Improve your grip strength - Part 1
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Introduction
Grip strength plays an important role across various activities and populations throughout the lifespan (1–8). Additionally it has been associated with future mortality, disability and morbidity across young to older age groups (3). Thus, the impacts of under rehabbing your grip can quite literally impact your life.
In older populations, reduced grip strength is associated with a whole host of comorbidities. If interested I’d encourage reading through the narrative review by Bohannon (4). To name a few it is an “explanator of concurrent overall strength, bone mineral density, cognitive impairment, sleep problems, diabetes, and quality of life.” It is also predictive for “future function, fractures, cognition and problems associated with hospitalisation.” Similar types of relationships are also seen between elite athletic performance and handgrip strength (5).
Does this mean that training your grip will resolve all these issues? While it’s likely not that simple, I’ll try to make sense of that towards the ends. Keeping in mind that correlation doesn’t guarantee causation, it does look to be a good general indictor of the ‘state of things’. Perhaps it’s as simple as a stronger grip enables individuals to engage with more of their environment, encouraging internal adaptations to raise the systemic baseline function.
Median nerve
The median nerve provides motor output to various muscles responsible for gripping and wrist movement. While it acts on all the fingers, it has a bias to the thumb, first and second fingers. This is important to consider during rehab when a patient has a median nerve injury. While the location and degree of a median nerve injury will be different patient to patient, we commonly see the carpal tunnel as a source of prolonged compression to the median nerve (9).
Generally, with a peripheral nerve injury (i.e., neuropathy), you may have associated pain, dysesthesia, allodynia, reduced neural conduction and atrophy of the innervated muscles, to name a few. So, how does a nerve become ‘healed’. Fundamentally, all tissue will heal over time, albeit it may not be of the same quality. The timeframes for this will vary depending on the type of nerve injury (10). In compression type injuries, like carpal tunnel syndrome, you might expect complete resolution of symptoms versus a crush or laceration of the nerve, where a nerve may never regain it’s full function.
How do we manage these things? While time, as mentioned above, is fundamental, one must identify the specific impairments for an individual and address these in parallel. What is the strength like? Do they have adequate joint range, nerve excursion and muscle range etc. Are desensitisation protocols required? Maybe someone has issues with smooth or sharp surfaces.
While strength training, yet, isn’t directly indicated from research as a relevant intervention to peripheral nerve injuries, it likely improves the mechanical properties of nerves. Properties which are typically compromised with compression type injuries. To learn more about neuromechanics, watch my videos on nerve sliders and flossing exercises.
In a complete sense you would include exercises that encourage movement of joints that the median nerve passes i.e. the wrist, elbow and shoulder. Grip variations will be built into these movements depending on the apparatus used. This video will demonstrate and provide examples for how one implements the median portion of gripping into their exercises.
Ulnar nerve
What else makes up our ability to grip? An interesting study from 2010 looked to isolate different components of what make up the strength of ones grip (11). Specifically, the median and ulnar nerve contributions. This is an important impairment to consider when looking into rehab of various hand and elbow injuries. In the context of this video, we are considering the ulnar nerve contribution to grip. Injuries to the ulnar nerve tend to happen at either the cubital tunnel of the elbow or guyon’s canal of the wrist (12).
So, what did the 2010 study find? They found that when the 4th and 5th digit were not used during a hand dynamometer test, there was, on average, a 55% decrease in strength. Interestingly, it was the loss of the 5th finger which caused a greater reduction over the 4th; 33% and 21% respectively.
What does this mean for rehab? It is relevant to cue one to grip with their 4th and 5th digits when using various training apparatuses. This is straightforward in application and endurance based in prescription i.e. if the ulnar grip fails, then consider that the limiting factor, and stop that working set or activity.
Is it all about grip strength?
As always it is useful to have a contrasting viewpoint. Buckner et al., (6) noted that a study found no increases in grip strength from 12 months of resistance training in elderly women. They went on to suggest that general resistance training doesn’t improve grip strength. After diving into the referenced study, the resistance program wasn’t exactly geared towards developing grip strength. In fact, grip was hardly utilised in the exercises included in this study. The exercises chosen were bench press, leg press, biceps curls, triceps, quadricep curls. Strength is specific (7). While there is some transferability of strength from one movement to another, ultimately, it must have some similarity to the thing that is trying to be improved upon (8). Maybe if one used the increased bicep curl strength to do pull ups, we might see some transfer-ability into grip strength.
I suspect that grip is an emergent quality. One improves variables that constitute grip strength. This will likely lead to improved gripping abilities. But using grip as a way to train other variables may be unlikely. It may well be that grip becomes a thing in a stepwise fashion, similar to what is proposed for the vertebral column (13). Basically a ‘thing’ must come before the next ‘thing’. There are a lot of other factors to consider as well, factors beyond the scope of this article. Something as simple as whether you have training experience or not can greatly change what needs considering of what to focus on.
Conclusion
So, where to from here? To improve your grip, use it. Use it in various movements. Try lifting some heavy things. This will force more of your grip muscles to be used and increase strength. Or try to do light things to near grip failure. This will increase muscle size and subsequently strength.
References:
1. Cronin J, Lawton T, Harris N, Kilding A, McMaster DT. A Brief Review of Handgrip Strength and Sport Performance. The Journal of Strength & Conditioning Research. 2017 Nov;31(11):3187–217.
2. Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. Clinical Interventions in Aging. 2019;14:1681.
3. Tieland M, Trouwborst I, Clark BC. Skeletal muscle performance and ageing. J Cachexia Sarcopenia Muscle. 2018 Feb;9(1):3–19.
4. Frederiksen H, Gaist D, Petersen HC, Hjelmborg J, McGue M, Vaupel JW, et al. Hand grip strength: a phenotype suitable for identifying genetic variants affecting mid- and late-life physical functioning. Genet Epidemiol. 2002 Aug;23(2):110–22.
5. Carmelli D, Reed T. Stability and change in genetic and environmental influences on hand-grip strength in older male twins. J Appl Physiol (1985). 2000 Nov;89(5):1879–83.
6. Rantanen T, Volpato S, Ferrucci L, Heikkinen E, Fried LP, Guralnik JM. Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism. J Am Geriatr Soc. 2003 May;51(5):636–41.
7. Kowshik V, Velkumary S, Sethi P, Feula JM, Subhashri S, Abirami M. Association of handgrip strength and endurance with body composition in head and neck cancer patients. J Family Med Prim Care. 2021 Feb;10(2):910–6.
8. Trauber E. Grip Strength Provides More Information Than Meets the Eye [Internet]. blog. 2022 [cited 2022 Apr 18]. Available from: http://www.jospt.org/do/10.2519/jospt.blog.20220413/
9. Núñez de Arenas-Arroyo S, Cavero-Redondo I, Torres-Costoso A, Reina-Gutiérrez S, Guzmán-Pavón MJ, Martínez-Vizcaíno V. Accuracy of the Most Common Provocation Tests for Diagnosing Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2022 Aug;52(8):522–31.
10. Menorca RMG, Fussell TS, Elfar JC. Peripheral Nerve Trauma: Mechanisms of Injury and Recovery. Hand Clin. 2013 Aug;29(3):317–30.
11. Methot J, Chinchalkar SJ, Richards RS. Contribution of the ulnar digits to grip strength. Can J Plast Surg. 2010;18(1):e10–4.
12. Lleva JMC, Munakomi S, Chang KV. Ulnar Neuropathy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2023 Mar 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK534226/
13. Jones KE, Angielczyk KD, Pierce SE. Stepwise shifts underlie evolutionary trends in morphological complexity of the mammalian vertebral column. Nat Commun. 2019 Nov 7;10(1):5071.
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