Chapter 15 Closed Kinetic Chain Training

Copyright 2005 Lippincott Williams & Wilkins

Chapter 15Closed Kinetic Chain Training


Physiologic Principles of Closed Kinetic Chain (CKC) Training

1. Muscular factors

2. Biomechanical factors

3. Neurophysiologic factors


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]).


Muscular Factor – SSC

1. Combine speed and strength of contractions.

2. Involves rapid closing and opening of the kinetic chain.

3. Closed kinetic chain (CKC) activities that stimulate the use of SSC include:

Running Jumping Box drills Skipping


Biomechanical Factors

1. Shape/geometry of joint surfaces.

2. Joint approximation.3. Joint receptor stimulation.

Joint Approximation Joint Congruency Joint Stability


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.


Closed Chain Pronation


Neurophysiologic Factors1. Mechanoreceptors – CKC activities stimulate

mechanoreceptors.2. Balance – CKC exercises focusing on balance

and postural control are used to restore normal kinesthesia.

3. Neural adaptation – CKC training enhances neural drive for muscle group recruitment.

4. Specificity of training – CKC relies on specificity.


Examination and Evaluation

Testing of CKC – Static and dynamicStatic balance testingExcursion test in single limb stance“ProWedgeIt” – Assesses patient’s

function in frontal planeLower extremity functional profile


ProWedgeIt


Therapeutic Exercise Intervention

Position and function of entire kinetic chain should be considered.

Focus rehabilitation on functional limitations of entire limb.


Elements of Movement System

Base Element Impairments

Muscle performanceRange of motionMuscle lengthJoint mobility/integrity


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.


Biomechanical Element

Element Most Affected by CKC Training

Major biomechanical considerations:1. Placement of the center of mass.2. Placement of the foot and all

joint centers proximal to the foot.


Center of Mass and CKC


Dosage – Parameters

Type of contractionIntensitySpeedDuration

FrequencySequenceEnvironmentFeedback


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.


Lower Extremity ExamplesExercise Addressing Balance Impairment


Exercise Addressing ROM and Joint Mobility Impairment


Exercise Addressing Muscle Performance Impairment


Exercise Addressing Muscle Performance and Balance Impairment


Upper Extremity ExamplesExercise Addressing Muscle Performance Impairment


Exercise Addressing Muscle Performance and Balance Impairment


Exercise Addressing ROM and Joint Mobility Impairment


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.


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.


Summary (cont.)

Common characteristics of CKC include: Dependence of joint motionMotion proximal and distal to center of

rotationGreater joint compressive forcesStabilization via joint congruencyMuscle recruitmentEccentric followed by concentric

contractions for more functional patterns

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Chapter 15 Closed Kinetic Chain Training