Test-Retest Reliability of Isokinetic Strength Measurement in Standardized and Lengthened Hamstring Positions Among Healthy Adults
Maria Belinda Cristina C. Fidel, Helen A. Banwell, Consuelo G. Suarez
Apr 2025 DOI 10.35460/2546-1621.2024-0176 Access

Abstract
Introduction: Strength is a key modifiable risk factor for hamstring strains with significant differences between injured and non-injured sides in the lengthened position. Ensuring the test-retest reliability of measurement protocols ensures consistent injury prevention, rehabilitation and return-to-sport planning.
Objective: To evaluate the test-retest reliability of hamstring strength protocols in both standardized and lengthened positions among healthy adults.
Study Design: Test-retest reliability study
Setting: Human Performance Laboratory, Fr. Roque Ruano building, University of Santo Tomas, Espana Manila
Participants: Ten healthy adults (six males and four females; mean age: 26.5 ± 4.03 years)
Main Outcome Measures: Absolute and relative peak torque for concentric and eccentric hamstring and quadriceps were measured at 60°/sec, 180°/sec and 240°/sec in the standardized position (hip and knee flexed at 90°). In the lengthened position (hip flexed at 85° and knee at 30°), isometric knee flexion and peak torque for concentric and eccentric hamstring and quadriceps were assessed at 60°/sec and 180°/sec. Strength ratios were calculated for both positions.
Results: Intraclass Correlation Coefficient (ICC) values demonstrated good to excellent reliability for peak torque measurements, with higher reliability in the standardized position (ICC 0.83-0.94) than in the lengthened position (ICC 0.79-0.96). Conventional and functional ratios varied, with lower ICCs for the right leg in the standardized position (ICC 0.32-0.92) and moderate to good reliability in the lengthened position (ICC 0.63-0.87).
Conclusion: Standardized and lengthened positions provide reliable assessments of absolute and relative peak torque for hamstring and quadriceps muscles during concentric and eccentric contractions across all speeds, including conventional and functional strength ratios.
- Perkins S, Canavan P. Isokinetic assessment of knee flexor and extensor strength and lower extremity flexibility assessment of an NCAA Division III men’s soccer team. Int J Sports Phys Ther [Internet]. 2023;V18(3):626–35. Available from: http://dx.doi.org/10.26603/001c.74971
- Baumgart C, Kurz E, Freiwald J, Hoppe MW. Effects of hip flexion on knee extension and flexion isokinetic angle-specific torques and HQ-ratios. Sports Med Open [Internet]. 2021;7(1):41. Available from: http://dx.doi.org/10.1186/s40798-021-00330-w
- Pincivero DM, Lephart SM, Karunakara RA. Reliability and precision of isokinetic strength and muscular endurance for the quadriceps and hamstrings. Int J Sports Med [Internet]. 1997;18(2):113–7. Available from: http://dx.doi.org/10.1055/s-2007-972605
- Toonstra J, Mattacola CG. Test-retest reliability and validity of isometric knee-flexion and -extension measurement using 3 methods of assessing muscle strength. J Sport Rehabil [Internet]. 2013;22(1). Available from: http://dx.doi.org/10.1123/jsr.2013.tr7
- Parraca JA, Adsuar JC, Domínguez-Muñoz FJ, Barrios-Fernandez S, Tomas-Carus P. Test-retest reliability of isokinetic strength measurements in lower limbs in elderly. Biology (Basel) [Internet]. 2022;11(6):802. Available from: http://dx.doi.org/10.3390/biology11060802
- Yeung SS, Suen AM, Yeung EW. A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor. Br. J. Sports Med. 2009 Aug 1;43(8):589-94.
- Van Dyk N, Bahr R, Whiteley R, Tol JL, Kumar BD, Hamilton B, Farooq A, Witvrouw E. Hamstring and quadriceps isokinetic strength deficits are weak risk factors for hamstring strain injuries: a 4-year cohort study. Am. J. Sports Med. 2016 Jul;44(7):1789-95.
- Croisier JL, Forthomme B, Namurois MH, Vanderthommen M, Crielaard JM. Hamstring muscle strain recurrence and strength performance disorders. Am. J. of Sports Med. 2002 Mar;30(2):199-203.
- Sugiura Y, Saito T, Sakuraba K, Sakuma K, Suzuki E. Strength deficits identified with concentric action of the hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters. J. Orthop. Sports Phys. Ther. 2008 Aug;38(8):457-64.
- Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am. J. Sports Med. 2008 Aug;36(8):1469-75.
- Green B, Bourne MN, Pizzari T. Isokinetic strength assessment offers limited predictive validity for detecting risk of future hamstring strain in sport: a systematic review and meta-analysis. Br. J. Sports Med. 2018 Mar 1;52(5):329-36.
- Green B, Bourne MN, Van Dyk N, Pizzari T. Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport. Br. J. Sports Med. 2020 Sep 1;54(18):1081-8.
- Correia P, Santos P, Mil-Homens P, Gomes M, Dias A, Valamatos MJ. Rapid hamstrings to quadriceps ratio at long muscle lengths in professional football players with previous hamstring strain injury. EJSS (Champaign) [Internet]. 2020;20(10):1405–13. Available from: http://dx.doi.org/10.1080/17461391.2020.1714741
- Nara G, Samukawa M, Oba K, Koshino Y, Ishida T, Kasahara S, et al. The deficits of isometric knee flexor strength in lengthened hamstring position after hamstring strain injury. Phys Ther Sport [Internet]. 2022;53:91–6. Available from: https://doi.org/10.1016/j.ptsp.2021.11.011
- Arifin WN, Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MALAYSIA. A web-based sample size calculator for reliability studies. Educ Med J [Internet]. 2018;10(3):67–76. Available from: http://dx.doi.org/10.21315/eimj2018.10.3.8
- Feiring DC, Ellenbecker TS, Derscheid GL. Test-retest reliability of the biodex isokinetic dynamometer. J Orthop Sports Phys Ther [Internet]. 1990;11(7):298–300. Available from: http://dx.doi.org/10.2519/jospt.1990.11.7.298
- Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med [Internet]. 2016;15(2):155–63. Available from: http://dx.doi.org/10.1016/j.jcm.2016.02.012
- Impellizzeri FM, Bizzini M, Rampinini E, Cereda F, Maffiuletti NA. Reliability of isokinetic strength imbalance ratios measured using the Cybex NORM dynamometer. Clin Physiol Funct Imaging [Internet]. 2008;28(2):113–9. Available from: http://dx.doi.org/10.1111/j.1475-097X.2007.00786.x
Articles related to the one you are viewing
There are currently no results to show, please try again later
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0
International License, which permits use, share — copy and redistribute the material in any medium or format,
adapt — remix, transform, and build upon the material, as long as you give appropriate credit,
provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner,
but not in any way that suggests the licensor endorses you or your use. You may not use the material for
commercial purposes. If you remix, transform, or build upon the material, you must distribute your
contributions under the same license as the original. You may not apply legal terms or technological
measures that legally restrict others from doing anything the license permits. The images or other
third party material in this article are included in the article’s Creative Commons license, unless indicated
otherwise in a credit line to the material. If material is not included in the article’s Creative Commons
license and your intended use is not permitted by statutory regulation or exceeds the permitted use,
you will need to obtain permission directly from the copyright holder. To view a copy of this license,
visit https://creativecommons.org/licenses/by-nc-sa/4.0/.