Older Adults & Grip Strength

You likely know the importance of increasing client’s overall strength to maintain health, independence, and prevent adverse fall-related events.

But do you know that specifically strengthening your client’s grip is necessary as well?

Read this article to find out why and how to target grip strength.

Why is Grip Strength Important?

While grip strength is typically associated with having a strong handshake (which we don't seem to need following the introduction of the elbow bump during 2020), science has shown grip strength to be what's called a biomarker.¹

By definition, a biomarker is a broad term which indicates an "objective indication of (a) medical state, observed outside of the patient."² Basically, it's an indicator of some health condition or state of one's health that isn't necessarily something the patient is aware of.

For example, when one goes to the doctor, they typically explain their symptoms. The symptoms are what a patient is feeling and aware of. 

When the doctor does lab work, the doctor may discover some biomarkers, in the form of a high white blood cell count, for example, which indicates a certain illness. The biomarker is the indicator that something is going on or expected to occur.

According to research, grip strength has been found to be a biomarker for "overall strength, upper limb function, bone mineral density, fractures, falls, malnutrition, cognitive impairment, depression, sleep problems, diabetes, multi-morbidity, and quality of life."¹

This means that having decreased grip strength has been linked to the following:

1. Decreased overall strength
2. Decreased upper limb functions
3. Decreased bone mineral density
4. Fractures
5. Increased incidence of falls
6. Malnutrition
7. Cognitive impairment
8. Depression
9. Sleep problems
10. Diabetes
11. Multi-morbidity (having multiple medical conditions)
12. Decreased quality of life

Whoa!  Right?  Who knew grip strength was that important?

Don't Panic Your Clients

After reading all the indicators of poor grip strength you may scare your older adult clients if they tell them that they don't have a strong grip and therefore, may break a hip any second.

Take a deep breath. That is not the case.

Research has simply shown links between grip strength and the above health concerns, but that doesn't mean decreased grip strength will cause a fall or fracture.

However, it is an important indicator to be aware of and to address.

How Do I Test Grip Strength?

(Proper arm position for handheld dynamometer)

Typically, when your clients go see their primary care doctor, the doc will do quick muscle tests, like have the client grab the doc’s index and middle fingers and squeeze them as hard as they can. 

This will give a general idea of decreased grip strength, but it's not the most objective way to measure it. 

To be more objective, you can use a device called a handheld dynamometer.

You will have your client place their arm down by their side and then have them bend their elbow to 90 degrees. 

Instruct your client to squeeze this device n as hard as they can and hold that squeeze for about five seconds. 

The dynamometer will show the grip strength in kilograms. 

Have your client repeat the test two more times and then take the average value of the three trials.

Based on research, cutoff scores for older adults to be able to manage heavy tasks are 18.25 kg for females and 28.5 kg for males. 

How Do I Know if My Clients Need More Grip Strength?

Even if you don’t have the tools to objectively test your clients, you can use the squeeze test. Also, as we know with older adults, strength decreases naturally with age, so it never hurts to bump up the focus on grip strength! 

But, in particular, if your client falls below the normative values, it's really important to boost that strength to help increase strength, function, and possibly quality of life!

How to Increase My Clients' Grip Strength?

Using the Lebert Fitness Equalizers is a GREAT way to increase grip strength!

Having your older clients do pull ups with them requires a lot of grip and will improve their grip strength over time.

If your older client can’t perform full pull ups yet, have you tried to modify them?

For example, you can place a fitness step on top of the legs of the Equalizer to limit the range, which may make the exercise achievable for some of your clients.

Or you can use the Equalizers to do standing dips, pushups, or even just have your clients stand and lift the Equalizers off of the ground to promote increased grip strength.

If your client needs some more simplified exercises, check out my recommendations below!

7 Exercises to Promote Grip Strength

Wring the Towel Horizontal

1. Roll a towel or fold a Flex Kord band (the thicker it is the more resistance)
2. Hold the towel horizontally
3. Place both hands towards each end of the roll, palms facing down
4. Squeeze the towel roll with both hands
5. Rotate one wrist forward, while the other rotates back, like you're wringing out water in a towel, this is 1 rep
6. Perform 10x
7. Rest for 1-3 minutes
8. Repeat for 3 sets

Wring the Towel Vertically

1. Roll a towel or fold a Flex Kord band (the thicker it is the more resistance)
2. Hold the towel vertically
3. Place both hands towards each end of the roll, palms facing towards you
4. Squeeze the towel roll with both hands
5. Flex both wrists, then extend both wrists, this is 1 rep
6. Perform 10x
7. Rest for 1-3 minutes
8. Repeat for 3 sets

Rubber Band Extensions

1. Get a rubber band
2. Place your elbow on the table
3. With straight fingers, place your fingers together, resting on your thumb
4. Place the rubber band around your fingers and thumb, at the joint closest to your finger nails
5. Keeping your fingers straight, move your fingers and thumb away from each other, while trying to spread your fingers wide
6. You should feel some resistance from the rubber band
7. Return fingers and thumb to starting position
8. Repeat 10-15 times
9. Repeat on opposite hand
10. Complete 3 sets on each side

Ball Squeeze

1. Get a tennis ball or ball slightly more pliable (or ball of similar size)
2. Place your elbow on the table
3. Grab the ball with fingers and thumb spread wide
4. Curl fingers and thumb to squeeze the ball
5. Hold for 10 seconds
6. Release squeeze
7. Repeat 10-15 times
8. Repeat on opposite hand
9. Complete 3 sets on each side

Reverse Wrist Curls

1. Place a weight (from 1-5 pounds) on a table
2. Sit in a chair with the table to your right side
3. Place your forearm on the table, the with wrist hanging off of the table, palm facing down
4. Place the weight in your right hand
5. Keeping your forearm on the table, curl the weight up by extending your right wrist
6. Lower weight back down to starting position with control
7. Repeat 8-15 times
8. Repeat on opposite hand
9. Complete 3 sets on each side

Farmer Carry

1. Select a weight that is heavy for you, but not so heavy that you may drop it
2. Grab the weight with your right hand and straighten your elbow so your arm is down by your side
3. Holding the weight, walk forward for about 10-15 feet
4. Turn around and walk back to your starting position
5. Repeat 3 times
6. Repeat with opposite hand holding weight (adjust amount of weight if there's a significant difference in strength from right and left)
7. Complete 3 sets on each side

Towel Rows

1. Tie a knot at the end of a resistance band so it forms a large loop
2. Place the knot around the door handle and shut the door (at about chest height)
3. Take a towel roll at the end of the loop and firmly grab one side with each hand
4. Bring your shoulder blades together in the back
5. Bend your elbows towards your rib cage to pull the towel and band towards your chest
6. Slowly return arms to staring position
7. Repeat 8-15 times
8. Rest for 1-3 minutes
9. Complete 3 sets on each side

By Dr. Katie Landier, PT, DPT
Board Certified Specialist in Geriatric Physical Therapy