Fig. 2

Positions used to evaluate muscle strength of upper and lower extremities. Muscles strength were evaluated in newton (N). In supine position, we evaluated elbow flexor, elbow extensor, wrist extensor, ankle dorsiflexor and ankle plantar flexor muscles. Participant lied in supine position with arm beside their trunk, elbow flexed at 90°, and wrist in neutral position. Dynamometer were placed on anterior forearm, proximal to wrist joint, to assess elbow flexor and on the posterior forearm to assess elbow extensor. For wrist extensor muscle, participants remained in supine position with arm beside trunk, elbow extend with forearm in pronation and wrist in neutral position. Dynamometer were placed at posterior aspect of hand, proximal to metacarpophalangeal joints. For ankle dorsiflexor and plantar flexor muscles, participants were instructed to lied in supine position with hip and knee full extension and ankle in neutral position. Dynamometer were placed at posterior or anterior aspect of foot, proximal to metatarsophalangeal joints to assess ankle dorsiflexor and ankle plantar flexor muscles, respectively. In sitting position, we evaluated hip flexor, knee extensor, and knee flexor muscles. Participants were instructed to sit with hip and knee flexion at 90°. Dynamometer was placed over anterior thigh, proximal to knee joint, to evaluate hip flexor muscle. For knee flexor and extensor muscles, participants were instructed to remained in sitting position. Dynamometer was placed over the anterior or posterior aspect of leg, proximal to the ankle joint, to evaluate knee extensor and knee flexor muscles, respectively