Enhancing the examiner's resisting force improves the validity of manual muscle strength measurements: application to knee extensors and flexors.

The purposes of this study were to test whether an examiner's strength may affect the validity of the knee muscle strength measurements using a hand-held dynamometer (HHD) and whether enhancing the forces applied by an examiner using a resistance-enhanced dynamometer (RED) would improve measurement validity. Twenty-five young male volunteers (mean [±SD] age: 22.5 ± 1.7 years) without a history of injury to the test limb and 6 male and 6 female experienced examiners participated in this study. Maximum resisting forces of the knee flexors and extensors were measured using RED, HHD, and a dynamometer (Kin-Com). For all testing conditions, poor to moderate associations were found between the HHD and Kin-Com, whereas there was a good to excellent relationship between RED and Kin-Com. The systematic variations between RED and Kin-Com were also smaller than those between HHD and Kin-Com. The force values measured by RED were very close to those measured by Kin-Com. An examiner's strength affects the validity of the measurements using HHD. Enhancing the forces applied by the examiner to the tested segment using RED appeared to improve the validity of muscle strength measurements.