After sustaining an injury, one might go to seek further medical assessment by a licensed medical professional. Upon arrival to the facility, the individual may go through a battery of tests in order to determine a diagnosis, prognosis, and a plan of care. The data collected will allow the healthcare professional to develop and appropriate plan of care that will address the individual’s impairments and functional limitations. One of these objective measures, grip strength testing, is a common practice during the physical examination.
How is Grip Strength Evaluated?
Grip strength can be evaluated with the use of a dynamometer. A dynamometer is an evaluative instrument that is used by health care professionals as a part of a clinical evaluation. Patients are asked to sit in a chair, with their arm at their side, elbow bent at 90 degrees, and are asked to squeeze the device with their hand. The needle on the dial measures grip strength in pounds or kilograms. This process is performed typically 3 times, and an average is calculated.
Grip strength testing is an important objective measure as it evaluates the functional capability of the individual but is also used prognostic factor of frailty and mortality. According to Fried and colleagues, individuals who meet 3 of the 5 phenotypes are defined as being frail. 2 The criteria includes: weight loss, exhaustion, low physical activity, decreased walking speed, and grip strength.6 Frailty syndrome is characterized by a decline in overall health and function among older adults resulting in disability and potential hospitalization.2 Assessing grip strength may provide further information to improve the quality of care provided by practitioners.
Dynamometers Don’t Just Measure Strength
Dynamometers have been typically utilized to evaluate grip strength for pathologies or functional dysfunctions. However, dynamometers were one of the first instruments to be used by psychologists to evaluate mental strength.4 Paul Broca, Leonce Manouvrier, and other researchers believed that motor activity was closely associated with intellectual function and hand movements, which is an important role in the development of human intellect.4 Early usage of dynamometers may have demonstrated that hand grip measurements could provide more information to help guide clinical practice. Testing grip strength may be beneficial during assessments to evaluate the risks of physical and mental health.4
Identifying biopsychosocial influences is a key factor for determining patient outcomes.1 Utilizing a biopsychosocial approach may provide a sense of collaboration, understanding, and support.1 Identifying contextual factors and allostatic responses can affect a patient’s recovery during the rehabilitation process thus recognizing fear avoidance, pain catastrophizing, functional mobility, and pain.5 Also, literature has demonstrated a correlation of hand grip with psychological functioning and sleep.3
What Are We Truly Measuring?
It is essential that we re-evaluate what we are truly attempting to measure. There are many other components that can affect a patient’s clinical presentation. Perhaps it becomes more important that we are able to recognize potential holistic factors that can be assessed using dynamometers and other evaluative instruments. Further research is warranted to explore the possible correlation between grip strength, biopsychosocial factors, and other potential variables.
We must act and recognize these factors, as it can play a major role in the recovery for many individuals that are experiencing physical and/or emotional anguish. Healthcare professionals should take into consideration the whole clinical snapshot of the individual to better understand how to provide the highest level of care possible. Assessing grip strength may provide more data, so we can better address peoples’ values and expectations.
Article Written By Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT
- Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hübscher M. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care. 2017: 1-9. http://dx.doi.org/10.1002/msc.1191 https://doi.org/10.1002/msc.1191.
- Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, and McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56(3):M146–56.
- Loredo-Aguilera JA, Carmona-Torres JM, Cobo-Cuenca AI, Garcia=Pinillos F, & Latorre-Roman PA. (2019). Handgrip strength associated with psychological functioning, mood, and sleep in women over 65 years. International Journal of Envirnomenal Research and Public Health, 16: 873.
- Nicholas S, & Voboril D. (2017). The Collin dynamometer: history of the development of an instrument for measuring physical and mental strength. Topics in Cognitive psychology, 117: 173-219.
- Sueki DG, Cleland JA, Wainner RS. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. Journal of Manual & Manipulative Therapy, 2013; 21(2):90–102.
- Xue, QL. The frailty syndrome: definition and natural history. Clinical in Geriatric Medicine, 2017; 27(1): 1-15.