Kinetic Chain Exercise: Implications for the Anterior Cruciate Ligament Patient

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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Closed and Open Kinetic Chain Exercise for the Upper Extremity

Journal of Sport Rehabilitation ◽

10.1123/jsr.5.1.88 ◽

1996 ◽

Vol 5 (1) ◽

pp. 88-102 ◽

Cited By ~ 48

Author(s):

Kevin E. Wilk ◽

Christopher A. Arrigo ◽

James R. Andrews

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

Glenohumeral Joint ◽

Cruciate Ligament ◽

Ligament Injury ◽

Kinetic Chain ◽

Open Kinetic Chain ◽

Closed Kinetic Chain ◽

Anterior Cruciate ◽

Scientific Rationale

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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Open versus Closed Kinetic Chain Exercises following an Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Journal of Sports Medicine ◽

10.1155/2017/4721548 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Daniel Jewiss ◽

Cecilia Ostman ◽

Neil Smart

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Meta Analysis ◽

Kinetic Chain ◽

Randomized Controlled ◽

Open Kinetic Chain ◽

Closed Kinetic Chain ◽

Anterior Cruciate ◽

Open Versus

Background. There is no consensus on whether closed kinetic chain (CKC) or open kinetic chain (OKC) exercises should be the intervention of choice following an anterior cruciate ligament (ACL) injury or reconstruction. Methods. A systematic search identified randomized controlled trials of OKC versus CKC exercise training in people who had undergone ACL reconstructive surgery. All published studies in this systematic review were comparisons between OKC and CKC groups. Results. Seven studies were included. Lysholm knee scoring scale was not significantly different between OKC and CKC exercise patients: MD: −1.03%; CI: −13.02, 10.95; p value = 0.87 (Chi2 = 0.18, df = 1, and p value = 0.67). Hughston clinic questionnaire scores were not significantly different between OKC and CKC exercise patients: MD: −1.29% (−12.02, 9.43); p value = 0.81 (Chi2 = 0.01, df = 1, and p value = 0.93). Conclusions. While OKC and CKC may be beneficial during ACL surgical rehabilitation, there is insufficient evidence to suggest that either one is superior to the other.

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Comparison of closed and open kinetic chain exercise in the anterior cruciate ligament-deficient knee

The American Journal of Sports Medicine ◽

10.1177/036354659302100109 ◽

1993 ◽

Vol 21 (1) ◽

pp. 49-54 ◽

Cited By ~ 136

Author(s):

H. John Yack ◽

Cynthia E. Collins ◽

Terry J. Whieldon

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Kinetic Chain ◽

Open Kinetic Chain ◽

Anterior Cruciate ◽

Deficient Knee ◽

Anterior Cruciate Ligament Deficient

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Effects of Distally Fixated Versus Nondistally Fixated Leg Extensor Resistance Training on Knee Pain in the Early Period After Anterior Cruciate Ligament Reconstruction

Physical Therapy ◽

10.1093/ptj/82.1.35 ◽

2002 ◽

Vol 82 (1) ◽

pp. 35-43 ◽

Cited By ~ 37

Author(s):

Matthew C Morrissey ◽

Wendy I Drechsler ◽

Dylan Morrissey ◽

Philippa R Knight ◽

Paul W Armstrong ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Resistance Training ◽

Acl Reconstruction ◽

Knee Pain ◽

Cruciate Ligament ◽

Early Period ◽

Kinetic Chain ◽

Reconstruction Surgery ◽

Open Kinetic Chain ◽

Anterior Cruciate

Abstract Background and Purpose. Nondistally fixated (ie, what is often referred to as “open kinetic chain” [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called “closed kinetic chain” [CKC]) leg extensor training were compared for their effects on knee pain. Subjects. Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16–54). Methods. Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. Results. No differences in knee pain were found between the treatment groups. Discussion and Conclusion. Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.

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