What is your Grip Strength? (And why it matters)

Grip Strength Reading of an Experienced Female Bovine Practitioner on a Digital Hand Dynamometer

Bovine pregnancy diagnosis by rectal palpation remains a critical skill for bovine practitioners to master upon graduation, or as soon as possible thereafter. Although there are other methods for pregnancy diagnosis in cattle available (Biopryn, Milk Progesterone to name a few), the method of choice by most vets and farmers remains to obtain a diagnosis of pregnancy (or non-pregnancy) by rectal palpation using transrectal ultrasound. Although the beef side of practice has mainly gone to hands-free ultrasound diagnosis at a later stage of pregnancy, vets are still tasked with diagnosing pregnancy in dairy cattle at an earlier stage of gestation (typically starting at 28-32 days post-insemination). To identify an embryo in the uterus at this stage of gestation, the uterus must be fully retracted in order to effectively and systematically scan the entirety of both uterine horns.

Veterinary students receive formal training on the "how-to" of pregnancy diagnosis by rectal palpation, and they do this well once they know the in-situ anatomy of the bovine reproductive tract and the systematic process to perform a retraction and palpation. They also practice this skill on simulators. There is, however, a very steep learning curve to perform this task on live animals once you add in the real-life "squeezing" (anal tone, peristalsis, fecal output) that you must work through to perform the retraction, in particular. When mentoring vet students and new graduates in the field to further master their palpation skills, they likely easily pick up palpation (the act of feeling one of the positive signs of pregnancy, such as the vesicle, the fetus, or a fetal membrane slip) if an experienced vet retracts the uterus for them first, but they struggle to retract the uterus, or "uncurl" it from its normal state to be able to palpate a pregnancy.

I always tell veterinary students "Palpation is easy. Retraction is hard".

My previous solution to get through this challenge of retraction was to simply tell students and new graduates to get their arm in as many cows as possible and just struggle through the process. After all, that is what we all did as new vets, and eventually you get there once you have enough palpations under your belt. But not without, at times, and for many, a significant struggle that can not only cause fatigue and muscle pain, but can also be incredibly discouraging. The number of cows it "takes" to master this skill is to the tune of "hundreds" or more likely "thousands".

While I still advocate for students to get their arms in as many cows as possible to master the skill, I have since become enlightened by a study published in 2021 by the veterinary faculty at the University of Pretoria, South Africa, where they investigated what factors improve veterinary students' bovine pregnancy diagnosis accuracy. I will post a link to the study below, but in a nut shell, after looking at a number of factors, higher hand grip strength was associated with higher pregnancy diagnosis accuracy. To be specific, a hand grip strength of >30 Kg was associated with higher pregnancy diagnosis specificity.

Although this study nicely identified and quantified the importance of hand grip strength, I said to myself "of course it is!" That totally makes sense when I reflect on what happens to your forearm physique as you palpate and continue to palpate an insane amount of cows. That improvement in grip strength just naturally happens as you struggle through the process (without hitting the gym to specifically target these muscle groups). It also made sense in terms of what I have observed over the years with male versus female students and their initial progress. Men tend to have a grip strength over 30 Kg on average, while women tend to have less than 30 Kg. Male students and strong women have an easier time out of the gate with this task, and hence, are much less likely to become overwhelmingly discouraged.

But what if we can help veterinary students that want to pursue bovine practice by emphasizing the importance of hand grip strength earlier in vet school? Given that our student body is >80% women, this seems of particular importance. In this, I have found a new mission. I now introduce the importance of developing hand grip strength starting in our first year bovine reproduction clinical skills lab, and continue to emphasize this as students come up through the years. At a recent 4th year rotation I taught, students had the opportunity to test their grip strength, and we talked about exercises to specifically target forearm and grip strength. My new mantra is "get to 30 (Kg), but aim for 40".

For those looking to improve grip strength in preparation for a career in bovine practice, there are a multitude of resources online directing you to useful exercises. Of course, working with a personal trainer would be an excellent way to go too. In general, fitness and strength of your entire body is helpful to reduce chronic injury in bovine practice, so why not add a few more forearm exercises while you are at it.

When I think of all the things we use grip strength for in cattle practice, it goes well beyond palpation. Some things that come to mind are correction of dystocias, gripping the uterus during a C-section, pushing in prolapses, and general large animal handling. The benefits of improving, and maintaining grip strength are many.

Annandale et al. 2021. JVME 48 (2) Influence of an Exercise Program, Muscle Strength, Proprioception, and Arm Length on Veterinary Students’ Bovine Pregnancy Diagnosis Accuracy