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Limits of Stability Test: What It Is, How It Works, and Clinical Benefits

Limits of Stability is a functional and gold-standard test in balance assessment, widely used by clinicians and researchers to evaluate dynamic balance control and fall risk. This method measures how far and how well a person can shift their center of pressure (CoP) within their base of support, critical for maintaining balance during daily activities. It is essential for identifying postural control deficits, predicting fall risks, and tracking patient progress in neurological, vestibular, and orthopedic rehabilitation.



What are the Limits of Stability test?

Limits of Stability, dynamic balance

The Limits of Stability refers to the maximum distance a person can intentionally move their CoP in any direction without stepping or losing balance. This range, often visualized as a “cone of stability,” theoretically includes:


  • 6–8° forward

  • 8° laterally

  • 4.5° backward



How the Limits of Stability Test Works


In the LOS test, the patient is instructed to lean or shift their body in multiple directions—forward, backward, left, and right—without moving their feet. The movement should come from the ankles and trunk, not from stepping.


The Limits of Stability Test evaluates voluntary motor control through controlled leaning tasks in eight directions using a balance platform. The patient moves a visual marker (representing their CoP) toward targets on a screen, holding each position for 8 seconds before returning to center.


This protocol is:

  • Height-adjusted for personalized analysis.

  • Repeatable across all directions.

  • Quantitative, offering objective balance metrics.


Limits of Stability test performance



What Does LOS Assessment Measure?


Assessing the Limits of Stability provides insights into two key areas:


1. Stability Area and Reach Capacity


  • Endpoint Excursion (EPE): Initial reach toward the target (% of theoretical LOS).

  • Maximum Excursion (MXE): Farthest point reached during the trial (% of theoretical LOS).

  • Area of Stability: Total area of the maximum distances reached in the 8

    directions.


    Limits of Stability Test - area of stability report test PhysioSensing
    Report Test using PhysioSensing.
    Limits of Stability Test - area of stability
    Report Test using PhysioSensing.

2. Movement Control and Efficiency


  • Movement Velocity (MVL): Speed of CoP movement.

  • Directional Control (DCL): Accuracy of movement toward the target.

  • Reaction Time (RT): Time from signal to movement initiation.



Clinical Applications of the LOS Protocol


The LOS test is widely used in clinical settings, particularly for:


  • Vestibular rehabilitation: to assess balance deficits in patients with vertigo or labyrinth disorders

  • Stroke (CVA) rehabilitation: to identify asymmetries in weight distribution and postural control

  • Parkinson’s disease: to detect reduced movement amplitude and increased fall risk

  • Concussion and head trauma: to monitor readiness for return to play or work

  • Elderly fall prevention: to evaluate dynamic stability and prevent future falls



Top 5 Reasons for Reduced Limits of Stability


A reduced area of stability and impaired movement control can indicate a balance dysfunction and increased fall risk. Common causes include:


  1. Cognitive Impairment.

  2. Musculoskeletal Limitations.

  3. Sensory Deficits.

  4. Neurological Conditions.

  5. Fear of Falling.



Why Use Limits of Stability Test in Clinical Practice?


The Limits of Stability Test is ideal for:


  • Objective assessment: LOS provides quantifiable balance data, unlike subjective clinical balance scales

  • Early detection: Identifies instability before falls occur, especially in high-risk populations

  • Progress tracking: Enables comparison of performance over time through detailed reports and graphs

  • Real-time feedback: Enhances motor learning and patient motivation during therapy sessions

  • Customized treatment: Allows therapists to tailor rehab programs based on individual stability profiles



Limits od Stability Test in PhysioSensing


The LOS protocol is most accurate when performed using force platforms or pressure mapping systems, such as PhysioSensing, which provide real-time visual feedback and precise measurements.


  • LOS Clinical Report


Clinical Report LOS PhysioSensing
Limits of stability test - progress tracking

Limits of stability test - progress tracking

Limits of stability test - progress tracking
Example of report of LOS Test using PhysioSensing

  • Designing personalized balance training programs


Limits of stability training

Limits of Stability training

Limits of Stability training with PhysioSensing
LOS training

Conclusion


The Limits of Stability Test is a powerful, evidence-based tool for assessing dynamic balance. By measuring both the stability area and the quality of movement control, clinicians can identify balance deficits and tailor interventions to improve safety and mobility.


Want to integrate LOS testing into your clinic or research? Contact us to learn more about Physiosensing’s balance assessment solutions!


Limits of Stability Test with Pressure Plate

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PhysioSensing Balance Plate

Ana Souto

Meet Ana, a physiotherapist with a

master's degree in human physiology and certified by the American Institute of Balance.

Ana currently serves as the clinical specialist at PhysioSensing, a cutting-edge Balance Assessment and training device. Her approach is firmly rooted in the latest scientific findings, ensuring that PhysioSensing users receive the most effective and up-to-date care. In addition to her role in designing tailored programs, Ana plays a pivotal role in guiding new clients through the learning process of using PhysioSensing. She also provides advanced training and support to existing customers seeking to further deepen their clinical practice knowledge and stay on top of the latest scientific advancements.



References:

Goble, D. J., Coxon, J. P., Van Impe, A., Geurts, M., Doumas, M., Wenderoth, N., & Swinnen, S. P. (2011). Brain Activity during Ankle Proprioceptive Stimulation Predicts Balance Performance in Young and Older Adults. The Journal of Neuroscience, 31(45), 16344–16352. https://doi.org/10.1523/JNEUROSCI.4159-11.2011

Henry, M., & Baudry, S. (2019). Age-related changes in leg proprioception: Implications for postural control. Journal of Neurophysiology, 122(2), 525–538. https://doi.org/10.1152/jn.00067.2019

Melzer, I., Benjuya, N., Kaplanski, J., & Alexander, N. (2008). Association between ankle muscle strength and limit of stability in older adults. Age and Ageing, 38(1), 119–123. https://doi.org/10.1093/ageing/afn249

Tomita, H., Kuno, S., Kawaguchi, D., & Nojima, O. (2021). Limits of Stability and Functional Base of Support While Standing in Community-Dwelling Older Adults. Journal of Motor Behavior, 53(1), 83–91. https://doi.org/10.1080/00222895.2020.1723484

Uemura, K., Yamada, M., Nagai, K., Tanaka, B., Mori, S., & Ichihashi, N. (2012). Fear of falling is associated with prolonged anticipatory postural adjustment during gait initiation under dual-task conditions in older adults. Gait & Posture, 35(2), 282–286. https://doi.org/10.1016/j.gaitpost.2011.09.100

Vermette, M. J., Prince, F., Bherer, L., & Messier, J. (2023). Concentrating to avoid falling: Interaction between peripheral sensory and central attentional demands during a postural stability limit task in sedentary seniors. GeroScience, 46(1), 1181–1200. https://doi.org/10.1007/s11357-023-00860-z


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