Review Question - QID 1411

An important feature of closed kinetic chain exercises in the shoulder is that they allow for co-contraction of the periscapular and rotator cuff muscles.

Closed kinetic chain exercises are used early in the rehabilitation process. The distal segment is fixed, and an axial load is applied which provides glenohumeral compression and thereby reduces the demand on the rotator cuff. These exercises stimulate co-contractions of the scapular and rotator cuff muscles, load scapular stabilizers, and facilitate active motion.

Facilitated active motion exercises use proximal segment motion to stimulate and facilitate motion in the target tissue. These exercises are often performed in diagonal movements. Resistive active motion exercises are used later in the rehabilitation process. These are typically open kinetic chain exercises that involve active glenohumeral motion with extrinsic loads such as weights or exercise tubing. During the later stages of upper extremity rehabilitation, plyometrics are added. These exercises help to prepare the athlete for return to sport. When performed at slower speeds, these exercises emphasize stabilization and control. As the speeds increase, muscles begin to work in the stretch-shortening sequence associated with sports participation.

The review article by Kibler describes the rationale and typical progression used in shoulder rehabilitation.

Illustration A shows a clinical photo of a closed-chain shoulder shoulder exercise.