The effect of elbow position on the handgrip strength test in children: validity and reliability of TKK 5101 and DynX dynamometers




physical fitness, maximum grip performance, dynamometry, Bland and Altman


Background and Study Aim: One of the most widely applied methods to assess upper-body strength in children and adolescents is the handgrip strength test. While in adolescents it has been determined which elbow position, and which type of dynamometer are most appropriate for achieving the maximal grip strength, in children is still not clear. Therefore, the purpose of this study was to investigate whether elbow position and the type of dynamometer affect the handgrip strength in children. Material and Methods: Grip strength was measured by TKK and DynX dynamometers, and their validity and reliability were also analysed. A total of 60 children, 6 to 11 years old, participated in this study, and performed the handgrip strength test with their elbow extended and flexed at 90°. Results: While using the TKK dynamometer, grip strength was significantly higher when the test was performed with elbow extended, in contrast to those obtained with elbow flexed (14.58±3.04 kg vs 12.97±2.99 kg, p<0.001 for right, and 14.25±3.05 kg vs 12.61±2.99 kg, p<0.001 for left hand). Likewise, when using the DynX dynamometer, the difference between the two elbow positions was smaller but still significant (13.84±3.22 kg vs 13.35±3.01 kg, p=0.035 for right, and 13.35±2.95 kg vs 12.77±2.96 kg, p=0.003 for left hand). Conclusions: Both dynamometers provided sufficient results in terms of their reliability and the TKK dynamometer showed to be more valid. Performing the handgrip strength test with elbow extended appears to be the most appropriate position in order to obtain maximal results in children.


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Author Biographies

Stefan Kolimechkov, STK Sport; STK SPORT; London, United Kingdom.

Jose Castro-Piñero, University of Cádiz; Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, Spain

Lubomir Petrov, National Sports Academy; Department of Physiology and Biochemistry, National Sports Academy, Sofia, Bulgaria.

Albena Alexandrova, National Sports Academy; Department of Physiology and Biochemistry, National Sports Academy, Sofia, Bulgaria.


1. American College of Sports Medicine. ACSM's Health-Related Physical Fitness Assessment Manual, Fourth Edition. Kaminsky L, editor. USA: Lippincott Williams and Wilkins; 2014.

2. Ruiz J, J. Castro-Pinero, E. Artero, F. Ortega, M. Sjostrom, J. Suni, et al. Predictive validity of health-related fitness in youth: a systematic review. Br J Sports Med. 2009;43(12):909–23.

3. Smith JJ, Eather N, Morgan PJ, Plotnikoff RC, Faigenbaum AD, Lubans DR. The health benefits of muscular fitness for children and adolescents: a systematic review and meta-analysis. Sports Med. 2014;44(9):1209–23.

4. Ortega FB, Ruiz JR, Castillo MJ, Sjostrom M. Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes (Lond). 2008;32(1):1–11.

5. Santos R, Mota J. The ALPHA health-related physical fitness test battery for children and adolescents. Nutr Hosp, 2011;26:1199–200.

6. Council of Europe. Recommendation no. r (87) 9 of the Committee of ministers to member states on the EUROFIT tests of physical fitness. [Internet]. 1987. [updated 2020 Jun 05; cited 2020 Jun 25]. Available from:

7. Ruiz J, F. Ortega, A. Gutiérrez, D. Meusel, M. Sjöström, Castillo M. Health-related fitness assessment in childhood and adolescence: a European approach based on the AVENA, EYHS and HELENA studies. J Public Health. 2006;14(5):269–77.

8. Ortega FB, Cadenas-Sanchez C, Sanchez-Delgado G, Mora-Gonzalez J, Martinez-Tellez B, Artero EG, et al. Systematic review and proposal of a field-based physical fitness-test battery in preschool children: the PREFIT battery. Sports Med. 2015;45(4):533–55.

9. Bianco A, Jemni M, Thomas E, Patti A, Paoli A, Ramos Roque J, et al. A systematic review to determine reliability and usefulness of the field-based test batteries for the assessment of physical fitness in adolescents - The ASSO Project. International Journal of Occupational Medicine and Environmental Health. 2015;28(3):445–78.

10. Richards LG, Olson B, Palmiter-Thomas P. How forearm position affects grip strength. The American Journal of Occupational Therapy. 1996;50(2):133–8.

11. Su CY, Lin JH, Chien TH, Cheng KF, Sung YT. Grip strength in different positions of elbow and shoulder. Archives of Physical Medicine and Rehabilitation. 1994;75(7):812–5.

12. Parvatikar VB, Mukkannavar PB. Comparative Study of Grip Strength in Different Positions of Shoulder and Elbow with Wrist in Neutral and Extension Positions. Journal of Exercise Science and Physiotherapy. 2009;5(2):67–75.

13. Watanabe T, Owashi K, Kanauchi Y, Mura N, Takahara M, Ogino T. The short-term reliability of grip strength measurement and the effects of posture and grip span. The Journal of Hand Surgery. 2005;30(3):603–9.

14. El-Sais W, Mohammad W. Influence of different testing postures on hand grip strength. European Scientific Journal. 2014;10(36):290–301.

15. Espana-Romero V, Artero EG, Santaliestra-Pasias AM, Gutierrez A, Castillo MJ, Ruiz JR. Hand span influences optimal grip span in boys and girls aged 6 to 12 years. The Journal of Hand Surgery. 2008;33(3):378–84.

16. Harkonen R, Piirtomaa M, Alaranta H. Grip strength and hand position of the dynamometer in 204 Finnish adults. Journal of Hand Surgery. 1993;18(1):129–32.

17. Ruiz-Ruiz J, Mesa JL, Gutierrez A, Castillo MJ. Hand size influences optimal grip span in women but not in men. The Journal of Hand Surgery. 2002;27(5):897–901.

18. Ruiz JR, Espana-Romero V, Ortega FB, Sjostrom M, Castillo MJ, Gutierrez A. Hand span influences optimal grip span in male and female teenagers. The Journal of Hand Surgery. 2006;31(8):1367–72.

19. Balogun JA, Akomolafe CT, Amusa LO. Grip strength: effects of testing posture and elbow position. Archives of Physical Medicine and Rehabilitation. 1991;72(5):280–3.

20. Desrosiers J, Bravo G, Hebert R, Mercier L. Impact of elbow position on grip strength of elderly men. Journal of Hand Therapy, 1995;8(1):27–30.

21. Kuzala EA, Vargo MC. The relationship between elbow position and grip strength. The American Journal of Occupational Therapy, 1992;46(6):509–12.

22. Mathiowetz V, Rennells C, Donahoe L. Effect of elbow position on grip and key pinch strength. The Journal of Hand Surgery. 1985;10(5):694–7.

23. Oxford KL. Elbow positioning for maximum grip performance. Journal of Hand Therapy, 2000;13(1):33–6.

24. Fess E, Moran C. Clinical Assessment Recommendations. USA: American Society of Hand Therapists; 1981.

25. NHANES. Muscle Strength Procedures Manual. National Health and Nutrition Examination Survey (NHANES); 2013.

26. Kattel BP, Fredericks TK, Fernandez JE, Lee DC. The effect of upper-extremity posture on maximum grip strength. International Journal of Industrial Ergonomics. 1996;18(5-6):423–9.

27. España-Romero V, Ortega FB, Vicente-Rodríguez G, Artero EG, Rey JP, Ruiz JR. Elbow Position Affects Handgrip Strength in Adolescents: Validity and Reliability of Jamar, DynEx, and TKK Dynamometers. Journal of Strength and Conditioning Research, 2010;24:272–7.

28. Shechtman O, Gestewitz L, Kimble C. Reliability and validity of the DynEx dynamometer. Journal of Hand Therapy, 2005;18(3):339–47.

29. van den Beld WA, van der Sanden GA, Sengers RC, Verbeek AL, Gabreels FJ. Validity and reproducibility of the Jamar dynamometer in children aged 4-11 years. Disability and rehabilitation. 2006;28(21):1303–9.

30. Chatburn RL. Evaluation of instrument error and method agreement. AANA journal. 1996;64(3):261–8.

31. Atkinson G, Nevill AM. Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med. 1998;26(4):217–38.

32. Bland J, Altman D. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.

33. Carbonell-Baeza A, Alvarez-Gallardo IC, Segura-Jimenez V, Castro-Pinero J, Ruiz JR, Delgado-Fernandez M, et al. Reliability and feasibility of physical fitness tests in female fibromyalgia patients. Int J Sports Med. 2015;36(2):157–62.

34. España-Romero V, Artero EG, Jimenez-Pavón D, Cuenca-Garcia M, Ortega FB, Castro-Piñero J, et al. Assessing Health-Related Fitness Tests in the School Setting: Reliability, Feasibility and Safety; The ALPHA Study. Int J Sports Med, 2010;31:490–7.

35. Cadenas-Sanchez C, Martinez-Tellez B, Sanchez-Delgado G, Mora-Gonzalez J, Castro-Pinero J, Lof M, et al. Assessing physical fitness in preschool children: Feasibility, reliability and practical recommendations for the PREFIT battery. J Sci Med Sport. 2016;19(11):910–5.

36. Fernandez Santos JR, Ruiz JR, Gonzalez-Montesinos JL, Castro-Pinero J. Reliability and Validity of Field-Based Tests to Assess Upper-Body Muscular Strength in Children Aged 6-12 Years. Pediatr Exerc Sci. 2016;28(2):331–40.

37. Cadenas-Sanchez C, Sanchez-Delgado G, Martinez-Tellez B, Mora-Gonzalez J, Lof M, Espana-Romero V, et al. Reliability and Validity of Different Models of TKK Hand Dynamometers. The American Journal of Occupational Therapy, 2016;70(4):7004300010.

38. MDSystems.Inc., inventorDynX - Electronic Hand Dynamometer & Programmable Hand Exerciser , User's Guide. USA; 2014.

39. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Edition S, editor. USA: Lawrence Erlbaum Associates; 1988.

40. Sawilowsky S. New Effect Size Rules of Thumb. Journal of Modern Applied Statistical Methods. 2009;8(2):597–9.

41. Kolimechkov S, Petrov L, Alexandrova A. Alpha-fit test battery norms for children and adolescents from 5 to 18 years of age obtained by a linear interpolation of existing European physical fitness references. European Journal of Physical Education and Sport Science. 2019;5(4):1–14.

42. Council of Europe. Testing physical fitness - Eurofit, provisional handbook. 1983.
43. Kolimechkov S. Physical Fitness Assessment in Children and Adolescents: A Systematic Review. European Journal of Physical Education and Sport Science. 2017;3(4):65–78.

44. Bianco A, Mammina C, Jemni M, Filippi AR, Patti A, Thomas E, et al. A Fitness Index model for Italian adolescents living in Southern Italy: the ASSO project. J Sports Med Phys Fitness. 2016;56(11):1279–88.

45. Ahrens W, Bammann K, de Henauw S, Halford J, Palou A, Pigeot I, et al. Understanding and preventing childhood obesity and related disorders—IDEFICS: A European multilevel epidemiological approach. Nutrition, Metabolism and Cardiovascular Diseases, 2006;16:302–8.

46. Ortega F, E. Artero, J. Ruiz, V. España-Romero, D. Jiménez-Pavón, G. Vicente-Rodriguez, et al. Physical fitness levels among European adolescents: the HELENA study. British Journal of Sports Medicine. 2011;45:20–9.

47. Cronin J, Lawton T, Harris N, Kilding A, McMaster DT. A Brief Review of Handgrip Strength and Sport Performance. Journal of Strength and Conditioning Research. 2017;31(11):3187–217.

48. Bonitch-Gongora JG, Bonitch-Dominguez JG, Padial P, Feriche B. The effect of lactate concentration on the handgrip strength during judo bouts. Journal of Strength and Conditioning Research. 2012;26(7):1863–71.




How to Cite

Kolimechkov S, Castro-Piñero J, Petrov L, Alexandrova A. The effect of elbow position on the handgrip strength test in children: validity and reliability of TKK 5101 and DynX dynamometers. Pedagogy of Physical Culture and Sports. 2020;24(5):240-7.

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