Edited by Kevin E. Wilk
James R. Andrews, James M. Dennison and Kevin E. Wilk
Most physicians, trainers, and therapists are accustomed to thinking of open and closed kinetic chain terminology in terms of exercise and its application in rehabilitation protocols. This terminology can also be used to describe the mechanism by which injuries occur. Categorizing upper extremity injuries in this way not only provides vital insight into the mechanism of the injuries and helps identify possible injured structures but also allows the clinician to better develop treatment protocols. In this article, this categorization is applied to common shoulder and elbow injuries to provide insight into the nature of these injuries.
Kevin E. Wilk, Christopher A. Arrigo and James R. Andrews
The use of closed kinetic chain exercise has grown in the past several years. Closed kinetic chain exercises for the lower extremity have been firmly established in the literature and have been strongly recommended as an integral part of rehabilitation of the patient with anterior cruciate ligament injury. While the scientific and clinical rationale for using closed kinetic chain exercise for the lower extremity appears obvious, the scientific rationale for using closed kinetic chain exercise for the upper extremity is less clear. The purpose of this manuscript is to discuss the scientific rationale for closed kinetic chain for the upper extremity patient. In addition, exercise drills to enhance dynamic stability of the glenohumeral joint are discussed, and a rationale for using these exercises for specific glenohumeral joint pathologies is provided. The concepts of closed and open kinetic chain as applied to the lower extremity may not apply to the upper extremity due to the unique anatomical and biomechanical features as well as the function of the shoulder. It is recommended that clinicians use both closed kinetic chain and open kinetic chain exercises when treating the shoulder patient.
Michael M. Reinold, Casey C. Carter and Kevin E. Wilk
Kevin E. Wilk, Naiquan Zheng, Glenn S. Fleisig, James R. Andrews and William G. Clancy
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.
Michael M. Reinold, Glenn S. Fleisig, James R. Andrews, Kevin E. Wilk and Gene G. Jameson
Kevin E. Wilk, James R. Andrews, William G. Clancy Jr., Heber C. Crockett and James W. O'Mara Jr.
Treatment of posterior cruciate ligament (PCL) injuries has changed considerably in recent years. This article discusses current rehabilitation for PCL disruptions in athletes. The treatment of PCL injuries varies somewhat based on the chronicity (acute vs. chronic) of injury and associated pathologies. The authors provide their treatment algorithm for the acute and chronic PCL-injured-knee patient. Nonoperative rehabilitation is discussed with a focus on immediate motion, quadriceps muscle strengthening, and functional rehabilitation. A discussion of the biomechanics of exercise is provided, with a focus on tibiofemoral shear forces and PCL strains. Surgical treatment is also discussed, with the current surgical approach being either the two-tunnel or the one-tunnel patellar tendon autograft procedure. The rehabilitation program after surgery is based on the healing constraints, surgical technique, biomechanics of the PCL during functional activities, and exercise. With the new changes in surgical technique and in the rehabilitation process, the authors believe that the outcome after PCL reconstruction will be enhanced.