Skip to main content
Log in

Hip- and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable

Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In football, ice-hockey, and track and field, injuries have been predicted, and hip- and knee-strength deficits quantified using hand-held dynamometry (HHD). However, systematic bias exists when testers of different sex and strength perform the measurements. Belt-fixation of the dynamometer may resolve this. The aim of the present study was therefore to examine the inter-tester reliability concerning strength assessments of isometric hip abduction, adduction, flexion, extension and knee-flexion strength, using HHD with external belt-fixation.

Methods

Twenty-one healthy athletes (6 women), 30 (8.6) (mean (SD)) years of age, were included. Two physiotherapy students (1 female and 1 male) performed all the measurements after careful instruction and procedure training. Isometric hip abduction, adduction, flexion, extension, and knee-flexion strength were tested. The tester-order and hip-action order were randomised.

Results

No systematic between-tester differences (bias) were observed for any of the hip or knee actions. The intra-class correlation coefficients (ICC 2.1) ranged from 0.76 to 0.95. Furthermore, standard errors of measurement in per cent (SEM %) ranged from 5 to 11 %, and minimal detectable change in per cent (MDC %) from 14 to 29 % for the different hip and knee actions.

Conclusion

The present study shows that isometric hip- and knee-strength measurements have acceptable inter-tester reliability at the group level, when testing strong individuals, using HHD with belt-fixation. This procedure is therefore perfectly suited for the evaluation and monitoring of strong athletes with hip, groin and hamstring injuries, some of the most common and troublesome injuries in sports.

Levels of evidence

Diagnostic, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Akermark C, Johansson C (1992) Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med 20:640–643

    Article  PubMed  CAS  Google Scholar 

  2. Arokoski MH, Arokoski JPA, Haara M, Kankaanpaa M, Vesterinen M, Niemitukia LH, Helminen HJ (2002) Hip muscle strength and muscle cross sectional area in men with and without hip osteoarthritis. J Rheumatol 29:2185–2195

    PubMed  Google Scholar 

  3. Askling C, Saartok T, Thorstensson A (2006) Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Br J Sports Med 40:40–44

    Article  PubMed  CAS  Google Scholar 

  4. Atkinson G, Nevill AM (1998) Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 26:217–238

    Article  PubMed  CAS  Google Scholar 

  5. Beck M, Giess R, Wurffel W, Magnus T, Ochs G, Toyka KV (1999) Comparison of maximal voluntary isometric contraction and Drachman’s hand-held dynamometry in evaluating patients with amyotrophic lateral sclerosis. Muscle Nerve 22:1265–1270

    Article  PubMed  CAS  Google Scholar 

  6. Bennell KL, Crossley K (1996) Musculoskeletal injuries in track and field: incidence, distribution and risk factors. Aust J Sci Med Sport 28:69–75

    PubMed  CAS  Google Scholar 

  7. Bohannon RW, Vigneault J, Rizzo J (2008) Hip external and internal rotation strength: consistency over time and between sides. Isokin Exerc Sci 16:107–111

    Google Scholar 

  8. Casartelli NC, Maffiuletti NA, Item-Glatthorn JF, Staehli S, Bizzini M, Impellizzeri FM, Leunig M (2011) Hip muscle weakness in patients with symptomatic femoroacetabular impingement. Osteoarthr Cartil 19:816–821

    Article  PubMed  CAS  Google Scholar 

  9. Cetin C, Sekir U, Yildiz Y, Aydin T, Ors F, Kalyon TA (2004) Chronic groin pain in an amateur soccer player. Br J Sports Med 38:223–224

    Article  PubMed  CAS  Google Scholar 

  10. Croisier JL, Forthomme B, Namurois MH, Vanderthommen M, Crielaard JM (2002) Hamstring muscle strain recurrence and strength performance disorders. Am J Sports Med 30:199–203

    PubMed  Google Scholar 

  11. Crow JF, Pearce AJ, Veale JP, VanderWesthuizen D, Coburn PT, Pizzari T (2009) Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players. J Sci Med Sport 13:202–204

    Article  PubMed  Google Scholar 

  12. Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R (2010) Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study. Am J Sports Med 38:2051–2057

    Article  PubMed  Google Scholar 

  13. Hopkins WG (2000) Measures of reliability in sports medicine and science. Sports Med 30:1–15

    Article  PubMed  CAS  Google Scholar 

  14. Kelln BM, Mckeon PO, Gontkof LM, Hertel J (2008) Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active, young adults. J Sport Rehabil 17:160–170

    PubMed  Google Scholar 

  15. Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, Roberts C, Shoukri M, Streiner DL (2011) Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. Int J Nurs Stud 48:661–671

    Article  PubMed  Google Scholar 

  16. Kramer JF, Vaz MD, Vandervoort AA (1991) Reliability of isometric hip abductor torques during examiner- and belt-resisted tests. J Gerontol 46:M47–M51

    Article  PubMed  CAS  Google Scholar 

  17. Malliaras P, Hogan A, Nawrocki A, Crossley K, Schache A (2009) Hip flexibility and strength measures: reliability and association with athletic groin pain. Br J Sports Med 43:739–744

    Article  PubMed  CAS  Google Scholar 

  18. Nadler SF, DePrince ML, Hauesien N, Malanga GA, Stitik TP, Price E (2000) Portable dynamometer anchoring station for measuring strength of the hip extensors and abductors. Arch Phys Med Rehabil 81:1072–1076

    Article  PubMed  CAS  Google Scholar 

  19. O’Connor DM (2004) Groin injuries in professional rugby league players: a prospective study. J Sports Sci 22:629–636

    Article  PubMed  Google Scholar 

  20. Orchard J, Seward H (2002) Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports Med 36:39–44

    Article  PubMed  CAS  Google Scholar 

  21. Scott DA, Bond EQ, Sisto SA, Nadler SF (2004) The intra- and interrater reliability of hip muscle strength assessments using a handheld versus a portable dynamometer anchoring station. Arch Phys Med Rehabil 85:598–603

    Article  PubMed  Google Scholar 

  22. Snyder KR, Earl JE, O’Connor KM, Ebersole KT (2009) Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clin Biomech 24:26–34

    Article  Google Scholar 

  23. Terwee CB, Bot SDM, De Boer MR, van der Windt DAWM, Knol DL, Dekker J, Bouter LA, De Vet HCW (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42

    Article  PubMed  Google Scholar 

  24. Thorborg K, Petersen J, Magnusson SP, Holmich P (2010) Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports 20:493–501

    Article  PubMed  CAS  Google Scholar 

  25. Thorborg K, Bandholm T, Schick M, Jensen J, Holmich P (2011) Hip strength assessment using handheld dynamometry is subject to intertester bias when testers are of different sex and strength. Scand J Med Sci Sports doi:10.1111/j.1600-0838.2011.01405.x

    Google Scholar 

  26. Thorborg K, Serner A, Petersen J, Moller Madsen T, Magnusson P, Holmich P (2011) Hip adduction and abduction strength profiles in elite soccer players implications for clinical evaluation of hip adductor muscle recovery after injury. Am J Sports Med 39:121–126

    Article  PubMed  Google Scholar 

  27. Tyler TF, Nicholas SJ, Campbell RJ, Mchugh MP (2001) The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med 29:124–128

    PubMed  CAS  Google Scholar 

  28. Visser J, Mans E, de Visser JM, van den Berg-Vos RM, Franssen H, De Jong JMBV, van den Berg LH, Wokke JHJ, de Haan RJ (2003) Comparison of maximal voluntary isometric contraction and hand-held dynamometry in measuring muscle strength of patients with progressive lower motor neuron syndrome. Neuromuscul Disord 13:744–750

    Article  PubMed  CAS  Google Scholar 

  29. Walter SD, Eliasziw M, Donner A (1998) Sample size and optimal designs for reliability studies. Stat Med 17:101–110

    Article  PubMed  CAS  Google Scholar 

  30. Wadsworth C, Nielsen DH, Corcoran DS, Phillips CE, Sannes TL (1992) Interrater reliability of hand-held dynamometry: effects of rater gender, body weight, and grip strength. J Orthop Sports Phys Ther 16:74–81

    PubMed  CAS  Google Scholar 

  31. Weir JP (2005) Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 19:231–240

    PubMed  Google Scholar 

  32. Widler KS, Glatthorn JF, Bizzini M, Impellizzeri FM, Munzinger U, Leunig M, Maffiuletti NA (2009) Assessment of hip abductor muscle strength. A validity and reliability study. J Bone Joint Surg 91A:2666–2672

    Article  Google Scholar 

  33. Wikholm JB, Bohannon RW (1991) Hand-held dynamometer measurements: tester strength makes a difference. J Orthop Sports Phys Ther 13:191–198

    PubMed  CAS  Google Scholar 

  34. Willy RW, Davis IS (2011) The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. J Orthop Sports Phys Ther 41:625–632

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the participating students and the cooperating staff from the Faculty of Physiotherapy, Metropolitan University College, Copenhagen, Denmark for their time and trouble during the study. A special thanks to Fie Johansson and André Christensen for their help with the testing and photographs of the testing set-up.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kristian Thorborg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thorborg, K., Bandholm, T. & Hölmich, P. Hip- and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable. Knee Surg Sports Traumatol Arthrosc 21, 550–555 (2013). https://doi.org/10.1007/s00167-012-2115-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2115-2

Keywords

Navigation