Open-Versus Closed-Kinetic Chain Exercise in Rehabilitation Rehabilitation Techniques for Sports...
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Transcript of Open-Versus Closed-Kinetic Chain Exercise in Rehabilitation Rehabilitation Techniques for Sports...
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 Wall slides Lunges Step ups
Fwd. & Lateral Leg Press Stationary Bicycle
TKE Trampoline BAPS Sideboard
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 co-contraction 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