How to Use the MSLHST Calculator

The Multiple Single-Leg Hop-Stabilization Test (MSLHST) is a validated dynamic and static balance assessment designed specifically for athletes. This calculator streamlines the test setup and scoring process used by sports medicine professionals, athletic trainers, and coaches.

Pre-Test Procedures

Before conducting the MSLHST, explain the test procedures to the subject. Perform screening of health risks and obtain informed consent. Prepare forms and record basic information such as age, height, body weight, gender, and test conditions. Perform an appropriate warm-up. See more details of pre-test procedures.

Step 1: Calculate Marker Distances

The MSLHST uses individualized jump distances based on the participant's standing height measured while wearing athletic shoes. This personalization ensures the test challenges athletes proportionally regardless of their size.

  1. Measure height accurately — Have the athlete stand with their back against a wall in athletic shoes. Record height in centimeters or feet/inches.
  2. Enter the measurement — Input the height into the calculator or use a preset for common athlete heights.
  3. Note both distances — The calculator provides Distance Y (for diagonal jumps) and Distance X (for forward and sideways jumps).
  4. Set up the course — Using measuring tape, place 10 markers according to the standard MSLHST layout diagram.

Test Layout Diagram

The markers are set out as illustrated below. The distances between the markers are calculated based on the participant's standing height using this calculator.

Diagram of the Multiple Single-Leg Hop-Stabilization Test (MSLHST)

Step 2: Conduct the Test

Once markers are positioned, the athlete performs the following protocol:

  1. Stand on one foot on the start marker, hands on hips, looking straight ahead
  2. When instructed, hop to the next marker following the numbered sequence
  3. Land covering the marker completely with the foot
  4. Maintain the single-leg stance for 5 seconds before hopping to the next marker
  5. Continue through all 10 markers, then repeat with the other leg

Use a metronome set to one beat per second to assist with timing the 5-second hold at each marker.

Step 3: Score Using BESS Method

The Balance Error Scoring System (BESS) provides a standardized framework for evaluating performance. Assessors observe each landing and 5-second hold, checking any errors that occur.

Error Type Code Description Points
Landing Errors L1 Not covering tape mark with foot 1
L2 Stumbling on landing 1
L3 Foot not facing forward (more than 10° deviation) 1
L4 Hands off hips during landing 1
Balance Errors B1 Touching down with non-supporting limb 1
B2 Non-supporting limb touching supporting limb 1
B3 Non-supporting limb moving >30° (flexion, extension, or abduction) 1
B4 Hands off hips during 5-second hold 1

Understanding Your MSLHST Results

The MSLHST produces a total error score ranging from 0 to 130 points. Lower scores indicate superior dynamic and static balance control. Research by Emery (2003) established scoring categories for athletic populations:

Score Range Rating Interpretation
0-5 Excellent Elite-level balance control typical of highly trained athletes
6-12 Good Above-average balance suitable for most competitive sports
13-20 Average Typical balance for recreational athletes; targeted training recommended
21-30 Below Average Balance deficits present; intervention and specific training indicated
>30 Poor Significant balance impairment; comprehensive assessment recommended

Comparing Left vs. Right Leg Performance

Asymmetry between legs provides valuable clinical information. A difference greater than 20% between dominant and non-dominant leg scores may indicate:

  • Previous injury affecting one side
  • Strength imbalances requiring targeted training
  • Proprioceptive deficits from past ankle sprains
  • Early signs of neuromuscular fatigue or dysfunction

Note the athlete's foot preference (dominant leg) when interpreting results, as some asymmetry is normal even in healthy athletes.

Sport-Specific Applications

The MSLHST has particular relevance for sports requiring single-leg stability, rapid direction changes, and dynamic balance:

Soccer and Football

Athletes in these sports frequently perform single-leg movements during kicking, cutting, and receiving challenges. MSLHST scores below 15 are associated with reduced ankle sprain risk. The test is commonly used in return-to-play protocols following lower extremity injuries.

Basketball and Volleyball

Jumping sports place significant demands on landing mechanics and single-leg stabilization. Pre-season MSLHST screening helps identify players who may benefit from neuromuscular training programs like the FIFA 11+ or similar protocols.

Court Sports (Tennis, Badminton, Squash)

Rapid multi-directional movements require excellent dynamic balance. Tennis players with better MSLHST scores demonstrate improved recovery from wide shots and reduced injury rates during lateral movements.

Winter Sports (Skiing, Snowboarding, Ice Hockey)

Single-leg balance directly impacts edge control and stability on variable surfaces. The MSLHST is used by ski racing programs to assess athletes' readiness for challenging terrain.

Track and Field

Sprinters, jumpers, and throwers all rely on single-leg force production and stability. The test helps identify asymmetries that may affect performance or increase injury risk.

The Science Behind the MSLHST

Formula Derivation

The MSLHST uses height-proportional distances to normalize the challenge across different-sized athletes:

Distance Y = 0.45 × Height

The 45% coefficient was established through research to provide an appropriately challenging but achievable jump distance for most athletic populations. This creates the longest (diagonal) jump in the test pattern.

Distance X = Y ÷ √2 ≈ 0.318 × Height

Using the Pythagorean theorem, when the diagonal distance Y is known and the forward and sideways components are equal (forming a 45-degree angle), each component X equals Y divided by the square root of 2. This mathematical relationship ensures consistent angular demands regardless of participant height.

Research Validation

The MSLHST was developed and validated by Emery (2003) as part of a comprehensive review of balance measurements appropriate for sports medicine applications. Key findings include:

  • Test-retest reliability: ICC of 0.82-0.89 when proper standardization is followed
  • Construct validity: Significant correlations with other dynamic balance measures (r = 0.68-0.74)
  • Discriminant validity: Successfully differentiates between injured and non-injured ankles
  • Sensitivity: Detects balance improvements following neuromuscular training interventions

How to Improve MSLHST Scores

Athletes with suboptimal scores can improve dynamic and static balance through targeted training:

Progressive Single-Leg Exercises

  • Single-leg stance (eyes open → eyes closed → unstable surface)
  • Single-leg Romanian deadlifts with bodyweight, then added resistance
  • Single-leg box hops with controlled landings
  • Star excursion balance test practice

Neuromuscular Training Programs

  • FIFA 11+ warm-up protocol (20-minute program)
  • Proprioceptive training on wobble boards or BOSU balls
  • Perturbation training for reactive balance
  • Plyometric progressions emphasizing landing control

Expected Improvement Timeline

Research suggests athletes can expect 15-25% improvement in MSLHST scores following 6-8 weeks of dedicated balance training performed 3 times per week. Reassess every 4-6 weeks to track progress and adjust training intensity.

Frequently Asked Questions

How do you calculate MSLHST marker distances?

The longest jumping distance (Y) equals 45% of the participant's standing height measured in shoes. The forward and sideways jump distance (X) is calculated using the Pythagorean theorem as X = Y ÷ √2, which equals approximately 31.8% of height. For example, a 180 cm athlete would have Y = 81 cm and X = 57.3 cm.

What is a good MSLHST score?

Lower scores indicate better balance. Elite athletes typically score 0-5 errors. Scores of 6-12 indicate good balance, 13-20 is average, and scores above 20 suggest balance deficits that may benefit from targeted intervention. The maximum possible score per leg is 80 errors (8 error types × 10 markers).

How is the MSLHST different from the BASS test?

The MSLHST is based on the BASS test but was specifically modified for athletic populations. Key differences include the use of the BESS scoring system for more detailed error categorization, individualized jump distances based on participant height, and standardized 5-second hold times at each marker.

How often should athletes be tested with the MSLHST?

Pre-season baseline testing is recommended for all athletes. Follow-up testing every 6-8 weeks during balance training programs helps track progress. The test should also be administered as part of return-to-play protocols following lower extremity injuries, comparing to the athlete's baseline scores.

Can the MSLHST be used for concussion assessment?

While the MSLHST assesses balance, which can be affected by concussion, it was not specifically designed for concussion evaluation. The standard BESS test or more specific concussion protocols (like SCAT5) are recommended for post-concussion balance assessment.

What surface should be used for the MSLHST?

The test should be conducted on a flat, smooth, non-slip surface. Common suitable surfaces include gymnasium floors, rubber athletic flooring, and firm wrestling mats. Avoid carpet, uneven ground, or surfaces that may cause slipping during the hop landings.

What equipment is needed for the MSLHST?

Required equipment includes a measuring tape (at least 5 meters), marking tape or floor markers, a metronome (physical or smartphone app), a scoring sheet or this calculator, and a flat non-slip testing surface. The test requires minimal equipment and can be set up in most athletic facilities.

References

  1. Emery, C. A. (2003). "Is there a clinical standing balance measurement appropriate for use in sports medicine? A review of the literature." Journal of Science and Medicine in Sport, 6(4), 492-504.
  2. Riemann, B. L., & Lephart, S. M. (2002). "The sensorimotor system, Part I: The physiologic basis of functional joint stability." Journal of Athletic Training, 37(1), 71-79.
  3. Gribble, P. A., et al. (2012). "Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury." Journal of Athletic Training, 47(3), 339-357.
  4. Bell, D. R., et al. (2011). "Systematic review of the Balance Error Scoring System." Sports Health, 3(3), 287-295.
  5. Hrysomallis, C. (2011). "Balance ability and athletic performance." Sports Medicine, 41(3), 221-232.
  6. McKeon, P. O., & Hertel, J. (2008). "Systematic review of postural control and lateral ankle instability." Journal of Athletic Training, 43(3), 305-315.

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