Open Kinetic Vs Closed Kinetic Chain Exercise in Rehabilitation

The topic of open Vs closed kinetic chain (OKC/CKC) exercise has been long debated with regard to strength and conditioning, rehabilitation and prehabilitation. Particularly in rehabilitation for anterior cruciate ligament (ACL) ruptures where restoration of quadriceps strength is essential for accelerated recovery. The Bone and Joint research organisation reported over 120,000 ACL injuries in the United States in 2014 alone with the majority of cases affecting young, active females (Kiapour and Murray.,2014). The aims of this article will be:

• To discuss the kinetic chain concept
• To analyse and investigate the differences between OKC and CKC exercises
• To identify the pro’s and con’s between OKC and CKC concepts

Kinetic chain concept

The concept of the kinetic chain was originally derived from mechanical engineering and was used to describe a linkage system. A linkage system was designed so that movement produced at one joint would be replicated by other joints within the system in a predictable manner. This movement could then be used to apply force to an object wit intention of moving it. Steindler, (1955) applied the concept to human biomechanics due to the similarity between the linkage system and musculoskeletal extremities and joints and their ability to perform movement.

Fig 1: Mechanical kinematic chain diagram for both open and closed concepts (Zabiulla,2015)

 

Open Kinetic Chain Exercises

There has been much debate in the definition or what constitutes as an open kinetic chain exercise. Gray,(1989);Palmitier et al.,(1991) and Panariello,(1991) have all provided various definitions with slightly contrasting factors. However, they all agree that an OKC exercise must be an isolated joint movement in one plane with the distal segment or extremity free. The term ‘isolated joint exercise’ may therefore be a more appropriate definition when referring to OKC exercise. Seated resisted knee extension and knee flexion movements are examples of OKC exercises if the joint remains isolated or body weight is un-supported. The use of isolated knee extensions for ACL rehabilitation has been a concern to clinicians due to excessive tibial translation applied to the knee joint and forces experienced at the hamstring harvest site if a graft was taken. However, one of the main focuses in ACL rehabilitation is regaining isokinetic strength of the Quadriceps. Dolan,(2010) and Mikkelsen et al.,(2001) found that OKC exercises used in ACL rehabilitation produce significant improvements in peak torque and strength at the quadriceps than CKC exercises alone. The results lead to a faster return to play rate. It can therefore be suggested that OKC exercises are superior when the goal is to strengthen one specific muscle group around a joint.

Closed Kinetic Chain Exercises

Characteristics that define CKC exercises include a multi joint movement within multiple planes, controlled by synergistic and antagonistic muscle contractions (Mayer et al.,2003). Authors have also suggested that feet or hands must be in contact with the ground and body weight is supported resulting in external factors such as gravity creating compressing forces upon the body. Weighted exercises such as barbell squats, deadlifts and Olympic lifts are all CKC exercises. They also include body weighted exercises such as squats, lunges and press ups. Due to their functional relativeness to everyday life, and in sport, CKC exercises are being used more frequently in prehabilitation and rehabilitation scenarios. Most athletes, regardless of sport, have functional CKC exercises such as Olympic lifts within a phase of periodisation due to their needs analysis of the sport. Strength, power, speed and coordination of multiple movements are all standard requirements within professional sport (Beachle and Earle,2008). With regards to rehabilitation CKC exercises, unlike OKC exercises, help develop proprioception, neuromuscular control and strength at multiple joints and muscle groups. There are some clinicians and coaches however, that seem sceptical in the use of CKC exercises in early stages of rehabilitation due increased risk of re-injry a multi joint movement possesses. Below is a table that identifies the pro’s and con’s of both exercise types.

 

 

	Pro’s	Cons
Open Kinetic chain	Isolates a single muscle group to increase strength. Extremities are left free from applied forces. Can be set up to focus on either eccentric or concentric contractions.	Can apply additional, overloading forces to a joint such as tibial translation. Requires additional equipment to be carried out effectively.
Closed Kinetic chain	Loads multiple muscle groups with one exercise. Improves proprioception, neuromuscular control and strength. Body weighted exercise can be carried out anywhere with no equipment required. Functional movements are more specific to sport.	Technique has to be performed properly otherwise loading won’t be distributed among muscle groups. Increased risk of injury if performed poorly.

 

Summary

Both OKC and CKC chain exercises have their place within rehabilitation and prevention programming. There are several main aspects a therapist/clinician should review before introducing them. These include:

• Stages of Healing and Injury – Depending on where your athlete is within the healing phase and the type of injury sustained will dictate the periodisation of rehabilitation plan and what exercises are favoured. Acute, sub-acute and chronic pathologies will influence which prescribed exercises are utilised at what stage. Post-surgery will significantly affect the healing time line due to the possibility of immobilisation.
• Needs Analysis of Sport – Although there are general periodisation phases within conditioning and rehabilitation, as the athlete progresses the exercises become more specific to the sport. Therefore a needs analysis must be reviewed to ensure the rehabilitation plan and exercises prescribed meet the required needs to safely return an athlete to skill related tasks or training.
• The Individual – Each athlete is an individual and requires specific, tailored rehabilitation plans. They will not only be influenced by the type of injury but by the mechanism of injury as well. Assessments for any deficits or In-balances that are linked to predisposition of injury will help determine the type and intensity of exercise used.

The main goals of rehabilitation are to, not only return an athlete as efficiently as possible to optimal playing performance, but to prevent re-injury from occurring and leave the athlete in a better state than they were found.

 

References

Beachle, T. and Earle, R. (2008) Essentials of strength training and conditioning. (3rd ed.) Champaign, IL: Human Kinetics.

Dolan, M. (2010) Open kinetic chain versus closed kinetic chain exercises after ACL injury. Athletic Therapy today. Vol. 3, No. 1: 8-10.

Mikkelsen, C., Werner, S. and Eriksson, E. (2001) Closed kinetic chain alone compared to combined open and closed kinetic chain exercises for quadriceps strengthening after ACL reconstruction with respect to return to sport. Knee surgery, Sports traumatology and arthroscopy . Vol. 8, No. 1: 337-342.

Mayer, F., Schlumberger, A., Cingel, R. and Laube, W. (2003) Training and testing in open versus closed kinetic chain. Isokinetics and Exercise Science. Vol. 11, No. 1: 181-187.

Wilk, K., Zheng, N., Fleisig, G., Andrews, J. and Clancy, W. (1997) Kinetic chain Exercise: Implications for the ACL patient. Journal of Sports Rehabilitation. Vol. 6, No. 1: 125-143.

Zabuilla, S. (2015) kinematic chain mechanism. [Online] Available from: http://www.slideshare.net/syedzabiullakhan/kinematic-chain-mechanism-inversiongrashoff [accessed 14 March 2016]