Handgrip strength testing
Table of contents
Handgrip dynamometry measures the force a person can exert when squeezing a device known as a dynamometer. It can form part of an assessment of muscle strength, sarcopenia, functional status or progress during rehabilitation. The figure obtained does not directly measure muscle mass, nor does it, on its own, enable the cause of a loss of strength to be identified.
What is handgrip dynamometry and what does it measure?
Dynamometry is a technique that quantifies muscle strength using a device called a dynamometer. This factsheet focuses on handgrip strength, one of the most commonly used methods in functional assessment and in the study of sarcopenia.
During the test, the person squeezes a handle for a few seconds and the device records the force achieved. The measurement directly reflects the strength of the hand and forearm during this manoeuvre. In certain contexts, it is also used as a practical indicator of overall muscle strength, although it does not accurately represent all the muscles in the body.
Dynamometry does not directly measure muscle mass, balance, endurance, coordination or the overall ability to carry out everyday activities.
Dynamometry provides information on a muscle’s ability to generate force. It can therefore complement body composition tests, which answer a different question: how much muscle tissue is estimated to be present.
Would you like more information about dynamometry?
The specialist can advise you on how the measurement is carried out, what information it provides and in which situations it may form part of a muscular or functional assessment.
When might a grip strength test be indicated?
The test may be requested when assessing muscle strength helps to answer a clinical question or evaluate progress. It can be used where there is a suspicion of loss of strength, functional impairment or sarcopenia, as well as during recovery following an injury, surgery or a prolonged period of immobilisation.
In rehabilitation, it allows progress to be compared between check-ups. It can also provide information in certain neurological, muscular or joint conditions and as part of a nutritional assessment.
The same figure does not have the same meaning in all these contexts. Its interpretation depends on the purpose of the measurement and the rest of the clinical assessment.
Dynamometry and sarcopenia
Muscle strength plays an important role in the assessment of sarcopenia, but a low reading does not in itself confirm the diagnosis.
According to the European EWGSOP2 guidelines, reduced strength suggests probable sarcopenia. To confirm the diagnosis, reduced muscle mass or muscle quality must also be demonstrated, and physical performance helps to assess its severity.
Dynamometry in rehabilitation
When used for monitoring, it allows us to check whether strength is improving, remaining stable or decreasing. This information is most useful when considered in relation to other changes, such as mobility, pain, independence or functional recovery.
Dynamometry and nutritional assessment
Grip strength can provide functional data as part of a nutritional assessment. It does not, on its own, diagnose malnutrition nor does it directly indicate muscle mass. It must be considered in conjunction with the patient’s medical history, weight, body composition, dietary intake and other assessments where indicated.
How to prepare for a hand grip strength test
The test does not usually require fasting or any changes to your medication. Before the test, you should mention any pain in your hand, wrist, elbow or shoulder, as well as any injuries, fractures or recent surgical procedures.
It is also important to mention any osteoarthritis, arthritis, tendinopathies, neurological or muscular conditions, and any difficulty in gripping objects or maintaining posture.
The healthcare professional may ask which is your dominant hand and whether you have undertaken any strenuous exercise shortly beforehand. Avoiding strenuous activity immediately before the test can help minimise the impact of fatigue. You should not stop any treatment on your own initiative.
How a handgrip dynamometry test is carried out
The person usually performs the test whilst seated. The healthcare professional adjusts the dynamometer’s grip to fit the size of the hand and explains how to apply the force. The exact position may vary depending on the protocol, but the aim is to maintain a defined and reproducible posture.
The person holds the dynamometer and squeezes as hard as they can safely manage for a few seconds. The healthcare professional checks that no movements of the torso, shoulder or arm are used to artificially increase the reading.
The procedure may be repeated several times, with a brief rest between attempts. Depending on the protocol, either the best result may be used or an average calculated.
When the test is used for follow-up, it is particularly important to maintain the same measurement conditions: the hand being assessed, posture, dynamometer, grip adjustment and the method used to calculate the result.
What you may feel during dynamometry
The test requires you to exert intense effort for a few seconds. You may feel pressure from the grip, tension in your fingers, hand or forearm, and brief muscle fatigue.
If you have osteoarthritis, an injury or pre-existing pain, the pressure may be uncomfortable and limit the amount of force you can exert. If you experience pain during the test, you should tell the healthcare professional before making any further attempts. The test usually lasts a few minutes and does not require a recovery period.
If the grip strength test is repeated to assess progress, carrying it out with the same hand, in a similar position and, where possible, using the same device, will provide a more useful comparison.
What information do the results of a dynamometry test provide?
Before interpreting a figure, the practitioner checks that the measurement is technically valid. They assess whether the person understood the procedure, whether the posture and adjustment of the dynamometer were correct, and whether pain, fatigue or any other limitation might have prevented a sufficient effort.
If these conditions are not met, a low figure may not reflect the actual strength, and it may be necessary to repeat the measurement. The result can be compared with appropriate reference values for age and sex, with the other hand, with a previous measurement, or with a cut-off point from a specific clinical algorithm.
Strength within the reference range used
This means that the measured strength falls within the expected range according to the criteria applied. It does not indicate that all muscles, muscle mass, mobility or nutritional status are normal. The test merely describes the strength obtained during that particular manoeuvre.
Reduced strength
A low figure indicates that the result is below the reference range used, but does not in itself explain the cause. There may be an actual loss of strength, but pain, osteoarthritis, a local injury, a neurological condition, fatigue, difficulty in understanding the manoeuvre, or poor technique may also be factors.
Differences between the two hands
A difference may be related to handedness, a previous injury, or a neurological or musculoskeletal disorder. Its significance depends on the magnitude of the difference, whether it is new, and the presence of other symptoms such as pain, changes in sensation or restricted movement.
Changes between assessments
An improvement or a worsening may indicate an actual functional change. The comparison is most valuable when the test is repeated using the same method and the result correlates with changes in other clinical and functional variables.
Dynamometry and grip strength values
There is no single figure that can be considered normal for everyone. Grip strength varies according to age, sex, the reference population, the hand being assessed, the dynamometer and the protocol used. For this reason, it is not advisable to interpret an individual result using a general table without knowing how the measurement was obtained.
In the European EWGSOP2 algorithm for the assessment of sarcopenia in older adults, values below 27 kg for men and 16 kg for women are used as a reference to identify reduced grip strength.
These cut-off points form part of a specific clinical algorithm and should not be used as universal thresholds for all ages, populations or clinical situations.
Limitations of handgrip dynamometry
The measurement relies on a voluntary effort. To obtain a useful result, the person must understand the instructions and exert as much force as they can safely manage.
Pain, osteoarthritis, a hand or wrist injury, tendinopathy, carpal tunnel syndrome or previous surgery can reduce grip strength without there necessarily being a generalised loss of muscle strength.
The reading may also be affected by posture, the type of dynamometer, the grip adjustment, the instructions given or the number of attempts. Consequently, results obtained using different devices or protocols are not always directly comparable.
Dynamometry does not measure overall muscle function either. It does not directly determine muscle mass, walking speed, balance, power or endurance.
Risks and possible discomfort associated with dynamometry
The test is usually well tolerated. The exertion may cause brief tension or fatigue in the hand and forearm and may temporarily increase any existing pain.
In the event of a fracture, injury, recent surgery or significant inflammation, the healthcare professional will assess whether the test can be carried out, needs to be adapted or should be postponed. Dynamometry does not involve radiation, needles or contrast agents.
Dynamometry, bioimpedance analysis and other muscle function tests
The test chosen depends on which aspect of function or muscle the medical team needs to assess. Dynamometry measures strength. Bioimpedance analysis allows different components of body composition to be estimated, including fat-free mass and certain muscle-related parameters.
Tests such as repeatedly standing up from a chair or measuring walking speed provide information on lower limb strength and physical performance. Dual-energy X-ray absorptiometry (DXA) can be used to estimate body composition and muscle mass.
In cases of localised weakness, a neurological or musculoskeletal examination may also be necessary and, in certain situations, other specific investigations. These tests are complementary and address different issues.
Specialists in dynamometry at the Publio Cordón Memorial Hospital
At Publio Cordón Memorial Hospital, dynamometry forms part of the Endocrinology and Nutrition department within the Metabolic Centre. The team comprises Dr Susana Monereo Megías and Dr José Atencia Goñi.
The test is used specifically in Dr Susana Monereo Megías’s practice, where dynamometry forms part of her standard techniques for assessing muscle strength.
Dr Susana Monereo also heads the Obesity and Cardiometabolic Risk Unit, of which Dr José Atencia Goñi is also a member. The unit incorporates the assessment of body composition, muscle mass and possible sarcopenic obesity into the metabolic evaluation.
Medical information for general guidance
This factsheet aims to help you understand what handgrip dynamometry measures, how it is carried out, what factors may influence its results, and how it forms part of the assessment of strength, muscle function and sarcopenia.
Memorial Publio Cordón Hospital promotes rigorous, understandable and useful medical information, linked to specialist care, research, scientific dissemination and advances in medicine.
The indication for and interpretation of grip strength testing must be tailored to the patient’s age, symptoms, pain levels, the device used and the protocol followed. A reduced grip strength reading does not, on its own, establish a diagnosis of sarcopenia, malnutrition, frailty or a neurological disorder.