How to Perform the Single-Leg Stance Test
The single-leg stance test is performed by having the patient stand on one leg (typically the non-dominant leg) with hands placed on the iliac crests (hips), holding the position for 20 seconds while you count the number of errors or loss of balance. 1
Test Setup and Patient Positioning
Before beginning the test:
- Have the patient remove shoes and roll up pant legs above the ankle
- Remove any ankle taping if present
- Ask which foot they would use to kick a ball (this identifies the dominant leg)
- The test is performed on the non-dominant leg
Standard Test Protocol
Basic positioning:
- Patient stands on the non-dominant foot
- Hands are placed on the iliac crests (hips)
- The dominant leg is held in approximately 30 degrees of hip flexion and 45 degrees of knee flexion 1
- Duration: 20 seconds per trial
Scoring:
- Count the number of times the patient moves out of position or needs to touch down with the opposite foot
- If the patient stumbles out of position, have them open their eyes, return to the start position, and continue balancing
- The test can be performed with eyes open or eyes closed depending on the clinical context 1
Clinical Context: 4-Stage Balance Test
The single-leg stance is actually the fourth and most difficult stage of a progressive balance assessment 2. The complete 4-Stage Balance Test includes:
- Feet side by side
- Instep of one foot touching the big toe of the other foot
- Tandem stance (one foot in front of the other, heel touching toe)
- Stand on one foot
Each position should be held for 10 seconds without moving the feet or needing support. If the patient cannot hold a position, the test stops 2.
Testing Recommendations
Number of trials: Perform three valid 20-second trials and use the mean value for analysis 3, 4. Some protocols use six attempts and take the best result 5.
Timing considerations: Test the patient more than 15 minutes after cessation of exercise to avoid confounding effects of fatigue on balance performance 1.
Environment: Conduct the test in a consistent setting where follow-up assessments will occur, rather than on the sideline 1.
Common Pitfalls to Avoid
- Practice effects exist: The test shows learning effects with repeated administration, so baseline measurements are valuable for comparison 1
- Inter-rater reliability concerns: Standardize the counting of errors and position requirements across examiners 1
- Visual condition matters: Performance differs significantly between eyes-open and eyes-closed conditions, so maintain consistency 3, 4
- Don't allow arm movement: Arms must remain on the hips throughout to standardize the test 1
Clinical Interpretation
The single-leg stance test is used to assess fall risk in older adults and postural stability in athletes following concussion 2, 1, 2. Inability to maintain the position for the full duration or excessive errors indicate impaired balance control requiring further evaluation or intervention.