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"Kinetic chain" approach in rehabilitation - Mrs. Fabienne Vandesteene
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Professional Podiatrists Members' Day 2nd of October 2011 ...

Professional Podiatrists Members' Day 2nd of October 2011

"Kinetic chain" approach in the rehabilitation of an athlete: increasing and decreasing chains
-- Mrs. Fabienne Vandesteene --

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"Kinetic chain" approach in rehabilitation - Mrs. Fabienne Vandesteene Presentation Transcript

  • 1. Kineticchainapproach in the rehabilitation of anathlete: increasing and decreasingchains
    Fabienne Van De Steene
    Sportkine UZ Gent
    RevakiUGent
  • 2. Let us look together…
    2
    podo congres - 2 okt 11
  • 3. contents
    Kineticchain
    Principle
    Condition
    Disadvantage
    Most common adaptation
    Hip
    Trunk
    Shoulder
    Crosschains
    3
    podo congres - 2 okt 11
  • 4. Kineticchain: principle
    podo congres - 2 okt 11
    4
    Human body = series of interrelated links orsegments
    Coordinatedaction of body segments
    Strength & power are generatedfromgroundreactionforces and transferredinto the final link of the chain (hand – foot)
  • 5. Kineticchain: principle
    podo congres - 2 okt 11
    5
    Open kineticchain
    Closedkineticchain
  • 6. Kinetic Chain
    Wrist
    F
    O
    R
    C
    E
    Elbow
    Shoulder
    Trunk
    and Back
    Legs
    0
    TIME
    (Kibler, Gent 2003)
    6
    podo congres - 2 okt 11
  • 7. Kineticchain: principle
    podo congres - 2 okt 11
    7
    Each link is necessaryformovement
    Injurycandevelop in the weakest link
    Knowledge of link important forinvestigation and treatment
    Groppel, 1992
  • 8. Kineticchain: principle
    podo congres - 2 okt 11
    8
    Each sport has hisspecificdemands
    Each sport has hisspecificadaptations
    Each sport has hisspecificenergyproduction in the body
  • 9. podo congres - 2 okt 11
    9
    Energy production in the kinetic chain
    Hip/trunk-energy 51%
    Shoulder-energy 13 %
    Elbow-energy 21%
    Wrist-energy 15%
    (Kibler et al. 1996)
  • 10. podo congres - 2 okt 11
    10
    Correlation Strength – Ball velocity
    Upper extremity strength .46
    Lower extremity strength .89
    (Kraemer et al. J Sport Rehab 1995)
  • 11. Kineticchain: principle
    podo congres - 2 okt 11
    11
    Proximal stability necessary for distal mobility
    Trunk, shoulders and upper limb are links in the increasing chain
    Trunk, hips and lower limb are links in the decreasing chain
    They cannot work independently from each other, however “dependent-compensatory”
  • 12. Large versus small knee flexion during tennis serve (Olympic Games Sydney)
    FleisigGS et al 1996
    Elliot et al 2003
    *Significant difference (p<0.05)
    12
    podo congres - 2 okt 11
  • 13. Kineticchain: principle
    podo congres - 2 okt 11
    13
    Legs/hip/trunk
    Stable basis
    Build up strengththrough the chain
    Shouldergirdle
    Move composedstrength
    Shoulder to hand – hip to foot
    Crossedchains!!!!
    Groppel, 1992
  • 14. Kineticchain: condition
    podo congres - 2 okt 11
    14
    Conditionforoptimalkineticchainfunctioning
    Joint needs to be in optimalposition to pass on the energy
    Muscleactivityneeds to beon time
    And in the proper sequence (exc-conc)
  • 15. Notonlyamount of muscleactivity is important,also proper timing and sequencing!
    Elite versus beginner tennis player – sequence in muscleactivity
    (Girard et al. Med Sci Sports Exc 2005, Lintner et al. 2008)
    15
    podo congres - 2 okt 11
  • 16. Kineticchain: disadvantage
    podo congres - 2 okt 11
    16
    Consequencesof optimalkineticchainfunctioning
    “mal”adaptations (Wolff’s low)
    Strengthimbalance
    Muscleweakness
    Joint stiffness

  • 17. 17
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  • 18. PITFALLS KINETIC CHAIN
    Wrist
    Wrist
    F
    O
    R
    C
    E
    Elbow
    Elbow
    F
    O
    R
    C
    E
    Shoulder
    Shoulder
    Trunk
    and Back
    Trunk
    and Back
    Legs
    Legs
    0
    0
    TIME
    TIME
    (Kibler, Gent 2003, adapted from Groppel)
    "catch up"
    18
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  • 19. KineticChain “Breakage”
    Usually acquired:
    Remote injury
    Incomplete healing after injury
    Muscle weakness or imbalance
    Muscle inflexibility or joint stiffness
    Improper mechanics
    (Lintner 2008)
    19
    podo congres - 2 okt 11
  • 20. Mathematical model kineticchain in tennis (Kibler et al. 1995)
    20% reduction in kineticenergyfrom the trunk
    34% increase in velocity
    70% increase in mass
    To achievesamekineticenergy of the hand
    "catch up"
    20
    podo congres - 2 okt 11
  • 21. KineticChain
    podo congres - 2 okt 11
    21
    Conclusion
    Chain is necessitybut…
    Chain is difficult to evaluate
    No “gold standard”
    Less “evidencebased”
    Trial and error…
  • 22. contents
    Kineticchain
    Principle
    Condition
    Disadvantage
    Most common adaptation
    Hip
    Trunk
    Shoulder
    Crosschains
    22
    podo congres - 2 okt 11
  • 23. hip
    podo congres - 2 okt 11
    23
    Commonadaptations
    Decreasedflexibility (rotation-extension)
    Decreasedabductionstrength (endurance)
    Muscleimbalance (abductors-adductors)
    Insufficientcontrol of localstabilizers
    How do we test?
    ROM (exo-endo-flexion-extension) / musclelength !!clinicalinvestigation!!
    Muscletesting (trendelenburg)
    Isokinetic-MMT
    Functional tests: squat-lounge
    Cools & Walravens 2007, Ellenbecker 2007, Vad 2003, Johansson & Cools 2010
  • 24. HIP
    podo congres - 2 okt 11
    24
  • 25. hip
    podo congres - 2 okt 11
    25
  • 26. hip
    podo congres - 2 okt 11
    26
    Commonadaptations
    Decreasedflexibility (rotation-extension)
    Decreasedabductionstrength (endurance)
    Muscleimbalance (abductors-adductors)
    Insufficientcontrol of localstabilizers
    How do we treat???
    Mobilising-stretching in the chain
    Restoremusclefunction
    Muscle training
    Analytical
    Functional
    Neuromuscularcoordination
  • 27. hip (mob/stretchingexc)
    podo congres - 2 okt 11
    27
  • 28. hip
    28
    podo congres - 2 okt 11
  • 29. Hip (neuromusccoord)
    29
    podo congres - 2 okt 11
  • 30. Hip (strength)
    30
    podo congres - 2 okt 11
  • 31. 31
    podo congres - 2 okt 11
  • 32. Hip
    podo congres - 2 okt 11
    32
    Commonadaptations
    Decreasedflexibility (rotation-extension)
    Decreasedabductionstrength (endurance)
    Muscleimbalance (abductors-adductors)
    Insufficientcontrol of localstabilizers
    Influenceonother joints
    Decreasing – increasingchain
    Ankle
    Foot

  • 33. Ankledistorsion
    Evidencebased risk factors:
    Posturalcontrol
    Proprioception
    General prevention
    Stability training
    Local
    General
    33
    podo congres - 2 okt 11
  • 34. podo congres - 2 okt 11
    34
    Preventief effect “stability training”
    “core stabilitymeasures” are predictivforlowerlimbinjuries
    Leeton et al. 2004
  • 35. 35
    podo congres - 2 okt 11
  • 36. 36
    podo congres - 2 okt 11
  • 37. Ankledistorsion
    Most important risk factor (prospectiveinvestigation):
    144 youthsoccerplayer U11-U17
     playerswith a lateralfootunroll:
    significant greaterchance
    (Witvrouw, Thijs, Van Ginckel, De Bo)
    37
    podo congres - 2 okt 11
  • 38. trunk
    podo congres - 2 okt 11
    38
    Commonadaptations
    Decreasedflexibilitydorsalstructures
    Decreased ROM extensionthoracicspine
    Hypermobilitycervicalspine (compensatory)
    Decreasedextensionstrength (endurance)
    Muscleimbalanceabdominals-back
    Decreased core stability
    How do we test?
    Sit and reach
    ROM investigation (functional)
    Muscletesting
    Isokinetic test
    Normalfysiological lordoses
    Cools & Walravens 2007, Ellenbecker 2007, Vad 2003, Johansson & Cools 2010
  • 39. trunk
    podo congres - 2 okt 11
    39
  • 40. trunk
    podo congres - 2 okt 11
    40
    Commonadaptations
    Decreasedflexibilitydorsalstructures
    Decreased ROM extensionthoracicspine
    Hypermobilitycervicalspine (compensatory)
    Decreasedextensionstrength (endurance)
    Muscleimbalanceabdominals-back
    Decreased core stability
    How do we test?
    Sit and reach
    ROM investigation (functional)
    Muscletesting
    Isokinetic test
    Normalfysiological lordoses
    Cools & Walravens 2007, Ellenbecker 2007, Vad 2003, Johansson & Cools 2010
  • 41. trunk
    podo congres - 2 okt 11
    41
  • 42. trunk
    podo congres - 2 okt 11
    42
    Commonadaptations
    Decreasedflexibilitydorsalstructures
    Decreased ROM extensionthoracicspine
    Hypermobilitycervicalspine (compensatory)
    Decreasedextensionstrength (endurance)
    Muscleimbalanceabdominals-back
    Decreased core stability
    How do we test?
    Sit and reach
    ROM investigation (functional)
    Muscletesting
    Isokinetic test
    Normalfysiological lordoses
    Cools & Walravens 2007, Ellenbecker 2007, Vad 2003, Johansson & Cools 2010
  • 43. trunk
    podo congres - 2 okt 11
    43
    Commonadaptations
    Decreasedflexibilitydorsalstructures
    Decreased ROM extensionthoracicspine
    Hypermobilitycervicalspine (compensatory)
    Decreasedextensionstrength (endurance)
    Muscleimbalanceabdominals-back
    Decreased core stability
    How do we treat???
    Mobilising-stretching in the chain
    Restoremusclefunction
    Muscle training
    Analytical
    Functional
    Neuromuscularcoordinationstrenght crosschain
  • 44. podo congres - 2 okt 11
    44
  • 45. podo congres - 2 okt 11
    45
  • 46. podo congres - 2 okt 11
    46
  • 47. podo congres - 2 okt 11
    47
  • 48. podo congres - 2 okt 11
    48
  • 49. podo congres - 2 okt 11
    49
  • 50. Shouldergirdle
    podo congres - 2 okt 11
    50
    Commonadaptations
    GIRD idshoulder: decreasedflexibility
    Muscleimbalance (IR>ER)
    Protractionscapula
    Alteredmusclerecruitmentscapula
    How do we test?
    GIRD- endorotation/ROM clinicalinvestigation
    Muscletesting
    Musclelength
    Scapular setting
    Trakis 2008, Dines 2009, Cools & Johansson 2010, Kibler 1996, Laudner 2007, Oyama 2008)
  • 51. podo congres - 2 okt 11
    51
    GIRD in the shoulder
  • 52. Shouldergirdle
    podo congres - 2 okt 11
    52
    Commonadaptations
    GIRD idshoulder: decreasedflexibility
    Muscleimbalance (IR>ER)
    Protractionscapula
    Alteredmusclerecruitmentscapula
    How do we test?
    GIRD- endorotation/ROM clinicalinvestigation
    Muscletesting
    Musclelength
    Scapular setting
    Trakis 2008, Dines 2009, Cools & Johansson 2010, Kibler 1996, Laudner 2007, Oyama 2008)
  • 53. podo congres - 2 okt 11
    53
    Scapular setting
  • 54. Shouldergirdle
    podo congres - 2 okt 11
    54
    Commonadaptations
    GIRD idshoulder: decreasedflexibility
    Muscleimbalance (IR>ER)
    Protractionscapula
    Alteredmusclerecruitmentscapula
    How to treat
    Mobilising/stretching
    Strength training
    Scapular setting
    Integrationchain!!!!
  • 55. Shouldergirdle
    podo congres - 2 okt 11
    55
    Muscularshortening
  • 56. Shouldergirdle
    podo congres - 2 okt 11
    56
    Commonadaptations
    GIRD idshoulder: decreasedflexibility
    Muscleimbalance (IR>ER)
    Protractionscapula
    Alteredmusclerecruitmentscapula
    How to treat
    Mobilising/stretching
    Strength training
    Scapular setting
    Integrationchain!!!!
  • 57. podo congres - 2 okt 11
    57
  • 58. Cross chain
    58
    podo congres - 2 okt 11
    A lot of sports movement have a cross chain
    pattern!!!!
    With influence from the decreasing and increasing chain...
  • 59. Cross chain
    mov
    59
    podo congres - 2 okt 11
    Compensations ... unavoidable???!!!
    All tissues are ...
    involved in the chain
    and in the adaptations from the chain
  • 60. podo congres - 2 okt 11
    60
    Compensation
  • 61. podo congres - 2 okt 11
    61
  • 62. Integration chain
    62
    podo congres - 2 okt 11
  • 63. CONCLUSION
    podo congres - 2 okt 11
    63
    Knowledge and assessment of sportspecificadaptationson ALL levels of the kineticchain !!!
    Flexibility + strength + motor control...
    Investigate/Treatadaptationson ALL levels of the kineticchain
    Integratekineticchainintoexercises - advice
  • 64. Questions??????????
    64
    podo congres - 2 okt 11
    Thank you!!!!!!!