Physical Therapy in Sport 22 (2016) 29e34

Contents lists available at ScienceDirect

Physical Therapy in Sport

journal homepage: www.elsevier.com/ptsp

Original research

Dynamic balance as measured by the Y-Balance Test is reduced in

individuals with low back pain: A cross-sectional comparative study
Troy L. Hooper a, *, C. Roger James a, Jean-Michel Brisme
e a, Toby J. Rogers b,
Kerry K. Gilbert a, Kevin L. Browne a, Phillip S. Sizer a
a
Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
b
B. Ward Lane College of Professional Studies, Lubbock Christian University, Lubbock, TX, USA

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: To determine the effects of current LBP (cLBP) and LBP history (hxLBP) on Y-Balance Test
Received 25 November 2015 (YBT) reach and establish relationships between YBT performance and demographic, behavioral, and
Received in revised form disability measures.
22 April 2016
Design: Cross-sectional comparative study.
Accepted 25 April 2016
Setting: Research laboratory.
Participants: Forty-two participants (24 males, 18 females) aged 18e50 years (30.9 ± 8.2 yr) in three
Keywords:
groups: cLBP, hxLBP, and healthy controls.
Postural balance
Low back pain
Interventions: Three YBT trials in anterior (ANT), posterolateral (PL), and posteromedial (PM) directions.
Y-Balance Test Main outcome measures: YBT reach (relative to leg length) was measured and compared amongst groups.
Star Excursion Balance Test Pearson correlations were calculated between reach distances and pain, disability, and fear avoidance
scores in the cLBP and hxLBP groups and age and activity level in all participants.
Results: For PL reach, cLBP (94.7 ± 10.6 cm) and hxLBP (94.2 ± 9.2 cm) groups demonstrated shorter
distances versus controls (105.8 ± 6.6 cm). For PM reach, cLBP (100.7 ± 8.4 cm) and hxLBP
(102.3 ± 7.6 cm) groups' distances were shorter versus controls (109.3 ± 6.7 cm). No significant difference
was found for ANT reach (control ¼ 66.4 ± 7.0 cm; cLBP ¼ 66.2 ± 6.2 cm; hxLBP ¼ 66.4 ± 3.1 cm). No
significant correlations were identified.
Conclusion: YBT performance is reduced in individuals with cLBP and hxLBP in the PL and PM directions
but not ANT. The YBT is useful for measuring balance deficits in these populations.
© 2016 Elsevier Ltd. All rights reserved.

1. Introduction
Low back pain (LBP) is an almost universal experience, with
75e90% of the population affected at some point in their lifetime
(Andersson, 1999). While some individuals experience LBP only
once, it is often recurrent. Recurrent LBP is defined as a return of
LBP with unilateral or bilateral symptoms between T12 and the
mid-thigh that lasts at least 24 h with a pain intensity greater than
2 cm on a 10 cm visual analog scale (VAS) following a period of at
least 30 pain-free days (Stanton, Latimer, Maher, & Hancock, 2011).
* Corresponding author. Department of Rehabilitation Sciences, Texas Tech Uni-
versity Health Sciences Center, ScD Program in Physical Therapy, Center for Reha-
bilitation Research, 3601 4th St; STOP 6226, Lubbock, TX, 79430-6226, USA. Tel.: þ1
806 743 2948.
E-mail address: troy.hooper@ttuhsc.edu (T.L. Hooper).
Once a person has recovered from a LBP episode, he or she has a
greater risk of future LBP. Approximately 50% of people have a
recurrence in one year, 60% in two years and 70% in five years
(Hestbaek, Leboeuf-Yde, & Manniche, 2003).
In addition to an increased risk of further LBP, people who
experience LBP episodes develop postural control deficits. Postural
control is the ability to maintain or return the body to a state of
equilibrium or balance (Cavanaugh, Guskiewicz, & Stergiou, 2005).
Compared with healthy controls, people with LBP demonstrate
increased postural sway (Ruhe, Fejer, & Walker, 2011) and greater
difficulty adapting to changing conditions (Mientjes & Frank, 1999).
Moreover, once they lose their balance, these individuals have more
difficulty recovering it (Brumagne, Cordo, & Verschueren, 2004).
These deficits begin appearing within the first three months (Sung,
Abraham, Plastaras, & Silfies, 2015) and can remain even after a
person's LBP has resolved (Bouche, Stevens, Cambier, Caemaert, &

http://dx.doi.org/10.1016/j.ptsp.2016.04.006
1466-853X/© 2016 Elsevier Ltd. All rights reserved.
30 T.L. Hooper et al. / Physical Therapy in Sport 22 (2016) 29e34

Danneels, 2005; van Diee €n, Koppes, & Twisk, 2010), which may beliefs or disability are unknown. Finally, this test's ability to
contribute to the individual's increased low back re-injury risk. detect dynamic balance deficits in people with a LBP history who
Current methods used to measure balance are generally are currently pain-free (hxLBP) is undetermined. This information
expensive and difficult to execute. Force plate instruments provide may help clinicians better understand the role of diminished bal-
quantified balance assessment by measuring ground reaction ance in LBP pathology and provide a simple test to detect these
forces, but such technology is typically expensive, the data can be changes and monitor treatment progression in these individuals.
complex to interpret, and the hardware can require large amounts The purpose of this study was to examine whether there are dif-
of space. These distinctions make using such technology imprac- ferences in YBT scores among participants with current LBP (cLBP),
tical in most clinical settings. Additionally, this technology utilizes hxLBP, and no history of LBP (control). An additional purpose was to
static tests that measure center of pressure displacement to investigate the relationship among YBT scores and activity level and
quantify balance. These tests are unable to measure the body's age in all three groups and YBT scores and pain, disability, as well as
ability to maintain balance while performing a functional move- fear of movement measurements for the cLBP and hxLBP groups.
ment (Bressel, Yonker, Kras, & Heath, 2007; Sell, 2012). Thus, we
need simple and inexpensive means to measure dynamic balance 2. Methods
for clinical use.
The Star Excursion Balance Test (SEBT), which was developed by 2.1. Study design and setting
Gray (1995), is commonly used to measure dynamic balance. This
test is preferred for its simplistic set up and execution, where the A one factor between-subjects design was used to examine
subject stands at the intersection of 8 tape strips successively differences in YBT scores among three groups: cLBP, hxLBP, and
placed on the floor at 45 angles. The subject performs a maximum control. The study was completed in a university research
reach in each of eight directions with the opposite leg: antero- laboratory.
lateral, anterior (ANT), anteromedial, medial, posteromedial (PM),
posterior, posterolateral (PL), and lateral. This way, the subject's 2.2. Participants
balance is challenged in multiple predetermined directions.
Because this test involves maintaining the center of mass over the Each group consisted of 8 males and 6 females. The hxLBP group
base of support rather than displacing center of pressure, it eval- included participants with a history of one or more recurrent LBP
uates a different component of balance than force plate in- episodes over the previous 18 months. These participants experi-
struments (Glave, Didier, Weatherwax, Browning, & Fiaud, 2016). enced one or more of the following: (a) a severity requiring medical
The SEBT has been used to detect balance deficits in lower ex- or allied health intervention; and/or (b) a severity impairing the
tremity injuries, such as chronic ankle instability, patellofemoral subject's ability to perform normal activities of daily living. At the
pain syndrome, and anterior cruciate ligament injury (Gribble, time of testing, participants were in a period of remission from
Hertel, & Plisky, 2012). Ganesh, Chhabra, and Mrityunjay (2015) their LBP symptoms (Macdonald, Moseley, & Hodges, 2010).
found that individuals with chronic LBP (i.e., greater than 6 Criteria for inclusion in the cLBP group were defined by the same
months duration) demonstrated decreased reach distances in all parameters as those described for the hxLBP group, except cLBP
directions except posterior. However, the study did not objectify participants were required to report that such a profile was
the pain, disability, or activity levels of the LBP participants. accompanied by present pain that was 2/10 cm on a VAS or an
Moreover, while age was considered, other potentially important average of 3/10 cm over the past week, versus a lack of present
factors such as activity level were not controlled. symptoms required of the hxLBP group. Moreover, these cLBP
A potential limitation of the SEBT is the extended amount of participants were excluded if they experience radicular low back or
time for its administration, which could produce subject fatigue leg pain or neurological signs. Participants in the control group
and decreased motivation (Hertel, Braham, Hale, & Olmsted- were free of LBP in the previous two years. Exclusion criteria for all
Kramer, 2006). In order to enhance testing efficiency and partici- groups were: (a) history of hip, knee, or ankle pain in the previous
pant motivation, as well as reduce required testing time and the two years; (b) history of lower extremity or lumbar spine surgery;
potential fatigue affect, Hertel et al. (2006) identified redundancy (c) pregnancy by self-report; (d) rheumatologic or neurological
among the eight directions and recommended reducing the test
direction number. In response, Plisky, Gorman, Butler, Kiesel,
Underwood, and Elkins (2009) adapted the SEBT to incorporate Table 1
only the ANT, PM, and PL testing directions, resulting in the Demographic data (mean ± SD).
commercially identified Y-Balance Test (YBT) Kit. These directions Group Current LBP History LBP Control P
were chosen because the sum of the reach distances in the three
Age (years) 30.4 ± 9.6 32.1 ± 8.3 30.2 ± 7.3 .802a
YBT directions were able to predict lower extremity injury risk in
Height (cm) 173.1 ± 8.1 175.9 ± 9.9 174.0 ± 10.6 .739a
high school basketball players (Plisky, Rauh, Kaminski, & BPAQ (scale 0e15) 7.8 ± 1.3 7.7 ± 1.4 8.1 ± 1.3 .702a
Underwood, 2006). Other studies (Coughlan, Fullam, Delahunt, Current pain (cm) 3.0 ± 1.4 NA NA
Gissane, & Caulfield, 2012; Fullam, Caulfield, Coughlan, & Average pain (cm) 4.0 ± 1.2 NA NA
Delahunt, 2014) found that PL and PM reach distances were Pain medication usage (%)
None 21.4 85.7 NA
similar during the YBT using the Kit versus the SEBT testing on the Occasional 64.3 14.3 NA
floor. However, the ANT reach distance was smaller using the YBT (Few times a month)
Kit. This difference was attributed to greater hip flexion during the Frequent 14.3 .0 NA
YBT (Fullam et al., 2014). Moreover, the YBT demonstrates good to (Few times a week)
RMDQ (scale 0e24) 5.6 ± 3.9 1.2 ± 1.4 NA .001b
excellent intra-rater (.85e.91) and inter-rater (.99e1.00) reliability
FABQ (scale 0e66) 20.8 ± 8.6 14.9 ± 10.7 NA .208b
(Plisky et al., 2009).
While the SEBT is able to detect dynamic balance deficits in a LBP ¼ low back pain; BPAQ ¼ Baecke Physical Activity Questionnaire;
RMDQ ¼ Roland Morris Disability Questionnaire; FABQ ¼ Fear Avoidance Beliefs
chronic LBP population (Ganesh et al., 2015), it is not known Questionnaire.
whether pain or activity levels influence test outcomes. Addition- a
¼1  3 ANOVA.
b
ally, the relationships between test outcomes and fear-avoidance ¼independent t-test.
 T.L. Hooper et al. / Physical Therapy in Sport 22 (2016) 29e34
disorders; (e) vestibular or other balance disorders, (f) present
treatment for inner ear, sinus, or upper respiratory infection, or
head cold, and (g) cerebral concussion within the previous three
months. In addition, no participants in either LBP group had
received therapy for LBP in the past year. Table 1 reports the inci-
dence and frequency of pain med use by each LBP group. Because
our study was a part of an additional study that excluded obese
participants, a BMI greater than 30 kg/m2 was an additional
exclusion criterion.
Large effect sizes were found in prior SEBT studies in partici-
pants with knee and ankle disorders (Gribble et al., 2012;
Herrington, Hatcher, Hatcher, & McNicholas, 2009). Using a ¼ .05
and b ¼ .20, it was determined that a minimum of nine participants
was required in each group. Accounting for attrition, a convenience
sample of 14 participants was chosen for each group. Participants
were recruited from local rehabilitation clinics and the general
public and included males and females between the ages of 18 and
50.
2.3. Testing procedures
Participants read and signed the informed consent form
approved by the university's Institutional Review Board and
completed a medical history questionnaire to determine their
eligibility for the study. Participants watched a video presenta-
tion explaining the purpose of the study and testing procedures.
Following the video, demographic data, including the subject's
height, weight, and dominant leg, defined at the limb used to
kick a ball, were recorded. All participants completed a medical
history questionnaire and the Baecke Physical Activity Ques-
tionnaire (BPAQ) (Baecke, Burema, & Frijters, 1982), which is a
self-administered questionnaire found to be reliable in LBP pa-
tients (Jacob, Baras, Zeev, & Epstein, 2001). The questionnaire
includes three indices that represent physical activity levels at
work, sports, and other leisure-time activities. Scores on the
BPAQ range from 0 to 15, with higher scores signifying higher
activity levels. Participants in the cLBP and hxLBP groups
completed the Roland Morris Disability Questionnaire (RMDQ) to
measure disability levels caused by LBP (Roland & Fairbank,
2000) and the Fear Avoidance Beliefs Questionnaire (FABQ) to
Fig. 1. The Y-Balance Test reach directions. (A) anterior, (B) posteromedial, (C) posterolateral.
31
measure the presence of pain-related fear of movement
(Waddell, Newton, Henderson, Somerville, & Main, 1993). Two
10 cm VAS forms that recorded participants' current and average
pain level over the past week, respectively, were completed by
cLBP and hxLBP participants.
Leg length was measured as the distance from the stance-leg
anterior superior iliac spine to the medial malleolus, and all reach
distances were normalized to this value as a percentage of this
measurement. Participants were next instructed on proper YBT
performance (Gribble et al., 2012; Plisky et al., 2009) using the Y-
Balance Test Kit (Perform Better, West Warwick, RI) and allowed
four practice trials to minimize practice effects (Robinson &
Gribble, 2008). Participants performed the test without shoes to
eliminate the potential influence of varying footwear (Gribble et al.,
2012). They were instructed to stand on their dominant limb with
the edge of their toes at the marked starting line and their hands
placed on their hips and to reach as far as possible with the non-
stance limb in the ANT, PM, and PL directions (Fig. 1). The three
testing directions were randomized to prevent an order effect.
Three successful repetitions were performed in each direction, and
the mean scores for each direction were used for statistical calcu-
lations. A minimum of 30 s was allowed between trials to reduce
fatigue effects.
2.4. Statistical analysis
Descriptive statistics (mean ± SD) were calculated for age,
weight, height, and BPAQ scores for all participants and VAS as well
as questionnaire scores for cLBP and hxLBP participants. Data were
tested for normality (Shapiro-Wilk's Test) and homogeneity of
variance (Levene's Test). Independent samples one-way analyses of
variance (ANOVAs) were used to determine any differences in de-
mographic characteristics among the three groups. Differences in
pain, disability level, and fear-avoidance beliefs between the two
LBP groups were tested with independent samples t tests.
Three independent samples one-way ANOVAs were performed
to investigate significant reach distance differences among the
control, cLBP, and hxLBP groups. Tukey's post-hoc tests were used
to identify the location of significant differences within each
analysis. Bivariate Pearson product moment correlations were
32 T.L. Hooper et al. / Physical Therapy in Sport 22 (2016) 29e34

calculated for each group (3 total) to determine if a relationship Table 2

exists between reach distance in each direction and VAS, RMDQ, Correlation matrix of reach distances and demographic variables.

and FABQ scores in the cLBP and hxLBP groups and age, and BPAQ Age BPAQ RMDQ FABQ Current pain
scores in all participants. The level of significance was set at a ¼ .05 Control
for all analyses. Effect size was expressed as partial eta squared Anterior .39 .37
(hp 2 ) with hp 2  .01 indicating small, hp 2  .06 medium, and Posterolateral .14 .08
hp 2  .14 large effects (Portney & Watkins, 2009). All statistical Posteromedial .10 .06
hxLBP
analyses were performed using SPSS Statistics, Version 22.0 (SPSS
Anterior .12 .33 .01 .00
Inc, Chicago, IL). Posterolateral .25 .09 .13 .24
Posteromedial .34 .05 .05 .23
LBP
3. Results Anterior .32 .18 .03 .03 .18
Posterolateral .06 .03 .43 .08 .18
There were no significant (P > .05) differences among groups for Posteromedial .31 .17 .10 .35 .42
age, height, or BPAQ scores (Table 1). No significant differences (F hxLBP ¼ low back pain history; cLBP ¼ current low back pain; BMI ¼ body mass
[2,39] ¼ .10; P ¼ .990; hp 2 ¼ .001; power ¼ .051) were found be- index; BPAQ ¼ Baecke Physical Activity Questionnaire; RMDQ ¼ Roland Morris
tween the mean Anterior reach distances for the control Disability Questionnaire; FABQ ¼ Fear Avoidance Beliefs Questionnaire.
(66.4 ± 7.0 cm), cLBP (66.2 ± 6.2 cm), or hxLBP (66.4 ± 3.1 cm)
groups (Fig. 2). However, a significant main effect for reach distance
deficits remain in this population even after the pain disappears;
was found in the PL direction (F[2,39] ¼ 7.49; P ¼ .002; hp 2 ¼ .278;
however, these studies relied on expensive laboratory equipment
power ¼ .925). Reach distances were significantly reduced in the
(Bouche et al., 2005; van Diee €n et al., 2010). The YBT can be per-
cLBP (94.7 ± 10.6 cm; P ¼ .006) and hxLBP (94.2 ± 9.2 cm; P ¼ .004)
formed quickly in a clinical setting and requires little training,
groups compared to the control group (105.8 ± 6.6 cm), with no
which optimizes it for testing dynamic balance in this population.
difference found between the two LBP groups (P ¼ .984). Similarly, a
Our findings of significant between-group reach distance dis-
significant main effect for reach distance was found in the PL di-
parities during reach trials in the posterior but not anterior di-
rection (F[2,39] ¼ 5.11; P ¼ .011; hp 2 ¼ .208; power ¼ .792), with
rections is not consistent with previous research in LBP participants
reach distances significantly reduced in the cLBP (100.7 ± 8.4 cm;
(Ganesh et al., 2015). Ganesh et al. (2015) found that reach dis-
P ¼ .013) and hxLBP (102.3 ± 7.6 cm; P ¼ .048) groups each
tances in chronic LBP participants of a similar age (34.30 ± 8.67 yr)
compared to the control group (109.3 ± 6.7 cm). No difference was
were diminished in all three directions tested in the current study.
found between the cLBP and hxLBP groups (P ¼ .850) in the PL
There may be several explanations for the differences between
direction.
Ganesh et al. (2015) and our present study. First, the LBP classifi-
Correlation results are listed in Table 2. No statistically signifi-
cation of participants in the two studies is likely different. Ganesh
cant (P > .05) correlations were observed in any of the three groups
et al. (2015) did not report the pain levels or functional status of
between any of the listed variables.
participants, lending to potential differences between the samples.
Second, there may be disparities between samples with respect to
4. Discussion postural control, especially considering that the previous study
examined participants with chronic LBP of greater than 6 months.
This study set out to examine for differences in YBT reach scores This could have created greater impairment in their participants
between normal, cLBP and hxLBP participants. We discovered that versus our participants who experienced relatively low pain levels
YBT reach distances in the PM and PL directions were lower in the (3.0 ± 1.4 cm).
cLBP and hxLBP groups versus the pain-free control group. The ability to maintain postural control during dynamic move-
Conversely, no differences were found in the ANT direction. A ment circumstances is a complex skill requiring interaction be-
secondary goal was to examine the relationships among YBT scores, tween the visual (Mergner, Schweigart, Maurer, & Blümle, 2005),
age, and activity level in all three groups, along with YBT scores and somatosensory (Bove, Nardone, & Schieppati, 2009), and vestibular
pain, disability, and fear of movement measurements for the cLBP systems (Bacsi & Colebatch, 2004). When one of these is impaired,
and hxLBP groups. No statistically significant correlations were the body may attempt to compensate by increasing its reliance on
observed. the other systems, and failure in this compensation will lead to loss
This study is the first to demonstrate that the YBT can detect of balance and diminished postural control (Guskiewicz & Perrin,
dynamic balance deficits in people with a LBP history who are 1996). During the ANT reach trials, the subject is able to visualize
currently pain-free. Previous studies have reported that balance the moving limb throughout the activity; therefore, the visual
system may compensate for any somatosensory deficits present in
the LBP groups. During the posterior trials, the lower limb is placed
behind the body out of the line of sight, which reduces the ability of
the visual system to compensate for these deficits (Mergner et al.,
2005). These directions may have been the only two that were
sufficiently challenging to stress the postural control system in both
LBP groups to a point that limited the participants' reach. Moreover,
it may be that postural control deficits in hxLBP or cLBP participants
with minor pain are too small to be detected in the ANT direction.
Differences in the body's center of gravity position during the
anterior versus posterior reaching trials may be another explana-
tion for the lack of a deficit in the ANT direction. To maintain bal-
ance, the body's center of gravity must remain within its base of
Fig. 2. Normalized reach distances for current LBP, LBP history, and control groups. support. It is likely that the center of gravity moves farther from the
Error bars represent 95% confidence intervals. LBP ¼ low back pain. *Indicates P < .01. stance limb during the posterior trials than in the anterior
 T.L. Hooper et al. / Physical Therapy in Sport 22 (2016) 29e34
direction, creating a greater challenge to balance during the PM and
PL trials. In response to either present (cLBP group) or previous
(hxLBP group) LBP experiences, the participants may have learned
to restrict how far they allowed their center of gravity to shift for-
ward in general, maintaining a closer proximity within their base of
support (Brumagne, Janssens, Janssens, & Goddyn, 2008). This
postural control adaptation may have limited our participants'
ability to maintain a balanced position during our more challenging
posterior reach trials (Sung et al., 2015). Thus, their limited reach
distances may reflect a postural control deficit in these two
directions.
No correlations between the variables measured and reach
distance were significant. This finding agrees with a previous study
that found no correlations between trunk motor control and pain
intensity or fear of movement in patients with acute-to-subacute,
non-sensitized LBP (Sung et al., 2015). The lack of correlation be-
tween pain level and reach distance in our study may be due to the
overall low pain and disability levels in the cLBP group. One factor
that potentially affects reach distance is fear of movement. This is
especially important in LBP populations, as these individuals are
often apprehensive to perform dynamic tasks due to fear of further
pain and injury in response to the movement (Rainville, Smeets,
Bendix, Tveito, Poiraudeau, & Indahl, 2011). Thus, our partici-
pants' pain may not have been of sufficient magnitude to produce
fear or movement apprehension that would result in reduced reach
distances. This same lack of apprehension may have influenced the
low correlation between FABQ scores and reach distances. In a
parallel fashion, our participants' relatively low disability (RMDQ)
levels may not have been sufficient to correspond with their reach
distances, lending to the low correlation between the two variables.
A wider range of ages and activity levels may have produced a more
meaningful correlation between each variable and reach distance.
Several considerations should inform the interpretation of our
results. First, our present YBT directions were originally chosen to
maximize the utility of the test for detecting balance deficits in
people with chronic ankle instability (Plisky et al., 2006). However,
the directions associated with this standard YBT may not best
represent the planes in which LBP sufferers experience the greatest
control deficits. Future studies should be conducted to determine
which directions of the SEBT are most sensitive to detect balance
deficits in different LBP populations.
Second, the pain, disability, and fear-avoidance levels experi-
enced by the cLBP group were relatively low. However, our sample
may represent the large number of individuals with low levels of
LBP-related fear and dysfunction who do not seek care for their LBP
(Ferreira, Machado, Latimer, Maher, Ferreira, & Smeets, 2010).
These individuals continue to perform their normal daily and sport
activities despite their LBP experience. Conversely, this study did
show that these individuals have appreciable balance deficits that
may lead to more significant pain and disability and increase lower
extremity injury risk in the future (Wilkerson & Colston, 2015;
Zazulak, Hewett, Reeves, Goldberg, & Cholewicki, 2007). Thus,
providers should be mindful of these issues and attempt to address
these balance deficits in those with low levels of LBP. Finally,
although attempts were made to control factors other than balance
that may affect YBT performance, variables not measured, such as
strength (Ambegaonkar, Mettinger, Caswell, Burtt, & Cortes, 2014;
Gordon, Ambegaonkar, & Caswell, 2013) or joint range of motion
(Hoch, Staton, & McKeon, 2011) may affect performance.
5. Conclusions
Balance deficits are common in individuals with LBP and often
remain after pain is resolved. Clinicians need tools to assess and
treat these balance issues. The YBT is capable of detecting dynamic
33
balance deficits in individuals with recurrent LBP with present
symptoms, as well as persons with a recent LBP history. It is a
simple test that requires little training and can be performed easily
in a clinical setting. The YBT scores were not associated with ac-
tivity level or age in the three groups or disability or fear of
movement scores in the cLBP and hxLBP groups, although the
relatively narrow distribution of these variables in our study may
have influenced these results.
Disclosure
We certify that no party having a direct interest in the results of
the research supporting this article has or will confer a benefit on us
or on any organization with which we are associated AND, we did
not receive any financial or material support for this research (eg,
NIH or NHS grants). The manuscript submitted does not contain
information about medical device(s).
Conflict of interest
None declared.
Ethical approval
All procedures were approved by the Texas Tech University
Health Sciences Center Institutional Review Board (IRB). All par-
ticipants signed an approved informed consent form.
Funding
None declared.
Acknowledgments
The authors thank the Texas Tech University Department of
Kinesiology and Sport Management for the use of their facility. We
also thank Kayla Shaffer, BS and Ram Haddas, PhD for their assis-
tance with data collection.
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