Posted by Peak Sports
People usually start physical therapy when they have pain that is severe or when pain has lasted so long it just becomes annoying. But when is the best time to end physical therapy? The answer to this question isn’t always as clear but it is a topic worthy of discussion.
Over my career I’ve had people stop treatment for just about every reason imaginable including now a global pandemic. Never thought Id say that. Insurance and financial limitations sometimes come into play, but aside from that, I want the people leaving my care to move well and not hurt.
By “not hurt” I want people to be able to consistently perform all their normal activities without pain. It’s easy to feel good by avoiding stuff, but I want you to DO stuff and still feel good.
By “move well” I use objective, functional, and evidence based measures as much as possible. The Y Balance Test is one of these measures and is what I want to talk about here.
Shaped like a capitol letter “Y” this test will determine how well you use your limb and core together. The data from this creates an “injury risk profile” which compares your right and left sides. We know that the more disparate the limbs perform the greater the risk of injury. The number one predictor of future injury is past injury. Nothing we can do about that. But the second greatest predictor of future injury is asymmetry. This we have control over and can change with training so is the data we look at first.
The Y Balance test also gives us a performance profile. This data provides context for the injury risk profile. Let’s say you have relative symmetry between the two sides, which is good but, are they symmetrically great? Bad? Average? Without the performance profile you have no way of knowing. Thus, I always assess both.
I’ll use myself as an example. On February 1, 2020 I completed a goal of mine by competing in a powerlfting meet. I actually won for my age group. But I completely tore my rotator cuff in two places while doing so. Thus, starting physical therapy for the “severe pain” reason.
After four months of progressing my therapy I started feeling normal again, so last week I took the Y Balance Test. For an upper body issue this is what it looks like. You have one hand supported on the test kit and push the sliders reaching with the other. For lower body issues you stand on the test kit and push the sliders reaching with your other foot.
1. 2. 3.
These were my results.
Reach 1 left: 94.5cm, right: 94. .5 centimeter of assymetry, no problem
Reach 2 left: 82.5cm, right: 78.5 4 centimeter of assymetry, no problem
Reach 3 left”54.5cm, right: 63 8.5 centimeter of assymetry, PROBLEM
So from an injury risk point of view, I learned there is work yet to be done. Even though I feel good I don’t move well enough. Research tells us the assymetry should be no greater than 4 cm and reach #3 was with an 8.5cm difference. From a performance point of view the score was 93 which is considered good. So once I create symmetry I’m good to go. Knowing which direction is needing work helps me direct the rehab process specifically to emphasize those exercises which have the same requirements. This way I only have to do the exercises I need.
Am I ready to be done with physical therapy? Nope, not yet. At least now I know and will progress from here accordingly. Because I did the test I learned I have work left to do and which work it is that I need most.
The beauty of the Y balance test is that it can be used any time to determine if your body has symmetrical function. Is your training program giving you what you need to function optimally? Assess don’t guess. Get a Y Balance test.
Dan Swinscoe, MPT
Peak Sports and Spine Physical Therapy Issaquah and Klahanie