By: Bill Steinberger, MS, PT, CSCS

Most functional movements in the lower extremity take place when the foot is on the ground. The hip, knee and ankle joints, when taken together, comprise the lower extremity kinetic chain. When the distal segment is fixed and proximal segments move, the motion is called closed kinetic chain motion. Muscle contractions in closed kinetic chain motion are different from those in open kinetic chain motion at the same joint, and they also recruit all 3 joints in unison. Joint motion in the lower extremity is caused by many controlled muscle contractions that are the opposite of those in the open kinetic chain. For example, in the open kinetic chain, knee flexion is caused by concentric contraction of the hamstring muscles, which moves the tibia towards the femur. During closed kinetic chain motion, knee flexion is caused by controlled eccentric contraction of the quadriceps muscles, which moves the femur towards the tibia.

Closed kinetic chain exercise has become highly popular in rehabilitation, partly due to the belief that it is more closely related to function than open kinetic chain exercise. It is also believed that closed kinetic chain exercises are safer, particularly with regard to a healing anterior cruciate ligament (ACL) graft. Research has shown that ACL strain is reduced during closed kinetic chain exercise by virtue of the axial orientation of the applied load and muscular co-contraction of the quadriceps and hamstrings. In addition, closed kinetic chain exercise, through recruitment of all hip, knee and ankle extensors in synchrony takes advantage of specificity of training principles.

Research has also shown that closed kinetic chain exercise is more effective than joint isolation exercise in restoring function in patients with patellofemoral dysfunction, improving reflex stabilization and proprioception, reducing pain and promoting a return to normal daily activities and sports. For athletes in particular, closed kinetic chain exercise has been shown to more greatly improve strength and jumping ability in comparison to open kinetic chain exercise.

While open kinetic chain exercise certainly has its benefits and its own place in rehabilitation and strength training of the lower extremities, it is important to incorporate (and quite possibly emphasize) closed kinetic chain exercises for the greatest functional gains.

Active exercise has become better understood over the past ten years as a valuable tool in soft tissue pain and injuries. Improved circulation of blood and other body fluids and controlled reactivation of the joints and muscles are achieved with exercise.

Eccentric Exercise
Widely publicized in the early and mid 1970’s for its value in body building and fitness training, eccentric exercise has proven to be an effective component of the rehabilitation in tendinitis and epicondylitis conditions like tennis elbow.

Unloading Techniques
When exercise is applied while the effects of gravity are minimized, several conditions see benefits that otherwise might have been aggravated by exercise. The spine, shoulder and knee joints are commonly approached at Accelerate PT with exercise setups, which eliminate the use of secondary muscles that substitute for the weakened primary movers of the effected joints. A gradual progression in the loading of the joints facilitates progress in functional tasks including weight-bearing activities.

Aquatic Exercises
Another transitional form of exercise is submersion in water for both loading the muscles with resistance and/or to unload gravity from the body. Stimulation of proprioceptors and assisting the body to withstand longer duration exercise training are possible using public and private swimming pools and hot tubs.

Stretching Exercises
In addition to restoring range of motion for joint and muscle conditions, nerve tissue benefits from stretching techniques for the extremities and the trunk. Specific techniques carried out daily are important in the management of postoperative joint conditions and postural maladies including thoracic outlet and carpal tunnel syndromes.

As Physical Therapists, we believe 75% of recovery depends on your involvement in a home program we set up with you. With many conditions and injuries, if you follow your home program as instructed and increase your self treatment, the frequency of physical therapy visits tends to be reduced.

Remember, physical therapy is a process. Seven days a week, you will need to exercise and treat yourself outside of this clinic to relieve the pain and stiffness commonly associated with injuries. We will follow your case until you are well or able to manage without us.

We will provide you with mechanisms and ideas for self treatment. Included among these may be instruction at public fitness centers. We can also help you find the equipment you need for self management and progressive training as Certified Strength and Conditioning Specialists.

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