Transcript Chapter 12: Open- vs. Closed

Kinetic Chain Exercises
Open vs. Closed
Kinetic Chain
Mazyad Alotaibi
Definition: In rehabilitation settings such as
sports and physical therapy clinics, the body is
often viewed as functioning in interconnected
segments, for example, the arm, shoulder, and
the spine. The theory behind this is that
movement of one part affects the others via a
chain reaction.
Kinetic chain were used to describe how forces
occur during human motion and how segments
(structures) of the body are linked
together.
Types: there are two types of kinetic chain exercises: Open (OKC) and Closed
(CKC).
Closed Kinetic Chain Exercise (CKC): (such as squatting) involve weight
bearing
 Distal segment is fixed or stabilized relative to proximal segment
 Used more often in rehabilitation for lower extremity conditions
 In closed kinetic chain exercises, movement at one joint produces
predictable movements at all other joints. Weight bearing closed kinetic
chain activities may increase joint compressive force and thus enhance joint
stability.
Open Kinetic Chain Exercise (OKC): (such as active flexion-extension) of
the leg do not involve weight bearing .
 Distal segment is mobile and not fixed
 In contrast, open kinetic chain exercises use isolated joint and muscle
function and the motion is uni-planer.
Closed kinetic chain exercises (CKCE): These are physical exercises
performed where the hand (for arm exercises) or foot (for leg exercises) is fixed
and cannot move. The hand/foot remains in constant contact with the surface,
usually the ground or the base of a machine. These exercises are typically
weight-bearing exercises, where an exerciser uses their own body weight and/
or external weight. Arm CKCE include pushups and handstand pushups. Leg
CKCE include back squat, front squat, leg press.
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Closed kinetic chain exercise could be used after anterior cruciate ligament
(ACL) reconstructive surgery. Closed kinetic chain exercises appear to have
gained popularity over more traditionally used open kinetic chain exercises
because many clinicians believe that CKC exercises are safer and more
functional.
Technique:
Open kinetic chain exercises (OKCE): These exercises are
performed typically where the hand or foot is free to move. These
exercises are typically non-weight bearing, with the movement
occurring at the elbow or knee joint. If there is any weight applied
it is to the distal (away from the point of attachment or origin)
portion of the limb. Arm OKCE include the bench press and leg
OKCE include knee extensions and straight leg raises. OKCE for
legs concentrate on a strong quadriceps contraction, which will
strengthen the quadriceps and restore quadriceps power output.
Muscle Action in the Kinetic Chain
Muscle actions that occur during open kinetic chain
activities are often reversed during closed chain drills
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Open chain – muscle origin is fixed with insertion moving
Closed chain – muscle insertion segment is fixed and muscle
work to move origin
Advantages of Open vs. CKC Exercises
Closed Chain Exercises
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Increase joint compressive forces
Increase joint stability
Decrease shear forces
Decrease acceleration forces
Stimulation of proprioceptors
Enhanced dynamic stability
More safer and produce less threatening forces
Co-activation and co-contraction
Functional and very sports specific
Open Kinetic Chain Exercises
 OKC activities are used primarily to develop muscular strength
 Increased acceleration forces
 Decreased resistance forces
 Increased distraction and rotational forces
 Increased deformation of joint and muscle mechanoreceptors
 Promotes functional activity
 Often isolated to single joint motion
Using CKC Exercises to Regain
Neuromuscular Control
Functional
weight-bearing
activity
requires
coordinated muscle and joint function
Lack of normal motion due to injury disrupts
movement on multiple levels
Closed chain activities requires integrated action of
all segments – facilitates proprioception and joint
position sense
Closed Kinetic Chain Exercises for
the Lower Extremity
Better
understanding
of
kinesiology
and
biomechanics has allowed for increased and earlier
use in rehabilitation
Alteration in rehabilitation techniques and shift in
protocols
Number of lower extremity exercises available
Leg Press
Decreases strain on low back, provides stability
and takes advantage of kinetic chain
Allows for
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Training more or less than body weight
Training legs independently
Stair Climbing
Useful for cardiovascular fitness and as OKC unit
Functions, biomechanicaly, similar to leg press
Maintain erect body position to maximize hamstring
recruitment
Elicits increased quadriceps EMG compared to hamstrings
Step-Ups
Can be performed forward, backward and laterally
Encourages movement of full body weight
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Stair climber maintains CoG at constant height
Use caution when anterior shear forces are a concern
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Lateral step-up results in high levels of shear
Hamstring activity not significant enough to neutralize forces
Ideal for quadriceps strengthening
Stationary Bicycling
Amount of weight bearing force exerted can be adapted
based on athlete’s limitations
Seat height must be adjusted to minimize knee flexion
moment
Seat can also be adjusted for ROM activities
Biomechanics of Open vs. CKC
Activities in the Upper Extremity
CKC exercise should also be incorporated into upper
extremity rehabilitation
Upper extremity generally operates as an open kinetic
chain
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High velocity, dynamic movements
Proximal segments serve stabilization role while distal
segments exhibit high degree of mobility
CKC activities for Upper limb include
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Push-ups, chin-ups, handstands
Combination activities
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Swimming and cross country skiing
CKC generally used in upper extremity to strength and
develop neuromuscular control in stabilizing
musculature
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Allows them to function as a stable base more effectively
during dynamic movements of distal segments
Shoulder Complex Joint
CKC exercises can promote and enhance joint stability
Enhances force couples
Function of scapula stabilizers
Elbow
Elbow is highly involved in open kinetic chain
activities
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Propels objects at rapid velocities with accuracy
When hitting, it must possess static stability and
dynamic strength
Swimming require it to produce power, and stability
Gymnastics and wrestling rely on it as both an open and
closed kinetic link for both stability and propulsion
CKC Exercises for the Upper
Extremity
Used to train co-contractions in the shoulder early in the
rehabilitation phase
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Enhance stability and decrease shutdown of rotator cuff
secondary to pain
Can be utilized in later stages for endurance of
glenohumeral and scapulothoracic musculature
OKC exercises should also be incorporated particularly
during middle phase of shoulder rehabilitation
For the elbow, CKC exercises assist in enhanced
muscular balance and neuromuscular control of
surrounding musculature
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Improve dynamic stability of proximal muscles
OKC exercises are essential for regaining strength
necessary for high velocity dynamic movements
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Throwing activities
Weight Shifting
Variety of exercises available that facilitate dynamic stability
through axial compression
Can be performed in a series of positions on varying surfaces
Degrees of body weight can also be altered
Shifting can occur in multiple directions
Alterations in base of support
PNF patterns can be incorporated
Rhythmic stabilization