Closed kinetic chain exercise has become popular in rehabilitation of the ACL patient. While many clinicians agree on the benefits of closed kinetic chain exercise, there is great discrepancy as to which exercises fit this category. This discrepancy stems from the fact that the kinetic chain concept was originally developed using mechanical engineering concepts and not human kinesiology. In this paper, the kinetic chain concept is redefined in a continuum of lower extremity exercises from closed kinetic chain to open kinetic chain. The placement of an exercise in this continuum is based upon joint kinematics, quadriceps and hamstring muscle activity, cruciate ligament stress, and joint weight-bearing load. An understanding of these factors can help the clinician design a comprehensive and effective rehabilitation program for the ACL patient.
K.E. Wilk is with HealthSouth Rehabilitation, 1201 11 th Ave. South, #100, Birmingham, AL 35205. N. Zheng and G.S. Fleisig are with the American Sports Medicine Institute, Birmingham, AL 35205. J.R. Andrews and W.G. Clancy are with the Alabama Orthopaedic and Sports Medicine Center, Birmingham, AL 35205.