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Grip Strength: Unleash the secret to primal strength, injury prevention, and overall health By: Dr. Arianne Missimer, PT, DPT, RD, SFG2, CICS, CSCS, T.P.I. MP 3, K‐Vest 3, FMT 1 & 2, NKT 2, FMS/SFMA, MI EBFA Clinic Director Kinetic Physical Therapy Founder of the Movement Paradigm Grip strength is the force applied by the hand to pull or suspend from objects and is a specific part of hand strength • Grip strength is correlated with the strength of the upper extremity, general strength of the body and some anthropometric measurements (Balogun et al., 1991) • Grip power is the result of forceful flexion of all finger joints with maximum voluntary force that the subject is able to exert under normal biokinetic conditions (Koley et al., 2009). Objectives 1. Recognize importance of grip strength for injury prevention, rehabilitation, and performance 2. Understand co‐activation pattern, myofascial lines, and hyperirradiation 3. Identify reliable measures for testing grip strength 4. Recognize appropriate treatment interventions and proper progressions for your athletes , patients, and clients There is more than 17,000 mechanoreceptors in the hand! Neuroscience. 2nd edition. Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Sunderland (MA): Sinauer Associates; 2001. Neuroscience. 2nd edition. Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Sunderland (MA): Sinauer Associates; 2001. How does grip improve stability, strength, and force production? 1. Co-activation patterns 2.Myofascial lines via fascial tensioning 3. Hyperirradiation Neurological connection of grip and RTC Roberts LV, Stinear CM, Lewis GN, and Byblow WD. “Task‐Dependent Modulation of Propriospinal Inputs to Human Shoulder.” Journal of Neurophysiology 100.4 (2008): 2109‐ 114. Rehabilitation • Improved joint centration • “….Anterior and middle deltoid activity decreased by 2% MVE, while posterior deltoid, infraspinatus and trapezius activity increased by 2% MVE and biceps brachii activity increased by 6% MVE.” Antony NT, Keir PJ. Effects of Posture, Movement and Hand Load on Shoulder Muscle Activity. Journal of Electromyography and Kinesiology 20.2: 191‐98. 2010. Hyperirradiation “a spreading and increased spread of a response” Hyperirradiation • The Law of Irradiation was discovered by Sir Charles Scott Sherrington • "A muscle working hard recruits the neighboring muscles, and if they are already part of the action, it amplifies their strength. The neural impulses emitted by the contracting muscle reach other muscles and 'turn them on' as an electric current starts a motor". • Increases neural drive Adler S, Beckers D, and Buck M. PNF in Practice: An Illustrated Guide. Berlin: Springer, • Increased strength in UQ 2000. Radiant Tension Myofascial Arm Lines Deep front line Superficial front line Deep back line Superficial back line Myers TW. Anatomy Trains. Myofascial Meridians Manual for Movement Therapists. Second Edition. Edinburgh, CA: Elsevier; 2009. Myofascial Arm Lines Deep Front Line Pec Minor Biceps Brachii Thenar muscles Superficial Front Line Pec Major and Lats Flexor group Carpal Tunnel Deep Back Line Rhomboids and Levator Triceps brachii Hypothenar muscles Superficial Back Line Trapezius Deltoid Extensor group Functional Lines Myers TW. Anatomy Trains. Myofascial Meridians Manual for Movement Therapists. Second Edition. Edinburgh, CA: Elsevier; 2009. “Grip strength is a predictor of mortality, disability, complications, and increased length of hospital stay.” Rantanen T, Guralnik JM, Foley D et al. Midlife hand grip strength as a predictor of old age disability. JAMA 1999; 281: 558–60. Assessments • Men 50# DB in each hand x 30 sec • Women and kids #35 DB in each hand x 30 sec – Loaded posture, breathing, compensations • Dynamometer Dynamometer • Quantified by measuring the amount of static force that the hand can squeeze around a dynamometer. • The Jamar dynamometer has been found to give the most accurate and acceptable measures of grip strength Standardized testing protocol • Seated with the shoulder adducted and neutrally rotated, the elbow flexed at 90 and forearm in neutral and the wrist between 0 and 30 degrees extension and between 0 degrees and 15 degrees ulnar deviation (Fess & Moran, 1981). • Small changes in body position can result in altered grip strengths. Grip Types • Crushing Grip • Pinch Grip • Open Hand Grip How do you effectively train grip ? Hanging!! Treatment • Kettlebell holds, screwdrivers, arm bars, TGU • Block weights • Hook Grip Kettlebell Swinging • Thick bar dumbbells (2.5” diameter) • Pinch plates • Sledgehammers Summary • Grip strength is widely accepted indicator of nutritional status, bone mineral content, muscular strength and functional integrity of upper extremity . • The assessment of grip strength plays a vital role in determining the efficacy of different treatment strategies of hand, elbow, shoulder, and core. • Unleash this secret of primal strength, injury prevention, and longevity. References Au AK, Keir PJ. Interfering effects of multitasking on muscle activity in the upper extremity. J Electromyogr Kinesiol 2007;17:578–86. Adler S, Beckers D, and Buck M. PNF in Practice: An Illustrated Guide. Berlin: Springer, 2000. Antony NT, Keir PJ. Effects of Posture, Movement and Hand Load on Shoulder Muscle Activity. Journal of Electromyography and Kinesiology 20.2: 191-98. 2010. Bohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry. BMC Musculoskelet Disord. 2015; 16: 139. Hogrel JY. Grip strength measured by high precision dynamometry in healthy subjects from 5 to 80 years. J Nutr Health Aging. 2012;16(9):769-74. Jedd Johnson- Diesel Crew. [email protected] Myers TW. Anatomy Trains. Myofascial Meridians Manual for Movement Therapists. Second Edition. Edinburgh, CA: Elsevier; 2009. Norman K, Stobaus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr. 2011 Apr;30(2):135-42. Neuroscience. 2nd edition. Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Sunderland (MA): Sinauer Associates; 2001. References PNF course. Institute of Physical Art. April 2013 Rantanen T, Guralnik JM, Foley D et al. Midlife hand grip strength as a predictor of old age disability. JAMA 1999; 281: 558–60. Roberts LV, Stinear CM, Lewis GN, and Byblow WD. “Task-Dependent Modulation of Propriospinal Inputs to Human Shoulder.” Journal of Neurophysiology 100.4 (2008): 2109-114. - See more at: Sporrong H, Palmerud G, Herberts P. Influences of handgrip on shoulder muscle activity. Eur J Appl Physiol Occupat Physiol 71: 485–492, 1995. Sporrong H, Palmerud G, Herberts P. Hand grip increases shoulder muscle activity: an EMG analysis with static hand contractions in 9 subjects. Acta Orthop Scand 67: 485–490, 1996. Sporrong H, Styf J. Effects of isokinetic muscle activity on pressure in the supraspinatus muscle and shoulder torque. J Orthop Res 17: 546 –553, 1999. Stevens PJ, Syddall HE, Patel HP, Martin HJ, Cooper C, Aihie SA. Is grip strength a good marker of physical performance among community-dwelling older people? Curr Opin Clin Nutr Metab Care. 2015 Sep;18(5):465-70.