Skip to main content
SpringerLink
Log in

Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In order to provide science-based guidelines for injury prevention or return to play, regular measurement of isometric and eccentric internal (IR) and external (ER) rotator strength is warranted in overhead athletes. However, up to date, no normative database exists regarding these values, when measured with a hand-held dynamometer. Therefore, the purpose of the study was to provide a normative database on isometric and eccentric rotator cuff (RC) strength values in a sample of overhead athletes, and to discuss gender, age and sports differences.

Methods

A HHD was used to measure RC strength in 201 overhead athletes between 18 and 50 years old from three different sports disciplines: tennis, volleyball and handball. Isometric as well as eccentric strength was measured in different shoulder positions. Outcome variables of interest were isometric ER and IR strength, eccentric ER strength, and intermuscular strength ratios ER/IR.

Results

Our results show significant side, gender and sports discipline differences in the isometric and eccentric RC strength. However, when normalized to body weight, gender differences often are absent. In general, strength differences are in favour of the dominant side, the male athletes and handball. Intermuscular ER/IR ratios showed gender, sports, and side differences.

Conclusion

This normative database is necessary to help the clinician in the evaluation of RC strength in healthy and injured overhead athletes. In view of the preventive screening and return-to-play decisions in overhead athletes, normalization to body weight and calculating intermuscular ratios are key points in this evaluation.

Level of evidence

Diagnostic study, Level III.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Andrade MS, De Lira CA, Vancini RL et al (2013) Profiling the isokinetic shoulder rotator muscle strength in 13- to 36-year-old male and female handball players. Phys Ther Sport 14:246–252

    Article  Google Scholar 

  2. Andrews AW, Thomas MW, Bohannon RW (1996) Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther 76:248–259

    CAS  PubMed  Google Scholar 

  3. Bohannon RW (1997) Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil 78:26–32

    Article  CAS  PubMed  Google Scholar 

  4. Bohannon RW (1986) Test–retest reliability of hand-held dynamometry during a single session of strength assessment. Phys Ther 66:206–209

    CAS  PubMed  Google Scholar 

  5. Borsa PA, Laudner KG, Sauers EL (2008) Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med 38:17–36

    Article  PubMed  Google Scholar 

  6. Byram IR, Bushnell BD, Dugger K et al (2010) Preseason shoulder strength measurements in professional baseball pitchers: identifying players at risk for injury. Am J Sports Med 38:1375–1382

    Article  PubMed  Google Scholar 

  7. Cadogan A, Laslett M, Hing W et al (2011) Reliability of a new hand-held dynamometer in measuring shoulder range of motion and strength. Man Ther 16:97–101

    Article  PubMed  Google Scholar 

  8. Clarsen B, Bahr R, Andersson SH et al (2014) Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. Br J Sports Med 48:1327–1333

    Article  PubMed  Google Scholar 

  9. Cools AM, De Wilde L, Van Tongel A et al (2014) Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra- and inter-rater reliability study of several testing protocols. J Shoulder Elb Surg 23:1454–1461

    Article  Google Scholar 

  10. Cools AM, Declercq G, Cagnie B et al (2008) Internal impingement in the tennis player: rehabilitation guidelines. Br J Sports Med 42:165–171

    Article  CAS  PubMed  Google Scholar 

  11. Cools AM, Palmans T, Johansson FR (2014) Age-related, sport-specific adaptions of the shoulder girdle in elite adolescent tennis players. J Athl Train 49:647–653

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cools AM, Struyf F, De Mey K et al (2014) Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med 48:692–697

    Article  PubMed  Google Scholar 

  13. Couppe C, Thorborg K, Hansen M et al (2014) Shoulder rotational profiles in young healthy elite female and male badminton players. Scand J Med Sci Sports 24:122–128

    Article  CAS  PubMed  Google Scholar 

  14. Ellenbecker T, Roetert EP (2003) Age specific isokinetic glenohumeral internal and external rotation strength in elite junior tennis players. J Sci Med Sport 6:63–70

    Article  CAS  PubMed  Google Scholar 

  15. Harbo T, Brincks J, Andersen H (2012) Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body mass, height, and sex in 178 healthy subjects. Eur J Appl Physiol 112:267–275

    Article  PubMed  Google Scholar 

  16. Hebert LJ, Maltais DB, Lepage C et al (2011) Isometric muscle strength in youth assessed by hand-held dynamometry: a feasibility, reliability, and validity study. Pediatr Phys Ther 23:289–299

    Article  PubMed  Google Scholar 

  17. Hughes RE, Johnson ME, O’driscoll SW et al (1999) Normative values of agonist–antagonist shoulder strength ratios of adults aged 20–78 years. Arch Phys Med Rehabil 80:1324–1326

    Article  CAS  PubMed  Google Scholar 

  18. Johansson FR, Skillgate E, Lapauw ML et al (2015) Measuring eccentric strength of the shoulder external rotators using a handheld dynamometer: reliability and validity. J Athl Train 50:719–725

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kibler WB, Press J, Sciascia A (2006) The role of core stability in athletic function. Sports Med 36:189–198

    Article  PubMed  Google Scholar 

  20. Kibler WB, Safran MR (2000) Musculoskeletal injuries in the young tennis player. Clin Sports Med 19:781–792

    Article  CAS  PubMed  Google Scholar 

  21. Kolber MJ, Beekhuizen K, Cheng MS et al (2007) The reliability of hand-held dynamometry in measuring isometric strength of the shoulder internal and external rotator musculature using a stabilization device. Physiother Theory Pract 23:119–124

    Article  PubMed  Google Scholar 

  22. Lintner D, Noonan TJ, Kibler WB (2008) Injury patterns and biomechanics of the athlete’s shoulder. Clin Sports Med 27:527–551

    Article  PubMed  Google Scholar 

  23. Reeser JC, Fleisig GS, Cools AM et al (2013) Biomechanical insights into the aetiology of infraspinatus syndrome. Br J Sports Med 47:239–244

    Article  PubMed  Google Scholar 

  24. Riemann BL, Davies GJ, Ludwig L et al (2010) Hand-held dynamometer testing of the internal and external rotator musculature based on selected positions to establish normative data and unilateral ratios. J Shoulder Elb Surg 19:1175–1183

    Article  Google Scholar 

  25. Schrama PP, Stenneberg MS, Lucas C et al (2014) Intraexaminer reliability of hand-held dynamometry in the upper extremity: a systematic review. Arch Phys Med Rehab 95:2444–2469

    Article  Google Scholar 

  26. Sciascia A, Kibler WB (2006) The pediatric overhead athlete: what is the real problem? Clin J Sport Med 16:471–477

    Article  PubMed  Google Scholar 

  27. Thorborg K, Bandholm T, Schick M et al (2013) Hip strength assessment using handheld dynamometry is subject to intertester bias when testers are of different sex and strength. Scand J Med Sci Sports 23:487–493

    Article  CAS  PubMed  Google Scholar 

  28. Westrick RB, Duffey ML, Cameron KL et al (2013) Isometric shoulder strength reference values for physically active collegiate males and females. Sports Health 5:17–21

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium

    Ann M. J. Cools, Fran Vanderstukken, Frédéric Vereecken, Mattias Duprez, Karel Heyman, Nick Goethals & Fredrik Johansson

  2. Department of Environmental Medicine, Karolinska Institute, Musculoskeletal and Sports Injury Epidemiology Center (MUSIEC), Stockholm, Sweden

    Fredrik Johansson

Authors
  1. Ann M. J. Cools
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fran Vanderstukken
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frédéric Vereecken
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mattias Duprez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karel Heyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nick Goethals
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fredrik Johansson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ann M. J. Cools.

Ethics declarations

Conflict of interest

This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

Additional information

Ethical Committee Approval number: B670201317814.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cools, A.M.J., Vanderstukken, F., Vereecken, F. et al. Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes. Knee Surg Sports Traumatol Arthrosc 24, 3838–3847 (2016). https://doi.org/10.1007/s00167-015-3755-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3755-9

Keywords

Search

Navigation