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The Single Leg Triple Hop for Distance Test

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The Single Leg Triple

Hop for Distance Test
Mary Williams, EdD, LAT, ATC,1 Antonio Squillante, Dott,2 and Jay Dawes, PhD, CSCS*D, NSCA-CPT*D, TSAC-F, FNSCA3
1
Sam Houston State University, Huntsville, Texas; 2Platoon Fitness of Philadelphia, Pennsylvania; and 3University of
Colorado, Colorado Springs, Colorado

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided
in the HTML and PDF versions of this article on the journal’s Web site (http://journals.lww.com/nsca-scj).

ABSTRACT
THE SINGLE LEG TRIPLE HOP
FOR DISTANCE TEST IS AN EASY
AND INEXPENSIVE METHOD OF
ASSESSING A PLAYER’S INJURY
RISK. THIS ARTICLE PROVIDES A
DETAILED DESCRIPTION OF HOW
TO PERFORM AND ANALYZE THE
RESULTS OF THIS TEST.
INTRODUCTION
njury rates in the lower extremity
not only concluded that higher rates
of ankle sprains occur in women com-
pared with men, but also report the
highest risk of ankle sprains in indoor/
court sports such as basketball, volley-
ball, and tennis compared with field and
ice sports. Ankle injuries can produce
functional limitations and may lead to
chronic ankle instability which can have
lasting long-term effects for the athlete
(15). A position paper by the National
Athletic Trainers’ Association (NATA)
(15) summarizing the importance of
sports such as American football and
soccer (14,28). Data from emergency
departments (1999–2008) in the United
States indicate that of all knee injuries
seen, strains and sprains made up nearly
half (42.1%) of knee injuries treated (7).
Of particular concern are injuries to
the anterior cruciate ligament (ACL)
because of the cost associated with this
injury and the potential long-term loss
of function associated with osteoarthri-
tis (1). Of all ACL injuries, noncontact

I
are a concern for a variety of sport
athletes (6,13,19). In fact, epidemi-
ological data from both high school
and collegiate sports settings project
that more than 50% of all sports-
related injuries are to the lower
extremity (6,13). These injuries, espe-
cially to the knee and ankle, are par-
ticularly common in sports such as
soccer and basketball (19).
A systematic review (5) examining
the incidence and prevalence of ankle
injuries in sport and military populations
Address correspondence to Dr. Mary
Williams, mary.williams@shsu.edu.
conservative management and preven-
tion of ankle injuries recommends
using lower extremity functional per-
formance tests (LEFPTs) after an ankle
sprain to make return-to-play deci-
sions, specifically single-limb hopping
tasks used in conjunction with other
tests. In this same position statement,
preventative multi-intervention train-
ing programs which include neuro-
muscular control, single-legged
balance training, and perturbation have
some support.
Knee injuries also are a major contribu-
tor to lower extremity injuries within
injuries present the most opportunity for
prevention through identification of
injury risk factors and the use of training
interventions. Neuromuscular training
programs that include strengthening,
plyometrics, and sports-specific agility
have been found to be most effective
in the prevention of noncontact ACL
injuries (8,18,21,30). A systematic review
(21) examining ACL prevention pro-
grams concluded that 2 particular pre-
vention programs, the Prevent Injury
and Enhance Performance and the
Sportsmetrics programs had positive
influence on injury reduction and ath-
letic performance. Both programs

94 VOLUME 39 | NUMBER 3 | JUNE 2017 Copyright Ó National Strength and Conditioning Association

Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
 provide a comprehensive approach
which includes emphasis on jumping
and landing components.
In terms of assessment, jump tests are
frequently used by professionals to
assess readiness in terms of functional
strength, but perhaps more importantly,
these tests can indicate the individual’s
ability to land and control the neuro-
muscular movement (12). Knee motion
and joint loading during landing tasks
have been found to be strong predictors
of ACL injury, specifically in female ath-
letes (12). Assessing for asymmetries
during the functions of jumping and
landing is a common approach in injury
rehabilitation settings, whereby the
health care professional references
the healthy extremity as a baseline of
“normal” or healthy (2,9,20,22,31).
LEFPTs are frequently used as a method
of predicting potential injury risk and per-
formance decrements by using running,
hopping, jumping, and leaping actions
similar to those performed in a wide vari-
ety of sports (16,24). Single leg hop tests
are simple to administer and require very
little equipment, making them accessible
to both strength and conditioning
coaches as well as athletic trainers to
determine preparticipation readiness.
However, the literature is lacking studies
that examine the ability of these tests to
predict injury in athletes (11). These tests
often help the coach or medical profes-
sional to discern between strength, power,
and neuromuscular control between the
dominant and nondominant leg (19). By
noting differences between the extremi-
ties, professionals can identify bilateral
deficits to adjust training interventions.
Reducing asymmetries between limbs in
single leg horizontal hopping tasks may
help reduce the risk of injury (3).
Single leg horizontal countermovement
jumps have been significantly correlated
with sport performance measures of
sprint speed, acceleration, and change of
direction time in both men and women
(17). Moreover, triple and quintuple
sequential hop tests seem to be correlated
with performance measures such as sprint
speed (27). Hop tests are frequently used
by health care professionals to assess
Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
lower extremity function and obtain mea- TEST RELIABILITY AND VALIDITY
surable data to make return-to-sport de- As with all performance assessments
cisions after injury. Single leg hop tests and screening tests, reliability and val-
have predominantly been studied among idity of the tests chosen by the pro-
individuals with a unilateral lower extrem- fessional should be established so that
ity injury with ACL reconstruction being the assessment is both replicable and
the most common (2,9,19,22,31). Overall, measures an element which can be
single leg hop tests enable health care addressed through exercise interven-
professionals to determine if any func- tions if needed. The SLTH for dis-
tional weaknesses exist in the injured tance has been found to be both
extremity compared with the healthy reliable and valid in clinical popula-
extremity using a bilateral comparison. tions as a performance-based outcome
The single leg triple hop (SLTH) for measure for patients undergoing reha-
distance test, first described by Noyes bilitation after ACL reconstruction (25).
et al. (22), is a LEFPT used to assess In healthy groups, the SLTH for dis-
unilateral lower-body function (see tance has been found to have strong
Video, Supplemental Digital Content test–retest reliability (.0.95) using US
Air Force cadets (26), and to be a valid
1, http://links.lww.com/SCJ/A216).
This test is unique in that it assesses predictor of lower extremity power and
an individual’s ability to decelerate on
ground contact by requiring the athlete
to “stick” the landing. Furthermore,
similar to sport, the momentum cre-
ated by the 3 sequential jumps must
be controlled by the athlete to success-
fully complete the test. This requires
use of the full muscle action spectrum
(4) to produce force (concentric),
reduce force (eccentric), and dynami-
cally stabilize (isometric) the body.
These are not only requisite skills for
efficient human movement, but may
also play a role in injury reduction.
TEST USEFULNESS
Historically, the SLTH has been used
by health care professionals for individ-
uals recovering from injury to determine
return-to-play status (2,9,19,22,31).
The SLTH for distance test has 2 pri-
mary assessment objectives:
 Assess functional strength, power,
and neuromuscular control during
the horizontal effort (measured in
distance), and
 Assessment of the individual’s ability
to decelerate the movement by land-
ing the jump on a single foot without
a step (observed by the tester).
For these reasons, this test should ide-
ally be administered during preseason
screening to identify asymmetries and
help identify those individuals who
may be at increased risk of lower
extremity injuries. Figure 1. Test layout.
95
Strength and Conditioning Journal | www.nsca-scj.com
 Exercise Technique
Figure 2. Single leg triple hop for distance.
strength in National Collegiate Athletic
Association men’s and women’s soccer
athletes (10).
TEST PROTOCOL
The suggested protocol for the SLTH
test for distance is relatively easy to apply
in both the clinical and field settings.
TEST SETUP
 Use an open area free of sharp objects
and clutter. Consider using surfaces
and footwear which are sport/
activity-specific when possible.
 The tester should place an 8-m strip
of athletic or floor tape on the test
surface (Figure 1).
 A 3-m strip of tape should then be
placed perpendicular to one end of
the 8-m strip to create the starting line.
TESTING PROCEDURE
 The athlete should begin by standing
on the designated test leg, with their
toe on the starting line (Figure 2).
 When ready, the athlete will perform
3 consecutive maximal hops forward
with the designated leg.
 The tester should measure the dis-
tance hopped from the starting line
to the point where the subject’s heel
lands on completing the third jump.
 Upper extremity movement during
single-leg horizontal hop testing is
96 VOLUME 39 | NUMBER 3 | JUNE 2017
Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
not restricted, although the subjects
are instructed to “stick” the landing
on the last hop.
 On landing, the athlete should not
shift or pivot the landing foot, or
allow the opposite foot to touch
the ground for support.
 The athlete should come to a com-
plete stop within 1 second of landing
for the test to be considered successful.
 Athletes should be allowed to perform
no more than 3 practice trials for each
leg (as to avoid fatigue) before per-
forming the test. After the practice
trials, 3 test trials are performed on
each leg in an alternating order.
 A 30-second rest period should be al-
lowed between practice and test trials.
 A mean distance of the 3 test trials
for each leg should be calculated.
The professional should stop the test
at any point when it becomes unsafe;
this includes fatigue of the athlete (see
Video, Supplemental Digital Content
1, http://links.lww.com/SCJ/A216,
shows the proper technique for per-
forming the SLTH).
INTERPRETATION OF RESULTS
According to the scores recorded for
each leg during the test, functional
Mean Distance on Nondominant Side
LSI 5
Mean Distance on Dominant Side
limitations in the lower extremities are
normally reported as a bilateral deficit
between the dominant and nondomi-
nant leg which can be easily quantified
using the limb symmetry index (LSI)
(31). This simple statistical tool has
been shown to represent an objective
criterion to identify functional imbal-
ance. It is determined by the ratio of
performance of the nondominant leg
to the performance on the dominant
leg, multiplied by 100. Noyes et al.
(22) determined an LSI of 85% or
greater to be within the normal range
of symmetry for both men and women,
although more recently O’Donnell et al.
(23) reported normal LSI values as
being greater than or equal to 90%.
Thomee’ et al. (29) explained that an
“LSI of 90%, that is, more than 10%
difference between legs following
ACL injury and reconstruction, has
been regarded as unsatisfactory for both
strength and hop performance, but it
can be argued that an LSI of 80%, for
example, should be enough, or that
nothing less than an LSI of 100% is
satisfactory.” Therefore, an LSI score
of 90% or greater is recommended to
detect weakness, which may predispose
an individual to injury.
3 100
 Table
Proposed normative data for single leg triple hop for distance test based on
work by Myers et al. (19)
Proposed normative data for single leg triple hop for distance test high school
and collegiate basketball and soccer athletes
Male College
Female College
Male High School
Female High School
Compared with other protocols avail-
able in previous literature, the SLTH
test for distance seems to be a FPT to
assess multiple domains of function.
Considering a normal LSI score as
equal or greater than 90%, the SLTH
test for distance can help to detect
asymmetries that may predispose an
athlete to lower extremity sports-
related injuries. Therefore, strength and
conditioning coaches should implement
this test in their preseason general
assessment to adjust lower-body gen-
eral, specific, and special exercises to
match the needs of their athletes. Iden-
tification of asymmetries or inability to
“stick” the landing can assist in identifi-
cation of functional weaknesses which
can be addressed with appropriate train-
ing interventions and injury prevention
strategies.
PROPOSED NORMATIVE DATA
Normative data for the SLTH for dis-
tance test have not yet been fully es-
tablished. However, preliminary work
by Myers et al. (19) with high school
and collegiate basketball and soccer
participants has proposed normative
data for these groups (Table). This
study used a sample of 372 healthy
high school and collegiate athletes
(185 females, 187 males) (Table 1). Fur-
ther work in the examination of nor-
mative data for jump tests is needed to
fully accept normative data for inter-
pretation of assessment findings.
SUMMARY
Lower extremity injuries are a concern
across a wide variety of sports; specif-
ically, injuries to the ankle and knee
Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
632 6 72 cm
470 6 53 cm
583 6 72 cm
428 6 54 cm
that can have immediate and long-
term consequences for the athlete. It
is the responsibility of the athletic
trainer and strength and conditioning
professional to take steps to prevent
injury occurrence in the athletes they
serve. The SLHT for distance is one
tool that can be used as a screen to
determine unilateral weakness which
may predispose an athlete to injury.
The SLTH test is a simple test to
administer, and does not require more
than a measuring device and tape for
the floor. Furthermore, the SLTH test
is a reliable and valid test which can be
used to assess lower extremity func-
tional performance. Outcomes from
this test can identify asymmetries in
the lower extremity, which can inform
the professional regarding appropriate
interventions regarding strength,
power, and neuromuscular control
interventions.
Conflicts of Interest and Source of Funding:
The authors report no conflicts of interest
and no source of funding.
Mary L. Williams is an Assistant Pro-
fessor and athletic training program
director at Sam Houston State
University.
Antonio Squillante is pursuing
a Master’s of Science degree in Kinesiol-
ogy from AT Stills University.
Jay Dawes is an Assistant Professor of
Strength and Conditioning and the
coordinator for Athletic Performance
Services at the University of Colorado-
Colorado Springs.
Strength and Conditioning Journal | www.nsca-scj.com
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