Why would you do a Y Balance Test Upper Quarter on someone with a lower body injury?
Why the Upper Quarter Y Balance Test is a Game Changer for Lower Body Rehab
I get this question all the time: "Phil, why are we putting an Upper Quarter Y Balance Test (UQYBT) in our lower body checklist? Is it really necessary when I’m treating a knee or an ankle?"
It seems like a stretch, right? But, if you’re only looking at an isolated quad or a single gastroc, you’re missing how the human body actually moves. I’ll be the first to admit, early in my career, I was guilty of this too—I stayed "below the belt" for lower body injuries. But the research and the results tell a different story.
It’s All One System
Now, think about it this way: we have tons of research showing that in patellofemoral pain and ankle sprains, core function and hip function are decreased. But why?
The body isn't just a bunch of muscles in a bag. When the quad contracts and fills its fascial volume, it’s tensioning that fascia into the glutes, which tensions the thoracolumbar fascia, which tensions all the way into the lats.
So, what does this mean for us? It means a "lower body" problem is often a "whole body" problem in disguise.
The Trunk Stability Push-Up
I’ve said it before, and I’ll say it again: I think so important to test Trunk Stability Push-up, especially in the presence of quad dysfunction. See this video on Quad Strength Symmetry after ACL Reconstruction and it's relationship to the push up.
Why? Because you’re tensioning the whole system from fingertips to toes through the core. The quads are right there in the middle of that tension chain. If you can’t tension the quads symmetrically and well, your trunk stability push-up is going to be dysfunctional.
The UQYBT takes that symmetrical trunk stability pattern and makes it asymmetrical and unilateral. We’re taking the athlete to their limit of stability, which requires integrated timing of the quads working with the core and the upper body.
What the Research Tells Us
Is there direct research saying a bad UQYBT score equals an ACL tear? No, not yet. But military research is a massive eye-opener. In that population, a poor score on the superolateral reach was a risk factor for whole-body injury.
The bottom line? A deficit in the upper quarter can be a "gauge" for a breakdown anywhere in the chain.
How to Implement This Right Away
How do you use this in the clinic tomorrow?
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Stop Guessing, Start Testing: Don’t assume the core is "fine" just because the patient is doing side planks. Get them on the UQYBT and see how they handle that limit of stability.
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Check the Checklist: If your ACL or ankle patient is hitting a plateau, move to the upper quarter testing. You might find that the reason their lower body power isn't returning is because they’ve lost the ability to tension the system from the top down.
As we discussed in the Rehab Roadmap modules, we want to make sure the entire system is functioning well from head to toe. Don't get bogged down in isolated testing.
Clinical practice is messy, and trying to figure out these fascial connections on your own can feel like drinking from a firehose. This is exactly why we created Coaches Club.
When you join Coaches Club, you get direct access to me and a community of "practical scholars" who are all working through these same cases. We have real-time discussions, Q&A sessions, and systematic thinking that takes you from "just doing rehab" to a master of the craft.
We learn best in community. Don't go it alone—let's build the future of rehabilitation and performance together.
