Traditional shoulder rehabilitation after injury includes a phase of rest, control of inflammation, and isolated muscle strengthening (1,2). Additional components of a shoulder rehab program may include scapular-stabilization, proprioceptive techniques, and closed kinetic chain exercise (3).
“Closed chain axial loading exercises are the primary means of early shoulder rehabilitation and are the mainstays of functional rehabilitation protocols”
- Ben Kibler et al. 2012 (4)
With all the above being said, closed kinetic chain exercises are being neglected in many rehabilitation programs for isolated rotator cuff strengthening. As stated in yesterdays post, the 4 rotator cuff muscles all have individual functions, however their main goal is to work together in stabilizing the shoulder.
Here are some of the benefits of closed kinetic chain exercise:
• Increased joint compressive forces (proprioception)
• Increased joint congruency (stability)
• Decreased shear and acceleration forces
• Enhanced dynamic stability (co-contraction)
Open kinetic chain characteristics:
• Increased shear and acceleration forced
• Increased distraction and rotation force (decreased proprioception)
• Isolated muscle strengthening (little to no co-contraction)
While keeping in mind the main function of the rotator cuff muscles, it is clear to see that closed kinetic chain exercises would be the most beneficial. This method causes co-contraction to provide joint stability, decreases shear forces that may damage soft tissue structures, increases joint compressive forces increasing stability and proprioception, and lastly is more functional than an open kinetic chain approach (5).
I hope this sheds some light shoulder rehabilitation and how the therapeutic approach should fit the main function of the rotator cuff muscles. Be sure to check out the articles below for more information, and as always, feel free to ask questions and make comment in regards to the post!
Check out this article by John McMullen et al. “A Kinetic Chain Approach for Shoulder Rehabilitation” (3) which outlines a shoulder rehabilitation program that integrates closed kinetic chain exercises, core-stabilization exercises, and functional movement patterns rather than isolated muscle exercises. → http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1323395/
Also check out the article by Ben Kibler et al. “Shoulder Rehabilitation Strategies, Guidelines, and Practice” to see their protocol involving several basic concepts of kinetic chain-based shoulder rehabilitation. →http://www.optechsportsmed.com/…/S1060-1872(12)000…/abstract
1. Brewster C, Schwab DR. Rehabilitation of the shoulder following rotator cuff injury or surgery. J Orthop Sports Phys Ther. 1993;18:422-426.
2. Wilk KE, Harrelson GL, Arrigo C, Chmielewski T. Shoulder rehabilitation. In: Andrews JR, Harrelson GL, Wilk KE, eds. Physical Rehabilitation of the Injured Athlete. 2nd ed. Philadelphia, PA: WB Saunders; 1998:478-553
3. McMullen, J., & Uhl, T. L. (2000). A Kinetic Chain Approach for Shoulder Rehabilitation. Journal of Athletic Training, 35(3), 329–337.
4. Kibler B, McMullen J, Uhl T, (2012). Shoulder Rehabilitation Strategies, Guidelines, and Practic. Operative Techniques in Sports Medicine, 20 (1), 103-112.
5. Prentice W. Open-Versus Closed-Kinetic Chain Exercise in Rehabilitation. Rehabilitation Techniques for Sports Medicine and Athletic Treating. PowerPoint presentation.