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Background Collegiate distance runners often suffer from running overuse injuries (ROI). The Y-Balance Test (YBT) has the potential to predict ROI risk in collegiate runners. Purpose To investigate whether a preseason clinical assessment of dynamic balance, through a modified version of the YBT (mYBT), can predict risk of ROIs during one NCAA Division I cross-country (XC) season. Study Design Prospective case-control study Methods Participants from a Division I XC team were screened for mYBT performance in four directions: anterior (AN), posteromedial (PM), posterolateral (PL), and posterior (PO). ROIs were tracked over the course of the XC season. Receiver operating characteristic (ROC) curve analysis (α = 0.05) was utilized to investigate the effectiveness of the mYBT in predicting injury risk. Results Nine (5 female, 4 male) of 29 runners developed an ROI during the XC season. Five components of the mYBT were found to predict injuries, including normalized nondominant PO score (AUC = 0.756, p = 0.03; RR = 1.90), AN raw difference and limb asymmetry (AUC = 0.808, p = 0.01), and PM raw difference and limb asymmetry in males (AUC = 0.958, p = 0.02). Conclusion Specific components of the mYBT can help predict the risk of developing a running overuse injury over one Division I XC season. Level of Evidence Screening, Level 3 [ABSTRACT FROM AUTHOR]