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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.

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Natalia Romero-Franco, Juan Antonio Montaño-Munuera, Juan Carlos Fernández-Domínguez and Pedro Jiménez-Reyes

in closed kinetic chain (CKC). As then, the evaluation of JPS with inclinometer has been used to describe the effects of fatiguing exercise, such as repeated series of 300-meter springs, which demonstrated that higher proprioceptive errors are shown in CKC knee movement when athletes are fatigued. 11

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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.

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Susan B. Andersen, Donna M. Terwilliger and Craig R. Denegar

The purpose of this study was to determine if a difference exists in the reproducibility of knee joint flexion angles in an open versus a closed kinetic chain. Thirty generally healthy subjects (12 males, 18 females; mean age 23.8 years) participated. Subjects actively reproduced small, medium, and large knee flexion angles (with target angles of 15°, 45°, and 75°, respectively) in an open and a closed kinetic chain while being videotaped. Goniometric measurements were taken from the videotape of initial and reproduced joint angles. Data were analyzed using ANOVA with repeated measures on kinetic chain test position and joint angle. Subjects more accurately reproduced knee flexion angles in a closed kinetic chain position. The main effect for angle and the interaction of angle and test position were nonsignificant. The results indicate that knee joint position is more accurately reproduced in closed kinetic chain. Closed kinetic chain testing is also a more functional assessment of joint position sense, and thus closed kinetic chain assessment of lower extremity joint position sense is recommended.

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Lílian Ramiro Felicio, Marcelo Camargo Saad, Rogério Ferreira Liporaci, Augusto do Prado Baffa, Antônio Carlos dos Santos and Débora Bevilaqua-Grossi

Purpose:

To evaluate patellar kinematics of volunteers without knee pain at rest and during isometric contraction in open- and closed-kinetic-chain exercises.

Methods:

Twenty individuals took part in this study. All were submitted to magnetic resonance imaging (MRI) during rest and voluntary isometric contraction (VIC) in the open and closed kinetic chain at 15°, 30°, and 45° of knee flexion. Through MRI and using medical e-film software, the following measurements were evaluated: sulcus angle, patellar-tilt angle, and bisect offset. The mixed-effects linear model was used for comparison between knee positions, between rest and isometric contractions, and between the exercises.

Results:

Data analysis revealed that the sulcus angle decreased as knee flexion increased and revealed increases with isometric contractions in both the open and closed kinetic chain for all knee-flexion angles. The patellar-tilt angle decreased with isometric contractions in both the open and closed kinetic chain for every knee position. However, in the closed kinetic chain, patellar tilt increased significantly with the knee flexed at 15°. The bisect offset increased with the knee flexed at 15° during isometric contractions and decreased as knee flexion increased during both exercises.

Conclusion:

VIC in the last degrees of knee extension may compromise patellar dynamics. On the other hand, it is possible to favor patellar stability by performing muscle contractions with the knee flexed at 30° and 45° in either the open or closed kinetic chain.

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Lynn Snyder-Mackler

Closed kinetic chain exercise is a common component of lower extremity rehabilitation. It has virtually replaced open kinetic chain exercise in the treatment of some conditions. In this paper, anatomy and physiology as they relate to closed chain exercise are examined to elucidate its unique contributions to rehabilitation. Claims made about the specificity, functionality, and safety of closed kinetic chain exercise are discussed. Muscle action, the stretch–shortening cycle, joint position sense, and clinical cases are used to illustrate the distinct role of closed kinetic chain exercise in rehabilitation.

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Scott M. Lephart and Timothy J. Henry

The confusion between the terms open kinetic chain and closed kinetic chain becomes even greater with application to the upper extremity. Upper extremity function is very difficult to define, due to the numerous shoulder positions and the great velocities with which the shoulder can move. Classifying exercises for rehabilitation of the upper extremity is very difficult due to the complexity of the joint. Many definitions and classification systems have been proposed; however, none of these entirely encompass rehabilitation of the upper extremity. Using previous classifications we have developed a Functional Classification System that is designed to serve as a template for upper extremity rehabilitation. This system has been designed to restore functional shoulder stability, which is dependent upon proper scapulothoracic and glenohumeral stability, and humeral control; all of these are in part mediated by neuromuscular mechanisms. The objective of our new Functional Classification System is to restore functional stability of the shoulder by reestablishing neuromuscular control for overhead activities.

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Sue Hillman

The kinetic chain is open in the upper extremity skills used in most sports. Although closed chain exercises will increase stability, open chain strengthening is more sport specific. This article addresses general concepts of upper extremity rehabilitation, including exercises to restore normal range of motion, joint mechanics, and muscle strength. The roles of proprioceptive neuromuscular facilitation, plyometric training, and elastic band exercises are also discussed. Finally, a progression of specificity training is presented to return the athlete to successful sport performance.

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Jose E. Rivera

Closed kinetic chain and functional rehabilitation have lately received increased attention in the rehabilitation community. The purpose of this paper is to review biomechanical considerations applicable to the lower extremity, in a way that clearly justifies the use of functionally sound rehabilitation exercises. The origin of the kinetic chain concept is reviewed, and the differences in biomechanical events in the foot, ankle, and knee under open versus closed chain conditions are described. An analysis of these biomechanical events supports the notion that function results from the integration of muscles and joints to achieve desired outcomes. This leads to the conclusion that rehabilitation exercises, in order to be functional, must demand integration of muscular activity, must be of a closed kinetic chain nature, and must challenge the utilization of normal proprioceptive mechanisms. Guidelines for the practical application of these principles are clearly outlined, and examples of functional activities are described. Readers are encouraged to explore creative and challenging approaches to help clients achieve their highest level of function.

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Mary E. Ubinger, William E. Prentice and Kevin M. Guskiewicz

When the upper extremity is injured, open kinetic chain (OKC) exercises are primarily used to increase strength and restore functional ability—the goals of rehabilitation. It is also imperative, however, that the receptors responsible for static and dynamic stabilization of the joint be trained. This can be done with closed kinetic chain (CKC) exercises. The purposes of this study were to investigate the effect of a 4-week CKC training program on the neuromuscular control of the upper extremity and to determine whether there was a significant difference between skill-dominant limb and nondominant limb stability indices. Thirty-two physically active participants (14 men, 18 women) were tested on the FASTEX 4 weeks apart. The training group's scores significantly improved, whereas the control group's scores remained the same. It was concluded that the CKC training significantly improved the training group's ability to remain stable. The results suggest that CKC training can increase the accuracy of joint position sense because of increased stimulation of the mechanoreceptors.