Closed Kinetic Chain Exercises Research Articles

Acute effect of open and closed kinetic chain training on lower limb muscle strength in young adults

Among training prescription variations for improving muscle strength, we can highlight open kinetic chain (OKC) and closed kinetic chain (CKC) exercises. The aim of this study was to investigate the acute effect of OKC and CKC exercises on lower limb muscle strength in young adults. Subjects were invited to participate in an acute training consisting of three OKC exercises and three CKC exercises and performed three sets of ten repetitions. To evaluate the torque and muscle power, an isokinetic dynamometer and a force platform were used. The analyzed variables were: peak of torque, time to peak torque, mean power and average power. Univariate analyses were used to compare the performance of participants in OKC and CKC exercises in torque and power tests. Peak torque was higher in the extensor and plantar flexion movements than knee and ankle joints, respectively. When comparing OKC and CKC exercises, OKC exercises produced a higher peak of torque and mean power in all the joints than CKC. We concluded that OKC exercises can be used for improving strength in young adults.

Loaded open-kinetic-chain exercises stretch the anterior cruciate ligament more than closed-kinetic-chain exercises: In-vivo assessment of anterior cruciate ligament length change

BackgroundUsage of open-kinetic-chain (OKC) or closed-kinetic-chain (CKC) exercises during rehabilitation planning after anterior cruciate ligament (ACL) reconstruction has been debated for decades. However, the ACL elongation pattern during different rehabilitation exercises at different loadings remains unclear. ObjectivesThis study aimed to determine the effects of OKC and CKC exercises on the length of ACL anteromedial bundle (AMB) and posterolateral bundle (PLB) to provide biomechanical support for making rehabilitation schedules. DesignLaboratory Descriptive Study. MethodEighteen healthy volunteers were asked to perform two OKC motions, including non-weight-bearing and 10 kg loaded seated knee extension (OKC-0, OKC-10), as well as two CKC motions, including box squat (BS) and deep single-legged lunge (Lunge). Techniques of 2D-to-3D image registration and 3D ligament simulation were used to quantify length changes of ACL. ResultsThe motion which led to the least and most ACL elongation were OKC-0 and OKC-10, respectively. The AMB and PLB were significantly longer in OKC-10 than those in OKC-0 during 0–60° and 0–55° of knee flexion (p < 0.01). Compared with reference length, the AMB and PLB were stretched during 0–30° and 0–10° respectively during OKC-10. During CKC exercises, the AMB and PLB were also stretched from 0 to 25°and 0–5°, respectively. Additionally, no significant difference was found in the length change of ACL bundles between BS and lunge. ConclusionsOKC-0 may be safe for the rehabilitation program after ACL reconstruction, and loaded exercises shall be applied when restricted with >30° in early-stage rehabilitation.

Open Versus Closed Kinetic Chain Exercise: a Comparison of Walking Capacity in Chronic Post-Stroke Phase

Introduction: The chronic post-stroke phase is often accompanied by various sensory, cognitive, motoric, coordination, and balance impairments. Decreased strength and motoric control contribute to walking capacity in patients with stroke. This study aims to evaluate the effect of Open Kinetic Chain (OKC) vs Closed Kinetic Chain (CKC) exercise on walking capacity in the chronic post-stroke phase. Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) were reported to improve functional mobility and balance in the chronic post-stroke phase. However, there is a lack of studies emphasizing the effect of OKC and CKC on walking capacity.&#x0D; Methods: This study is a quasi-experimental pre- and post-controlled trial group design. Twenty subjects were randomized into two groups of equal size: the CKC group (n=10) and the OKC group (n=10). There was one subject from each group who dropped out at the end of the study. CKC and OKC groups were trained for 6 weeks. The walking capacity was measured with 2 Minutes Walking Test (2WMT).&#x0D; Results: 2WMT results showed improvement in both groups after 6 weeks of intervention, 56,17 ± 10,95 ± to 57,43 ± 11,29 in CKC group (p&lt;0.001) and 57,04 ± 8,58 to 58,19 ± 8,77 in OKC group (p&lt;0.002).&#x0D; Conclusion: CKC and OKC exercise significantly improve the 2WMT results after 6 weeks of intervention.&#x0D; Keywords: Chronic post-stroke phase, walking capacity, open kinetic chain exercise, closed kinetic chain exercise

Open Versus Closed Kinetic Chain Exercise: a Comparison of Walking Capacity in Chronic Post-Stroke Phase

ABSTRACTIntroduction: The chronic post-stroke phase is often accompanied by various sensory, cognitive, motoric, coordination, and balance impairments. Decreased strength and motoric control contribute to walkingcapacity in patients with stroke. Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) were reported to improve strength, functional mobility and balance in the chronic post-stroke phase. However, there is aphysiologically differences between CKC and OKC exercise. This study aims to compare the result of two methods of progressive resistant training (PRT) on walking capacity in the chronic post-stroke phase.Methods: This study is a quasi-experimental pre- and post-controlled trial group design. Twenty subjects were randomized into two groups of equal size: the CKC group (n=10) and the OKC group (n=10). Therewas one subject from each group who dropped out at the end of the study. CKC and OKC groups were trained for 6 weeks. The walking capacity was measured with 2 Minutes Walking Test (2WMT).Results: 2WMT results showed improvement in both groups after 6 weeks of intervention, while CKC group show greater improvement in walking distance 56,17 ± 10,95  to 57,43 compared to OKC group57,04 ± 8,58 to 58,19 ± 8,77 (p&lt;0.002).Conclusions: This study shows CKC group showed slightly better improvement in walking capacity after 6 weeks of progressive resistance training compare to OKC group. However, there were no statisticallydifferences between the groups

Effects of Open and Closed Chain Exercises on Dynamic Balance and Range of Motion in Patients with Knee Osteoarthritis: RCT

Background: Osteoarthritis is a combination of mechanical problems characterized by degradation of articular cartilage, articulating joints and subchondral space. Aim: To compare the effects of open chain kinetic exercises and closed kinetic chain exercises in improving dynamic balance and range of motion in patients with knee osteoarthritis. Study Design: Randomized controlled trial. Methodology: Study was conducted at Chugtai Medical center Lahore and sample of 46 patients were recruited and were randomly allocated in two groups. One group performed OKC exercises and the other group was asked to perform CKC exercises, while both of the groups received a common baseline treatment prior to corresponding intervention. Two session a week were given for a period of one month. Goniometry and Y-balance scale were used to assess ROM and dynamic balance pre and post treatment, respectively. Data was evaluated by using SPSS version 23. Results: In this study, the intra-group analysis illustrated that the increase in range of motion and improvement in dynamic balance was statistically significant in both groups with p-value&lt;0.05. Whereas, the inter-group analysis showed that both interventions were clinically effective in treating knee osteoarthritis with p-value&gt;0.05 during the treatment session of four weeks. Practical Implication: This study highlighted that physical training that includes open kinetic chain (OKC) and closed kinetic chain (CKC) exercises were found to be effective in improving balance and in increasing range of motion by reducing pain among osteoarthritis patients. Conclusion: It was concluded that patients with OKC exercises have shown equal improvement in ROM and dynamic balance compared to those who have been treated with CKC exercises. Keywords: Osteoarthritis, Exercises and Dynamic Balance.

EFFECTS OF UNSTABLE SURFACE CLOSED KINETIC CHAIN EXERCISES ON HAMSTRING:QUADRICEP RATIO AND NEUROMUSCULAR ACTIVATION

PURPOSE: To examine the effects of performing closed-kinetic chain exercises on an unstable surface on the hamstring:quadricep ratio and motor unit recruitment in males and females. METHODS: Ten males (20.1 + 1.1 yrs) and ten females (21.2 + 2.1 yrs) performed closed kinetic chain exercises (CKCs) including a front lunge (FL), side lunge (SL), and single-leg squat (SLSQ). Each of the CKCs were performed twice on both a stable (SS) and unstable surface (US). Electromyography (EMG) of the vastus lateralis (VL) and biceps femoris (BF) was recorded on the dominant leg. Raw EMG recordings were normalized to maximal voluntary isometric contractions (MVICs) and analyzed for root mean square (RMS). The hamstring:quadricep ratio (H:Q) was calculated using RMS as: BF/VL. Data were analyzed using mixed-design repeated-measures ANOVA. RESULTS: No significant differences were observed between males and females during the FL (p = 0.666), SLSQ (p = 0.589), or SL (p = 0.768). During the FL, a main effect of condition was observed for H:Q (F = 10.832; p = 0.004) and RMS of VL (F = 17.462; p < 0.001) with a lower H:Q during US (0.362 + 0.072) compared to SS (0.48 + 0.1) and greater RMS of the VL during US (31.98 + 2.99) compared to SS (29.4 + 3.21). No main effect of condition for RMS of BF was observed (F = 0.184; p = 0.673). During the SLSQ, a main effect of condition was observed for H:Q (F = 12.662; p = 0.002) and RMS of VL (F = 6.646; p = 0.019), with lower H:Q during US (0.423 + 0.109) compared to SS (0.538 + 0.129) and greater RMS of VL during US (48.412 + 5.53) compared to SS (42.627 + 3.84). A main effect of condition was also observed for the BF (F = 14.983; p = 0 .001), with a significant decrease during US (15.051 + 3.56) compared to SS (20.631 + 4.51). During the SL, a main effect of condition was observed for H:Q (F = 8.909; p = 0.008) and RMS of VL (F = 75.454; p < 0 .001) with a greater H:Q during US (0.493 + 0.055) compared to SS (0.378 + 0.043) and lower RMS of VL during US (35.497 + 3.406) compared to SS (40.884 + 3.791). A main effect of condition was also observed for the BF (F = 17.808; p < 0 .001), with a significant increase during US (12.641 + 2.478) compared to SS (8.777 + 2.339). CONCLUSIONS: While no significant differences were observed between males and females, data suggest that performing CKCs on an unstable surface results in changes in H:Q and motor unit recruitment of the BF and VL.

Effects Of Fatigue On Hamstring:quadricep Ratio And Neuromuscular Activation During Closed Kinetic Chain Exercises

PURPOSE: To examine the effects of fatigue on the hamstring:quadricep ratio and motor unitrecruitment during closed kinetic chain exercises. METHODS: Ten males (20.1 + 1.1 yrs) and ten females ( 21.2 + 2.1 yrs) cycled at 110% of theirPhysical Working Capacity Fatigue Threshold (PWCFT) until exhaustion (TTE). Participants alsoperformed three closed kinetic chain (CKC) exercises before (PRE) and after (POST) the TTE, includinga front lunge (FL), side lunge (SL), and single leg squat (SLSQ). Each of the four CKC exercises wereperformed twice PRE and twice POST. Electromyography (EMG) of the vastus lateralis (VL) and bicepsfemoris (BF) was recorded on the dominant leg. Raw EMG recordings were normalized to maximalvoluntary isometric contractions (MVICs) and analyzed for root mean square (RMS). Thehamstring:quadricep ratio (H:Q) was calculated using RMS as:BF/VL. Data were analyzed usingmixed-design repeated-measures ANOVA. RESULTS: During the FL, a main effect of time was observed for the H:Q (F = 10.199;p = 0.005) andRMS of the VL (F = 17.462;p < 0.001). Specifically, H:Q was lower at POST (0.388 + 0.081) comparedto PRE (0.451 + 0.091) and RMS of VL was higher at POST (33.435 + 3.113) compared to PRE (27.937+ 3.004). No main effect of time (F = 6.275;p = 0.22) for RMS of the BF was observed. During theSLSQ, a main effect of time was observed for the H:Q (F = 7.498;p = 0.014) and RMS of the VL (F = 13.380;p = 0.002). Specifically, H:Q was lower at POST (0.392 + 0.087) compared to PRE (0.527 + 0.119) and RMS of VL was higher at POST (50.683 + 4.056) compared to PRE (41.457 + 4.391). Nomain effect of time (F = 0.238;p = 0.632) was observed for RMS of the BF During the SL, a main effectof time was observed for H:Q (F = 7.526;p = 0.013) and RMS of the VL (F = 9.548;p = 0.006).Specifically, H:Q was higher at POST (0.493 + 0.097) compared to PRE (0.354 + 0.098) and RMS of VLwas lower at POST (37.24 + 1.072) compared to PRE (49.644 + 1.083). No main effect of time (F = 0.766;p = 0.392) was observed for RMS of the BF. CONCLUSIONS: Fatigue may impact the H:Q ratio during closed-kinetic chain exercises These datasuggest that changes in the H:Q ratio may be dependent on fatigue-related changes in motor unitrecruitment of quadricep muscles.

Comparison between the Effect of Closed Kinetic Chain and Open Kinetic Chain exercises in the strengthening of Vastus Medialis Obliqus in subjects with Patello-Femoral Pain Syndrome - a randomized control trial

Aim: To compare the effects of closed kinetic chain and open kinetic chain exercises in the strengthening of vastus medialis obliqus in subjects with Patello-femoral pain syndrome. Methods: The study was a randomized controlled trial. It was conducted to compare the impact of open and closed kinetic chain exercises to strengthen the Vastus medialis obliqus in PFPS patients. For this purpose, 36 patients both males and females with age 20-40 years having PFPS were allocated randomly to two experimental (group A and group B) and one control group C. Group A, practised open kinetic chain exercises and the second group B practiced closed kinetic chain exercises, the control group C was given general physical therapy exercises, for four weeks. The assessment of Pain and function of the individual taking part in this study were was done before starting the treatment, at 2 weeks and at 4 weeks, using Numerical Pain rating scale and Kujala Anterior knee pain scale, respectively. Results: In conclusion, significant changes i.e. in alleviating pain and enhancing overall functionality has been seen in Group B that performed closed kinetic chain exercises for about 4 weeks. Similarly, there was also a remarked change in pain reduction besides improved function in group A and group C. By comparing all the three groups, significant advantage has been noted with closed kinetic chain exercises as compared to open kinetic chain and conventional PT techniques. Conclusion: Although, both exercise regimens were significant in pain reduction and enhancing function, but close kinetic chain exercises produced remarkable effects. Keywords: Closed kinetic chain exercises, Function Open kinetic chain exercises, Pain, Patello-femoral pain syndrome, PFPS.

Comparison of Effectiveness of Forward Walking vs Retro Walking on Pain and Function in Patients with Postmenopausal Osteoarthritis of Knee

Background and Objectives: Osteoarthritis (OA) is the most common form of arthritis and the leading source of physical disability with severely impaired quality of life in people. The overall prevalence of OA in India is found to be higher in females than in males. Rehabilitation exercises in the form of Closed Kinetic Chain Exercises (CKCE) are an effective way in the management of OA knee. This study aims to evaluate the effectiveness of forward walking versus retrowalking on pain and function in postmenopausal women with OA knee. Methods: 30 postmenopausal females diagnosed with OA knee were randomly allocated into 2 groups. Group A received forward walking while Group B received retrowalking. Both the groups received conventional physiotherapy such as strengthening exercises and Ultrasound along with their assigned interventions. The outcomes were measured in terms of Numerical Pain Rating Scale (NPRS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) at the start of the intervention and at the end of 6 weeks. Results: The results of the present study showed statistically significant difference within the groups for all outcome measures; but significant difference was found only for WOMAC scores between the groups. Further it was also found that ROM of the knee showed a significant difference both within the groups as well as between the groups. Group B showed better improvement that Group A for pain and function of the knee. Interpretation and Conclusion: The present study concludes that both forward walking and retrowalking are individually effective in reducing pain and improving function of post-menopausal women with OA knee. However, retrowalking results in greater reduction in pain and improved function of postmenopausal women with OA knee. Keywords: Retro walking, Forward Walking, Osteoarthritis, Menopause.

Efficacy of Open versus Closed Kinetic Chain Exercises on Dynamic Balance and Health Status in Individuals with Osteoarthritis of Knee Joint: A Quasi-experimental Study

Introduction: Osteoarthritis is an inflammatory disorder characterised by changes in the biomechanics, biochemistry and genetic background of joint cartilage and subchondral bone. When distal parts move freely throughout exercises in a weight-bearing position, the phrase open kinetic exercises is employed. Closed kinetic exercises are employed in a weight-bearing position when the body travels through a hard and quick distal phase. Aim: To compare the efficacy of Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) exercises on dynamic balance and health status in individuals with osteoarthritis of knee joint. Materials and Method: A single-blinded experimental study was conducted from April 2020 to May 2021 at Dr D.Y. Patil college of Physiotherapy, Pimpri-Chinchwad area, Pune, Maharashtra, India. A sample of 30 subjects with unilateral osteoarthritis of knee joint, between the age of 40-60 years of both genders, were recruited. They were divided into open kinetic group (Group A) and closed kinetic group (Group B) using convenient sampling method. Y-balance and Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) (Pune CRD version) were used as outcome measures-preintervention, post two weeks and post four weeks of intervention. Data normality was tested by Shapiro-wilk test. Significance was tested using paired t-test within the groups for WOMAC and Y-balance test. Unpaired t-test was used between the groups. Results: Among 30 subjects, 17 were males and 13 females. There was a significant improvement in dynamic balance (p-value=0.001) and WOMAC (p-value=0.001) in both the groups. In group A, preintervention mean values for WOMAC was 41.2±10.53, and post four weeks of intervention it was 34.53±10.12 (p-value=0.001). Preintervention mean for Y-balance test was 0.554±14.6 and after four weeks of intervention mean was 0.586±13.8 (p-value &lt;0.001). In group B, preintervention mean for WOMAC was 40.87±8.33, and after four weeks of intervention, mean was 30.47±7.22 (p-value=0.001); while preintervention mean for Y-balance test was 0.583±7.8 and after four weeks of intervention, mean was 0.645±7.0 (p-value=0.001). Between groups, analysis showed p-value=0.051 for both groups post four weeks of intervention. Conclusion: The study concluded that CKC exercises are more effective than OKC exercises in improving dynamic balance and decrease in pain, stiffness, and improving physical function in knee osteoarthritis.

Effectiveness of Closed Kinetic Chain Exercise on Increasing Functional Strength in Knee Osteoarthritis Patients

Introduction: The prevalence of osteoarthritis increases with age with functional impairment. With Closed Kinetic Chain Exercise (CKCE) patients are able to increase movement in the knee area. Objective: To provide an overview of various evidence from previous studies regarding the effectiveness of Closed Kinetic Chain Exercise in improving functional ability in patients with knee osteoarthritis. Methods: Conducted a literature review by searching through electronic databases namely Garuda, Pubmed, and Google Scholar, and obtained 5 relevant research articles from 2016-2021 based on inclusion and exclusion criteria. Results: After being given closed kinetic chain exercise, it was found that there was a decrease in complaints such as pain and an increase in the strength of functional movement in patients with knee osteoarthritis. Conclusion: closed kinetic chain exercise is effective in improving functional ability in patients with knee osteoarthritis

Acute Effects of Open Kinetic Chain Exercise Versus Those of Closed Kinetic Chain Exercise on Quadriceps Muscle Thickness in Healthy Adults.

This study aimed to compare immediate changes in the thickness of the rectus femoris (RF), vastus intermedius (VI), vastus lateralis (VL), vastus medialis (VM), and vastus medialis oblique (VMO) muscles after open kinetic chain exercise (OKCE) and closed kinetic chain exercise (CKCE) and identify the effect of both exercise types on each quadricep muscle for early rehabilitation to prevent knee joint injury. Twenty-six healthy participants (13 males and 13 females) were randomly divided into the OKCE (n = 13) and CKCE (n = 13) groups. The thickness of their quadriceps muscles was measured using a portable ultrasonic imaging device before and after exercise in the sequence RF, VI, VL, VM, and VMO. A two-way repeated measures analysis of variance was used to compare the thickness of each component of the quadriceps muscles between the two groups. The thickness of the RF, VL, VM, and VMO muscles increased after OKCE, and the thickness of the VI muscle showed the greatest increase with a medium–large effect size (F = 8.52, p = 0.01, and d = 0.53). The thickness of the VI, VL, VM, and VMO muscles increased after CKCE, and the VMO muscle had the largest effect size (F = 11.71, p = 0.00, and d = 1.02). These results indicate that the thickness of the quadriceps muscles can be selectively improved depending on the type of exercise.

Effects of Open Versus Closed Kinetic Chain Exercises in Patients with Knee Osteoarthritis

Effects of Open Versus Closed Kinetic Chain Exercises in Patients with Knee Osteoarthritis

Biomechanical correlation at the knee joint between static lunge and single-leg drop landing - a comparative study among three different toe directions

BackgroundToe direction is a critical factor affecting knee biomechanics during various movements including closed kinetic chain (CKC) exercise and landing tasks. Physiotherapists always concentrate on the control of toe direction during CKC exercise as a first step for athletes, as it is believed that correction of toe direction during CKC exercise is important to maintain the appropriate toe position even in high demanding activities such as landing tasks. The purpose of the present study was to investigate knee biomechanics during CKC exercise as well as landing tasks with three different toe directions, and clarify whether biomechanical parameters during CKC exercise would be related to those during landing tasks.MethodsA total of 23 male recreational level athletes (mean age = 20.0 ± 1.1 yrs) participated. Tegner activity score were 7 for all male subjects. First, the subjects performed weight-bearing static lunge tests (SL) under three different toe directions, including 0 degrees (Toe-neutral: TN), 20 degrees (Toe-In: TI), and - 20 degrees (Toe-out: TO). Thereafter, SLDL was done under three different toe directions. Three-dimensional knee kinematics and kinetics at 60 degrees of knee flexion were calculated. As a statistical analysis, Pearson's correlation coefficient was used to evaluate the relationship between SL and SLDL. The statistical significance level wasset at P=0.05.Results and ConclusionsKnee abduction angle showed significant correlation between SL and SLDL in all three different directions (TI: r=0.631, p<0.001, TN: r=0.678, p<0.001, TO: r=0.572, p<0.001). In terms of knee internal rotation, strong correlation was also found (TI: r=0.846, p<0.001, TN: r=0.791, p<0.001, TO: r=0.749, p<0.001). In addition, external knee abduction moment presented significant correlation in all three different directions (TI: r=0.574, p<0.001, TN: r=0.499, p<0.01, TO: r=0.469, p<0.01). From the present study, significant correlation between SL and SLDL was found in knee abduction angle, knee internal rotation, and external knee abduction moment under all three different directions including TI, TN, and TO. Physiotherapist should take care of toe direction and reform the movements especially for athletes who present malalignment of the knee joint during SL with TI or TO to prevent ACL injury in landing tasks.

The Effects of Routine Physiotherapy Alone and in Combination with Either Tai Chi or Closed Kinetic Chain Exercises on Knee Osteoarthritis: A Comparative Clinical Trial Study

Background: Osteoarthritis is a common chronic degenerative disorder. Exercise is regarded as a common practice for the elderly, especially those with knee osteoarthritis. Objectives: This study aimed to examine and compare the effects of Tai Chi and closed kinetic chain exercises on patients with knee osteoarthritis. Methods: Forty-eight patients with knee osteoarthritis participated in this clinical trial study, which was carried out in a private clinic (2016) in district thirteen of Tehran, Iran. They were randomly assigned equally to closed kinetic chain exercise (CKCE) group, Tai Chi Exercise (TCE) group, and no exercise group. All three groups were equally treated using a standard physical therapy protocol. The CKCE group performed static stretching and CKCE, and the TCE group performed Tai Chi warm-up and cool-down and the form 6 of Yang style of Tai Chi exercises. All three groups were evaluated at baseline, sixth, and twelfth sessions of treatment and one- month post- treatment using a six-minute walk test and the knee injury and osteoarthritis outcome score (KOOS) questionnaire. Results: According to KOOS subscale, the TCE improved the symptoms (68.94 ± 9.24) (P < 0.001), pain (75.13 ± 12.33) (P < 0.001), ADL (76.50 ± 12.03) (P = 0.01), and the total score (72.12 ± 8.63) (P < 0.001) significantly more than the CKCE (55.50 ± 13.61, 64.75 ± 10.58, 67.25 ± 9.96, 67.25 ± 7.82, respectively) and routine physiotherapy (34.62 ± 11.34, 53.06 ± 9.36, 61.69 ± 10.32, 51.50 ± 7.24, respectively) in patients with knee OA. Both the TCE (376.43 ± 88.18) (P < 0.001) and CKCE (353.50 ± 78.15) (P < 0.001) groups showed improved walking distance significantly more than the no exercise group (315.35 ± 66.33) in patients with knee OA. Conclusions: In patients with knee OA, Tai Chi exercise relieved pain and symptom even in a short time, and improved QOL, sport, and recreational activities, and ADL. The effects of both TCE and CKCE on the improvement of QOL were similar.

The Effect of Open- Versus Closed-Kinetic-Chain Exercises on Anterior Tibial Laxity, Strength, and Function Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Background There is controversy surrounding the early use of open-kinetic-chain (OKC) quadriceps-strengthening exercises following anterior cruciate ligament reconstruction (ACLR) due to the belief that increased strain on the graft could cause damage. Objectives To determine whether OKC quadriceps exercises result in differences in anterior tibial laxity, strength, function, quality of life, or adverse events in the ACLR population, when compared to closed-kinetic-chain (CKC) quadriceps exercises. Methods Seven electronic databases (MEDLINE, Embase, AMED, CINAHL, SPORTDiscus, PEDro, and the Cochrane Central Register of Controlled Trials) were searched through April 2017. A systematic review with meta-analysis was conducted on randomized controlled trials comparing OKC versus CKC exercises following ACLR. Outcomes of interest were tibial laxity, strength, and function. A methodological quality assessment of the included studies was completed, and the results were synthesized using meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Ten studies were included in the review. The meta-analysis demonstrated low- to moderate-quality evidence of no between-group differences in anterior tibial laxity, strength, or patient-reported function at any time point. Meta-analysis was unable to be performed for functional outcomes. Conclusion There was limited to moderate-quality evidence of no difference in anterior tibial laxity, strength, patient-reported function, or physical function with early or late introduction of OKC exercises in the ACLR population, when compared to CKC exercises, at all follow-up time points. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(7):552-566. Epub 23 Apr 2018. doi:10.2519/jospt.2018.7656.

The Effects of Open versus Closed Kinetic Chain Exercises on Ankle Joint Function in Athletes with Chronic Ankle Instability

Objective: Lateral ankle sprains are common sport injuries that often result in structural and functional alterations leading to chronic ankle instability (CAI). Insufficiencies in proprioception, neuromuscular control, and strength are suggested as contributing factors to CAI. Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) exercises often constitute the core of ankle specific training before progression to advanced training. Though commonly used in the management of CAI, there is no consensus regarding their efficacy on physical therapy outcomes. The purpose of this study was to compare the effect of OKC and CKC exercises on dynamic postural control, self-reported function, and subjective sense of instability in subjects with CAI. Methods: Subjects with unilateral CAI were randomly assigned into three groups: OKC (n=5), CKC (n=6), and control (n=6). Outcome measures included star excursion balance test (SEBT) reach distance, center of pressure (COP) sway velocity, sway area, and path length; and Foot and Ankle Ability Measure-Sport Subscale. Intervention groups completed 6 weeks of exercises. Also, subjects completed a global rating of change (GROC) form at week 6 post-intervention. Results: Following intervention, both OKC and CKC groups had significant improvements in the outcome measures, indicating an improvement in dynamic postural control and subjective function; however, CKC had greater improvements than OKC. The control group did not show improvements. GROC revealed a significant difference in median score for CKC group when compared to OKC and control groups (p=0.04 and p=0.03, respectively). Conclusion: The 6-week of OKC and CKC exercise programs improved parameters of postural control and subjective function in CAI subjects. CKC exercises, however, were more effective than OKC exercises. Hence, exercise programs should become more functional and task oriented. Further research is needed in a larger cohort of subjects to determine effects of both training programs on ankle joint injury risk factors.

Open versus Closed Kinetic Chain Exercises following an Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Background There is no consensus on whether closed kinetic chain (CKC) or open kinetic chain (OKC) exercises should be the intervention of choice following an anterior cruciate ligament (ACL) injury or reconstruction. Methods A systematic search identified randomized controlled trials of OKC versus CKC exercise training in people who had undergone ACL reconstructive surgery. All published studies in this systematic review were comparisons between OKC and CKC groups. Results Seven studies were included. Lysholm knee scoring scale was not significantly different between OKC and CKC exercise patients: MD: −1.03%; CI: −13.02, 10.95; p value = 0.87 (Chi2 = 0.18, df = 1, and p value = 0.67). Hughston clinic questionnaire scores were not significantly different between OKC and CKC exercise patients: MD: −1.29% (−12.02, 9.43); p value = 0.81 (Chi2 = 0.01, df = 1, and p value = 0.93). Conclusions While OKC and CKC may be beneficial during ACL surgical rehabilitation, there is insufficient evidence to suggest that either one is superior to the other.

Effect of Hip Adduction Position on the Vastus Medialis Oblique and Vastus Lateralis During Closed Kinetic Chain Exercise in Sitting Posture

Background: Several studies have discussed diverse exercise methods considered to be useful for the selective contraction of the vastus medialis oblique (VMO) muscle for the treatment of patellofemoral pain syndrome. Some studies have reported that exercise methods, including hip adduction, in closed kinetic chain exercises are more effective in terms of the muscle activation of the VMO and the timing of the muscle’s initial contraction. We focused on isometric contraction during a closed kinetic chain exercise with hip adduction. Objects: The purpose of this study was to examine muscle activation in the VMO and the vastus lateralis (VL) and the onset time difference between their initial contractions via closed kinetic chain isometric quadriceps femoris exercises including hip adduction. Methods: In total, 36 healthy subjects adopted two hip positions during isometric contraction of the quadriceps femoris in a closed kinetic chain exercise (hip neutral and hip adduction position). Statistical analyses were conducted using a paired t-test (α=.05). Results: Isometric contraction of the quadriceps femoris in a closed kinetic chain exercise caused a greater increase in VMO muscle activity in the hip adduction position [52.68±22.21 percentage of maximal voluntary isometric contraction (%MVIC)]than the hip neutral position (43.43±19.85 %MVIC). The onset time difference (VL-VMO) decreased more in the hip adduction position (-82.14±34.2 ㎳) than the hip neutral position (73.94±2.94 ㎳). Conclusion: We recommend this exercise as a clinically useful therapeutic method for patients with patellofemoral pain syndrome due to weakening of the VMO muscle and lateral inclination of the patella.

A Comparative Study on Effectiveness of Open Versus Closed Kinetic Chain Exercises to Improve Gait in Spastic Diplegic Cerebral Palsy

A Comparative Study on Effectiveness of Open Versus Closed Kinetic Chain Exercises to Improve Gait in Spastic Diplegic Cerebral Palsy