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Open-Versus Closed-Kinetic Chain Exercise in Rehabilitation Rehabilitation Techniques for Sports Medicine and Athletic Training William E. Prentice.

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Presentation on theme: "Open-Versus Closed-Kinetic Chain Exercise in Rehabilitation Rehabilitation Techniques for Sports Medicine and Athletic Training William E. Prentice."— Presentation transcript:

1 Open-Versus Closed-Kinetic Chain Exercise in Rehabilitation Rehabilitation Techniques for Sports Medicine and Athletic Training William E. Prentice

2 Introduction Closed Kinetic Chain (CKC): effective technique of rehabilitation Closed Kinetic Chain (CKC): effective technique of rehabilitation Particularly with injuries involving the lower extremity Particularly with injuries involving the lower extremity Ankle, knee and hip constitute the kinetic chain of 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 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 Will involve fixed joints with mobile joints in between

3 Introduction Open Kinetic Chain (OKC): distal segment is mobile or not fixed Open Kinetic Chain (OKC): distal segment is mobile or not fixed Isolated joint exercise. i.e.. Seated leg extension Isolated joint exercise. i.e.. Seated leg extension Most Upper extremity movements in sports are open chain with the hand moving freely Most Upper extremity movements in sports are open chain with the hand moving freely

4 Concept of Kinetic Chain Closed Link system: each moving body segment receives force from and transfers force to, adjacent body segments 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 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. 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 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 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. Functional action that cannot be reproduced during isolated OKC ex.

5 Advantages and Disadvantages of OKC vs. CKC Exercises Choice to use one or the other depends on desired treatment goal Choice to use one or the other depends on desired treatment goal Characteristics of CKC: Characteristics of CKC: Increased joint compressive forces Increased joint compressive forces Increased joint congruency (stability) Increased joint congruency (stability) Decreased shear forces Decreased shear forces Decreased acceleration forces Decreased acceleration forces Stimulation of proprioceptors Stimulation of proprioceptors Large resistance forces Large resistance forces Enhanced dynamic stability Enhanced dynamic stability

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

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

8 Advantages and Disadvantages of OKC vs. CKC Exercises Biomechanical Perspective Biomechanical Perspective OKC: isolated to single joint OKC: isolated to single joint Beneficial to improve strength and increase ROM at specific 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 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 Loss of ROM, pain or swelling may not allow athlete to perform CKC exercises

9 CKC to regain NM Control Coordinated movement is controlled by CNS that that integrates input from joint and muscle mechanoreceptors acting within kinetic chain 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 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 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 Reestablish joint position sense and proprioception through facilitation of proprioceptive feedback

10 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 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) Foot shock absorber and force producer through normal ambulation (gait) OKC exercises produce a lot of shear force on tibiofemoral (knee) joint OKC exercises produce a lot of shear force on tibiofemoral (knee) joint Co-contraction of hamstring or CKC exercises reduces shear force Co-contraction of hamstring or CKC exercises reduces shear force OKC exercises produce a lot of compressive forces on PTF joint OKC exercises produce a lot of compressive forces on PTF joint CKC exercises decreases contact stress by increasing contact area on femur CKC exercises decreases contact stress by increasing contact area on femur

11 CKC Exercises for LE Mini squats Mini squats Wall slides Wall slides Lunges Lunges Step ups Step ups Fwd. & Lateral Fwd. & Lateral Leg Press Leg Press Stationary Bicycle Stationary Bicycle TKE Trampoline BAPS Sideboard

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

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

14 OKC vs. CKC in Upper Extremity OKC Exercises in UE: OKC Exercises in UE: Essential to regain high velocity dynamic movement of shoulder, elbow, wrist and hand 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 CKC and OKC should both be used in rehab to stabilize and build muscular strength and endurance in upper extremity

15 OKC vs. CKC in Upper Extremity Weight shifting Weight shifting Standing, quadruped, tripod, stable, unstable and movable surfaces Standing, quadruped, tripod, stable, unstable and movable surfaces Push ups Push ups Press ups Press ups Step ups Step ups Slideboard Push up with rotation

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

17 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 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 Each movement learned and reinforced through repetition Holistic, integrating sensory, motor, and psychological aspects of rehabilitation Holistic, integrating sensory, motor, and psychological aspects of rehabilitation Incorporates reflex activities from spinal level and upward, either inhibiting or facilitating them as appropriate Incorporates reflex activities from spinal level and upward, either inhibiting or facilitating them as appropriate

18 Basic Principles of PNF Patient taught patterns from starting to terminal position Patient taught patterns from starting to terminal position Verbal and physical cues, brief and simple Verbal and physical cues, brief and simple Patient watches moving limb for visual feedback for directional and positional control Patient watches moving limb for visual feedback for directional and positional control Manual contact with appropriate pressure is essential Manual contact with appropriate pressure is essential Firm and confident Firm and confident Manner in which AT touches patient will facilitate movement Manner in which AT touches patient will facilitate movement Proper body position and mechanics of AT in line with movement patterns Proper body position and mechanics of AT in line with movement patterns Amount of resistance should facilitate maximal response and smooth coordinated movement Amount of resistance should facilitate maximal response and smooth coordinated movement

19 Basic Principles of PNF Rotational movement is critical component because maximal contraction is impossible without it Rotational movement is critical component because maximal contraction is impossible without it Distal movement occurs first: Distal movement occurs first: Quick stretch before muscle contractions facilitates a muscle to respond with greater force Quick stretch before muscle contractions facilitates a muscle to respond with greater force

20 Basic strengthening techniques Rhythmic initiation Rhythmic initiation Repeated contraction Repeated contraction Slow reversal Slow reversal Slow reversal hold Slow reversal hold Rhythmic stabilization Rhythmic stabilization

21 PNF patterns Human movement rarely involves straight motion because all muscles are spiral in nature and lie in diagonal directions 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 PNF patterns are diagonal and rotational movements Three components Three components Flexion-extension Flexion-extension Abduction-adduction Abduction-adduction Internal rotation-external rotation Internal rotation-external rotation

22 PNF Patterns Figures 14-1 and in text Figures 14-1 and in text Rule of 30’s Rule of 30’s


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