SECTION I - KINESIOLOGY / RESEARCH PAPER
Isokinetic vs. Hand-Held Dynamometry for Assessing Knee Flexor and Extensor Strength in Athletes: Evaluating a Low-Cost Alternative across the Range of Motion
 
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1
School of P.E. and Sport Science, National and Kapodistrian, University of Athens, Athens, Greece.
 
2
School of P.E. and Sport Science, Democritus University of Thrace, Thrace, Greece.
 
 
Submission date: 2025-06-22
 
 
Final revision date: 2025-07-25
 
 
Acceptance date: 2025-09-05
 
 
Online publication date: 2025-09-23
 
 
Corresponding author
Gregory C. Bogdanis   

School of P.E. & Sport Science, National and Kapodistrian University of Athens, Greece, 41 Ethnikis Antistasis Street, 172 37, Athens, Greece
 
 
 
KEYWORDS
TOPICS
ABSTRACT
We explored whether hand-held dynamometry (HHD) could serve as a low-cost, portable alternative for assessing knee flexion and extension strength across the full range of motion. Twelve healthy athletes (7 men, 5 women; aged 21.4–28.5 years) performed maximal concentric (60°/s) and isometric flexion-extension efforts on an isokinetic dynamometer in prone and seated positions. On two separate occasions, peak extension and flexion torque were measured at six knee angles, and values obtained using HHD and isokinetic dynamometry (ISD) were compared at corresponding angles. HHD data demonstrated high reliability at all angles for knee flexion and extension (ICC = 0.812–0.971, p < 0.001). Knee extension torque was similar in HHD and prone ISD isometric measurements at all angles (p > 0.38). Knee flexion torque was similar in HHD and seated ISD isometric measurements at all angles (p ≥ 0.48). The conventional hamstring to quadriceps (H/Q) ratio was similar in HHD and ISD in the seated position for both concentric and isometric measurements (56 ± 11%, 55 ± 8% and 51 ± 10%, respectively, p > 0.792). Angle-specific H/Q ratios from HHD were similar to those obtained by all modes of testing at all knee angles (p > 0.70), except for the knee angle of 10o, which was the position where the knee was almost extended. The highest H/Q ratios were observed at the knee angles of 10o and 30o (p < 0.001). HHD is valid and reliable for assessing knee strength, yielding results comparable to ISD across the range of motion of the knee joint. The findings also emphasize the importance of considering angle-specific H/Q ratios.
REFERENCES (42)
1.
aumgart, C., Kurz, E., Freiwald, J., & Hoppe, M. W. (2021). Effects of Hip Flexion on Knee Extension and Flexion Isokinetic Angle-Specific Torques and HQ-Ratios. Sports Medicine - Open, 7(1), 41. https://doi.org/10.1186/s40798....
 
2.
Baumgart, C., Welling, W., Hoppe, M. W., Freiwald, J., & Gokeler, A. (2018). Angle-specific analysis of isokinetic quadriceps and hamstring torques and ratios in patients after ACL-reconstruction. BMC Sports Science, Medicine and Rehabilitation, 10(1), 1–8. https://doi.org/10.1186/s13102....
 
3.
Bohannon, R. W. (1990). Hand-held compared with isokinetic dynamometry for measurement of static knee extension torque (parallel reliability of dynamometers). Clinical Physics and Physiological Measurement, 11(3), 217–222. https://doi.org/10.1088/0143-0....
 
4.
Bonetti, L. V., Floriano, L. L., dos Santos, T. A., Segalla, F. M., Biondo, S., & Tadiello, G. S. (2017). Isokinetic performance of knee extensors and flexors in adolescent male soccer athletes. Sport Sciences for Health, 13(2), 315–321. https://doi.org/10.1007/s11332....
 
5.
Chavarro-Nieto, C., Beaven, M., Gill, N., & Hebert-Losier, K. (2023). Hamstrings injury incidence, risk factors, and prevention in Rugby Union players: a systematic review.  Physician and Sportsmedicine, 51(1), 1–19. https://doi.org/ 10.1080/00913847.2021.1992601.
 
6.
Cheung, R., Smith, A., & Wong, D. (2012). H:Q ratios and bilateral leg strength in college field and court sports players. Journal of Human Kinetics, 33(1), 63–71. https://doi.org/10.2478/v10078....
 
7.
Choi, J., Loh, P. Y., & Muraki, S. (2024). Transient Electromyographic Responses by Isokinetic Torque Release during Mechanically Assisted Elbow Flexion. Journal of Human Kinetics, 90, 17–28. https://doi.org/10.5114/jhk/16....
 
8.
Croisier, J. L., Ganteaume, S., Binet, J., Genty, M., & Ferret, J. M. (2008). Strength imbalances and prevention of hamstring injury in professional soccer players: A prospective study. American Journal of Sports Medicine, 36(8), 1469–1475. https://doi.org/10.1177/036354....
 
9.
Daneshjoo, A., Rahnama, N., Mokhtar, A. H., & Yusof, A. (2013). Bilateral and unilateral asymmetries of isokinetic strength and flexibility in male young professional soccer players. Journal of Human Kinetics, 36(1), 45–53. https://doi.org/10.2478/hukin-....
 
10.
Deighan, M. A., Serpell, B. G., Bitcon, M. J., & De Ste Croix, M. (2012). Knee Joint Strength Ratios and Effects of Hip Position in Rugby Players. Journal of Strength and Conditioning Research, 26(7), 1959–1966.
 
11.
Deones, V. L., Wiley, S. C., & Worrell, T. W. (1994). Assessment of Quadriceps Muscle Performance by a Hand-Held Dynamometer and an Isokinetic Dynamometer. Journal of Orthopaedic and Sports Physical Therapy, 20(6), 296–301.
 
12.
Ema, R., Wakahara, T., & Kawakami, Y. (2017). Effect of hip joint angle on concentric knee extension torque. Journal of Electromyography and Kinesiology, 37, 141–146. https://doi.org/10.1016/j.jele....
 
13.
Fieseler, G., Molitor, T., Irlenbusch, L., Delank, K. S., Laudner, K. G., Hermassi, S., & Schwesig, R. (2015). Intrarater reliability of goniometry and hand-held dynamometry for shoulder and elbow examinations in female team handball athletes and asymptomatic volunteers. Archives of Orthopaedic and Trauma Surgery, 135(12), 1719–1726. https://doi.org/10.1007/s00402....
 
14.
Fulcher, M. L., Hanna, C. M., & Raina Elley, C. (2010). Reliability of handheld dynamometry in assessment of hip strength in adult male football players. Journal of Science and Medicine in Sport, 13(1), 80–84. https://doi.org/10.1016/j.jsam....
 
15.
Green, B., Bourne, M. N., & Pizzari, T. (2018). Isokinetic strength assessment offers limited predictive validity for detecting risk of future hamstring strain in sport: a systematic review and meta-analysis. British Journal of Sports Medicine, 52(5), 329–336. https://doi.org/10.1136/bjspor....
 
16.
Griffin, L. Y., Agel, J., Albohm, M. J., Arendt, E. A., Dick, R. W., Garrett, W. E., Garrick, J. G., Hewett, T. E., Huston, L., Ireland, M. L., Johnson, R. J., Kibler, W. B., Lephart, S., Lewis, J. L., Lindenfeld, T. N., Mandelbaum, B. R., Marchak, P., Teitz, C. C., & Wojtys, E. M. (2000). Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. Journal of the American Academy of Orthopaedic Surgeons, 8(3), 141–150. https://doi.org/10.5435/001246....
 
17.
Guex, K., Gojanovic, B., & Millet, G. P. (2012). Influence of hip-flexion angle on hamstrings isokinetic activity in sprinters. Journal of Athletic Training, 47(4), 390–395. https://doi.org/10.4085/1062-6....
 
18.
Hasler, E. M., Denoth, J., Stacoff, A., & Herzog, W. (1994). Influence of hip and knee joint angles on excitation of knee extensor muscles. Electromyography and Clinical Neurophysiology, 34(6), 355–361.
 
19.
Heiser, T. M., Weber, J., Sullivan, G., Clare, P., & Jacobs, R. R. (1984). Prophylaxis and management of hamstring muscle injuries in intercollegiate football players. The American Journal of Sports Medicine, 12(5), 368–370. https://doi.org/10.1177/036354....
 
20.
Hewett, T., Lindenfeld, T., Riccovene, J., & Noyes, F. (1999). The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study. American Journal of Sports Medicine, 28(6), 919–920.
 
21.
Johansson, F. R., Skillgate, E., Lapauw, M. L., Clijmans, D., Deneulin, V. P., Palmans, T., Engineer, H. K., & Cools, A. M. (2015). Measuring eccentric strength of the shoulder external rotators using a hand-held dynamometer: Reliability and validity. Journal of Athletic Training, 50(7), 719–725. https://doi.org/10.4085/1062-6....
 
22.
Juan-Recio, C., Prat-Luri, A., Barbado, D., Vera-Garcia, F. J., & Moreno-Pérez, V. (2024). Reliability of a Trunk Flexion and Extensor Muscle Strength Test with Hand-Held and Isokinetic Dynamometers in Female Athletes. Journal of Human Kinetics, 92, 43–52. https://doi.org/10.5114/jhk/17....
 
23.
Kellis, E., & Blazevich, A. J. (2022). Hamstrings force-length relationships and their implications for angle-specific joint torques: a narrative review. BMC Sports Science, Medicine and Rehabilitation, 14(1), 1–34. https://doi.org/10.1186/s13102....
 
24.
Kellis, E., Sahinis, C., & Baltzopoulos, V. (2023). Is hamstrings-to-quadriceps torque ratio useful for predicting anterior cruciate ligament and hamstring injuries? A systematic and critical review. Journal of Sport and Health Science, 12(3), 343–358. https://doi.org/10.1016/j.jshs....
 
25.
Kelln, B. M., McKeon, P. O., Gontkof, L. M., & Hertel, J. (2008). Hand-held dynamometry: Reliability of lower extremity muscle testing in healthy, physically active, young adults. Journal of Sport Rehabilitation, 17(2), 160–170. https://doi.org/10.1123/jsr.17....
 
26.
Knapik, J. J., Bauman, C. L., Jones, B. H., Harris, J. M., & Vaughan, L. (1991). Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. American Journal of Sports Medicine, 19(1), 76–81. https://doi.org/10.1177/036354....
 
27.
Kolber, M. J., & Cleland, J. A. (2005). Strength testing using hand-held dynamometry. Physical Therapy Reviews, 10(2), 99–112. https://doi.org/10.1179/108331....
 
28.
Li, R. C., Jasiewicz, J. M., Middleton, J., Condie, P., Barriskill, A., Hebnes, H., & Purcell, B. (2006). The development, validity, and reliability of a manual muscle testing device with integrated limb position sensors. Archives of Physical Medicine and Rehabilitation, 87(3), 411–417. https://doi.org/10.1016/j.apmr....
 
29.
Li, R., & Maffulli, N. (1996). Isokinetic strength of the quadriceps and hamstrings and functional ability of anterior cruciate deficient knees in recreational athletes. British Journal of Sports Medicine, 30(2), 161–164. https://doi.org/10.1136/bjsm.3....
 
30.
Macedo, M. de C., Souza, M. A., Ferreira, K. R., Campos, L. O., Souza, I. S. O., Barbosa, M. A., Brito, C. J., Intelangelo, L., & Barbosa, A. C. (2022). Validity and Test-Retest Reliability of a Novel Push Low-Cost Hand-Held Dynamometer for Knee Strength Assessment during Different Force Ranges. Diagnostics, 12(1), 186. https://doi.org/10.3390/diagno....
 
31.
Maffiuletti, N. A., & Lepers, R. (2003). Quadriceps femoris torque and EMG activity in seated versus supine position. Medicine & Science in Sports & Exercise, 35(9), 1511–1516.
 
32.
Malouin, F., Richards, C. L., & Dumas, F. (1998). Evaluation of reflex- and nonreflex- induced muscle resistance to stretch in adults with spinal cord injury using hand-held and isokinetic dynamometry. Physical Therapy, 78(9), 964–975.
 
33.
Martin, H., Yule, V., Syddall, H., Dnnison, E., Cooper, C., & Sayer, A. (2006). Is Hand-Held Dynamometry Useful for the Measurement of Quadriceps Strength in Older People ? A Comparison with the Gold Standard Biodex Dynamometry. Gerontology, 52(3), 154–159. https://doi.org/10.1159/000091....
 
34.
Martins, J., Da Silva, J. R., Da Silva, M. R. B., & Bevilaqua-Grossi, D. (2017). Reliability and validity of the belt-stabilized hand-held dynamometer in hip-and knee-strength tests. Journal of Athletic Training, 52(9), 809–819. https://doi.org/10.4085/1062-6....
 
35.
Orchard, J. (1997). Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. American Journal of Sports Medicine, 25(1), 81–85.
 
36.
Pavol, M. J., & Grabiner, M. D. (2000). Knee strength variability between individuals across ranges of motion and hip angles. Medicine and Science in Sports and Exercise, 32(5), 985-992.
 
37.
Piao, C., Yoshimoto, N., Shitama, H., Makino, K., & Wada, F. (2004). Validity and Reliability of the Measurement of the Quardriceps Femoris Muscle Strength with a Hand-Held Dynamometer on the Affected Side in Hemiplegic Patients. Journal of UOEH, 26(1), 1–11.
 
38.
Reed, R. L., Hartog, R. Den, Yochum, K., Pearlmutter, L., Ruttinger, A. C., & Mooradian, A. D. (1993). A Comparison of Hand-Held Isometric Strength Measurement with Isokinetic Muscle Strength Measurement in the Elderly. Journal of the American Geriatrics Society, 41(1), 53–56.
 
39.
Salzman, A., Torburn, L., & Perry, J. (1993). Contribution of rectus femoris and vasti to knee extension an electromyographic study. Clinical Orthopaedics and Related Research®, 290, 236–243.
 
40.
Suchomel, T. J., Nimphius, S., & Stone, M. H. (2016). The Importance of Muscular Strength in Athletic Performance. Sports Medicine, 46(10), 1419–1449. https://doi.org/10.1007/s40279....
 
41.
Thorstensson, A., Grimby, G., & Karlsson, J. (1976). Force velocity relations and fiber composition in human knee extensor muscles. Journal of Applied Physiology, 40(1), 12–16. https://doi.org/10.1152/jappl.....
 
42.
Whiteley, R., Jacobsen, P., Prior, S., Skazalski, C., Otten, R., & Johnson, A. (2012). Correlation of isokinetic and novel hand-held dynamometry measures of knee flexion and extension strength testing. Journal of Science and Medicine in Sport, 15(5), 444–450. https://doi.org/10.1016/j.jsam....
 
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