1. Julio A. Martinez-Silvestrini, MD Board Certified, Sports Medicine Associate Clinical Professor Tufts School of Medicine Boston, MA Medical Director Baystate Physical Medicine and Rehabilitation Springfield, MA @JulioMartinezMD

2. None @JulioMartinezMD

3. Goals Define the “kinetic chain” as a concept Discuss the role of kinetic chain dysfunction as a risk to develop shoulder injuries Evaluation for the kinetic chain in the throwing athlete @JulioMartinezMD

4. The Kinetic Chain The concept originated in 1875 Franz Reuleaux, Mechanical Engineer Overlapping segments connected would create a system that allows the movement of one joint to affect the movement of another joint. @JulioMartinezMD

5. The Kinetic Chain Dr. Arthur Steindler applied the concept to human movements in 1955. The foot bone's connected to the leg bone. The leg bone's connected to the knee bone. The knee bone's connected to the thigh bone. Doing the skeleton dance. - The Skeleton Song (Dem Bones) 1800’s @JulioMartinezMD

6. Thoracolumbar fascia Transitional area which transfer forces between the lower extremity and the upper extremity. Possible role in stability and spine proprioception. Attachments to the anterior surface of the quadratus lumborum, transversus abdominis and muscles from the thoracolumbosacral region, erector spinae and gluteus maximus. @JulioMartinezMD

7. Pectoralis Core Hip extensors Hip flexors Ankle plantarflexors @JulioMartinezMD

8. Kinetic Chain elements evaluation @JulioMartinezMD

9. Core stability @JulioMartinezMD

10. Hip flexors flexibility @JulioMartinezMD

11. Hip abductors strength @JulioMartinezMD

12. Functional evaluation Assessment of single leg balance Core proprioception Endurance @JulioMartinezMD

14. Prevention Periscapular and gluteal musculature strengthening Core stability Shoulder and pelvic girdle flexibility Proprioceptive training Upper and lower extremities Appropriate body mechanics and adequate posture @JulioMartinezMD

15. Proprioception @JulioMartinezMD

17. References Bell DR, et al. Systematic Review of the Balance Error Scoring System. Sports Health: A Multidisciplinary Approach May 2011 3:287-295 Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part I: pathonantomy and biomechanics. Arthroscopy. 2003;404-420. Cavallo J, Speer KP. Shoulder instability and impingement in throwing athletes. Med Sci Sports Med. 1998;30(4):S18-25. De Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: A meta-analysis.Am J. Roentgenology. 2009;92(6):1701-1707. Dillman CJ, Fleisig GS, Andrews JR. Biomechanics of pitching with emphasis upon shoulder kinematics. J Orthop Sports Phys Ther. 1993;18:402-408. Jobe FW, Kvnite RS. Shoulder pain in the overhand or throwing athlete: The relationship of anterior instability and rotator cuff impingement. Orthop Review.1989;963-975. Kinesiology of the human body under normal and pathological conditions. Arthur Steindler, M.D., (Hon.) F.R.C.S. Eng., F.A.C.S., F.I.C.S. Springfield, Illinois, Charles C. Thomas, 1955 Martinez-Silvestrini, JA, Micheo W. Shoulder pain in the throwing athlete. PM&R Knowledge Now. http://now.aapmr.org/msk/disorders-upper-limb/Pages/Shoulder-pain-in-the-throwing-athlete.aspx. Electronic Publication. December 2012. Reuleaux, Franz, and Alex B.W. Kennedy (ed.), and Alex B.W. Kennedy (trans.). Kinematics of Machinery : Outlines of a Theory of Machines. London: Macmillan and Co., 1876 Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports Phys Ther. 1993;18:365-378. Zaremski JL, Krabak BJ. Shoulder injuries in the skeletally immature baseball pitcher and recommendations for the prevention of injury. PM&R. 2012;4:509-517. @JulioMartinezMD