The Elbow Flexion Strength Test measures how much force a client can produce when bending the elbow against resistance. It is commonly used to assess elbow flexor force output in a controlled isometric setup. The main contributors include the biceps brachii, brachialis and brachioradialis, although shoulder position, forearm position, wrist position and grip can all influence the result.

This test can provide useful context for lifting, pulling, carrying, climbing, gripping, rowing, grappling, manual work, upper-limb strength profiling and progress tracking. A single elbow flexion score should not be used to diagnose biceps injury, nerve involvement, elbow pathology, shoulder pathology or readiness for sport or work on its own.

The Muscle Meter is a handheld dynamometry tool used to measure force output during push, pull and isometric strength assessments. When used on its own, the Muscle Meter primarily measures peak force, which is the highest force value produced during the test. When used with Measurz, Muscle Meter data can be recorded and analysed with a broader set of strength and force-time metrics, including peak force, impulse, torque, rate of torque development, rate of force development, time to peak and fatigue index.

For routine elbow flexion testing, peak force is usually the main metric. Force as a percentage of body weight may be useful if directly calculated from the client’s test force and body weight, especially for internal profiling, occupational comparison or sport comparison. Rate of force development and time to peak may be useful when rapid pulling, grappling, climbing or bracing force matters. Impulse may be useful if sustained elbow flexion force over a defined time window is intentionally tested. Fatigue index is only relevant if repeated or sustained elbow flexion efforts are part of the protocol.

What Is the Elbow Flexion Strength Test?

The Elbow Flexion Strength Test is an isometric upper-limb strength assessment where the client attempts to bend the elbow into the Muscle Meter, strap or fixed setup without visible joint movement. The device is usually placed against the distal forearm or wrist region.

The movement direction is elbow flexion. The purpose of the test is to measure how much pulling or bending force the client can produce in a specific shoulder, elbow and forearm position.

Consistent setup matters because shoulder position, elbow angle, forearm position, device placement, strap angle, wrist position, trunk position and client effort can all affect the result. This test measures force output in a specific setup. It does not fully measure grip strength, pulling endurance, upper-limb power, biceps tendon integrity, elbow function, shoulder function or sport/work readiness on its own.

Step-by-Step Protocol / Practice

1. Prepare the client

Explain that the test measures how strongly they can bend the elbow into the Muscle Meter. Record baseline symptoms, elbow discomfort, biceps-region discomfort, shoulder symptoms, wrist or forearm symptoms, fatigue, recent training or work exposure, and confidence with maximal effort.

Use at least one submaximal practice trial so the client understands the direction of force and how to build force smoothly.

2. Set the client position

A common setup is seated or standing with the shoulder close to neutral, the elbow flexed to approximately 90 degrees, and the forearm in a consistent position. The forearm may be supinated, neutral or pronated depending on the protocol, but the same position should be used at retest.

Record:

• Seated, standing or supine position
• Shoulder position
• Elbow angle
• Forearm position
• Wrist position
• Device contact point
• Whether the trunk was supported
• Whether the opposite arm was relaxed or stabilised

3. Set up the device or straps

For a handheld setup, the professional holds the Muscle Meter against the distal forearm or wrist region while the client bends the elbow into it. For stronger clients or improved repeatability, a strap-stabilised or fixed setup may be used.

If using a strap, record:

• Anchor point
• Strap angle
• Strap length
• Device position
• Whether any pre-tension was used
• Whether the anchor moved during testing

Push, pull, handheld and strap-stabilised scores should be recorded separately unless the protocol supports direct comparison.

4. Place the device, strap or handle

Place the Muscle Meter against the distal forearm or wrist region, using a consistent contact point. Avoid painful pressure over the wrist, radius, ulna or irritated soft tissue.

The force direction should be elbow flexion. The client should attempt to bend the elbow while the device or strap resists movement.

5. Stabilise the position

Stabilise the upper arm, shoulder and trunk so the client does not compensate with shoulder flexion, shoulder extension, trunk leaning, wrist flexion, gripping, pulling through the body or whole-arm movement.

The aim is controlled elbow flexion force in the chosen position.

6. Give clear instructions

Use consistent instructions such as:

“Bend your elbow into the device as hard as you can and hold.”
“Build up smoothly, then pull hard.”
“Keep your shoulder and body still.”
“Keep your wrist position the same.”
“Keep breathing.”
“Tell me if you feel pain, cramping, tingling or anything unusual.”

Use the same wording at retest where possible.

7. Record trials

Use 1–2 practice trials, then record 2–3 maximal trials. A common contraction duration is 3–5 seconds. Rest for 30–60 seconds between trials, or longer if symptoms, fatigue or cramping occur.

Record whether the final score uses the best trial or the average of recorded trials. Either approach may be used if it is applied consistently.

8. Identify invalid trials

Repeat or mark a trial as invalid if:

• The shoulder moves
• The trunk leans
• The elbow angle changes before the effort
• The wrist position changes
• The device slips
• The strap or anchor moves
• The client grips or twists heavily to create force
• Pain or cramping limits effort
• The client starts before the device is ready
• The client holds their breath excessively
• The professional cannot hold the device steady

9. Record symptoms

Record elbow pain, biceps-region discomfort, forearm symptoms, wrist symptoms, shoulder symptoms, cramping, tingling, confidence, apprehension and symptom response after testing. Do not repeatedly test through high pain, worsening symptoms or strong cramping.

For retesting, match the same position, device placement, strap setup, instructions, contraction duration, rest period, scoring method and symptom recording.

Why It Is Used

The Elbow Flexion Strength Test is used to quantify elbow flexor force output in a repeatable setup. It may be useful for:

• Baseline upper-limb strength assessment
• Side-to-side comparison
• Monitoring change over time
• Biceps and elbow flexor strength profiling
• Comparing pulling, carrying or gripping capacity with related tests
• Supporting sport, gym and occupational assessment reasoning
• Workplace context where lifting, carrying, pulling or tool use are relevant
• Fitness and performance progress tracking
• Client education

The test should support assessment reasoning. It should not be used as a stand-alone diagnostic or clearance measure.

What It Measures

The test primarily measures isometric elbow flexion force output in the chosen setup. It reflects the client’s ability to produce bending force through the elbow flexors.

It may provide useful information about:

• Elbow flexion force capacity
• Biceps and elbow flexor contribution
• Side-to-side force difference
• Confidence producing force
• Pain response during resisted elbow flexion
• Change in force over time
• Relationship between strength and pulling, lifting or carrying tasks

It does not directly measure:

• Biceps tendon integrity
• Nerve conduction
• Shoulder stability
• Elbow joint pathology
• Grip strength
• Pulling endurance
• Upper-limb power
• Tissue healing
• Readiness to return to sport or work

Understanding the Result, Reference Values and What to Look For

What a higher or lower result may suggest

A higher score may suggest greater elbow flexion force output in that specific test setup. A lower score may suggest reduced elbow flexion force output, but the reason should be interpreted carefully.

Lower force may be influenced by pain, apprehension, poor familiarisation, fatigue, guarding, inconsistent device placement, poor stabilisation, reduced confidence, shoulder symptoms, wrist symptoms, grip limitation or compensation.

One result should not be interpreted in isolation. Interpretation is strongest when the same setup is repeated over time and reviewed alongside symptoms, confidence, shoulder and elbow range of motion, grip strength, related upper-limb tests, sport demands, work demands and functional goals.

What can influence the result

Important influences include:

• Pain
• Apprehension
• Poor familiarisation
• Fatigue
• Guarding
• Poor shoulder or trunk stabilisation
• Shoulder compensation
• Wrist compensation
• Different elbow angle
• Different forearm position
• Different device placement
• Different strap angle
• Grip contribution
• Breath holding
• Client confidence
• Professional strength if using handheld resistance

Normative, reference and comparative values

Published Muscle Meter-specific universal norms for elbow flexion are limited. Reference values should therefore be used as context only and not as direct targets unless the protocol is closely matched.

More user-friendly comparison data include:

• A systematic review of isometric elbow strength included 19 studies and 1,880 healthy volunteers, but found that elbow strength values varied widely because studies used different devices, joint positions and testing positions. This means broad elbow flexion norms should be interpreted cautiously.
• In that review, elbow flexion was measured in 1,552 healthy volunteers, which shows that elbow flexion has been studied, but not always with methods that transfer neatly to a Muscle Meter setup.
• The most commonly recommended reproducible position across elbow flexion/extension testing is seated, shoulder neutral, elbow at approximately 90 degrees, and forearm position recorded.
• If the Muscle Meter displays kg or kg-force, a simple bodyweight calculation can make results easier to understand. For example, if an 80 kg client records 32 kg in elbow flexion, that equals approximately 40% body weight. This is an internal comparison value, not a universal norm.
• For side-to-side comparison, a difference of around 10% or more is often worth reviewing more closely, especially if it matches symptoms, previous injury, confidence changes, work limitations or sport-specific differences. This should not be used as a strict pass/fail cut-off.
• Dominance may influence upper-limb strength in some people, but the dominant side is not always meaningfully stronger. Record dominance and compare it with symptoms, history and task demands.
• For general clients, the most useful comparisons are usually the client’s own baseline, right-to-left difference, percentage of body weight if calculated, symptoms, confidence and repeated testing under the same setup.

These values are best used as comparison data. They can help provide context, but they should not be used as diagnostic, clearance or pass/fail cut-offs.

Practical interpretation priorities

Use this order:

1. Compare with the client’s own baseline.
2. Compare right and left sides when relevant.
3. Review force relative to body weight where calculated.
4. Consider symptoms during and after testing.
5. Consider confidence and effort quality.
6. Review whether compensations were present.
7. Compare with related strength, mobility or performance tests.
8. Relate the result to pulling, lifting, carrying, sport, work or daily-life demands.
9. Retest under the same conditions to monitor change.
10. Do not use reference values as pass/fail criteria.

What to look at for each relevant Muscle Meter metric

Peak force
Use for maximum elbow flexion force output, baseline strength, side-to-side comparison, progress tracking and comparing force across retests. Look for best score or average score, consistent setup, side-to-side difference, change from baseline, pain response and compensation during maximal effort.

Force as percentage of body weight
Use only when calculated directly from test force and body weight. It may be useful for internal profiling, occupational comparison or sport comparison, but it should not be treated as a universal target unless the protocol and population match the comparison data.

Torque
Use only when the lever arm is measured and a more biomechanical interpretation is needed. It can help when forearm length or device placement changes the raw force reading. It should not be used as normative data unless the reference data match the setup closely.

Rate of force development
Use when rapid pulling, grappling, climbing or bracing force matters. Look for early force production and whether rate of force development changes while peak force stays similar.

Time to peak
Use to understand whether force is produced quickly or gradually. Look for delayed peak force, faster time to peak across retests, and whether a slower time reflects caution, pain, poor cueing or an actual performance difference.

Impulse
Use only if a defined sustained force window is intentionally tested. Look for whether the client can sustain elbow flexion force briefly and whether impulse improves while peak force stays similar.

Fatigue index
Use only if repeated or sustained elbow flexion efforts are part of the protocol. Look for drop-off across repeated trials, symptom-related fatigue and whether fatigue improves across a training block.

Assessing and Providing Context for Different Client Populations

Youth clients
Consider growth, maturation, coordination, attention, training age and familiarisation. Practice trials are important because maximal elbow flexion effort can be difficult to coordinate.

Adults and general fitness clients
Use the test for baseline upper-limb strength, progress tracking and confidence with loading. Compare results with grip, shoulder strength, elbow mobility and general exercise goals.

Older adults
Consider lifting, carrying, transfers, household tasks, fatigue, rest periods and confidence using the upper limb. A lower score may provide useful context, but it should not be interpreted without function.

Athletes and sport clients
Consider pulling, climbing, rowing, grappling, gymnastics, combat sport, throwing preparation and contact-sport control. Peak force alone does not equal sport performance, but it can support a broader upper-limb strength profile.

Workplace and manual task clients
Consider lifting, carrying, pulling, tool use, repeated upper-limb tasks and manual handling demands. Do not use one score to clear work duties.

Clients returning after injury
Use the test to monitor force output, confidence and symptom response. Strength alone should not confirm readiness.

Clients with pain or persistent symptoms
Pain, fear, guarding, fatigue, apprehension and confidence may reduce force. Record symptom response carefully and compare with related tests.

Higher body mass clients
Absolute force and force relative to body mass may both be useful. Interpret results in relation to goals, symptoms and functional demands, not assumptions about body size.

Reliability, Validity and Measurement Considerations

Repeatability improves when the same setup is used each time. Record and standardise:

• Same test position
• Same shoulder position
• Same elbow angle
• Same forearm position
• Same wrist position
• Same device placement
• Same strap setup, if used
• Same anchor height and distance, if straps are used
• Same strap angle, if straps are used
• Same stabilisation
• Same instructions
• Same contraction duration
• Same rest period
• Same scoring method
• Same symptom and compensation recording

Upper-limb handheld dynamometry can be useful when protocols are standardised, but elbow results are position-specific. Small changes in elbow angle, forearm rotation, shoulder position or device contact point can change the score.

For stronger clients, handheld resistance may be limited by professional strength. Strap-stabilised or fixed setups can improve repeatability.

Common Errors and Limitations

Common errors include:

• Shoulder movement during the test
• Trunk leaning
• Wrist position changing
• Forearm rotation changing between trials
• Device placement changing between trials
• Strap or anchor movement
• Pulling through the shoulder or body
• Breath holding
• Testing through high pain or cramping
• Comparing different protocols directly
• Treating the score as a diagnosis

Limitations include:

• Testing is setup-dependent
• Manual resistance may be limited by professional strength
• Muscle Meter-specific universal norms may be limited
• Published elbow flexion norms vary by device and position
• Pain, fear or guarding can reduce force output
• Peak force does not measure endurance or movement quality
• Strong symmetry does not automatically indicate readiness for sport or work

Practical Applications

The Elbow Flexion Strength Test may be useful for:

• Baseline upper-limb strength assessment
• Side-to-side comparison
• Monitoring response to exercise or intervention
• Supporting pulling, lifting and carrying assessment reasoning
• Comparing with grip, shoulder strength and elbow range of motion
• Sport and workplace strength profiling
• Client education
• Fitness and performance progress tracking

Ideas to Make the Result Better

If force is low on both sides, consider assessing grip strength, shoulder strength, elbow range of motion, pulling tolerance, recent workload and confidence with loading.

If one side is much lower, compare with symptoms, injury history, shoulder strength, grip, elbow mobility, pulling tasks and work or sport demands.

If pain or cramping limits the result, record symptom location and review whether device placement, elbow angle, forearm position or effort level needs modification.

If force is good but function is limited, compare with grip, shoulder strength, rowing or pulling tasks, carrying tolerance, endurance, workload and task exposure.

If the client is improving, keep the same test setup and monitor whether force, symptoms, confidence and function improve together.

Recommended Standard Protocol Summary

Position: Seated or standing, shoulder neutral or recorded position
Start position: Elbow approximately 90 degrees flexed
Joint or trunk angle: Record shoulder, elbow, forearm and wrist position
Trials: 1–2 practice trials, then 2–3 recorded trials
Contraction duration: 3–5 seconds
Rest: 30–60 seconds between efforts
Metric: Peak force, plus percentage of body weight if directly calculated
Attachment or device setup: Muscle Meter against distal forearm or wrist region, with consistent contact point
Final score: Best trial or average of trials
Key retesting requirement: Same shoulder position, elbow angle, forearm position, device placement, instructions, contraction duration, rest and scoring method

FAQs

What does the Elbow Flexion Strength Test measure?

It measures isometric elbow flexion force output in a specific test setup.

Which muscles contribute to elbow flexion?

The biceps brachii, brachialis and brachioradialis contribute, but shoulder, wrist, grip and forearm position can also influence the result.

Should the result be recorded as percentage of body weight?

It can be if you calculate it directly from test force and body weight. For upper-limb testing, it is usually most useful for internal comparison rather than as a universal target.

Are there universal elbow flexion norms for the Muscle Meter?

Published universal Muscle Meter norms for this exact protocol appear limited. Baseline, side-to-side comparison and repeated testing are usually more useful.

What numerical values are useful for comparison?

Useful numerical comparisons include baseline change, side-to-side difference, bodyweight percentage if calculated, and whether a difference of around 10% or more matches symptoms, history or task demands.

Can this test diagnose a biceps tendon injury?

No. It can measure force output, but it does not diagnose a condition or explain symptoms on its own.

What can make the result unreliable?

Different elbow angle, forearm position, shoulder movement, wrist compensation, device slipping, pain, fatigue and inconsistent instructions can affect results.

What should be recorded in Measurz?

Record side, shoulder position, elbow angle, forearm position, device placement, peak force, percentage bodyweight if calculated, symptoms, compensations, confidence, scoring method and related findings.

Key Takeaways

• The Elbow Flexion Strength Test measures isometric elbow flexion force output.
• Peak force is usually the main routine Muscle Meter metric.
• Published elbow flexion norms vary by device, position and population, so broad values should be used cautiously.
• A systematic review included elbow flexion data from 1,552 healthy volunteers, but protocols were too varied for simple universal targets.
• Percentage of body weight should only be used when calculated directly from force and body weight.
• Baseline comparison, side-to-side comparison and retesting consistency are usually more useful than broad norms.
• Measurz should capture setup, symptoms, bodyweight-normalised values where calculated, compensations and retesting conditions.

References

Aerts, F., Sheets, H., Anderson, C., Bussie, N., Hoskins, R., Maninga, A., & Novak, E. (2025). Reliability and agreement of hand-held dynamometry using three standard rater test positions. International Journal of Sports Physical Therapy, 20(2), 253–262. https://doi.org/10.26603/001c.128286

Bohannon, R. W. (1997). Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Archives of Physical Medicine and Rehabilitation, 78(1), 26–32. https://doi.org/10.1016/S0003-9993(97)90005-8

de Boer, Y. A., van den Akker-Scheek, I., Huizinga, M. R., Reininga, I. H. F., Brouwer, R. W., & Stevens, M. (2022). What is known about muscle strength reference values for adults measured by hand-held dynamometry: A scoping review. Archives of Rehabilitation Research and Clinical Translation, 4(1), 100172. https://doi.org/10.1016/j.arrct.2021.100172

Kotte, S. H. P., Viveen, J., Koenraadt, K. L. M., The, B., & Eygendaal, D. (2018). Normative values of isometric elbow strength in healthy adults: A systematic review. Shoulder & Elbow, 10(3), 207–215. https://doi.org/10.1177/1758573217744557