The importance of the single leg stance test for older patients

The single leg stance test is important in establishing both baseline ability and improvement and should be part of your initial assessment

As children, we were fearless about running, climbing, and jumping. We just somehow trusted our bodies to somehow take us as far and as high as possible. Even as young adults, we still could push our bodies to do those same feats, albeit perhaps not quite with the same abandon as when we were younger. Unfortunately, our bodies may not be quite as reliable as we get older, as a result of aging. Loss of cartilage and bone mass due to age can stiffen joints, reduce endurance, and slow us down. Worse yet, it can be more difficult to maintain balance with age, leading to falls and possible bone breaks. This is why proper assessment, including the single leg stance test is so critical.

How common are balance disorders and falls among the elderly?

Approximately 13% of individuals between the ages of 65-85, and 46% of those of ages 85 and older, have some type of balance disorder. Among older patients presenting to specialty clinics, approximately 20% had some type of balance disorder.

Such disorders can result from cardiovascular or metabolic disease, neurological issues, and musculoskeletal disorders, among other causes.¹ According to the Centers for Disease Control and Prevention, almost 30% of older adults reported at least one fall during 2014, resulting in an estimated 29 million falls for that year.²

Approximately 37% of these reported falls required medical treatment or restricted activity for 24 hours. This worked out to approximately 7 million older adults suffering some type of injury as a result of a fall.

What is the single leg stance test?

The single-leg stance test, as the name implies, measures how long the patient can stand on one leg, unassisted, with arms crossed across the chest and hands on opposite shoulders.³

The patient should keep their eyes open and try to focus on an object at eye height. It is best to have the patient take off their shoes beforehand. The test is timed from when one leg is lifted, until it is either placed back on the ground or the patients moves their arms away from their torso, in an effort to regain balance.

Patients who cannot stand on one leg for more than five seconds are considered to be at an increased risk for falling.^3,4

Practical applications

A 2017 article in the Journal of Geriatric Physical Therapy reported on results from a 12-week study to compare the effect of a balance training program against a control group to examine the effect of balance training on daily physical activity.⁵

The 12-week study included 91 study subjects, all of whom had osteoporosis. The single-leg stance test was used as an assessment of balance for the study. At the end of the study, the researchers found that those who did the balance training program were more likely to reach a physical activity goal of 5,000 steps per day, as compared to the control group.⁵

Preventing falls starts with improving balance, which is why the single leg stance test is so important in establishing both baseline ability and improvement. It should be part of your initial assessment for all your older patients.

References

1. Değer TB, Saraç ZF, Savaş ES, Akçiçek SF. The relationship of balance disorders with falling, the effect of health problems, and social life on postural balance in the elderly living in a district in Turkey. Geriatrics (Basel). 2019 May 17;4(2):37.
2. Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged ≥65 years – United States, 2014. MMWR Morbidity and Mortality Weekly Report. 2016;65(37):993-998.
3. Single-leg or “one-legged stance test.” Rehabilitation measures database. Shirley Ryan Ability Lab. Updated June 2017. Accessed March 31, 2022.
4. Jonsson E, Seiger A, Hirschfeld H. One-leg stance in healthy young and elderly adults: A measure of postural steadiness? Clinical Biomechanics. 2004;19(7):688-694.
5. Dohrn IM, Hagströmer M, Hellénius ML, Ståhle A. Short- and long-term effects of balance training on physical activity in older adults with osteoporosis: A randomized controlled trial.Journal of Geriatric Physical Therapy. 2017;40(2):102-111.