23.
    Sliwowski R, Grygorowicz M, Wieczorek A, Jadczak L. The relationship between jumping performance, isokinetic strength and dynamic postural control in elite youth soccer players. J Sports Med Phys Fitness. 2018;58(9):1226–33. Scholar
  24. 24.
    Undheim MB, Cosgrave C, King E, Strike S, Marshall B, Falvey E, Franklyn-Miller A. Isokinetic muscle strength and readiness to return to sport following anterior cruciate ligament reconstruction: is there an association? A systematic review and a protocol recommendation. Br J Sports Med. 2015;49(20):1305–10. Scholar
  25. 25.
    Davies GJ. A compendium of isokinetics in clinical usage. 4th ed. LaCrosse: S & S Publishers; 1994.Google Scholar
  26. 26.
    Andrade MDS, De Lira CAB, Koffes FDC, Mascarin NC, Benedito-Silva AA, Da Silva AC. Isokinetic hamstrings-to-quadriceps peak torque ratio: the influence of sport modality, gender, and angular velocity. J Sports Sci. 2012;30(6):547–53. Scholar
  27. 27.
    Buchanan PA, Vardaxis VG. Lower-extremity strength profiles and gender-based classification of basketball players ages 9-22 years. J Strength Cond Res. 2009;23(2):406–19. Scholar
  28. 28.
    Cheung RT, Smith AW, Wong del P. H:q ratios and bilateral leg strength in college field and court sports players. J Hum Kinet. 2012;33:63–71. Scholar
  29. 29.
    Kabacinski J, Murawa M, Mackala K, Dworak LB. Knee strength ratios in competitive female athletes. PLoS One. 2018;13(1):e0191077. Scholar
  30. 30.
    O'Malley E, Richter C, King E, Strike S, Moran K, Franklyn-Miller A, Moran R. Countermovement jump and isokinetic dynamometry as measures of rehabilitation status after anterior cruciate ligament reconstruction. J Athl Train. 2018;53(7):687–95. Scholar
  31. 31.
    Risberg MA, Steffen K, Nilstad A, Myklebust G, Kristianslund E, Moltubakk MM, Krosshaug T. Normative quadriceps and hamstring muscle strength values for female, healthy, elite handball and football players. J Strength Cond Res. 2018;32(8):2314–23. Scholar
  32. 32.
    Rosene JM, Fogarty TD, Mahaffey BL. Isokinetic hamstrings:quadriceps ratios in intercollegiate athletes. J Athl Train. 2001;36(4):378–83.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Barber-Westin SD, Noyes FR, Galloway M. Jump-land characteristics and muscle strength development in young athletes: a gender comparison of 1140 athletes 9 to 17 years of age. Am J Sports Med. 2006;34(3):375–84. Scholar
  34. 34.
    Burland JP, Toonstra J, Werner JL, Mattacola CG, Howell DM, Howard JS. Decision to return to sport after anterior cruciate ligament reconstruction, part I: a qualitative investigation of psychosocial factors. J Athl Train. 2018;53(5):452–63. Scholar
  35. 35.
    Herrington L, Ghulam H, Comfort P. Quadriceps strength and functional performance after anterior cruciate ligament reconstruction in professional soccer players at time of return to sport. J Strength Cond Res. 2018.
  36. 36.
    Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM. Quadriceps neuromuscular function in patients with anterior cruciate ligament reconstruction with or without knee osteoarthritis: a cross-sectional study. J Athl Train. 2018;53(5):475–85. Scholar
  37. 37.
    Kuenze CM, Foot N, Saliba SA, Hart JM. Drop-landing performance and knee-extension strength after anterior cruciate ligament reconstruction. J Athl Train. 2015;50(6):596–602. Scholar
  38. 38.
    Knezevic OM, Mirkov DM, Kadija M, Milovanovic D, Jaric S. Evaluation of isokinetic and isometric strength measures for monitoring muscle function recovery after anterior cruciate ligament reconstruction. J Strength Cond Res. 2014;28(6):1722–31. Scholar
  39. 39.
    Toonstra J, Mattacola CG. Test-retest reliability and validity of isometric knee-flexion and -extension measurement using 3 methods of assessing muscle strength. J Sport Rehabil Tech Notes. 2013;7.Google Scholar
  40. 40.
    Hansen EM, McCartney CN, Sweeney RS, Palimenio MR, Grindstaff TL. Hand-held dynamometer positioning impacts discomfort during quadriceps strength testing: a validity and reliability study. Int J Sports Phys Ther. 2015;10(1):62–8.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Mentiplay BF, Perraton LG, Bower KJ, Adair B, Pua YH, Williams GP, McGaw R, Clark RA. Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study. PLoS One. 2015;10(10):e0140822. Scholar
  42. 42.
    Stark T, Walker B, Phillips JK, Fejer R, Beck R. Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review. PMR. 2011;3(5):472–9. Scholar
  43. 43.
    Kim WK, Kim DK, Seo KM, Kang SH. Reliability and validity of isometric knee extensor strength test with hand-held dynamometer depending on its fixation: a pilot study. Ann Rehabil Med. 2014;38(1):84–93. Scholar
  44. 44.
    Beenakker EA, van der Hoeven JH, Fock JM, Maurits NM. Reference values of maximum isometric muscle force obtained in 270 children aged 4–16 years by hand-held dynamometry. Neuromuscul Disord. 2001;11(5):441–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Kraemer WJ, Patton JF, Gordon SE, Harman EA, Deschenes MR, Reynolds K, Newton RU, Triplett NT, Dziados JE. Compatibility of high-intensity strength and endurance training on hormonal and skeletal muscle adaptations. J Appl Physiol. 1995;78(3):976–89.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Reiman MP, Manske RC. Functional testing in human performance. Champaign: Human Kinetics; 2009.Google Scholar
  47. 47.
    Benton MJ, Raab S, Waggener GT. Effect of training status on reliability of one repetition maximum testing in women. J Strength Cond Res. 2013;27(7):1885–90. Scholar
  48. 48.
    Neto JC, Cedin L, Dato CC, Bertucci DR, Perez S, Baldissera V. A single session of testing for one repetition maximum (1RM) with either exercises is trustworthy. J Exerc Physiol Online. 2015;18(3):74–80.Google Scholar
  49. 49.
    Redden J, Stokes K, Williams S. Establishing the reliability and limits of meaningful change of lower limb strength and power measures during seated leg press in elite soccer players. J Sports Sci Med. 2018;17(4):539–46.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Seo DI, Kim E, Fahs CA, Rossow L, Young K, Ferguson SL, Thiebaud R, Sherk VD, Loenneke JP, Kim D, Lee MK, Choi KH, Bemben DA, Bemben MG, So WY. Reliability of the one-repetition maximum test based on muscle group and gender. J Sports Sci Med. 2012;11(2):221–5.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Barber-Westin SD, Noyes FR. Testing for neuromuscular problems and athletic performance. In: ACL injuries in the female athlete. 2nd ed. New York: Springer; 2018. p. 289–333.CrossRefGoogle Scholar
  52. 52.
    Chimera NJ, Swanik KA, Swanik CB, Straub SJ. Effects of plyometric training on muscle-activation strategies and performance in female athletes. J Athl Train. 2004;39(1):24–31.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Young W, MacDonald C, Heggen T, Fitzpatrick J. An evaluation of the specificity, validity and reliability of jumping tests. J Sports Med Phys Fitness. 1997;37(4):240–5.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Laffaye G, Wagner PP, Tombleson TI. Countermovement jump height: gender and sport-specific differences in the force-time variables. J Strength Cond Res. 2014;28(4):1096–105. Scholar
  55. 55.
    Jones MT, Matthews TD, Murray M, Van Raalte J, Jensen BE. Psychological correlates of performance in female athletes during a 12-week off-season strength and conditioning program. J Strength Cond Res. 2010;24(3):619–28. Scholar
  56. 56.
    Vescovi JD, McGuigan MR. Relationships between sprinting, agility, and jump ability in female athletes. J Sports Sci. 2008;26(1):97–107. Scholar
  57. 57.
    Hoffman JR, Ratamess NA, Neese KL, Ross RE, Kang J, Magrelli JF, Faigenbaum AD. Physical performance characteristics in National Collegiate Athletic Association Division III champion female lacrosse athletes. J Strength Cond Res. 2009;23(5):1524–9. Scholar
  58. 58.
    Enemark-Miller EA, Seegmiller JG, Rana SR. Physiological profile of women’s Lacrosse players. J Strength Cond Res. 2009;23(1):39–43. Scholar
  59. 59.
    Gabbett TJ, Sheppard JM, Pritchard-Peschek KR, Leveritt MD, Aldred MJ. Influence of closed skill and open skill warm-ups on the performance of speed, change of direction speed, vertical jump, and reactive agility in team sport athletes. J Strength Cond Res. 2008;22(5):1413–5. Scholar
  60. 60.
    McCormick BT, Hannon JC, Newton M, Shultz B, Detling N, Young WB. The effects of frontal- and sagittal-plane plyometrics on change-of-direction speed and power in adolescent female basketball players. Int J Sports Physiol Perform. 2016;11(1):102–7. Scholar
  61. 61.
    Roden D, Lambson R, DeBeliso M. The effects of a complex training protocol on vertical jump performance in male high school basketball players. J Sports Sci. 2014;2:21–6.Google Scholar
  62. 62.
    Mihalik JP, Libby JJ, Battaglini CL, McMurray RG. Comparing short-term complex and compound training programs on vertical jump height and power output. J Strength Cond Res. 2008;22(1):47–53. Scholar
  63. 63.
    Vaverka F, Jandacka D, Zahradnik D, Uchytil J, Farana R, Supej M, Vodicar J. Effect of an arm swing on countermovement vertical jump performance in elite volleyball players: final. J Hum Kinet. 2016;53:41–50. Scholar
  64. 64.
    Noyes FR, Barber-Westin SD, Smith ST, Campbell T. A training program to improve neuromuscular indices in female high school volleyball players. J Strength Cond Res. 2011;25(8):2151–60. Scholar
  65. 65.
    McFarland IT, Dawes JJ, Elder CL, Lockie RG. Relationship of two vertical jumping tests to sprint and change of direction speed among male and female collegiate soccer players. Sports. 2016;4(1). Scholar
  66. 66.
    Harper LD, Hunter R, Parker P, Goodall S, Thomas K, Howatson G, West DJ, Stevenson E, Russell M. Test-retest reliability of physiological and performance responses to 120 minutes of simulated soccer match play. J Strength Cond Res. 2016;30(11):3178–86. Scholar
  67. 67.
    de Hoyo M, Gonzalo-Skok O, Sanudo B, Carrascal C, Plaza-Armas JR, Camacho-Candil F, Otero-Esquina C. Comparative effects of in-season full-back squat, resisted sprint training, and plyometric training on explosive performance in U-19 elite soccer players. J Strength Cond Res. 2016;30(2):368–77. Scholar
  68. 68.
    Hammami R, Granacher U, Makhlouf I, Behm DG, Chaouachi A. Sequencing effects of balance and plyometric training on physical performance in youth soccer athletes. J Strength Cond Res. 2016;30(12):3278–89. Scholar
  69. 69.
    Noyes FR, Barber-Westin SD, Tutalo Smith ST, Campbell T. A training program to improve neuromuscular and performance indices in female high school soccer players. J Strength Cond Res. 2013;27(2):340–51. Scholar
  70. 70.
    Steffen K, Bakka HM, Myklebust G, Bahr R. Performance aspects of an injury prevention program: a ten-week intervention in adolescent female football players. Scand J Med Sci Sports. 2008;18(5):596–604. Scholar
  71. 71.
    Gabbett TJ. Physiological and anthropometric characteristics of elite women rugby league players. J Strength Cond Res. 2007;21(3):875–81. Scholar
  72. 72.
    Coen MM. 1985 National School Population Fitness Survey from President’s Council on Physical Fitness and Sports. Washington, DC; 1986.Google Scholar
  73. 73.
    Bianco A, Lupo C, Alesi M, Spina S, Raccuglia M, Thomas E, Paoli A, Palma A. The sit up test to exhaustion as a test for muscular endurance evaluation. Springerplus. 2015;4:309. Scholar
  74. 74.
    Alaranta H, Hurri H, Heliovaara M, Soukka A, Harju R. Non-dynamometric trunk performance tests: reliability and normative data. Scand J Rehabil Med. 1994;26(4):211–5.Google Scholar
  75. 75.
    Harding VR, Williams AC, Richardson PH, Nicholas MK, Jackson JL, Richardson IH, Pither CE. The development of a battery of measures for assessing physical functioning of chronic pain patients. Pain. 1994;58(3):367–75.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Chaudhari AMW, Jamison ST, Best TM. Proximal risk factors for ACL injury: role of core stability. In: Noyes FR, Barber-Westin S, editors. ACL injuries in the female athlete: causes, impacts, and conditioning programs. Berlin: Springer; 2018. p. 189–205. Scholar
  77. 77.
    Barber-Westin SD, Hermeto AA, Noyes FR. A six-week neuromuscular training program for competitive junior tennis players. J Strength Cond Res. 2010;24(9):2372–82. Scholar
  78. 78.
    McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil. 1999;80(8):941–4.PubMedCrossRefGoogle Scholar
  79. 79.
    Mills JD, Taunton JE, Mills WA. The effect of a 10-week training regimen on lumbo-pelvic stability and athletic performance in female athletes: a randomized-controlled trial. Phys Ther Sport. 2005;6(2):60–6. Scholar
  80. 80.
    Barber SD, Noyes FR, Mangine RE, McCloskey JW, Hartman W. Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees. Clin Orthop Relat Res. 1990;255:204–14.Google Scholar
  81. 81.
    Engelen-van Melick N, van Cingel RE, Tijssen MP, Nijhuis-van der Sanden MW. Assessment of functional performance after anterior cruciate ligament reconstruction: a systematic review of measurement procedures. Knee Surg Sports Traumatol Arthrosc. 2013;21(4):869–79. Scholar
  82. 82.
    Hegedus EJ, McDonough SM, Bleakley C, Baxter D, Cook CE. Clinician-friendly lower extremity physical performance tests in athletes: a systematic review of measurement properties and correlation with injury. Part 2-the tests for the hip, thigh, foot and ankle including the star excursion balance test. Br J Sports Med. 2015;49(10):649–56. Scholar
  83. 83.
    Kroman SL, Roos EM, Bennell KL, Hinman RS, Dobson F. Measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis: a systematic review. Osteoarthr Cartil. 2014;22(1):26–39. Scholar
  84. 84.
    Logerstedt D, Grindem H, Lynch A, Eitzen I, Engebretsen L, Risberg MA, Axe MJ, Snyder-Mackler L. Single-legged hop tests as predictors of self-reported knee function after anterior cruciate ligament reconstruction: the Delaware-Oslo ACL cohort study. Am J Sports Med. 2012;40(10):2348–56. Scholar
  85. 85.
    Meierbachtol A, Rohman E, Paur E, Bottoms J, Tompkins M. Quantitative improvements in hop test scores after a 6-week neuromuscular training program. Sports Health. 2016;9(1):22–9. Scholar
  86. 86.
    Noyes FR, Barber SD, Mangine RE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991;19(5):513–8.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Hartigan EH, Axe MJ, Snyder-Mackler L. Time line for noncopers to pass return-to-sports criteria after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2010;40(3):141–54. Scholar
  88. 88.
    Herbst E, Hoser C, Hildebrandt C, Raschner C, Hepperger C, Pointner H, Fink C. Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part II: clinical application of a new test battery. Knee Surg Sports Traumatol Arthrosc. 2015;23(5):1283–91. Scholar
  89. 89.
    Logerstedt D, Di Stasi S, Grindem H, Lynch A, Eitzen I, Engebretsen L, Risberg MA, Axe MJ, Snyder-Mackler L. Self-reported knee function can identify athletes who fail return-to-activity criteria up to 1 year after anterior cruciate ligament reconstruction: a delaware-oslo ACL cohort study. J Orthop Sports Phys Ther. 2014;44(12):914–23. Scholar
  90. 90.
    Thomee R, Neeter C, Gustavsson A, Thomee P, Augustsson J, Eriksson B, Karlsson J. Variability in leg muscle power and hop performance after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20(6):1143–51. Scholar
  91. 91.
    Schelin L, Tengman E, Ryden P, Hager C. A statistically compiled test battery for feasible evaluation of knee function after rupture of the anterior cruciate ligament - derived from long-term follow-up data. PLoS One. 2017;12(5):e0176247. Scholar
  92. 92.
    Welling W, Benjaminse A, Seil R, Lemmink K, Gokeler A. Altered movement during single leg hop test after ACL reconstruction: implications to incorporate 2-D video movement analysis for hop tests. Knee Surg Sports Traumatol Arthrosc. 2018;26(10):3012–9. Scholar
  93. 93.
    Wren TAL, Mueske NM, Brophy CH, Pace JL, Katzel MJ, Edison BR, Vandenberg CD, Zaslow TL. Hop distance symmetry does not indicate normal landing biomechanics in adolescent athletes with recent anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2018;48(8):622–9. Scholar
  94. 94.
    Barber-Westin SD, Noyes FR. Decreasing the risk of anterior cruciate ligament injuries in female athletes. In: Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia: Elsevier; 2017. p. 373–404.CrossRefGoogle Scholar
  95. 95.
    Gustavsson A, Neeter C, Thomee P, Silbernagel KG, Augustsson J, Thomee R, Karlsson J. A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006;14(8):778–88. Scholar
  96. 96.
    Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR. Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther. 2007;87(3):337–49.PubMedPubMedCentralCrossRefGoogle Scholar
  97. 97.
    Greenberger HB, Paterno MV. Relationship of knee extensor strength and hopping test performance in the assessment of lower extremity function. J Orthop Sports Phys Ther. 1995;22(5):202–6.PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Wilk KE, Romaniello WT, Soscia SM, Arrigo CA, Andrews JR. The relationship between subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed knee. J Orthop Sports Phys Ther. 1994;20(2):60–73.PubMedPubMedCentralCrossRefGoogle Scholar
  99. 99.
    Xergia SA, Pappas E, Georgoulis AD. Association of the single-limb hop test with isokinetic, kinematic, and kinetic asymmetries in patients after anterior cruciate ligament reconstruction. Sports Health. 2014;7(3):217–23. Scholar
  100. 100.
    Hamilton RT, Shultz SJ, Schmitz RJ, Perrin DH. Triple-hop distance as a valid predictor of lower limb strength and power. J Athl Train. 2008;43(2):144–51.PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Ross MD, Langford B, Whelan PJ. Test-retest reliability of 4 single-leg horizontal hop tests. J Strength Cond Res. 2002;16(4):617–22.PubMedPubMedCentralGoogle Scholar
  102. 102.
    Mansour JM, Pereira JM. Quantitative functional anatomy of the lower limb with application to human gait. J Biomech. 1987;20(1):51–8.PubMedCrossRefGoogle Scholar
  103. 103.
    Bird SP, Markwick WJ. Musculoskeletal screening and functional testing: considerations for basketball athletes. Int J Sports Phys Ther. 2016;11(5):784–802.PubMedPubMedCentralGoogle Scholar
  104. 104.
    Chimera NJ, Warren M. Use of clinical movement screening tests to predict injury in sport. World J Orthop. 2016;7(4):202–17. Scholar
  105. 105.
    Filipa A, Byrnes R, Paterno MV, Myer GD, Hewett TE. Neuromuscular training improves performance on the star excursion balance test in young female athletes. J Orthop Sports Phys Ther. 2010;40(9):551–8. Scholar
  106. 106.
    Hopper A, Haff EE, Barley OR, Joyce C, Lloyd RS, Haff GG. Neuromuscular training improves movement competency and physical performance measures in 11-13-year-old female netball athletes. J Strength Cond Res. 2017;31(5):1165–76. Scholar
  107. 107.
    Lockie RG, Schultz AB, Callaghan SJ, Jeffriess MD. The relationship between dynamic stability and multidirectional speed. J Strength Cond Res. 2016;30(11):3033–43. Scholar
  108. 108.
    McCann RS, Kosik KB, Terada M, Beard MQ, Buskirk GE, Gribble PA. Associations between functional and isolated performance measures in collegiate women’s soccer players. J Sport Rehabil. 2016;26(5):376–85. Scholar
  109. 109.
    Munro AG, Herrington LC. Between-session reliability of the star excursion balance test. Phys Ther Sport. 2010;11(4):128–32. Scholar
  110. 110.
    Paz GA, Gabbett TJ, Maia MF, Santana H, Miranda H, Lima V. Physical performance and positional differences among young female volleyball players. J Sports Med Phys Fitness. 2016;57(10):1282–9.PubMedGoogle Scholar
  111. 111.
    Rouissi M, Haddad M, Bragazzi NL, Owen AL, Moalla W, Chtara M, Chamari K. Implication of dynamic balance in change of direction performance in young elite soccer players is angle dependent? J Sports Med Phys Fitness. 2018;58(4):442–9. Scholar
  112. 112.
    Sabin MJ, Ebersole KT, Martindale AR, Price JW, Broglio SP. Balance performance in male and female collegiate basketball athletes: influence of testing surface. J Strength Cond Res. 2010;24(8):2073–8. Scholar
  113. 113.
    Steffen K, Nilstad A, Krosshaug T, Pasanen K, Killingmo A, Bahr R. No association between static and dynamic postural control and ACL injury risk among female elite handball and football players: a prospective study of 838 players. Br J Sports Med. 2017;51(4):253–9. Scholar
  114. 114.
    Stiffler MR, Sanfilippo JL, Brooks MA, Heiderscheit BC. Star excursion balance test performance varies by sport in healthy division I collegiate athletes. J Orthop Sports Phys Ther. 2015;45(10):772–80. Scholar
  115. 115.
    McLeod TC, Armstrong T, Miller M, Sauers JL. Balance improvements in female high school basketball players after a 6-week neuromuscular-training program. J Sport Rehabil. 2009;18(4):465–81.PubMedCrossRefGoogle Scholar
  116. 116.
    Pfile KR, Gribble PA, Buskirk GE, Meserth SM, Pietrosimone BG. Sustained improvements in dynamic balance and landing mechanics after a 6-week neuromuscular training program in college women’s basketball players. J Sport Rehabil. 2016;25(3):233–40.PubMedCrossRefGoogle Scholar
  117. 117.
    Steib S, Zahn P, Zu Eulenburg C, Pfeifer K, Zech A. Time-dependent postural control adaptations following a neuromuscular warm-up in female handball players: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2016;8:33. Scholar
  118. 118.
    Kalichman L, Lachman H, Freilich N. Long-term impact of ankle sprains on postural control and fascial densification. J Bodyw Mov Ther. 2016;20(4):914–9. Scholar
  119. 119.
    Kosik KB, Gribble PA. The effect of joint mobilization on dynamic postural control in patients with chronic ankle instability: a critically appraised topic. J Sport Rehabil. 2016:1–15. Scholar
  120. 120.
    Kwon YU, Blaise Williams DS. The effect of variable rest intervals and chronic ankle instability on triplanar ankle motion during performance of the Star Excursion Balance Test. Hum Mov Sci. 2017;52:143–50. Scholar
  121. 121.
    Wright CJ, Linens SW, Cain MS. A randomized controlled trial comparing rehabilitation efficacy in chronic ankle instability. J Sport Rehabil. 2016;26(4):238–49. Scholar
  122. 122.
    Hooper TL, James CR, Brismee JM, Rogers TJ, Gilbert KK, Browne KL, Sizer PS. Dynamic balance as measured by the Y-balance test is reduced in individuals with low back pain: a cross-sectional comparative study. Phys Ther Sport. 2016;22:29–34. Scholar
  123. 123.
    Ganesh GS, Chhabra D, Pattnaik M, Mohanty P, Patel R, Mrityunjay K. Effect of trunk muscles training using a star excursion balance test grid on strength, endurance and disability in persons with chronic low back pain. J Back Musculoskelet Rehabil. 2015;28(3):521–30. Scholar
  124. 124.
    Tsigkanos C, Gaskell L, Smirniotou A, Tsigkanos G. Static and dynamic balance deficiencies in chronic low back pain. J Back Musculoskelet Rehabil. 2016;29(4):887–93. Scholar
  125. 125.
    Dobija L, Coudeyre E, Pereira B. Measurement properties of the star excursion balance test in the anterior crucial ligament-deficient subjects - preliminary analysis. Ann Phys Rehabil Med. 2016;59S:e18. Scholar
  126. 126.
    Harput G, Howard JS, Mattacola C. Comparison of muscle activation levels between healthy individuals and persons who have undergone anterior cruciate ligament reconstruction during different phases of weight-bearing exercises. J Orthop Sports Phys Ther. 2016;46(11):984–92. Scholar
  127. 127.
    Herrington L, Hatcher J, Hatcher A, McNicholas M. A comparison of star excursion balance test reach distances between ACL deficient patients and asymptomatic controls. Knee. 2009;16(2):149–52. Scholar
  128. 128.
    Zult T, Gokeler A, van Raay JJ, Brouwer RW, Zijdewind I, Hortobagyi T. An anterior cruciate ligament injury does not affect the neuromuscular function of the non-injured leg except for dynamic balance and voluntary quadriceps activation. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):172–83. Scholar
  129. 129.
    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):501–6.PubMedPubMedCentralGoogle Scholar
  130. 130.
    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):911–9.PubMedCrossRefGoogle Scholar
  131. 131.
    Kinzey SJ, Armstrong CW. The reliability of the star-excursion test in assessing dynamic balance. J Orthop Sports Phys Ther. 1998;27(5):356–60.PubMedCrossRefGoogle Scholar
  132. 132.
    Gribble PA, Kelly SE, Refshauge KM, Hiller CE. Interrater reliability of the star excursion balance test. J Athl Train. 2013;48(5):621–6. Scholar
  133. 133.
    Hertel J, Miller SJ, Denegar CR. Intratester and intertester reliability during the star excurision balance tests. J Sport Rehabil. 2000;9:104–16.CrossRefGoogle Scholar
  134. 134.
    Ambegaonkar JP, Mettinger LM, Caswell SV, Burtt A, Cortes N. Relationships between core endurance, hip strength, and balance in collegiate female athletes. Int J Sports Phys Ther. 2014;9(5):604–16.PubMedPubMedCentralGoogle Scholar
  135. 135.
    Alnahdi AH, Alderaa AA, Aldali AZ, Alsobayel H. Reference values for the Y balance test and the lower extremity functional scale in young healthy adults. J Phys Ther Sci. 2015;27(12):3917–21. Scholar
  136. 136.
    van Lieshout R, Reijneveld EA, van den Berg SM, Haerkens GM, Koenders NH, de Leeuw AJ, van Oorsouw RG, Paap D, Scheffer E, Weterings S, Stukstette MJ. Reproducibility of the modified star excursion balance test composite and specific reach direction scores. Int J Sports Phys Ther. 2016;11(3):356–65.PubMedPubMedCentralGoogle Scholar
  137. 137.
    Gribble PA, Hertel J. Considerations for normalising measures of the star excursion balance test. Meas Phys Educ Exerc Sci. 2003;7(2):89–100.CrossRefGoogle Scholar
  138. 138.
    Chtara M, Rouissi M, Bragazzi NL, Owen AL, Haddad M, Chamari K. Dynamic balance ability in young elite soccer players: implication of isometric strength. J Sports Med Phys Fitness. 2018;58(4):414–20. Scholar
  139. 139.
    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):321–9.PubMedPubMedCentralGoogle Scholar
  140. 140.
    Lee DK, Kim GM, Ha SM, Oh JS. Correlation of the Y-balance test with lower-limb strength of adult women. J Phys Ther Sci. 2014;26(5):641–3. Scholar
  141. 141.
    Robinson R, Gribble P. Kinematic predictors of performance on the star excursion balance test. J Sport Rehabil. 2008;17(4):347–57.PubMedCrossRefGoogle Scholar
  142. 142.
    Robinson RH, Gribble PA. Support for a reduction in the number of trials needed for the star excursion balance test. Arch Phys Med Rehabil. 2008;89(2):364–70. Scholar
  143. 143.
    Walaszek R, Chwala W, Walaszek K, Burdacki M, Blaszczuk J. Evaluation of the accuracy of the postural stability measurement with the Y-balance test based on the levels of the biomechanical parameters. Acta Bioeng Biomech. 2017;19(2):121–8.PubMedGoogle Scholar
  144. 144.
    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. N Am J Sports Phys Ther. 2009;4(2):92–9.PubMedPubMedCentralGoogle Scholar
  145. 145.
    Hudson C, Garrison JC, Pollard K. Y-balance normative data for female collegiate volleyball players. Phys Ther Sport. 2016;22:61–5. Scholar
  146. 146.
    Smith CA, Chimera NJ, Warren M. Association of Y balance test reach asymmetry and injury in division I athletes. Med Sci Sports Exerc. 2015;47(1):136–41. Scholar
  147. 147.
    Gorman PP, Butler RJ, Rauh MJ, Kiesel K, Plisky PJ. Differences in dynamic balance scores in one sport versus multiple sport high school athletes. Int J Sports Phys Ther. 2012;7(2):148–53.PubMedPubMedCentralGoogle Scholar
  148. 148.
    Garrison JC, Arnold A, Macko MJ, Conway JE. Baseball players diagnosed with ulnar collateral ligament tears demonstrate decreased balance compared to healthy controls. J Orthop Sports Phys Ther. 2013;43(10):752–8. Scholar
  149. 149.
    Butler RJ, Southers C, Gorman PP, Kiesel KB, Plisky PJ. Differences in soccer players’ dynamic balance across levels of competition. J Athl Train. 2012;47(6):616–20. Scholar
  150. 150.
    Butler RJ, Queen RM, Beckman B, Kiesel KB, Plisky PJ. Comparison of dynamic balance in adolescent male soccer players from rwanda and the United States. Int J Sports Phys Ther. 2013;8(6):749–55.PubMedPubMedCentralGoogle Scholar
  151. 151.
    Chimera NJ, Smith CA, Warren M. Injury history, sex, and performance on the functional movement screen and Y balance test. J Athl Train. 2015;50(5):475–85. Scholar
  152. 152.
    Ageberg E, Bennell KL, Hunt MA, Simic M, Roos EM, Creaby MW. Validity and inter-rater reliability of medio-lateral knee motion observed during a single-limb mini squat. BMC Musculoskelet Disord. 2010;11:265. Scholar
  153. 153.
    Alenezi F, Herrington L, Jones P, Jones R. The reliability of biomechanical variables collected during single leg squat and landing tasks. J Electromyogr Kinesiol. 2014;24(5):718–21. Scholar
  154. 154.
    Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011;39(4):866–73. Scholar
  155. 155.
    Ugalde V, Brockman C, Bailowitz Z, Pollard CD. Single leg squat test and its relationship to dynamic knee valgus and injury risk screening. PMR. 2015;7(3):229–35. Scholar
  156. 156.
    Zeller BL, McCrory JL, Kibler WB, Uhl TL. Differences in kinematics and electromyographic activity between men and women during the single-legged squat. Am J Sports Med. 2003;31(3):449–56.PubMedCrossRefGoogle Scholar
  157. 157.
    Baldon Rde M, Lobato DF, Carvalho LP, Santiago PR, Benze BG, Serrao FV. Relationship between eccentric hip torque and lower-limb kinematics: gender differences. J Appl Biomech. 2011;27(3):223–32.PubMedCrossRefGoogle Scholar
  158. 158.
    Willson JD, Ireland ML, Davis I. Core strength and lower extremity alignment during single leg squats. Med Sci Sports Exerc. 2006;38(5):945–52.PubMedCrossRefGoogle Scholar
  159. 159.
    Claiborne TL, Armstrong CW, Gandhi V, Pincivero DM. Relationship between hip and knee strength and knee valgus during a single leg squat. J Appl Biomech. 2006;22(1):41–50.PubMedPubMedCentralCrossRefGoogle Scholar
  160. 160.
    Stickler L, Finley M, Gulgin H. Relationship between hip and core strength and frontal plane alignment during a single leg squat. Phys Ther Sport. 2015;16(1):66–71. Scholar
  161. 161.
    Barber-Westin SD, Noyes FR. Risk factors for anterior cruciate ligament injuries in the female athlete. In: Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia: Elsevier; 2017. p. 344–72.CrossRefGoogle Scholar
  162. 162.
    Munro A, Herrington L, Carolan M. Reliability of 2-dimensional video assessment of frontal-plane dynamic knee valgus during common athletic screening tasks. J Sport Rehabil. 2012;21(1):7–11.PubMedCrossRefPubMedCentralGoogle Scholar
  163. 163.
    Burnham JM, Yonz MC, Robertson KE, McKinley R, Wilson BR, Johnson DL, Ireland ML, Noehren B. Relationship of hip and trunk muscle function with single leg step-down performance: implications for return to play screening and rehabilitation. Phys Ther Sport. 2016;22:66–73. Scholar
  164. 164.
    Kline PW, Johnson DL, Ireland ML, Noehren B. Clinical predictors of knee mechanics at return to sport after ACL reconstruction. Med Sci Sports Exerc. 2016;48(5):790–5. Scholar
  165. 165.
    Ireland ML, Bolgla LA, Noehren B. Gender differences in core strength and lower extremity function during static and dynamic single-leg squat tests. In: Noyes FR, Barber-Westin S, editors. ACL injuries in the female athlete: causes, impacts, and conditioning programs. Berlin: Springer; 2018. p. 239–57. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Cincinnati Sports Medicine and Orthopaedic CenterThe Noyes Knee InstituteCincinnatiUSA
  2. 2.Noyes Knee InstituteCincinnatiUSA

Personalised recommendations