Kinetic chain rehabilitation: a theoretical framework

Aaron Sciascia, Robin Cromwell, Aaron Sciascia, Robin Cromwell

Abstract

Sequenced physiologic muscle activations in the upper and lower extremity result in an integrated biomechanical task. This sequencing is known as the kinetic chain, and, in upper extremity dominant tasks, the energy development and output follows a proximal to distal sequencing. Impairment of one or more kinetic chain links can create dysfunctional biomechanical output leading to pain and/or injury. When deficits exist in the preceding links, they can negatively affect the shoulder. Rehabilitation of shoulder injuries should involve evaluation for and restoration of all kinetic chain deficits that may hinder kinetic chain function. Rehabilitation programs focused on eliminating kinetic chain deficits, and soreness should follow a proximal to distal rationale where lower extremity impairments are addressed in addition to the upper extremity impairments. A logical progression focusing on flexibility, strength, proprioception, and endurance with kinetic chain influence is recommended.

Figures

Figure 1
Figure 1
Sleeper stretch.
Figure 2
Figure 2
Cross-body stretch.
Figure 3
Figure 3
Corner stretch.
Figure 4
Figure 4
(a) Facilitation of scapular retraction: hip and trunk extension facilitates scapular retraction. (b) Facilitation of scapular protraction: hip and trunk flexion facilitate scapular protraction.
Figure 5
Figure 5
(a) Starting position for the lawnmower maneuver. (b) This exercise accentuates scapular external rotation through the use of the transverse plane.
Figure 6
Figure 6
(a) Starting position for low row exercise. (b) Terminal position for low row exercise.
Figure 7
Figure 7
Side stepping.
Figure 8
Figure 8
(a) Examples of hip abduction strengthening. (b) Examples of hip extension strengthening.
Figure 9
Figure 9
(a) Power position begins with the dominant arm in the 90/90 position and forearm pronated. (b) Next, while maintaining the 90/90 arm position, rotate the trunk forward to simulate the throwing motion phases of acceleration to ball release.
Figure 10
Figure 10
(a) Starting position for the step back exercise. (b) Step back with power position encouraging use of a stable back leg.
Figure 11
Figure 11
Rebounder with power position.

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Source: PubMed

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