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
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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

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
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

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
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

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

12. 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

13. 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

14. 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

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

18. 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

19. 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

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

21. 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

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