Chapter 15
Closed Kinetic Chain Training
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Physiologic Principles of Closed Kinetic
Chain (CKC) Training
1. Muscular factors
2. Biomechanical factors
3. Neurophysiologic factors
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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]).
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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:
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Running
Jumping
Box drills
Skipping
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Biomechanical Factors
1. Shape/geometry of joint
surfaces.
2. Joint approximation.
3. Joint receptor stimulation.
Joint Approximation
Joint Congruency
Joint Stability
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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.
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Closed Chain Pronation
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Neurophysiologic Factors
1. 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.
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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
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ProWedgeIt
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Therapeutic Exercise Intervention
Position and function of entire
kinetic chain should be considered.
Focus rehabilitation on functional
limitations of entire limb.
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Elements of Movement System
Base Element Impairments
Muscle performance
Range of motion
Muscle length
Joint mobility/integrity
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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.
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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.
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Center of Mass and CKC
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Dosage – Parameters
Type of contraction
Intensity
Speed
Duration
Frequency
Sequence
Environment
Feedback
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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.
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Lower Extremity Examples
Exercise Addressing Balance Impairment
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Exercise Addressing ROM and Joint
Mobility Impairment
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Exercise Addressing Muscle
Performance Impairment
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Exercise Addressing Muscle
Performance and Balance Impairment
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Upper Extremity Examples
Exercise Addressing Muscle Performance Impairment
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Exercise Addressing Muscle Performance
and Balance Impairment
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Exercise Addressing ROM and Joint
Mobility Impairment
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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.
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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.
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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
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