Pain free grip strength test.

Description The pain-free grip (PFG) test is used to measure the amount of force that the patient generates to the onset of pain; when there is no pain the test result could be regarded as maximum grip strength. It is commonly performed in patients with lateral epicondylalgia (LE). LE is characterised by the presence of pain over the lateral humeral epicondyle which is provoked by at least two of: gripping, resisted wrist or middle finger extension, or palpation (Stratford et al 1993) in conjunction with reduced PFG over the affected side (Stratford et al 1993; Vicenzino et al 1996; Vicenzino et al 1998). Therefore, PFG is measured clinically in LE since gripping tasks are reported to reproduce the patient's lateral elbow pain (Vicenzino et al 2007). The PFG should be used before and following an intervention to evaluate treatment effects and to monitor the progress of LE condition. PFG is measured using a grip dynamometer in a relaxed supine position with legs straight and feet apart. The tested elbow is then positioned in an extended and pronated position (Smidt et al 2002). PFG has also been reported to be measured in sitting with the elbow in 90 degree flexion supported (Balogun et al 1991; Hillman et al 2005). The participant is instructed to squeeze the dynamometer maximally over the unaffected side at a gradual rate. This is followed by squeezing the dynamometer on the affected side. The patient is asked to grip the dynamometer at the same rate as the unaffected side but to stop when pain is experienced. The clinician observes for any attempt to generate a quick force while squeezing the grip dynamometer. This is to avoid squeezing the dynamometer beyond the onset of pain rendering the test invalid. The clinician should ensure that the elbow is kept consistently in the same extended and pronated position during subsequent testing within the same testing session since PFG strength testing performed in varying elbow positions can potentially yield different results (Mathiowetz et al 1985). The handle of a grip dynamometer typically allows adjustment of grip size. Therefore, the same grip size should be set up if the same patient is being tested during repeated measurements and over different occasions. It is advised to repeat the testing three times with 1 minute rest intervals (Watanabe et al 2005). The average of these three repetitions should be used for comparison between the …