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Open-Versus Closed-

Kinetic Chain Exercise


in Rehabilitation

Rehabilitation Techniques for Sports Medicine and


Athletic Training
William E. Prentice
Introduction

Closed Kinetic Chain (CKC): effective technique of


rehabilitation
Particularly with injuries involving the lower extremity
Ankle, knee and hip constitute the kinetic chain of lower
extremity
When distal segment of lower extremity is fixed/stabilized or
weight bearing it is considered Closed
Will involve fixed joints with mobile joints in between
Introduction

Open Kinetic Chain (OKC): distal segment is mobile or not


fixed
Isolated joint exercise. i.e.. Seated leg extension
Most Upper extremity movements in sports are open chain
with the hand moving freely
Concept of Kinetic Chain

Closed Link system: each moving body segment receives force


from and transfers force to, adjacent body segments
Movement and one joint produce predictable movement at all other
joints
Muscle recruitment and joint movements are different than when
distal segment moves freely in OKC ex.
Concurrent shift: Concentric and eccentric contractions at opposite
ends of a muscle during CKC movement
For example: during squat to stand the hip and knee both extend and
the rectus femoris shortens at the distal end and lengthens at the
proximal end
Functional action that cannot be reproduced during isolated OKC ex.
Advantages and Disadvantages of OKC vs.
CKC Exercises

Choice to use one or the other depends on desired


treatment goal
Characteristics of CKC:
Increased joint compressive forces
Increased joint congruency (stability)
Decreased shear forces
Decreased acceleration forces
Stimulation of proprioceptors
Large resistance forces
Enhanced dynamic stability
Advantages and Disadvantages of OKC vs.
CKC Exercises

OKC characteristics:
Increased acceleration forces
Decreased resistance forces
Increased distraction and rotational forces
Increased deformation of joint and muscle mechanoreceptors
Greater shear forces
Great moment forces (1 joint in motion)
Isolation exercise use contraction of specific muscle or muscle
group that produces single plane or occasionally multiplanar
movement
Advantages and Disadvantages of OKC vs.
CKC Exercises

Biomechanical Perspective:
CKC : safer and produce stresses and forces that are
potentially less of a threat to healing structures
Co-contraction of agonist and antagonist must occur during
normal movements to provide joint stabilization
Decrease shear forces seen in OKC that may damage soft tissue
structures that are healing
Increase joint compressive forces will further enhance joint
stability
CKC more functional than OKC: most sport related activity and
activities of daily living involve CKC of lower extremity
Advantages and Disadvantages of OKC vs.
CKC Exercises

Biomechanical Perspective
OKC: isolated to single joint
Beneficial to improve strength and increase ROM at specific
joint
Correct strength deficits of specific muscles or joints and
beginning of rehabilitation when athlete not able to perform
CKC exercises
Loss of ROM, pain or swelling may not allow athlete to perform CKC
exercises
CKC to regain NM Control

Coordinated movement is controlled by CNS that that


integrates input from joint and muscle mechanoreceptors
acting within kinetic chain
CKC Exercises that act to integrate all of the functioning
elements would seem to be most appropriate
CKC recruit foot, ankle, knee and hip muscles that reproduce
normal loading and movement forces in all joints
Reestablish joint position sense and proprioception through
facilitation of proprioceptive feedback
CKC Exercises for LE
Biomechanically shock absorption, foot flexibility, foot
stabilization, acceleration and deceleration, multiplanar
movement and joint stabilization must occur in all joints of
LE for normal function to occur
Foot shock absorber and force producer through normal
ambulation (gait)
OKC exercises produce a lot of shear force on tibiofemoral
(knee) joint
Co-contraction of hamstring or CKC exercises reduces shear force
OKC exercises produce a lot of compressive forces on PTF joint
CKC exercises decreases contact stress by increasing contact area
on femur
CKC Exercises for LE

Mini squats TKE


Wall slides Trampoline
Lunges BAPS
Step ups Sideboard
Fwd. & Lateral
Leg Press
Stationary Bicycle
OKC vs. CKC in Upper Extremity

UE most functional as OKC system


Hand moves freely
Dynamic movement
High velocity
Proximal segment of UE used as stabilization as distal segments
have high degrees of mobility
OKC vs. CKC in Upper Extremity

CKC in UE:
Strengthening and neuromuscular control of shoulder girdle stabilizers
and core
Co-contraction and muscle recruitment in early stages of rehab to
prevent shutdown of rotator cuff
Scapular stabilizers and Rotator Cuff control movement about shoulder
Provide stabile base for more mobile and dynamic movements at distal end
Promote and enhance dynamic joint stability
Resistance axially or rotationally
Joint compression and approximation acts to enhance muscular co-
contraction about the joint producing dynamic stability
OKC vs. CKC in Upper Extremity

OKC Exercises in UE:


Essential to regain high velocity dynamic movement of
shoulder, elbow, wrist and hand

CKC and OKC should both be used in rehab to stabilize and build
muscular strength and endurance in upper extremity
OKC vs. CKC in Upper Extremity

Weight shifting Slideboard


Standing, quadruped, tripod, Push up with rotation
stable, unstable and movable
surfaces
Push ups
Press ups
Step ups
PNF Exercises for Strength and Endurance

Uses proprioceptive, cutaneous and auditory input to


produce functional movement
First used to treat patients with paralysis or other
neuromuscular disorders
Since 1970s used in rehabilitation to increase strength,
range of motion and flexibility
Used to decrease deficiencies in strength , flexibility, and
neuromuscular coordination in response to demands that are
placed on NM system
PNF Exercises for Strength and Endurance

Emphasis on selective re-education of individual motor


elements through development of NM control, joint
stability and coordinated mobility
Each movement learned and reinforced through repetition
Holistic, integrating sensory, motor, and psychological
aspects of rehabilitation
Incorporates reflex activities from spinal level and upward,
either inhibiting or facilitating them as appropriate
Basic Principles of PNF

Patient taught patterns from starting to terminal position

Verbal and physical cues, brief and simple

Patient watches moving limb for visual feedback for directional and
positional control
Manual contact with appropriate pressure is essential
Firm and confident
Manner in which AT touches patient will facilitate movement

Proper body position and mechanics of AT in line with movement patterns

Amount of resistance should facilitate maximal response and smooth


coordinated movement
Basic Principles of PNF

Rotational movement is critical component because


maximal contraction is impossible without it
Distal movement occurs first:

Quick stretch before muscle contractions facilitates a


muscle to respond with greater force
Basic strengthening techniques

Rhythmic initiation

Repeated contraction

Slow reversal

Slow reversal hold

Rhythmic stabilization
PNF patterns

Human movement rarely involves straight motion because


all muscles are spiral in nature and lie in diagonal
directions
PNF patterns are diagonal and rotational movements

Three components
Flexion-extension
Abduction-adduction
Internal rotation-external rotation
PNF Patterns

Figures 14-1 and 14-30 in text

Rule of 30s