Handheld Dynamometry Testing in the Clinic

Hey Team,

I’m so excited to be contributing to the Hawkin Dynamics blog series for shoulder handheld dynamometry (HHD) and force plate testing in the clinic and in the sports setting.

I’ve always been fascinated by numbers and data, so much so that I aim to use data-driven decision-making where I can with my athletes and clinic patients. 

For as long as I can remember, I have been using a dynamometer as a part of my physio toolbox. I’m even more excited to share what I’m doing with Hawkin TruStrength, Hawkins' take on the Dynamometer, and how it will level up my shoulder game… watch this space for that upcoming blog post soon!

Let’s take a deep dive into why everyone, in my opinion, should be using a handheld dynamometer to objectively measure shoulder strength. Invest in a dynamometer, you won’t regret it!

1. Muscle Strength Assessment:
Handheld dynamometers are excellent for quantifying muscle strength. Use them to assess specific muscle groups, provide objective data on baseline strength, and monitor changes over time. This information guides the development of targeted strengthening exercises tailored to individual needs. I get excited when I can challenge a patient during their rehab and justify it against the dynamometer testing scores.

Patients like seeing numbers and knowing where they stand against the normative data.
Test important muscle groups such as the rotator cuff, scapular, and larger torque-producing shoulder muscles.

2. Objective Progress Tracking:
Utilize handheld dynamometers to track progress during rehabilitation. Regular strength assessments help in objectively measuring improvements, allowing for timely adjustments to treatment plans. This not only motivates patients but also ensures that interventions are continually optimized for the best outcomes. 

Patients like to see progress and rewards for their hard work. This can help keep all stakeholders accountable to make informed decisions about progressing (or regressing) a patient’s rehabilitation program.

3. Identifying Asymmetries:
Handheld dynamometers are valuable in identifying side-to-side strength asymmetries. Recognizing these imbalances early on enables targeted interventions to address specific weaknesses and restore symmetry (if it’s relevant to that athlete’s sport and patient’s goals). This is crucial for preventing compensatory patterns that may lead to further issues. Some sports will display obvious asymmetries in their testing. Overhead athletes who play a unilateral sport (e.g., baseball, tennis, and volleyball) will have anywhere from approximately 10-40% increased strength on their dominant side compared to a swimming athlete where we’d be expecting symmetry. Overhead athletes will typically present with increased internal rotation strength in comparison to external rotation, however, a balance in their IR:ER ratio (internal ratio to external ratio) is important to monitor for different sports and shoulder pathology.

Patients like to know their numbers can help guide their training intensity to keep them healthy and on the field. Not injured and on the disabled list. Monitoring training load and the response it has on their strength capacity helps to give us an indication if the athlete has paid too high of a price when returning to training or competition.

4. Functional and Kinetic Chain Testing:
Incorporate handheld dynamometers into functional testing scenarios. Assessing strength in the kinetic chain, specifically the lower limb, for overhead athletes can provide crucial pieces to the puzzle to find contributing factors that may be the source of the weak link in the chain. This can guide the development of functional and sport-specific rehabilitation programs, in addition to our data-driven upper limb rehabilitation decisions.

Patients need to know that the shoulder and upper limbs, in overhead activity, are the end result of the force produced by the lower limb and trunk. Don’t neglect the kinetic chain. Having a system or framework to routinely test the kinetic chain helps us as therapists not to miss a possible contributing factor, and to show our athletes that we are providing a holistic approach to their assessment and management of their problem.

5. Education and Patient Engagement:
Make use of handheld dynamometers as educational tools. Displaying objective strength measurements to patients helps them understand their progress and the importance of prescribed exercises. 

Patient engagement is crucial in any rehabilitation program. Individuals become more actively involved and are more likely to get better results.

So as a handheld dynamometers advocate, what tips can I offer to ensure you get the most out of using a dynamometer…

Consistent Technique:
To ensure consistent testing techniques to obtain reliable and reproducible results, standardize the testing position and instructions to minimize variability in measurements. I based my testing setup on the literature published by Ben Ashworth. I mimic what the research shows and then I know I am comparing my testing data with what the evidence suggests. I have my own dataset and evidence within my Simple Shoulder Systems App for my athletes and non-athletic patients. 

Handheld dynamometers have very good intra-rater reliability. Meaning when you test it repeatedly yourself as the therapist, testing is reliable. I can appreciate that isokinetic dynamometry is a gold standard here, but, in a clinical setting, handheld dynamometers are much more practical and easier to implement.

Communication is Key:
Clearly communicate with patients during strength testing. Explain the purpose, provide encouragement, and gather feedback to ensure their comfort and understanding.

I like to use a break test. My cues are “match my pressure. Don’t let me move you. I am trying to break your contraction as I gradually build up my resistance. The test will go for 2-3 seconds and we will do a best of 3."

Complement with all of your mobility, strength, and power assessments:
If only it was so simple that you could rely on one testing metric to determine if a patient was getting better or ready to return to sport? I probably wouldn't have a job if this was the case?! 

Combine handheld dynamometer assessments with mobility, strength, power, proprioceptive, endurance, and motor control assessments (to name a few). This holistic approach provides a well-rounded view of an individual's strength and functional capabilities to help you make better clinically reasoned decisions. This is where I love the Hawkin Dynamics cloud and its data visualization. Specifically, I use the trend report for CMPU, the profile report for individual vs. team for the desired tests and metrics that are relevant to their injury/sport, and the comparison report for the ASH test. A spider graph is a great way to depict all the metrics that you feel are important to their athletic makeup and presentation.

Incorporating handheld dynamometers into your clinic practice enhances the precision of muscle strength assessments, contributing to more effective and personalized physiotherapy interventions.

My next blog post will discuss how to implement force plate testing within the overhead athletes.
See you at the next blog post 💪

Regards,
Ben Onofrio

PS. I help allied health clinicians improve their knowledge and confidence when it comes to assessing and managing shoulder injuries, so they can avoid burnout, save their thumbs, and be seen as the expert!

If you want to learn more, join my free Facebook page for engaging content and videos (Allied Health - Level Up Your Shoulder Game | Facebook), follow me on social media (you can find me at Ben Onofrio and Simple Shoulder Systems), or join my community at benonofrio.com where you can subscribe to my email list to level up your shoulder game.

Interested in how Hawkin Dynamics can help you level up?

References

• Ashworth, B., Hogben, P., Singh, N., Tulloch, L., & Cohen, D. D. (2018). The Athletic Shoulder (ASH) test: reliability of a novel upper body isometric strength test in elite rugby players. BMJ Open Sport & Exercise Medicine, 4(1), e000365.
• Chamorro, C., Arancibia, M., Trigo, B., Arias-Poblete, L., & Jerez-Mayorga, D. (2021). Absolute reliability and concurrent validity of hand-held dynamometry in shoulder rotator strength assessment: systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(17), 9293.
• Fanning, E., Maher, N., Cools, A., & Falvey, E. C. (2020). Outcome measures after shoulder stabilization in the athletic population: A systematic review of clinical and patient-reported metrics. Orthopaedic journal of sports medicine, 8(9), 2325967120950040.
• McLaine, S. J., Ginn, K. A., Kitic, C. M., Fell, J. W., & Bird, M. L. (2016). The reliability of strength tests performed in elevated shoulder positions using a handheld dynamometer. Journal of sport rehabilitation, 25(2).