Chapter 15 Closed Kinetic Chain Training

1. Chapter 15Closed Kinetic Chain Training

2. Physiologic Principles of Closed Kinetic Chain (CKC) Training • Muscular factors • Biomechanical factors • Neurophysiologic factors

3. Muscular Factors • Stimulates muscular co-contractions – Enhancing stability in weight-bearing position. • Provides dynamic stabilization – Improved postural holding and support. • Contractions are generally eccentric followed by co-activation and concentric muscle function (e.g., stretch-shortening cycle [SSC]).

4. Muscular Factor – SSC • Combine speed and strength of contractions. • Involves rapid closing and opening of the kinetic chain. • Closed kinetic chain (CKC) activities that stimulate the use of SSC include: • Running • Jumping • Box drills • Skipping Plyometric Training

5. Biomechanical Factors • Shape/geometry of joint surfaces. • Joint approximation. • Joint receptor stimulation. Joint Approximation Joint Congruency Joint Stability

6. Wolff’s Law Bone Remodels According to the Stresses Placed Upon It. Additional support for using CKC exercises in rehabilitation is provided by the constant remodeling of tissues.

7. Closed Chain Pronation

8. Neurophysiologic Factors • Mechanoreceptors – CKC activities stimulate mechanoreceptors. • Balance – CKC exercises focusing on balance and postural control are used to restore normal kinesthesia. • Neural adaptation – CKC training enhances neural drive for muscle group recruitment. • Specificity of training – CKC relies on specificity.

9. Examination and Evaluation • Testing of CKC – Static and dynamic • Static balance testing • Excursion test in single limb stance • “ProWedgeIt” – Assesses patient’s function in frontal plane • Lower extremity functional profile The test can become the exercise

10. ProWedgeIt

11. Therapeutic Exercise Intervention • Position and function of entire kinetic chain should be considered. • Focus rehabilitation on functional limitations of entire limb.

12. Elements of Movement SystemBase Element Impairments • Muscle performance • Range of motion • Muscle length • Joint mobility/integrity

13. Base Element Considerations • Open kinetic chain (OKC) exercises in gravity assisted positions may be necessary until muscle performance improves to a functional level. • Consider proximal and distal segments when choosing CKC exercises. • CKC exercises after joint mobilization can be helpful to ensure proper kinematics.

14. Biomechanical Element Element Most Affected by CKC Training Major biomechanical considerations: • Placement of the center of mass. • Placement of the foot and all joint centers proximal to the foot.

15. Center of Mass and CKC

16. Type of contraction Intensity Speed Duration Frequency Sequence Environment Feedback Dosage – Parameters

17. Dosage – General Considerations • Acquiring good postural control is important for efficient function and safety. • Intensity should be low early in rehabilitation process. • CKC exercises should be performed slowly and under neuromuscular control. • As coordination and tissue status improves, increase mechanical stress by increasing weight-bearing forces.

18. Lower Extremity ExamplesExercise Addressing Balance Impairment

19. Exercise Addressing ROM and Joint Mobility Impairment

20. Exercise Addressing Muscle Performance Impairment

21. Exercise Addressing Muscle Performance and Balance Impairment

22. Upper Extremity ExamplesExercise Addressing Muscle Performance Impairment

23. Exercise Addressing Muscle Performance and Balance Impairment

24. Exercise Addressing ROM and Joint Mobility Impairment

25. Precautions and Contraindications Safety Is Primary!! • Begin at submaximal levels and progress to functional goals. • Incorporate criteria for gradation of the exercise. • If substitution occurs, alter the exercise to an easier level.

26. Summary • CKC exercises use the forces of weight bearing and the effect of gravity to simulate functional activities. • Proximal segments move over more fixed distal segments. • Success of using CKC activities in rehabilitation begins with understanding kinetics and kinematics of joints and subsequent kinesiology.

27. Summary (cont.) • Common characteristics of CKC include: • Dependence of joint motion • Motion proximal and distal to center of rotation • Greater joint compressive forces • Stabilization via joint congruency • Muscle recruitment • Eccentric followed by concentric contractions for more functional patterns