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Closed Kinetic Chain Strenghtening of The shoulder

Closed Kinetic Chain Strenghtening of The shoulder. By: James White, PT, DPT, OCS. Shoulder Pain. Shoulder pain affects approximately 7-27% of the population. 1 Shoulder pain accounts for approximately 33% of all physician visits for musculoskeletal pain. 1. Shoulder Rehabilitation.

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Closed Kinetic Chain Strenghtening of The shoulder

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  1. Closed Kinetic Chain Strenghtening of The shoulder By: James White, PT, DPT, OCS

  2. Shoulder Pain • Shoulder pain affects approximately 7-27% of the population.1 • Shoulder pain accounts for approximately 33% of all physician visits for musculoskeletal pain.1

  3. Shoulder Rehabilitation • Several articles have shown that manual therapy plus therapeutic exercise are effective for treating shoulder pain.2,3

  4. Shoulder Stability • Shoulder stability is the result of a complex interaction between static and dynamic shoulder restraints.4 • Static stability: bony congruence (only about 25% contact between surfaces), the labrum, the joint capsule, the superior glenohumeralligament (SGHL), the middle glenohumeralligament (MGHL), and the inferior glenohumeralligament complex (IGHLC).4

  5. Shoulder Stability Cont. • Dynamic stability: Rotator cuff, Biceps Brachii, Scapular stabilizers.4 • Proprioception via mechanoreceptors in capsuloligamentous structures.4

  6. CKC Definition • Closed kinetic chain (CKC) exercise: the distal segment of a joint meets with a force that restrains or prohibits its free motion.5

  7. Effects of CKC Exercises • These exercises increase joint compression, which enhances joint stability.5 • Closed kinetic chain exercises produce a co-contraction of surrounding musculature.5

  8. Effects of CKC Exercises • Hayes et al advocate upper extremity weight-bearing exercises to restore normal patterns of scapular stabilizer recrutiment.4 • Guerrero et al statedthat weight-bearing activity generates specificpatterns of cocontraction of the rotator cuf, glenohumeral muscles, and periscapularstabilizers, as this is how these muscles are used in many activities of daily life.6

  9. Effects of CKC Exercises • Andrade et al studied the co-activation of shoulder muscles during CKC exercises on unstable surfaces.7 • Exercises included the Wall-Press, Push-up and Bench-Press • Bench-press exercises mostly favored muscle activity for the Pec Major and Triceps Brachii, while the push-ups favored the Posterior Deltoid and Triceps Brachii, and the wall-press favouredthe Posterior Deltoid and Serratus Anterior

  10. Example CKC Exercises • Push-ups • Push-ups with a plus • Wall press • Press-downs • Wrap Thera-Band around the patient’s hands and have the patient maintain tension through the Thera-Band as he/she alternately walks the hands up a wall • Reaching in quadraped, or push-up position • Rocking side to side on BOSU in push-up position

  11. Summary • Shoulder pain is a common ailment in the United States • The shoulder relies primarily on dynamic stabilization • Closed kinetic chain exercises promote co-contraction of scapular and shoulder stabilizers

  12. Case Study(Full case report attached) • 15 y.o. male s/p spearing injury to sternum in a football game. • The pt was diagnosed with hypermobility of the left first sternocostal attachment • The pt c/o pain and popping with L UE elevation and lifting > 10 lbs • The pt was treated with mobilizations to the upper thoracic spine and CKC exercises for the upper extremities • The pt was seen for 15 visits, and was DC’d with 0/10 pain, full pain-free ROM, and able to return to football

  13. References • 1) Michener LA, Walsworth MA, Doukas WC. Reliability and Diagnostic Accuracy of 5 Physical Examination Tests and Combination of Tests for Subacromial Impingement. Arch Phys Med RehabilVol 90, November 2009. • 2) Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther. 2000 Mar;30(3):126-37. • 3) Winters JC, Sobel JS, Groenier KH, et al. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study.BMJ. 1997 May 3;314(7090):1320-5. • 4) Hayes K, Callanan M, Walton J, et al. Shoulder Instability: Management and Rehabilitation. . J Orthop Sports Phys Ther. 2002;32:497–509 • 5) Schulthies SS, Ricard MD, Alexander KJ, et al. An electromyographicinvestigation of 4 elastic-tubing closed kinetic chain exercises after anterior cruciate ligament reconstruction. J Athl Train. 1998 Oct;33(4):328-35 • 6) Guerrero P, Busconi B, Deangelis N. Congenital Instability of the Shoulder • Joint: Assessment and Treatment Option. J OrthopSports Phys Ther 2009; 39(2):124-134 • 7) Andrade R, Araujo RC, Tucci HT, et al. Coactivation of the shoulder and arm muscles during closed kinetic chain exercises on an unstable surface. Singapore Med J. 2011 Jan;52(1):35-41.

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