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.
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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
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.
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
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.
Use this order:
Compare with the client’s own baseline.
Compare right and left sides when relevant.
Review force relative to body weight where calculated.
Consider symptoms during and after testing.
Consider confidence and effort quality.
Review whether compensations were present.
Compare with related strength, mobility or performance tests.
Relate the result to pulling, lifting, carrying, sport, work or daily-life demands.
Retest under the same conditions to monitor change.
Do not use reference values as pass/fail criteria.
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.
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.
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 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
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
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.
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
It measures isometric elbow flexion force output in a specific test setup.
The biceps brachii, brachialis and brachioradialis contribute, but shoulder, wrist, grip and forearm position can also influence the result.
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.
Published universal Muscle Meter norms for this exact protocol appear limited. Baseline, side-to-side comparison and repeated testing are usually more useful.
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.
No. It can measure force output, but it does not diagnose a condition or explain symptoms on its own.
Different elbow angle, forearm position, shoulder movement, wrist compensation, device slipping, pain, fatigue and inconsistent instructions can affect results.
Record side, shoulder position, elbow angle, forearm position, device placement, peak force, percentage bodyweight if calculated, symptoms, compensations, confidence, scoring method and related findings.
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.
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
