Improving Grip Strength in a Patient with Left Forearm Weakness
Author: Michele S. Jang, PT
Abstract: Patients with forearm weakness are often prescribed therapy. A variety of modalities including electrical stimulation, thermal agents, massage, stretching, strengthening, surgery, medication & manual therapy are commonly utilized (1,2,3,4,5,6,7,8,9,10,11,12,13). The purpose of this report is to demonstrate how in one session of Integrative Manual Therapy (IMT) for the treatment of the structures of the arm can improve grip strength without any direct strength training. In this case study, the patient is a 52 year old woman with complaints of limitations in activities of daily living including decreased strength of her left arm. The woman received treatment with IMT focusing on her left upper extremity. After treatment was completed, the woman presented with a significant increase in grip strength.
Key Words: Grip Strength, Strength, Upper Extremity, Dynamometer
Introduction
Patients with forearm weakness are often prescribed therapy. A variety of modalities including electrical stimulation, thermal agents, massage, stretching, strengthening, surgery, medication & manual therapy are commonly utilized (1,2,3,4,5,6,7,8,9,10,11,12,13). The purpose of this report is to demonstrate how in one session of Integrative Manual Therapy for the treatment of the structures of the arm can improve grip strength without any direct strength training.
Case Description
The patient is a 52 year old woman with a chief complaint of an inability to perform her duties as a full time homemaker. Specifically, she reports weakness & pain in her left arm while grasping and lifting objects. She also complains of occasional low back pain. She first noticed the left forearm pain and weakness 3 months prior to our examination while lifting a sofa. The weakness is constant and the pain intermittent. The patient is right hand dominant. She reports that she would use her right arm solely and if necessary employ her left arm to assist her in vacuuming, laundry, cooking & dishwashing. She does not take any medication for her discomfort. No X-rays or MRI’s of her forearm were taken.
Past Medical History
A review of her medical history reveals stomach ulcers. Traumas sustained include multiple ski injuries, falls & a motor vehicle accident in the 1960's. She also experienced Temporal Mandibular Joint Dysfunction.
Treatment
During a 2 hour treatment session the following Integrative Manual Therapy techniques were performed:
Outcomes
The Baseline Hydraulic Hand Dynamometer was used to measure the patients left grip strength before & after the above techniques were performed. The best of 3 attempts was recorded. Results are as follows:
| Test Position in Sitting | Grip Strength (in pounds) | Strength Change (in pounds) | |
| Before TX | After TX | ||
| Left shoulder 0degree flex/abducted, elbow 90 flexed | 34 | 39 | +5 |
| * Right side = 60 pounds | |||
| Left shoulder 90 flexed/0 deg abducted, elbow fully extended | 31 | 38 | + 7 |
| * Right side = 54 pounds | |||
Discussion
In Essentials of Strength Training & Conditioning by Baechle, a physiological alteration in muscle is seen after 6 weeks of strengthening. Vendors of exercise equipment claim improvements in grip strength varying in duration - some as early as 3 weeks (19,20,21). In contrast the grip strength of this patient treated with Integrative Manual Therapy _ improved in a 2 hour period. These results support the hypothesis that addressing the structural integrity of muscle, nerves, arteries, veins, fascia & bone (i.e. using Integrative Manual Therapy) is an efficient and effective means of gaining grip strength. The selection of treatment was based on Myofascial Mapping (15) results. Myofascial Mapping is an assessment tool providing information about dysfunction that is unique to an individual. A treatment plan is established based on these findings. Prior to forearm treatment, this patient had manual therapy intervention at the pelvis, sacrum, cervical spine and ribs. How this intervention affected the results at the forearm is unclear at this time. Future study should include 1) Determining grip strength at the time of initial evaluation; 2) Determining grip strength after treatment to areas of the body prior to direct treatment of the forearm; 3) Recording each grip strength attempt and their averages.
References