Shoulder open and closed kinematic chain.pptx

Shoulder open and closed kinematic chain-
Open kinematic chain-
One end of the series is free to move while the other is fixed, movement can take place at one joint without causing motion at other joints in the chain, although the segments will move in space.
Closed kinematic chain-
Both ends of the chain are fixed, movement at one joint not only moves one or more other segments in space but will also create movement in one or more other joints in the chain.
• Kinetic chain rehabilitation exercises use functional movement patterns to facilitate scapular motion and then to strengthen scapular musculature.
• Closed chain exercises is a co-contraction of both the agonist and the antagonist muscle groups that help enhance stability of GH joint.
• Open chain exercises have increased stress forces against glenohumeral joint

1. Shoulder open and closed kinematic chain Syeda Nusrath Fatima (MPT)

2. INTRODUCTION Shoulder complex design enables great mobility of the upper extremity. Joints of shoulder complex- Glenohumeral Acromioclavicular Sternoclavicular scapulothoracic

3. Kinematic chains: Open kinematic chain- One end of the series is free to move while the other is fixed, movement can take place at one joint without causing motion at other joints in the chain, although the segments will move in space. Closed kinematic chain- Both ends of the chain are fixed, movement at one joint not only moves one or more other segments in space but will also create movement in one or more other joints in the chain.

4. Kinetic chain rehabilitation exercises use functional movement patterns to facilitate scapular motion and then to strengthen scapular musculature. Closed chain exercises is a co-contraction of both the agonist and the antagonist muscle groups that help enhance stability of GH joint. Open chain exercises have increased stress forces against glenohumeral joint

5. Closed chain stabilization exercises for the scapular muscles- Scapular wall clock exercise- hand is stabilized against a wall and the hand is rotated to different positions of the clock. This is done by creating an isometric contraction in the direction of the numbers around the clock face. Therapist can also give manual resistance in the same directions to the patient’s arm as they are stabilizing it by holding on to the wall. These motions are thought to effectively stimulate rotator cuff activity. Initially, these manoeuvres are done with shoulder in <90° of abduction or flexion. As tissue healing improves and the motion is recovered, strengthening progresses to greater amounts of abduction and forward flexion.

6. Open chain exercises for the scapular stabilizers- Open chain exercises are done with the distal end of the extremity no longer stabilized against a fixed object. Rotational exercises- should begin comfortably at patient’s side and advance to 90° based on patient’s injury, level of discomfort and stage of soft tissue healing.

7. Shoulder girdle functions in both open and closed chain activities. Open chain stabilization exercises for the shoulder girdle- Patient position- Supine holding a rod with elbows extended and shoulders flexed to 90° Therapist’s position- therapist stands near the patient’s head and grasps the rod. Procedure- patient is instructed to hold against or match the resistance provided. Rod is pushed, pulled and rotated in various directions. As the patient gains control, progress to sitting and then standing and have the patient hold the arm in various positions as alternating resistance is applied.

8. Closed chain stabilization exercises- Patient position- standing with shoulders flexed 90° and hands supported against a wall or leaning into hands on a table. Procedure- patient is asked to shift his body weight from one extremity to the other (rock back and forth). Resistance is applied against the shoulders. progression- patient alternatively lift upper extremity and then the other, so that one extremity bears the body weight and stabilizes against the shifting load. Manual resistance is applied.

9. References Clinical orthopaedic rehabilitation- S. Brent Brotzman Therapeutic exercise- Carolyn Kisner

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