The Single-Leg Balance with Head Up/Down test adds vertical head movement to single-leg stance. It challenges balance while the head moves through flexion and extension, making symptom recording, safety screening and consistent protocol setup essential. The original article correctly identified that exact Measurz-style norms are limited; this updated version strengthens the benchmark section using related single-leg stance evidence and newer research on vision, head motion and balance control.
Single-leg balance with head up/down is a progression from standard single-leg balance. It combines a narrow single-limb support base with vertical head movement, which increases coordination and sensory demands.
The test may challenge visual, vestibular, cervical proprioceptive and lower-limb postural-control contributions. However, it should not be described as a vestibular, concussion or cervical test. It is best used as a practical balance progression and monitoring task.
Research supports that balance performance depends on sensory input, including vision, vestibular input and somatosensory information. Standard single-leg stance is widely used, but adding active head movement changes the task and limits how directly standard single-leg norms can be applied. The Shirley Ryan AbilityLab describes the standard Single Leg Stance test as a timed one-leg stance task, usually with eyes open and arms on hips, but this does not include head movement.
Test type: Static balance with vertical head movement
Main score: Time in seconds
Optional scores: Number of head nods, head movement rhythm, symptom response
Best use: Balance progression, stance-side comparison and head-movement tolerance monitoring
Main caution: Screen for dizziness, neck pain, headache, nausea, visual disturbance and neurological symptoms
Evidence level for norms: Level 3 for this exact protocol, with Level 2 contextual benchmarks from standard single-leg stance research
Clinical status: Not a stand-alone diagnostic test
The Single-Leg Balance with Head Up/Down test is a timed balance task where the client stands on one leg while moving the head vertically through a comfortable range.
The client maintains single-leg stance while repeatedly looking up and down. The head movement adds a sensory and coordination challenge compared with quiet single-leg stance.
This test is not designed to diagnose vestibular, cervical, neurological or concussion-related conditions. It is a field-based balance progression that can help monitor balance control and symptom response during controlled head movement.
This test is used to:
Progress standard single-leg balance.
Observe balance control during vertical head movement.
Compare left and right stance sides.
Monitor symptoms during head movement.
Add a more functional sensory challenge than quiet single-leg stance.
Support return-to-activity reasoning where head movement matters.
Track change across sessions using a repeatable protocol.
It is most useful when standard single-leg balance is already safe and the client can tolerate gentle head movement.
The test measures how long the client can maintain single-leg stance while moving the head up and down.
Performance may reflect:
Stance-limb control.
Trunk and hip strategy.
Foot and ankle control.
Head-movement tolerance.
Confidence.
Symptom response.
Sensory integration.
Ability to maintain posture while visual and head-position demands change.
It does not identify the exact reason for poor performance. A lower score may relate to balance capacity, pain, fatigue, confidence, dizziness, neck symptoms, lower-limb control or unfamiliarity with the task.
This test may be useful for:
Athletes and field-sport players.
Runners.
Clients progressing balance training.
Lower-limb rehabilitation.
Post-injury monitoring.
Older adults who can safely complete standard single-leg stance.
Professionals wanting to observe head-movement tolerance during balance.
Use caution or avoid the test if the client reports dizziness, vertigo, nausea, headache, neck pain, visual disturbance, recent concussion, neurological symptoms, high falls risk, poor standard single-leg balance or unsafe standing tolerance.
Stopwatch or Measurz timer.
Flat, non-slip surface.
Stable support nearby.
Professional guarding.
Optional metronome to standardise head-nod rhythm.
Optional marker or target to standardise head movement range.
Confirm the client can safely complete standard single-leg balance with eyes open.
Ask about dizziness, vertigo, nausea, headache, neck pain, visual disturbance or neurological symptoms.
Position the client on a flat, non-slip surface.
Stand close enough to guard without restricting movement.
Ask the client to stand on one leg with a standardised arm position, such as hands on hips or arms crossed.
Record the stance side.
Ask the client to move the head gently up and down through a comfortable range.
Use a consistent rhythm if appropriate, such as one head-nod cycle per second.
Start timing when the foot lifts and the first head movement begins.
Stop timing if:
The raised foot touches the floor.
The raised foot touches the stance leg, if this is part of your stopping criteria.
The stance foot moves or hops.
Support is used.
Head movement stops.
The client reports dizziness, nausea, headache, neck pain or concerning symptoms.
The agreed time cap is reached.
Record the time in seconds.
Record symptoms, stopping reason and head-movement quality.
Repeat up to three trials per side if appropriate.
Retest using the same stance side order, head range, rhythm, surface, footwear and arm position.
A time cap should be selected before testing. For many Measurz use cases, 20 or 30 seconds is practical. If using a metronome, record the rhythm so the test can be repeated consistently.
Record time in seconds.
Also record:
Stance side.
Number of head nods, if counted.
Head-nod rhythm.
Approximate head movement range.
Symptoms.
Stopping reason.
Best or average score.
Confidence or fear.
Sway and compensation.
A shorter score may suggest difficulty maintaining single-leg balance while the head moves. It may also reflect fatigue, low confidence, pain, dizziness, neck symptoms, reduced lower-limb control or inconsistent head movement.
Compare:
Left versus right stance.
Standard single-leg eyes-open result.
Single-leg balance with head rotation, if available.
Baseline versus retest.
Symptom response across sessions.
Quality of movement, not just time.
Do not infer a specific cause from this test alone.
Evidence level: Level 3 — practical comparison guidance for this exact protocol.
No high-quality published normative data were found for the exact Single-Leg Balance with Head Up/Down Measurz-style protocol. The addition of vertical head movement changes the task, so standard single-leg stance values should not be applied directly as pass/fail norms.
The closest useful evidence comes from standard single-leg stance testing. Springer et al. tested 549 healthy adults aged 18 years and older using the unipedal stance test with eyes open and eyes closed. Participants completed three trials, with the best and mean scores recorded, and testing was capped at 45 seconds. The study found that performance decreased with age and that inter-rater reliability for the best of three trials was excellent for both eyes-open and eyes-closed conditions. These values provide useful context for standard single-leg stance, but they do not include head movement.
The Shirley Ryan AbilityLab notes that standard one-legged stance is timed from when one foot lifts until the raised foot touches down, touches the stance leg, or arms leave the hips, and it reports that inability to hold a one-leg stand for at least 5 seconds is associated with increased risk of injurious falls. This is a useful context benchmark for basic single-leg balance, but it should not be transferred directly to a head-movement version of the test.
Recent research also reinforces why this protocol should be treated as its own task. A 2024 PLOS ONE study found that visual occlusion affected movement into and control of single-limb stance in adults, suggesting that single-leg balance performance is sensitive to changes in visual contribution and task demands. Although this study did not test vertical head nods, it supports the idea that changing sensory conditions changes balance performance.
For Measurz, use practical benchmarks rather than universal cut-offs:
Prerequisite benchmark: the client should safely complete standard single-leg balance eyes open before adding head movement.
Baseline benchmark: compare the client to their own previous result under the same protocol.
Side comparison: compare left and right stance side using the same head rhythm and range.
Task comparison: compare with standard single-leg eyes-open balance and single-leg balance with head rotation if tested.
Symptom benchmark: record whether dizziness, headache, nausea, visual disturbance, neck pain or confidence changes occur.
Quality benchmark: track sway, trunk strategy, foot movement, head range and whether head movement stops before balance is lost.
Progress benchmark: improvement is more meaningful when time, symptom response and movement quality improve together.
Do not apply standard eyes-open or eyes-closed single-leg stance norms directly to this head up/down version.
No strong reliability, SEM, MDC or MCID values were found for the exact Single-Leg Balance with Head Up/Down field protocol.
Evidence from related single-leg stance testing can guide interpretation. Springer et al. reported excellent inter-rater reliability for standard unipedal stance best-of-three scores, with ICC values of 0.994 for eyes open and 0.998 for eyes closed. However, their protocol did not include head movement, so these values should be treated as related context rather than exact reliability values for this test.
Zaghlul et al. studied single-leg stance on a Lafayette stability platform in healthy active university students. Participants performed three successful 20-second trials on the dominant leg under eyes-open and eyes-closed conditions. The study supports the reliability of platform-based single-leg testing in those conditions, but it did not include vertical head movement.
Head movement can change postural-control demands. Research on walking with head turns suggests that head movement alters sensory reference frames and movement strategy, particularly in older adults, even though that work studied gait rather than static single-leg stance.
Because exact measurement error is not established for this protocol, small changes should be interpreted cautiously. Stronger interpretation comes from consistent improvements across repeated sessions, similar testing conditions, better symptom tolerance, improved movement quality and agreement with related tests such as standard single-leg balance, gait, strength, ROM or functional balance measures.
Sensitivity and specificity are not applicable to this general balance progression.
The Single-Leg Balance with Head Up/Down test is not designed to diagnose vestibular, cervical, concussion-related or neurological conditions. It is best used to measure and monitor balance performance and symptom response during a controlled head-movement challenge.
If symptoms are provoked, record them clearly. Dizziness, nausea, headache, visual disturbance, neck pain or neurological symptoms may indicate that further assessment or referral is appropriate, depending on the client context and professional scope.
Suggested wording:
“This test is not designed to diagnose a condition. It is best used to monitor how the client maintains single-leg balance during controlled vertical head movement and whether symptoms are provoked under standardised conditions.”
Common errors include:
Testing without screening for dizziness, headache, nausea, neck pain or visual symptoms.
Adding head movement before standard single-leg balance is safe.
Poor guarding.
Not recording stance side.
Using inconsistent head range.
Using inconsistent rhythm.
Continuing the timer after head movement stops.
Allowing hopping or stance-foot repositioning without recording it.
Comparing results directly with standard single-leg stance norms.
Not recording symptoms or stopping reason.
Changing footwear, surface or arm position between sessions.
Key limitations include:
No high-quality norms for the exact head up/down protocol.
No established universal MDC, MCID or SEM.
Strong influence of confidence and symptom expectation.
Head movement range may vary between testers and sessions.
Neck symptoms or dizziness may limit performance.
Poor result does not identify the cause.
The test is less appropriate for high falls-risk clients unless modified.
Use this test to:
Progress balance from quiet single-leg stance.
Add controlled head-movement challenge.
Compare left and right stance sides.
Monitor symptom response during vertical head movement.
Support sport or activity progressions where head movement occurs.
Compare with single-leg head rotation balance.
Educate clients about balance strategy and symptom response.
Track progress as part of a broader balance battery.
This result can support return-to-training or activity decisions, but it should not be used as the only clearance measure.
In Measurz, record enough detail to repeat the test accurately.
Include:
Test name: Single-Leg Balance with Head Up/Down.
Stance side: left or right.
Trial number.
Time in seconds.
Best score or average score.
Maximum time cap.
Number of head nods, if counted.
Head movement direction: up/down.
Head movement rhythm.
Approximate head range.
Arm position.
Footwear.
Surface.
Whether standard single-leg balance was completed first.
Pain score.
Dizziness score.
Nausea score.
Headache score.
Neck symptoms.
Visual symptoms.
Confidence rating.
Sway or trunk compensation.
Foot movement or hopping.
Support use.
Stopping reason.
Baseline score.
Retest date.
Related single-leg balance, head rotation, gait, ROM, strength or functional balance findings.
For progress tracking, repeat the same stance side order, head rhythm, head range, footwear, surface, arm position and time cap.
Single-Leg Balance Eyes Open
Single-Leg Balance Eyes Closed
Single-Leg Balance with Head Rotation
Tandem Balance Test
Tandem Balance Eyes Closed
Double-Leg Balance Eyes Closed
Functional Reach Test
Y-Balance Test
Star Excursion Balance Test
Gait Speed
Timed Up and Go
Measurz app balance assessment workflow
No. It can challenge balance while the head moves, but it does not isolate vestibular function or confirm a vestibular condition.
Yes. The client should safely complete standard single-leg balance eyes open before head movement is added.
No high-quality norms were found for this exact protocol. Use baseline comparison, side-to-side comparison, symptom response and related single-leg balance results instead.
Standard single-leg stance norms can provide context, but they should not be applied directly because head movement changes the task.
Record dizziness, nausea, headache, neck pain, visual disturbance, pain, loss of confidence and any symptoms that cause the test to stop.
Single-leg balance with head up/down is a useful balance progression, not a stand-alone diagnostic test.
Test standard single-leg balance first and screen for dizziness, headache, nausea, neck pain and visual symptoms.
No high-quality norms were found for the exact head up/down protocol.
Standard single-leg stance evidence can provide context, but should not be applied directly.
Measurz recording should include time, stance side, head rhythm, symptoms, confidence, compensation and stopping reason.
Buckley, J. G., Frost, S.-S., Hartley, S., Rodacki, A. L. F., & Barrett, B. T. (2024). Moving from stable standing to single-limb stance or an up-on-the-toes position: The importance of vision to dynamic balance control. PLOS ONE, 19(7), e0307365. doi:10.1371/journal.pone.0307365
Fitzgerald, C., Thomson, D., Zebib, A., Clothier, P. J., & Gupta, A. (2020). A comparison of gait stability between younger and older adults while head turning. Experimental Brain Research, 238, 1871–1883. doi:10.1007/s00221-020-05846-3
Shirley Ryan AbilityLab. (2025). Single leg stance or “one-legged stance test”. Rehabilitation Measures Database.
Springer, B. A., Marin, R., Cyhan, T., Roberts, H., & Gill, N. W. (2007). Normative values for the unipedal stance test with eyes open and closed. Journal of Geriatric Physical Therapy, 30(1), 8–15.
Zaghlul, N., Goh, S. L., Razman, R., Danaee, M., & Chan, C. K. (2023). Test-retest reliability of the single leg stance on a Lafayette stability platform. PLOS ONE, 18(1), e0280361. doi:10.1371/journal.pone.0280361
