Reliability and Validity of the EasyForce®

Dynamometer Compared to Handheld John Karl, PT, DPT1

Birendra Dewan, PT, PhD1
Dynamometry for Isometric Strength Michael Masaracchio, PT, PhD1
Testing of the Upper and Lower Extremities: Kaitlin Kirker, PT, DPT1
A Pilot Study
1
Department of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY

ABSTRACT assess strength, by examining volitional ac- uncomfortable on the skin, causing tempo-
Background and Purpose: A new tivity throughout an arc of motion.1,2 Man- rary skin irritation and/or tenderness during
pull-type dynamometer, the EasyForce®, ual muscle testing is graded on a 0-5 scale, maximal isometric testing.
may offer clinical advantages for measuring with higher grades representing increased A newly designed dynamometer, the
strength. The purpose of the current study strength.2 A previous literature review con- EasyForce®, has recently gained popularity.
was to assess the intra-rater reliability of the cluded that MMT is clinically useful dur- This device functions as a pull-type dyna-
EasyForce® and its concurrent validity com- ing the examination process, but further mometer, with a fixed attachment at one end,
pared to the Lafayette Manual Muscle Tester research is needed to validate the results.1 which contributes to its usability, and may
in healthy individuals. Methods: Maximal Given the questionable reliability of MMT demonstrate improved reliability and valid-
voluntary isometric contraction was tested grades above 3/5, other methods of strength ity. The device may be more advantageous
using the Lafayette Manual Muscle Tester assessment have frequently been imple- than push-type dynamometers to minimize
and the EasyForce® to explore the associa- mented in clinical practice to provide a more human error by removing the physical role
tion between the two instruments. Measure- precise level of measurement that is sensitive of the clinician in stabilization of the de-
ments of the shoulder girdle and knee were to small changes in strength.3,4 This is par- vice. The pull style with rounded anchor and
performed on healthy, active individuals re- ticularly important when making decisions carabiner style design could also potentially
cruited from the undergraduate and gradu- regarding return to play, during assessment improve upon the mechanical design with
ate student population on two separate days, of side to side strength symmetry for reduc- efficient alignment of “line of drive” or “line
with 48-72 hours between sessions and at ing risk of re-injury.5-8 of pull.” While the EasyForce® offers clinical
the same time of day for each participant. Handheld dynamometry (HHD) pro- advantages, it must first be validated in com-
Results: Thirty participants, age 29.97± vides another option for strength assessment parison with the Lafayette Manual Muscle
3.25 years, were enrolled in the study. In- at a significantly lower cost than that of an Tester, whose reliability and validity have al-
traclass correlation coefficients for the Easy- isokinetic strength machine. Handheld dy- ready been established. Two previous studies
Force® ranged from 0.87-0.98 for the shoul- namometry is considered a reliable and valid evaluated the reliability of the EasyForce® on
der and 0.80-0.81 for the knee. Assessment instrument for muscle strength assessment different muscle groups and demonstrated
of concurrent validity demonstrated strong when compared to isokinetic testing across moderate to excellent intraclass correlation
correlations between the EasyForce® and all populations.9,10 These devices are com- coefficients (ICC).13,14 While Kozinc et al,13
Lafayette dynamometers for all measure- monly used by physical therapists, and have compared the EasyForce® to other rigid dy-
ments in both sessions, which were statisti- specifically gained popularity within the namometers, validity of the device has not
cally significant (τb = 0.45 to 0.78, p<.001). realm of sports rehabilitation and return to yet been established. Therefore, the purpose
Wilcoxon signed-rank tests showed statisti- play testing.11 Standard HHDs, such as the of this study was to assess the intra-rater reli-
cally significant differences between devices Lafayette Manual Muscle Tester (Model ability of the EasyForce® and its concurrent
during both sessions (p<0.001 to p=0.02). 01163), are commonly used in outpatient validity compared to the Lafayette Manual
Clinical Relevance: Based on the results of orthopedic clinical settings. Several authors Muscle Tester in healthy individuals.
this study, clinicians should consistently use have documented the accuracy of HHD,
the same dynamometer, regardless of type, demonstrating moderate to excellent valid- METHODS
across treatment sessions to measure strength ity (ICCs>0.70) for the hip and knee.9,10,12 Subjects
changes. Conclusion: The EasyForce® is a re- However, this type of HHD has some disad- This study was conducted from October
liable and valid tool to measure strength of vantages. Primarily, the design of the device 2022 to April 2023 at the Brooklyn Campus
the upper and lower extremities. does not allow for secure fixation for stan- of Long Island University. A convenience
dardization of testing procedures requiring sample of 30 healthy, active individuals
Key Words: force production, Lafayette variations in set-up during the testing of were recruited from the undergraduate and
Manual Muscle Tester, strength assessment, different groups of muscles. Additionally, graduate student population via posted flyers
muscle testing since standard HHDs function as a push- and informational announcements following
dynamometer, a greater emphasis is placed class sessions. Participants were included in
INTRODUCTION on the clinician providing a counterforce the study if they were (1) between the ages
Manual muscle testing (MMT) is com- during isometric strength testing. From a of 18 and 50 years old, (2) able to read and
monly implemented in clinical practice to patient perspective, the attachments can be follow instructions in English, and (3) will-
28 Orthopaedic Practice volume 36 / number 4 / 2024
ing to perform moderate isometric strength- seconds. Make contact with the device, then Statistical Analysis
ening exercises. Participants were excluded if build up to your maximum force as quickly Mean values of the three MVIC trials were
they were (1) pregnant, (2) unable to per- as possible.” After 10 seconds, the peak force calculated for each testing position. Values
form daily activities and moderate-intense was recorded. Three consecutive measure- were recorded on the device in pounds and
exercise activities, (3) had shoulder, lumbar ments were taken for each position with 30 were converted to Newtons (N). To evaluate
spine, knee, ankle, or foot pain, (4) had cur- seconds rest between trials. The average of intra-rater reliability for the EasyForce®, ICC
rent injuries or movement restriction that the three measurements was calculated to was calculated using a two-way mixed effects
would limit performance of strength testing. improve consistency in the data. The same model for average measures and absolute
This study was approved by the Long Island sequence of measurement taken at session agreement (ICC (3,3)). Previous research sug-
University Institutional Review Board (ID: one was repeated at session two. Examiners gests this scale for interpreting ICC values:
22/04-060), and written informed consent remained consistent between sessions one <0.50 indicates poor reliability, 0.50-0.75
was obtained from all participants before and two and for the duration of the study indicates moderate reliability, 0.75-0.90 in-
participation. to assess intra-rater reliability. The order of dicates good reliability, and >0.90 indicates
dynamometer use was variable depending on excellent reliability.16 Absolute reliability was
Design when the participant arrived at the testing evaluated by calculating the Standard Error
The current study implemented a single site, but the order of muscle groups tested of Measurement (SEM) using the formula
cohort design to assess the intra-rater reli- remained consistent for each device. There for pooled standard deviations, , and Mini-
ability of the EasyForce® dynamometer and was a 30-minute rest period between assess- mal Detectable Change (MDC). A 95%
its concurrent validity compared to the La- Confidence Interval (CI) was calculated us-
ment of the same muscle group to minimize
fayette Manual Muscle Tester. Since this was ing the formula, .17
testing effect.15
a pilot study, no power analysis was con- Shapiro-Wilk tests confirmed that sev-
ducted. eral data sets were not normally distributed.
EasyForce® Dynamometer
The EasyForce® (Meloq AB, Stockholm, Thus, Kendall’s tau-b correlation coefficient
Methodology (τb) was used to evaluate the concurrent
Sweden) is a belt-stabilized pull-type digital
Data were collected for each participant validity of the EasyForce® compared to the
dynamometer that records the peak and av-
at the same time of day on two separate days Lafayette Manual Muscle Tester. To evalu-
erage force of tension, with a manufacturer-
with 48-72 hours between sessions. Two ate systematic between-device bias and assess
examiners followed a standardized testing reported accuracy of ±1%.14 Peak force mea-
agreement between the strength measure-
sequence with scripted instructions for par- surements were used in this study. The device
ments, a Wilcoxon Signed-rank test was run.
ticipants (Appendix). One examiner was a displays a running time in seconds, with the
Additionally, to illustrate the differences in
physical therapist with 22 years of clinical duration of testing controlled by the exam-
measurements between the two devices as
experience in an outpatient orthopedic and iner using the manual start/stop button.
a function of the strength obtained, Bland-
sports medicine practice, who is also a Board For all testing procedures, the EasyForce®
Altman plots were constructed in tests with
Certified Orthopaedic Clinical Specialist was anchored to a stable surface and either
higher strength values. Statistical analyses
and a Fellow in the American Academy of a handle or cuff attachment was used. Inter-
were performed using IBM SPSS Statistics
Orthopedic Manual Physical Therapists. The rater reliability of the EasyForce® has been
for Windows, version 26 (IBM Corp, Ar-
second examiner was a physical therapist as- reported as ICC=0.82-0.91 for the shoulder
monk, NY). The significance level was set at
sistant with 6 years of experience. He has and ICC=0.65-0.83 for the knee. Intra-rater α = 0.05 (two-tailed).
completed advanced specialization training reliability was reported as moderate to ex-
in sport performance and is currently a third cellent (ICC=0.66-0.91).14 The cost of the RESULTS
year Doctor of Physical Therapy student. EasyForce® is approximately $430. Thirty participants (mean age [SD],
Participants completed a warm-up for 24.97y ± 3.25 years; 16 females, 14 males)
the upper and lower extremities before test- Lafayette Manual Muscle Tester were enrolled in the study. The average
ing (Appendix). Maximal voluntary iso- The Lafayette Manual Muscle Tes- height, weight, and body mass index were
metric contraction (MVIC) was tested by ter (Model 01163) (Lafayette Instrument 169.49cm ± 8.81cm, 70.93kg ± 14.74kg,
one examiner using the Lafayette Manual Company, Lafayette, IN) was anchored to and 24.25 ± 3.77, respectively. One partici-
Muscle Tester and a second examiner using a stable surface using a mobilization belt pant was unable to attend the second session.
the EasyForce® dynamometer. In both cases, and required additional stabilization by the Data from one other participant for the knee
the examiner completing the testing session examiner to prevent unwanted movement. flexion trial with the EasyForce® dynamome-
stabilized the device on the fixed object. Inter-rater and intra-rater reliability of the ter during the first session was discarded due
For consistency throughout the study, the Lafayette Manual Muscle Tester has been to inability to maintain the testing position
right upper and lower extremity was tested. reported as good to excellent (ICC=0.77- for 10 seconds. Due to pairwise deletion, the
Standardized testing procedures included 0.98 and ICC=0.84-0.97, respectively) for total N was not consistent across all analyses.
shoulder external rotation (ER), shoulder peak force across muscle groups, with mini-
internal rotation (IR), scapular muscle test- mal detectable change also available.12 The Intra-rater Reliability
ing in shoulder extension (EXT), “T” posi- concurrent validity was reported as moder- Intra-rater reliability results for the Easy-
tion (90° of abduction), and “Y” position ate to excellent (ICCs>0.70) for the hip and Force® dynamometer are presented in Table
(135° of abduction), knee flexion, and knee knee.12 Peak force measurements were used 1. The ICC values ranged from 0.87 to 0.98
extension (Appendix). The participant was by Mentiplay et al12 in this study. The ap- (good to excellent reliability) for the shoul-
instructed, “The device will measure for 10 proximate cost of this device is $1500. der measurements and 0.80 to 0.81 (good
Orthopaedic Practice volume 36 / number 4 / 2024 29
 Table 1. Intra-rater Reliability for EasyForce Dynamometer Across Two Sessions for the Current Study

N Session 1 Session 2 SEM MDC

Isometric Test ICC (95% CI)
Mean (SD) Mean (SD)
ER 29 67.84 (27.44) 68.93 (29.27) .89 (.77 to .95) 9.62 26.67
IR 29 93.95 (37.01) 100.34 (40.25) .89 (.77 to .95) 12.88 35.71
Shoulder EXT 29 51.40 (30.12) 52.94 (29.60) .98 (.95 to .99) 4.53 12.55
T 29 36.46 (20.25) 36.80 (20.54) .93 (.87 to .97) 5.24 14.52
Y 29 31.41 (15.71) 31.34 (16.25) .87 (.74 to .94) 5.83 16.16
Flexion 28 168.60 (54.49) 184.20 (60.26) .81 (.59 to .91) 25.37 70.32
Knee
Extension 29 396.77 (174.66) 444.37 (209.22) .80 (.61 to .91) 85.54 237.09
Abbreviations: CI, confidence interval; ER, external rotation; IR, internal rotation; ICC, Intraclass correlation coefficient; MDC, Minimal Detectable Change; EXT,
shoulder extension; SD, standard deviation; T, “T” position (90° of shoulder abduction); SEM, Standard error of measurement; Y, “Y” position (135° of abduction).
Mean, SD, SEM and MDC are in newtons.

reliability) for the knee measurements. All its concurrent validity compared to the La- and underwent a single training session prior
ICC values were statistically significant fayette Manual Muscle Tester in young, to data collection. Familiarity with the de-
(P<0.001). healthy adults. The EasyForce® demonstrat- vices may play a role in minor adjustments
The SEM were lower for the shoul- ed good to excellent intra-rater reliability between repetitions, thus ensuring the most
der measurements ranging from 5.24N to for assessment of shoulder muscle strength reliable measures.
12.88N compared to the knee measure- (external rotators, internal rotators, and Compared to previously published reli-
ments, which ranged from 25.37N to periscapular muscles) and good reliability ability data on the EasyForce®,13,14 the cur-
85.54N. Similarly, MDC values were lower for assessment of quadriceps and hamstring rent study also revealed larger SEM and
for the shoulder ranging from 12.55N to strength. The results from the current study MDC values. One plausible explanation
35.71N compared to the knee, which ranged demonstrated statistically significant strong may be a difference in the method used to
from 70.32N to 237.09N. positive correlations between all the mea- anchor the EasyForce®. Both Kozinc et al13
surements between the EasyForce® and the and Trajkovic et al14 used a belt-stabilizing
Concurrent Validity Lafayette dynamometers, indicating validity technique, in which the dynamometer was
Results for the concurrent validity of for the specific muscle testing used in the
secured to the examiner’s waist or thigh.
the EasyForce® compared to the Lafayette current study. However, the systematic dif-
However, in order to accurately compare the
Manual Muscle Tester are presented in Table ference in measurements between the devices
EasyForce® to the Lafayette Manual Muscle
2. There were strong, positive correlations indicates that measurement of strength with
Tester in the current study, the testing pro-
between the EasyForce® and Lafayette dy- the EasyForce® is not interchangeable with
cedures were standardized to be anchored to
namometers for all measurements in both the Lafayette Manual Muscle Tester, espe-
cially at higher muscle strengths. Clinically, sturdy stationary objects, such as a treadmill,
sessions, which were statistically significant
this suggests being consistent, the same dy- high-low table, and weight plates. A second
(τb = 0.45 to 0.78, P<.001). Wilcoxon
namometer should be used between sessions potential explanation may be the differences
signed-rank tests were statistically signifi-
to assess progress accurately. in activity level of participants across studies.
cant between all measurements from both
devices during both sessions (P<0.001 to This study demonstrated greater overall Participants in the two previous studies13,14
P=0.027), except for knee flexion in both intra-rater reliability (ICC = 0.80 to 0.98) reported being active in their leisure time,
sessions (P>0.05). The average measure- for the EasyForce®, as compared to previous whereas activity level was not surveyed in
ments from the EasyForce® dynamometer studies (ICC = 0.66 to 0.91).13,14 Higher in- this study, and likely included a broad spec-
were lower for the shoulder measurements tra-rater reliability in the current study may trum of exercise engagement. Lastly, both
(at lower isometric strengths) and higher for be attributed to the examiners’ extensive ex- previous studies included 3 warm-up trials at
the knee measurements (at higher isometric perience using handheld dynamometers for submaximal intensity (~50, ~70, and ~90%
strengths) compared to the Lafayette dyna- strength testing in clinical practice, the stan- of self-perceived maximal effort) to familiar-
mometer. Bland-Altman plots (Figure 1) dardized positions and testing procedures, ize themselves with each task preceding the
demonstrated at higher isometric strengths and/or the ability to firmly stabilize the 3 active trials. This current study included
differences between the measurements from dynamometers when testing. The examin- a detailed demonstration prior to the three
the two devices increased progressively. ers in this study were clinicians practicing in active trials, in lieu of practice rounds to re-
outpatient orthopedic and sports medicine duce the potential for fatigue prior to data
DISCUSSION facilities. Conversely, the examiners in the collection. Furthermore, practice of a task
This study evaluated the intra-rater reli- previous studies by Kozinc et al13 and Tra- at titrated intervals prior to the 3 maximal
ability of the EasyForce® dynamometer and jkovic et al14 had backgrounds in kinesiology active trials may mimic a typical pyramid
30 Orthopaedic Practice volume 36 / number 4 / 2024
 Table 2. Concurrent Validity of EasyForce Compared to the Lafayette Manual Muscle Tester for the Current Study
Session 1
Isometric Test Wilcoxon
EasyForce Lafayette Kendall’ tau_b
N Signed-rank N
Mean (SD) Mean (SD) P-value τb P-value
ER 30 67.06 (27.30) 76.26 (28.61) .02* .614 <.001*
IR 30 93.03 (36.71) 98.87 (37.48) .02* .746 <.001*
Shoulder EXT 30 50.78 (29.79) 61.34 (27.22) <.001* .786 <.001*
T 30 35.87 (20.16) 44.20 (18.11) <.001* .718 <.001*
Y 30 30.93 (15.66) 36.80 (14.58) .02* .448 <.001*
Flexion 29 166.61 (54.58) 163.32 (53.66) .87 .498 <.001*
Knee
Extension 30 392.20 (173.44) 260.20 (93.42) <.001* .453 <.001*
Session 2
Isometric Test Wilcoxon
EasyForce Lafayette Kendall tau_b
N Signed-rank
Mean (SD) Mean (SD) p-value τb P-value
ER 29 68.93 (29.27) 80.83 (26.53) <.001* .76 <.001*
IR 29 100.34 (40.25) 109.41 (41.26) .03* .77 <.001*
Shoulder EXT 29 52.94 (29.60) 59.84 (26.02) .004* .72 <.001*
T 29 36.80 (20.54) 48.91 (20.66) <.001* .61 <.001*
Y 29 31.34 (16.25) 41.44 (15.52) .001* .51 <.001*
Flexion 29 180.52 (62.41) 174.29 (63.20) .18 .66 <.001*
Knee
Extension 29 444.37 (209.22) 295.43 (72.33) <.001* .47 <.001*
Abbreviations: ER, external rotation; IR, internal rotation; EXT, shoulder extension; SD, standard deviation; T, “T” position (90° of shoulder abduction);
Y, “Y” position (135° of abduction). Mean and SD are in newtons. * indicate statistically significant p-values.

scheme exercise routine, potentially induc- Conversely, this study revealed larger av- higher isometric strength testing. The Easy-
ing a within session training effect. erage EasyForce® readings for the knee mea- Force®, on the other hand, uses a soft, pli-
The descriptive analysis of the Easy- surements when compared to the Lafayette able ankle belt cuff, which conforms to the
Force® revealed smaller average readings for Manual Muscle Tester. Although the set-up shape of the limb and can be adjusted to fit
the shoulder measurements when compared for knee flexion and extension was similar, the participants’ ankle girth. This eliminated
to the Lafayette Manual Muscle Tester. with both devices secured around the dis- concerns of discomfort, likely resulting in a
This variation may be explained using the tal leg superior to the malleoli, Bland Alt- more accurate measure of maximal strength.
EasyForce® handle attachment, whereas the man plots (Figure 1) depict lower strength This study is not without limitations.
Lafayette device was placed proximally at readings on the Lafayette Manual Muscle First, as is the nature of pilot studies, the
the dorsum of the wrist and stabilized by a Tester with a progressive increase in the dif- sample size is relatively small. A post-hoc
belt. Application of the resistance force at the ference between devices at higher isometric power analysis was considered, however,
wrist reduces the length of the external mo- strengths. A possible explanation may be
since all ICC results were statistically sig-
ment arm by 3 to 4 inches, which may result participant comfort during the testing pro-
nificant, the authors decided that this was
in higher force production with the Lafayette cedures. When using the Lafayette Manual
not necessary. Second, the device test order
compared to the EasyForce®. The EasyForce® Muscle Tester, participants consistently re-
handle was used during both internal and ported discomfort at the distal leg, as the between sessions was not maintained for
external rotation, as well as for all periscapu- narrow-padded stirrup only contacts a small each participant, which may have intro-
lar muscle testing, which is consistent with surface area. Therefore, discomfort at the duced order-effect bias or differences in level
lower force readings across all shoulder test- point of contact may have resulted in par- of fatigue. However, there was a 30-minute
ing procedures. No formal analysis was per- ticipants subconsciously reducing the force time period between assessment of the same
formed to account for these variables. of muscle contraction to avoid discomfort at muscle group, which according to resistance
Orthopaedic Practice volume 36 / number 4 / 2024 31
 Figure 1. Bland-Altman Plots with Limits of Agreement (mean difference ± 1.96×SD) for the difference between EasyForce and
Lafayette Dynamometers for Knee Flexion (A,B) and Knee Extension (C,D). Solid horizontal line indicates mean difference, dotted
horizontal lines indicate upper and lower Limits of Agreement.

training principles is sufficient rest to allow fects delayed onset muscle soreness.18 While of soreness and fatigue in their methodologi-
for recovery15 and likely negates any order no formal analysis was conducted, only 7% cal designs.
effect bias. Third, as previously mentioned, of participants reported moderate soreness
practice trials were not conducted prior to on the second day of testing, with the rest CONCLUSIONS
testing to avoid fatigue; however, this could reporting mild or no soreness. The EasyForce® dynamometer is a reliable
have introduced variability in performance and valid tool to measure muscle strength of
between participants depending on their CLINICAL RELEVANCE the upper and lower extremities. However,
previous familiarity with the testing. To This study discusses the nuances and lim- the measurements from the EasyForce® are
address this concern, measurements across itations of current strength testing devices systematically different from the Lafayette
three trials were averaged to obtain stability commonly used in clinical practice. The re- Manual Muscle Tester. Clinicians should
maintain consistency of device usage be-
in the data. Fourth, the EasyForce® handle sults suggest the EasyForce® dynamometer is
tween sessions for valid assessment of change
attachment for shoulder measurements comparable to the Lafayette Manual Muscle
in muscle strength measurements.
crosses the wrist, which is inconsistent with Tester and may be more user friendly in a
the design of the Lafayette Manual Muscle sports medicine setting providing clinicians
ACKNOWLEDGEMENTS
Tester. This difference in the design of ap- with key objective data to help determine The authors would like to thank the
plication by default was maintained in the return to play readiness. Future studies on participants for donating their time to this
study to reflect real-world application. Final- the EasyForce® should examine concurrent study, as well as Meloq AB for donating the
ly, the length of time between sessions may validity compared to an isokinetic strength EasyForce® device to Long Island University
not have been sufficient to eliminate the ef- machine and implement multi-angle iso- for testing and educational purposes.
fects of muscle soreness associated with max- metric testing positions to assess the device’s
imal force production, although there is no ability to consistently measure valid force
consistent recommendations in the literature output at varying joint angles. Additional
on the timing of sessions and how that ef- considerations for future trials are the effects
32 Orthopaedic Practice volume 36 / number 4 / 2024
 Warm-up Procedures

1. Jog x1 minute
Appendix. Warm-up and Standardized Testing Procedures
2. Jumping jacks x30 repetitions
3. Squats x30 repetitions
4. Bilateral shoulder horizontal abduction with theraband x 30 repetitions
5.Warm-up
Bilateral shoulder external rotation with theraband x 30 repetitions
Procedures Standardized Testing Procedures
1. Jog x1 minute The patient is instructed:
Standardized Testing Procedures
2. Jumping jacks x30 repetitions “The device will measure for 10 seconds.
3. Squats x30 repetitions Make contact with the device, then build up
4. B
 ilateral shoulder
The patient is instructed: horizontal abduction to your maximum force as quickly as possible.”
with theraband x 30 repetitions
“The5.device
Bilateral shoulder
will measureexternal rotation
for 10 withMake contact with the device, then build up to your
seconds.
theraband x 30 repetitions
maximum force as quickly as possible.”
EasyForce Examples
EasyForce Examples
Upper Extremity Testing Upper Extremity Testing
Shoulder External Rotation Procedure
Shoulder External Rotation Patient position: standingProcedure
with the
shoulder in neutral and the elbow bent
to 90º of flexion with a towel under the
armpit.

The EasyForce is attached to the

numbered strap and secured in a closed
door. The
Patient hand grip
position: accessory
standing is used.
with the shoulder in neutral and the
elbow bent to 90º of flexion with a towel under the armpit.
The patient holds the hand grip and
performs
The isometric
EasyForce external
is attached rotation
to the numbered strap and secured in
awith thedoor.
closed shoulder and forearm
The hand in neutral
grip accessory is used.
rotation.
The patient holds the hand grip and performs isometric external
rotation with the shoulder and forearm in neutral rotation.

14

Shoulder
ShoulderInternal
InternalRotation
Rotation Procedure
Procedure
Patient position: standing with the
shoulder in neutral and the elbow bent
to 90º of flexion with a towel under the
armpit.

Patient
The position:
EasyForcestanding with the
is attached to shoulder
the in neutral and the
elbow
numbered strap and secured in a closed the armpit.
bent to 90º of flexion with a towel under
door. The hand grip accessory is used.
The EasyForce is attached to the numbered strap and secured in
a closed door. The hand grip accessory is used.
The patient holds the hand grip and
Theperforms isometric
patient holds internal
the hand rotation
grip and with
performs isometric internal
the shoulder
rotation with the and forearm
shoulder in neutral
and forearm in neutral rotation.
rotation.

Shoulder Extension Procedure

Orthopaedic Practice volume 36 / number 4 / 2024 33 Patient position: prone with the test arm
at the side in 0º of flexion/extension and
 rotation.

Appendix. Continued

Shoulder Extension Procedure

Shoulder Extension Procedure
Patient position: prone with the test arm
at the side in 0º of flexion/extension and
the contralateral arm holding onto the
table with
Patient the cervical
position: spinethe
prone with rotated to at the side in 0º of
test arm
the non-test side.
flexion/extension and the contralateral arm holding onto the
table with the cervical spine rotated to the non-test side.
The EasyForce is attached to the
numbered
The strapis and
EasyForce secured
attached to 50lb
to the of strap and secured to
numbered
weight
50lb placed placed
of weight on the on
floor.
theThe
floor.hand 15accessory is
The hand grip
grip
used. accessory is used.

Periscapular “T” The patient

The patient performs
performsProcedure
isometricshoulder
isometric shoulderextension with the
shoulder in internal rotation (palmthe
Patient
extension position:
with the prone
shoulderwith
in up).test arm
internal
rotation
at 90º (palm up).
of abduction and the contralateral
arm holding onto the table with the15
cervical spine rotated to the non-test
side.
Periscapular
Periscapular “T”
“T” ProcedureProcedure
Patient position: prone
The EasyForce with thetotest
is attached thearm
at numbered
90º of abduction
strap andand the contralateral
secured to 50lb of
arm holding
weight onto on
placed thethe
table withThe
floor. the hand
cervical
grip spine rotated
accessory is to the non-test
used.
Patient
side. position: prone with the test arm at 90º of abduction
and the contralateral arm holding onto the table with the cervi-
calThe patient
rotatedperforms isometric
side. shoulder
Thespine
EasyForce to attached
is the non-test
to the
horizontal abduction with
numbered strap and secured to 50lb the shoulder
of
Thein neutral
EasyForce rotation
is (palm
attached to
weight placed on the floor. The hand down).
the numbered strap and secured to
50lb of weight placed
grip accessory is used. on the floor. The hand grip accessory is
used.
The patient performs isometric shoulder
The patient abduction
horizontal performs isometric
with the shoulder
shoulderhorizontal abduction
with
in neutral rotation (palm down). (palm down).
the shoulder in neutral rotation

Periscapular “Y” Procedure

Periscapular “Y”
Patient position: proneProcedure
with the test arm
at 135º of abduction and the
contralateral arm holding onto the table
Periscapular “Y” with the cervical spine rotated to the
Procedure
non-test
Patient side.
Patient position: pronewith
position: prone withthe
thetest
testarm
armat 135º of abduction
at 135º
and of abductionarm
the contralateral andholding
the onto the table with the cervi-
The
cal spineEasyForce
contralateral is attached
armtoholding
rotated the to
thethe
onto side.
non-test table
numbered
with strapspine
the cervical androtated
securedtotothe50lb of
weight
The placed
EasyForce
non-test side. on the to
is attached floor. The handstrap and secured to
the numbered
50lb
gripof accessory
weight placed on the floor. The hand grip accessory is
is used.
The EasyForce is attached to the
used.
numbered
The patient strapperforms
and secured to 50lb shoulder
isometric of
The patient
weight placedperforms
on theisometric
floor. shoulder
The hand scaption with the
scaption with the shoulder in neutral
shoulder
grip in neutral
accessory rotation
is used. (palm down).
rotation (palm down).
The patient performs isometric shoulder
scaption with the shoulder in neutral
rotation (palm down).

34 Orthopaedic Practice volume 36 / number 4 / 2024

 Lower Extremity Testing
Appendix. Continued Knee Flexion Procedure 16
Patient position: sitting with a half foam
Lower Extremity Testing roller under the distal femur, and the
knee in 90º of flexion with the hands
Knee Flexion
Knee Flexion Procedure Procedure
placed on the table slightly behind the
Patient position: sitting with a half foam
patient.
roller under the distal femur, and the
knee in 90º of flexion with the hands
The EasyForce is attached to the
placed on the table slightly behind the
numbered strap and secured in a closed
patient.
Patient position: sitting with a half foam roller under the distal
door. The ankle strap accessory is used.
femur, and the knee in 90º of flexion with the hands placed on
The EasyForce
the is attached to the
Thetable slightly
patient behind
performs the patient.
isometric knee
numbered strap and secured in a closed
flexion.
door. The EasyForce
ankle strapisaccessory
attached toisthe
used.
numbered strap and secured in
a closed door. The ankle strap accessory is used.
The patient performs isometric knee
The patient performs isometric knee flexion.
flexion.

Knee Extension
Knee Extension ProcedureProcedure
Patient position: sitting with a half foam
roller under the distal femur, and the
knee in 90º of flexion with the hands
Knee Extension Procedure
placed on the table slightly behind the
Patient position: sitting with a half foam
patient.position: sitting with a half foam roller under the distal
roller Patient
under the distal femur, and the
knee in 90º ofand
femur, flexion withinthe
the knee 90ºhands
of flexion with the hands placed on
The EasyForce is attached to the
placedtheontable
the table slightly
slightly behind behind the
the patient.
numbered strap and secured to the table.
patient.
TheEasyForce
The ankle strap accessory
is attached toisthe
used.
numbered strap and secured to
The EasyForce is attached
the table. The to the
ankle strap accessory is used.
The patient performs isometric knee
numbered strap and secured to the table.
extension.
The patient performs isisometric
The ankle strap accessory used. knee extension.

The patient performs isometric knee 17

extension.

Lafayette Hand-Held Dynamometer

Lafayette Hand-Held Examples Examples
Dynamometer
Upper Extremity Testing
Shoulder External Rotation Lower Extremity TestingProcedure
Shoulder External Rotation Patient position: standing with the
Procedure
shoulder in neutral and the elbow bent
to 90º of flexion with a towel under the
armpit.

The dynamometer is attached to a belt

and secured to a stable surface. The
Patientsupports
examiner position:thestanding
device inwith theatshoulder in neutral and the
place
theelbow
dorsalbent toof90º
aspect theofwrist.
flexion with a towel under the armpit.

TheThe
subject performs isometric
dynamometer external
is attached to a belt and secured to a stable
rotation with
surface. theexaminer
The shoulder in neutral the device in place at the dorsal
supports
rotation.
aspect of the wrist.

The subject performs isometric external rotation with the shoul-

der in neutral rotation.

Shoulder Internal Rotation Procedure

Patient position: standing with the
Orthopaedic Practice volume 36 / number 4 / 2024 35
shoulder in neutral and the elbow bent
to 90º of flexion with a towel under the
Appendix. Continued

ShoulderInternal
Shoulder InternalRotation
Rotation Procedure Procedure
Patient position: standing with the
shoulder in neutral and the elbow bent
to 90º of flexion with a towel under the
armpit.

The dynamometer
Patient position:isstanding
attached with
to a belt
the shoulder in neutral and the
and secured to a stable surface. The
elbow bent to 90º of flexion with a towel under the armpit.
examiner supports the device in place at
the palmar aspect of the wrist.
The dynamometer is attached to a belt and secured to a stable
surface.
The subjectThe examiner
performs supports
isometric the device in place at the palmar
internal
aspectwith
rotation of the
thewrist.
shoulder in neutral
rotation.
The subject performs isometric internal rotation with the shoul-
der in neutral rotation.

18
18

Shoulder Extension
Shoulder Extension Procedure
Procedure
Shoulder Extension Patient position:Procedure
prone with the test arm
at the side in 0º ofprone
Patient position: with the test and
flexion/extension arm
at the
the side in 0º arm
contralateral of flexion/extension
holding onto theand
the
Patient contralateral
table with the cervicaltest
position: prone witharm
the holding
spine atonto
arm rotated the
toin 0º of
the side
table
the with the
flexion/extension
non-test andside.cervical spine rotated to
the contralateral arm holding onto the
table with the cervical
the non-test side. spine rotated to the non-test side.

The The dynamometer

dynamometer is attachedistoattached
a belt andto a belt
secured to 50lb of
weightThe
and dynamometer
secured
placed on theto 50lb
floor. The is attached
ofexaminer to a belt
weightsupports
placed theondevice in
and
placethe
at floor. The examiner supports the on
the secured
palmar to
aspect 50lb
of theof weight
wrist. placed
the floor. The examiner supports theof
The device in place
patient performs at the shoulder
palmar aspect
device
the wrist. in place at the palmar aspect with
isometric extension
of the
shoulder in internal rotation (palm up).
the wrist.
The patient performs isometric shoulder
The patient
extension withperforms isometric
the shoulder shoulder
in internal
extension
rotation withup).
(palm the shoulder in internal
Periscapular “T” Position rotation (palm up). Procedure
Periscapular “T” Position Procedure
Periscapular “T” Position Procedure
Patient position: prone with the test arm
Patient position: prone with the test arm
at 90º of abduction and the contralateral
at 90º of abduction and the contralateral
arm
Patient holding
position: onto
prone withthe
thetable
test with
arm theof abduction
at 90º
arm holding onto the table with the
and cervical spinearm
the contralateral rotated
holdingtoonto
thethe
non-test
table with the cervi-
cervical spine rotated to the non-test
side.rotated to the non-test side.
cal spine
side.
The dynamometer is attached to a belt and secured to 50lb of
The
weightThe
dynamometer
dynamometer
placed isisattached
on the floor. The to a belt
attachedsupports
examiner to a belt
the device in
and
and secured to 50lb of weight placedon
place at secured
the dorsal to 50lb
aspect of the of weight
wrist. placed on
the floor. The examiner supports the
the floor. Theisometric
examiner supports the abduction
The device
patient performs
in place at the shoulder
dorsal horizontal
aspect of
device
with the in place
shoulder at the
in neutral dorsal
rotation (palmaspect
down).of
the
thewrist.
wrist.
The
Thepatient
patientperforms
performsisometric
isometricshoulder
shoulder
horizontal abduction with the shoulder
horizontal abduction with the shoulder
ininneutral
neutralrotation
rotation(palm
(palmdown).
down).
36 Orthopaedic Practice volume 36 / number 4 / 2024
 The patient performs isometric shoulder
horizontal abduction with the shoulder
Appendix. Continued in neutral rotation (palm down).

Periscapular
Periscapular “Y”“Y” Position
Position Procedure
Procedure
Patient position: prone with the test arm
at 135º of abduction and the
contralateral arm holding onto the table
Patient position: prone with the test arm at 135º of abduction
and with the cervical
the contralateral spine rotated
arm holding to the
onto the table with the cervi-
non-test side.
cal spine rotated to the non-test side.

The The
dynamometer is attachedistoattached
dynamometer a belt andto
secured
a beltto 50lb of
weight placed on the floor. The examiner supports the device in
and secured to 50lb of weight placed on
place at the dorsal aspect of the wrist.
the floor. The examiner supports the
The device in placeisometric
patient performs at the shoulder
dorsal aspect of
scaption19
with the
the wrist.
shoulder in neutral rotation (palm down).
19
The patient performs isometric shoulder
Lower Extremity Testing scaption with the shoulder in neutral
Knee Flexion rotation (palmProcedure
Lower Extremity Testing
down).
Lower Extremity Testing Patient position: sitting with a half foam
Knee Knee Flexion
Flexion roller under the Procedure
Procedure
distal femur, and the
Patient
knee in position: sitting
90º of flexion withwith
the ahands
half foam
roller
placedunder
on thethe distal
table femur,
slightly andthe
behind the
knee in 90º of flexion with the hands
patient.
placed
Patient on the
position: table
sitting slightly
with behind
a half foam roller the
under the distal
The dynamometer is attached to a belt
femur, and
patient. the knee in 90º of flexion with the hands placed on
theand
tablesecured
slightly behind the patient.
to a stable surface. The
The
examiner supports the device in place at
The dynamometer
dynamometer is attached
is attached to secured
to a belt and a belt to a stable
the
surface.posterior
The aspect
examiner of
supportsthe distal
and secured to a stable surface. The
the devicelower
in place at the poste-
leg.
rior aspect of the distal lower leg.
examiner supports the device in place at
the
TheTheposterior
patient
patient aspect
performs
performs of the
kneedistal
isometric
isometric lower
knee
flexion.
leg.
flexion.

Knee Extension The patient performs

Procedureisometric knee
flexion.
Patient position: sitting with a half foam
Knee Extension Procedure
roller under the distal femur, and the
Knee Extension knee in 90º of flexion with the hands
Procedure
placed on the table slightly
Patient position: sitting with behind thefoam
a half
patient.
roller under the distal femur, and the
Patient position: sitting with a half foam roller under the distal
knee in 90º of flexion with the hands
Theand
femur, dynamometer is of
the knee in 90º attached to a the
flexion with belthands placed on
theplaced
table on the
slightly tabletheslightly
behind patient.
and secured to a stable surface. The
behind the
patient.
examiner supports the device in place at
The dynamometer is attached to a belt and secured to a stable
the anterior
surface. aspect
The examiner of thethe
supports distal lower
device
The
riorleg.
dynamometer is attached
aspect of the distal lower leg.
toinaplace
beltat the ante-
and secured to a stable surface. The
examiner
TheThe
patient supports
patient performs
performs the device
isometric
isometric in place
knee
knee flexion. at
the anterior aspect of the distal lower
flexion.
leg.

The patient performs isometric knee

flexion.
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Orthopaedic Practice volume 36 / number 4 / 2024 37
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38 Orthopaedic Practice volume 36 / number 4 / 2024