The Shoulder Flexion Strength Test measures how much force a client can produce when lifting the arm forward against resistance. It is commonly used to assess isometric shoulder flexion force output in a controlled setup.
Shoulder flexion strength can provide useful context for overhead reaching, lifting, pushing, throwing, swimming, gym training, workplace tasks, upper-limb strength profiling and progress tracking. The main contributors include anterior deltoid, pectoralis major clavicular fibres, coracobrachialis and other shoulder and scapular stabilising muscles, although trunk position, scapular control, arm angle, device placement and client confidence can all influence the result.
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 shoulder 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 baseline comparison, side-to-side comparison and retesting. Rate of force development and time to peak may be useful when rapid shoulder flexion force matters, such as throwing, striking, swimming, climbing or high-speed upper-limb tasks. Impulse may be useful if sustained flexion force over a defined time window is intentionally tested. Fatigue index is only relevant if repeated or sustained shoulder flexion efforts are part of the protocol.
The result can support assessment reasoning and progress tracking, but it does not diagnose rotator cuff injury, shoulder impingement, tendon pathology, nerve involvement, instability, pain source or readiness for sport or work on its own.
The Shoulder Flexion Strength Test is an isometric upper-limb strength assessment where the client pushes the arm forward or upward into the Muscle Meter, strap or fixed setup without visible shoulder movement. The device is usually placed on the anterior or superior side of the forearm, wrist or upper arm depending on the chosen protocol.
The movement direction is shoulder flexion. The purpose of the test is to measure how much force the client can produce while holding a specific shoulder and arm position.
Consistent setup matters because shoulder flexion angle, elbow angle, scapular position, trunk position, device placement, lever length, strap angle and client effort can all affect the result. This test measures force output in a specific setup. It does not fully measure overhead function, throwing capacity, rotator cuff integrity, scapular control, endurance, pain source or sport/work readiness on its own.
Explain that the test measures how strongly they can lift or push the arm forward into the Muscle Meter. Record baseline symptoms, shoulder pain, neck symptoms, elbow or wrist symptoms, paraesthesia, fatigue, recent overhead activity, recent pushing or lifting load and confidence with maximal effort.
Use at least one submaximal practice trial so the client understands the direction of force and learns to build force smoothly without trunk leaning, shoulder hiking or breath holding.
Shoulder flexion can be tested seated, standing or supine depending on the protocol and available setup. A common setup is seated upright with the testing arm flexed to 90 degrees in front of the body.
Record:
Seated, standing, supine or other position
Test side
Shoulder flexion angle
Plane of movement
Elbow angle
Forearm position
Wrist position
Trunk position
Scapular position if observed
Device contact point
Whether a strap or fixed anchor was used
Whether symptoms were present before testing
The trunk should remain upright and stable. The client should avoid leaning backward, shrugging, rotating the trunk or using momentum.
For a handheld setup, the professional holds the Muscle Meter on top of the client’s forearm or at the chosen contact point while the client pushes into shoulder flexion. For stronger clients or improved repeatability, a strap-stabilised or fixed setup may be used.
If using a strap or anchor, record:
Anchor point
Strap angle
Strap length
Device position
Arm position
Whether any pre-tension was used
Whether the anchor or strap moved during testing
Handheld, strap-stabilised and fixed-frame scores should be recorded separately unless the protocol supports direct comparison.
Place the Muscle Meter on top of the forearm, wrist or upper arm depending on the selected lever length. Use the same contact point at retest. Avoid uncomfortable pressure over bony or sensitive areas.
The force direction should match shoulder flexion. The client should push upward or forward into the device without leaning the trunk, shrugging or changing the shoulder angle.
Stabilise the trunk and shoulder girdle as appropriate so the client does not compensate with trunk extension, trunk rotation, shoulder hiking, elbow movement, wrist pushing or whole-body bracing.
The aim is controlled shoulder flexion force in the chosen position.
Use consistent instructions such as:
“Push your arm forward and up into the device as hard as you can and hold.”
“Build up smoothly, then push hard.”
“Keep your body still.”
“Do not shrug or lean back.”
“Keep your wrist and elbow position steady.”
“Keep breathing.”
“Tell me if you feel shoulder pain, neck pain, tingling, weakness, dizziness or anything unusual.”
Use the same wording at retest where possible.
Use 1–2 practice trials, then record 2–3 maximal trials. The original brief protocol used a 2–3 second maximal hold, while many HHD protocols use 3–5 seconds. The chosen duration should be recorded and repeated consistently.
Rest for 30–60 seconds between trials, or longer if symptoms, fatigue, pain or apprehension 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 trunk leans backward or rotates
The shoulder shrugs significantly
The arm angle changes before or during the effort
The elbow or wrist position changes
The device slips
The strap or anchor moves
The client pushes with the body rather than the shoulder
Pain, paraesthesia or neurological symptoms limit effort
The client starts before the device is ready
The client holds their breath excessively
The professional cannot hold the device steady
Record shoulder pain, neck symptoms, elbow symptoms, wrist symptoms, paraesthesia, clicking, apprehension, confidence and symptom response after testing. Do not repeatedly test through worsening symptoms, significant paraesthesia, strong apprehension or high pain.
For retesting, match the same body position, shoulder angle, plane of movement, device placement, strap setup, instructions, contraction duration, rest period, scoring method and symptom recording.
The Shoulder Flexion Strength Test is used to quantify shoulder flexion force output in a repeatable setup. It may be useful for:
Baseline shoulder strength assessment
Side-to-side comparison
Monitoring change over time
Shoulder strength profiling
Comparing flexion with extension, abduction and rotation strength
Supporting overhead sport and gym strength assessment reasoning
Supporting workplace assessment where lifting, reaching, pushing or carrying is relevant
Tracking symptom response to resisted shoulder flexion
Client education
Fitness and performance progress tracking
The test should support assessment reasoning. It should not be used as a stand-alone diagnostic, injury-risk, performance-prediction or clearance measure.
The test primarily measures isometric shoulder flexion force output in the chosen setup. It reflects the client’s ability to produce forward or upward arm force while controlling trunk, scapular and shoulder position.
It may provide useful information about:
Shoulder flexion force capacity
Side-to-side force difference
Force relative to body weight, if calculated
Confidence producing shoulder force
Symptom response during resisted flexion
Change in force over time
Relationship between shoulder strength and related sport, work or daily-life tasks
It does not directly measure:
Cause of shoulder pain
Rotator cuff tissue status
Tendon pathology
Shoulder joint structure
Nerve function
Overhead skill
Throwing readiness
Work readiness
Sport readiness
A higher score may suggest greater shoulder flexion force output in that specific setup. A lower score may suggest reduced 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, reduced confidence, neck symptoms, shoulder symptoms, scapular compensation, trunk leaning or professional strength if using manual resistance.
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 range of motion, shoulder extension, abduction, internal rotation, external rotation, scapular control, overhead exposure, sport demands and work tasks.
Important influences include:
Shoulder pain
Neck symptoms
Apprehension
Poor familiarisation
Fatigue
Guarding
Shoulder flexion angle
Testing plane
Elbow angle
Lever length
Device placement
Strap angle
Trunk stabilisation
Shoulder shrugging
Scapular position
Breath holding
Client confidence
Professional strength if using handheld resistance
Published Muscle Meter-specific universal norms for shoulder 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:
The original shoulder flexion article reports broad example values of approximately 24–28 kg for males and 14–18 kg for females aged 20–29 years.
It also reports broad example values of approximately 18–22 kg for males and 10–14 kg for females aged 60–69 years.
These values are useful because they are already expressed as simple force values in kilograms, but they should not be treated as Muscle Meter pass/fail targets unless the body position, shoulder angle, contact point, lever length and testing method are closely matched.
A large healthy adult shoulder HHD study used a 5-second maximal isometric make contraction, three trials each side and body-mass normalisation. That study found shoulder strength was influenced by sex, body weight and activity level, and that most shoulder strength measures did not differ significantly between dominant and non-dominant sides.
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, overhead exposure or functional limitations. This should not be used as a strict pass/fail cut-off.
Comparing flexion with extension can also be useful. A large difference between directions may provide context, especially when paired with symptoms, overhead reaching, pushing, lifting, swimming, throwing or work demands.
If force is recorded as a percentage of body weight in Measurz, use it mainly for baseline comparison, side-to-side comparison and repeated testing under the same setup.
These values and comparisons are best used as context. They can help structure interpretation, but they should not be used as diagnostic, injury-risk, performance-prediction, clearance or pass/fail cut-offs.
Use this order:
Compare with the client’s own baseline.
Compare right and left shoulders if the opposite side is symptom-free.
Review force relative to body weight where calculated.
Compare flexion with extension, abduction and rotation strength where relevant.
Consider symptoms during and after testing.
Consider confidence and effort quality.
Review whether compensations were present.
Compare with shoulder range of motion and overhead task tolerance.
Relate the result to sport, gym, 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 shoulder flexion force output, baseline strength, side-to-side comparison, direction-to-direction comparison and progress tracking. Look for best score or average score, consistent setup, change from baseline, symptom response and whether compensations occurred.
Force as percentage of body weight
Use only when calculated directly from test force and body weight. It may help internal monitoring and comparison between sides, but it should not be treated as a universal target unless the comparison data use the same protocol.
Torque
Use only when lever arm is measured and a more biomechanical interpretation is needed. It can help when contact point or arm length 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 shoulder flexion force matters, such as throwing, striking, swimming, climbing or explosive lifting. 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. A slower time to peak may reflect caution, pain, apprehension, poor cueing or a true force-production difference.
Impulse
Use only if a defined sustained force window is intentionally tested. It may help when the aim is to understand force maintained over a brief flexion contraction.
Fatigue index
Use only if repeated or sustained shoulder flexion efforts are part of the protocol. Look for drop-off across repeated trials and whether the decline matches symptoms, fatigue or apprehension.
Youth clients
Consider growth, maturity, coordination, sport exposure, confidence and familiarisation. Use conservative interpretation because effort, attention and testing confidence can influence the result.
Adults and general fitness clients
Use the test for baseline shoulder strength, progress tracking and comparison with other shoulder directions. Compare results with range of motion, overhead tolerance, pushing tolerance, exercise exposure and symptoms.
Older adults
Consider comfort, shoulder mobility, neck symptoms, fatigue and confidence. Use a comfortable testing angle and avoid repeated maximal efforts if symptoms are provoked.
Athletes and sport clients
Consider throwing, swimming, climbing, gymnastics, racquet sports, contact sport and overhead lifting demands. Shoulder flexion strength can support profiling, but it should not be used alone to judge sport readiness.
Workplace and manual task clients
Consider overhead work, lifting, carrying, pushing, reaching and sustained arm positions. 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, body size, arm length and functional demands, not assumptions about body size.
Repeatability improves when the same setup is used each time. Record and standardise:
Same body position
Same test side order
Same shoulder flexion angle
Same movement plane
Same elbow angle
Same forearm and wrist position
Same trunk stabilisation
Same scapular observation
Same device placement
Same strap or anchor setup, if used
Same contraction duration
Same rest period
Same instructions
Same scoring method
Same symptom and compensation recording
Shoulder flexion strength testing is setup-dependent. Small changes in shoulder angle, movement plane, lever length, contact point or trunk stabilisation 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:
Trunk leaning backward
Trunk rotation
Shoulder shrugging
Arm angle changing
Testing in a different plane
Device placement changing between trials
Elbow or wrist pushing changing the lever
Breath holding
Testing through worsening symptoms
Strap or anchor movement
Poor familiarisation
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 shoulder flexion values vary by device, posture, arm angle and population
Pain, apprehension or guarding can reduce force output
Peak force does not measure endurance, coordination or overhead skill
Strong force or symmetry does not automatically indicate readiness for sport or work
The Shoulder Flexion Strength Test may be useful for:
Baseline shoulder strength assessment
Monitoring response to exercise or intervention
Right-to-left shoulder strength comparison
Shoulder direction-to-direction profiling
Overhead sport strength profiling
Occupational shoulder strength profiling
Comparing with shoulder extension, abduction, internal rotation, external rotation, range of motion and endurance tests
Client education
Fitness and performance progress tracking
If force is low on both sides, consider assessing shoulder range of motion, extension strength, abduction strength, external rotation strength, internal rotation strength, scapular control, neck symptoms, overhead exposure and familiarisation.
If one side is lower, compare with symptoms, previous injury, sport or work demands, range of motion, shoulder rotation strength and test setup.
If symptoms limit the result, record symptom location and type, review test angle and compare with related findings rather than forcing repeated maximal trials.
If force improves but symptoms remain, consider reviewing endurance, range of motion, overhead workload, sport exposure and recovery between sessions.
If the client is improving, keep the same test setup and monitor whether force, symptoms, confidence and function improve together.
Position: Seated, standing, supine or chosen shoulder flexion test position
Start position: Shoulder at recorded flexion angle, commonly 90 degrees if following the original setup
Joint or trunk angle: Record shoulder angle, plane, elbow angle, trunk position and scapular observation
Trials: 1–2 practice trials, then 2–3 recorded trials per side
Contraction duration: 2–3 seconds if following the original brief protocol, or 3–5 seconds if standardised that way
Rest: 30–60 seconds between efforts; longer if symptoms occur
Metric: Peak force, side-to-side difference, plus percentage of body weight if directly calculated
Attachment or device setup: Muscle Meter on top of forearm/wrist/upper arm or connected to a strap/anchor with consistent contact point
Final score: Best trial or average of trials
Key retesting requirement: Same body position, side order, shoulder angle, movement plane, device placement, instructions, contraction duration, rest and scoring method
It measures isometric shoulder flexion force output in a specific setup.
Key contributors include anterior deltoid, pectoralis major clavicular fibres and coracobrachialis, with scapular and trunk control also influencing the result.
Yes. Testing both sides allows side-to-side comparison, which is often more useful than interpreting one isolated value.
It can be if calculated directly from force and body weight. This is useful for internal comparison but should not be treated as a universal target.
Published universal Muscle Meter norms for this exact protocol appear limited. Baseline comparison, side-to-side comparison and repeated testing are usually more useful.
Broad example values include approximately 24–28 kg for males and 14–18 kg for females aged 20–29 years, and approximately 18–22 kg for males and 10–14 kg for females aged 60–69 years. These are context values, not pass/fail targets.
No. It can measure force output and symptom response, but it does not diagnose a condition or explain symptoms on its own.
Changing shoulder angle, trunk leaning, shoulder shrugging, device placement, pain, fatigue and inconsistent instructions can affect results.
Record side, position, shoulder angle, movement plane, device placement, peak force, symptoms, confidence, compensations, bodyweight-relative value if calculated, scoring method and related findings.
The Shoulder Flexion Strength Test measures isometric shoulder flexion force output.
Peak force is usually the main routine Muscle Meter metric.
Side-to-side comparison is especially useful when the opposite side is symptom-free.
Broad example values include 24–28 kg for males and 14–18 kg for females aged 20–29, but protocols vary.
Percentage of body weight should only be used when calculated directly from force and body weight.
Baseline comparison, symptom response and retesting consistency are more useful than broad norms.
Measurz should capture side, setup, symptoms, force, confidence, compensations and retesting conditions.
Andrews, A. W., Thomas, M. W., & Bohannon, R. W. (1996). Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Physical Therapy, 76(3), 248–259. https://doi.org/10.1093/ptj/76.3.248
Bradley, H., & Pierpoint, L. (2023). Normative values of isometric shoulder strength among healthy adults. International Journal of Sports Physical Therapy, 18(4), 977–988. https://doi.org/10.26603/001c.83938
Morin, M., Hébert, L. J., Perron, M., Petitclerc, É., Lake, S.-R., & Duchesne, E. (2023). Psychometric properties of a standardized protocol of muscle strength assessment by hand-held dynamometry in healthy adults: A reliability study. BMC Musculoskeletal Disorders, 24, 294. https://doi.org/10.1186/s12891-023-06400-2
Stark, T., Walker, B., Phillips, J. K., Fejer, R., & Beck, R. (2011). Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: A systematic review. PM&R, 3(5), 472–479. https://doi.org/10.1016/j.pmrj.2010.10.025
