Transcript Open-Versus Closed-Kinetic Chain Exercise in Rehabilitation

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
 Fwd. & Lateral
 Sideboard
 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 cocontraction 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
 Standing, quadruped, tripod,
stable, unstable and movable
surfaces
 Push ups
 Press ups
 Step ups
 Slideboard
 Push up with rotation
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
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 30’s