Closed Kinetic Chain Exercise for Shoulder Rehab

The shoulder is a frequently injured area among athletes and the public. Pathologies like rotator cuff tears, subacromial impingement, and frozen shoulder can all be partially treated with exercise therapy. There are two basic types of exercises that can be used for rehabilitation: open-kinetic chain (OKC) or closed kinetic chain (CKC). Some things a rehab professional must know are, what is the kinetic chain, what is the difference between OKC exercises and CKC exercises, which is more effective at rehab, and some examples to design a progressive rehabilitation program.

The body does not function in individual segments but movement is instead linked together through a complex coordination of joint motions (Blazevich, 2010). This complex of joint movement is called the kinetic chain. A tennis serve is a good example of maximizing the kinetic chain. To serve the ball at maximal velocity, movement must be coordinated at the ankles, knees, hips, elbows, shoulders, and wrists. If a joint element is not optimal service velocity will be decreased.

The two main types of exercise are OKC and CKC. In an OKC exercise the distal segment of an extremity can freely move and is usually characterized by a rotary stress pattern on the joint, movement through one axis, single joint movement and more isolated muscle action (Karandikar & Vargas, 2011). An example of shoulder OKC exercise would be dumbbell external rotation. A CKC exercise is when the distal segment meets considerable external resistance that prohibits or restrains its free motion and it produces movement in surrounding joints in a predictable fashion. CKC exercises produce linear stress patterns, movement occurs at multiple joints and axes, simultaneous movement in both segments, and increased muscular co-contraction and stabilization (Karandikar & Vargas, 2011). An example of CKC for the shoulder would be a push-up.

CKC exercise are generally recommended for shoulder rehabilitation.

Kibler and Livingston (2001) explain that CKC exercise are preferable because they initiate joint movements from the ground or a base of support, emphasize sequential control of segment motion, place the segments in functionally correct positions, control the transfer of generated loads, and emphasize position-specific proprioceptive feedback to initiate and control activation. They are also generally safer than OKC exercises because they produce minimal translation, shear, and distraction forces due to the compressive nature of the applied load and the greater control of the resultant motions (Kibler & Livingston, 2001). OKCs do have some value as they can emphasize a specific joint and its musculature, but much of the exercise selection should consist of CKC exercises when rehabbing a shoulder injury.

CKC rehab exercises should involve the trunk and hip musculature as they provide stability and force generation which decreases load on the injured shoulder. Muscle activation patterns should begin proximal to the body and should include rotation around the trunk as to mimic athletic patterns. Smith (2006) recommends multiplanar exercises such as transverse medicine ball slams, planks with arm flexion and extension, wall walking, physio-ball walkouts, and deceleration work with resistance bands.

References

Blazevich, A. (2010). Sports biomechanics: The basics: Optimising human performance(2nd ed.). London: Bloomsbury.

Karandikar, N., & Vargas, O. O. (2011). Kinetic chains: A review of the concept and its clinical applications. Physical Medicine & Rehabilitation, 3(8), 739-745.

Kibler, W. B., & Livingston, B. (2001). Closed-chain rehabilitation for upper and lower extremities. Journal of the American Academy of Orthopaedic Surgeons, 9(6), 412-421.

Smith, D. M. (2006). Incorporating kinetic-chain integration, part 2: Functional shoulder rehabilitation. Athletic Therapy Today, 11(5), 63-65.