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

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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

  1. 1. Kineticchainapproach in the rehabilitation of anathlete: increasing and decreasingchains<br />Fabienne Van De Steene<br />Sportkine UZ Gent<br />RevakiUGent<br />
  2. 2. Let us look together…<br />2<br />podo congres - 2 okt 11<br />
  3. 3. contents<br />Kineticchain<br />Principle<br />Condition<br />Disadvantage<br />Most common adaptation<br />Hip<br />Trunk<br />Shoulder<br />Crosschains<br />3<br />podo congres - 2 okt 11<br />
  4. 4. Kineticchain: principle<br />podo congres - 2 okt 11<br />4<br />Human body = series of interrelated links orsegments<br />Coordinatedaction of body segments<br />Strength & power are generatedfromgroundreactionforces and transferredinto the final link of the chain (hand – foot)<br />
  5. 5. Kineticchain: principle<br />podo congres - 2 okt 11<br />5<br />Open kineticchain<br />Closedkineticchain<br />
  6. 6. Kinetic Chain<br />Wrist<br />F<br />O<br />R<br />C<br />E<br />Elbow<br />Shoulder<br />Trunk <br />and Back<br />Legs<br />0<br />TIME<br />(Kibler, Gent 2003)<br />6<br />podo congres - 2 okt 11<br />
  7. 7. Kineticchain: principle<br />podo congres - 2 okt 11<br />7<br />Each link is necessaryformovement<br />Injurycandevelop in the weakest link<br />Knowledge of link important forinvestigation and treatment<br />Groppel, 1992<br />
  8. 8. Kineticchain: principle<br />podo congres - 2 okt 11<br />8<br />Each sport has hisspecificdemands<br />Each sport has hisspecificadaptations<br />Each sport has hisspecificenergyproduction in the body<br />
  9. 9. podo congres - 2 okt 11<br />9<br />Energy production in the kinetic chain <br />Hip/trunk-energy 51%<br />Shoulder-energy 13 %<br />Elbow-energy 21%<br />Wrist-energy 15% <br />(Kibler et al. 1996)<br />
  10. 10. podo congres - 2 okt 11<br />10<br />Correlation Strength – Ball velocity<br />Upper extremity strength .46<br />Lower extremity strength .89 <br />(Kraemer et al. J Sport Rehab 1995)<br />
  11. 11. Kineticchain: principle<br />podo congres - 2 okt 11<br />11<br />Proximal stability necessary for distal mobility<br />Trunk, shoulders and upper limb are links in the increasing chain<br />Trunk, hips and lower limb are links in the decreasing chain<br />They cannot work independently from each other, however “dependent-compensatory”<br />
  12. 12. Large versus small knee flexion during tennis serve (Olympic Games Sydney)<br />FleisigGS et al 1996<br />Elliot et al 2003<br />*Significant difference (p<0.05) <br />12<br />podo congres - 2 okt 11<br />
  13. 13. Kineticchain: principle<br />podo congres - 2 okt 11<br />13<br />Legs/hip/trunk<br />Stable basis<br />Build up strengththrough the chain<br />Shouldergirdle<br />Move composedstrength<br />Shoulder to hand – hip to foot<br />Crossedchains!!!!<br />Groppel, 1992<br />
  14. 14. Kineticchain: condition<br />podo congres - 2 okt 11<br />14<br />Conditionforoptimalkineticchainfunctioning<br />Joint needs to be in optimalposition to pass on the energy<br />Muscleactivityneeds to beon time<br />And in the proper sequence (exc-conc)<br />
  15. 15. Notonlyamount of muscleactivity is important,also proper timing and sequencing!<br />Elite versus beginner tennis player – sequence in muscleactivity<br />(Girard et al. Med Sci Sports Exc 2005, Lintner et al. 2008)<br />15<br />podo congres - 2 okt 11<br />
  16. 16. Kineticchain: disadvantage<br />podo congres - 2 okt 11<br />16<br />Consequencesof optimalkineticchainfunctioning<br />“mal”adaptations (Wolff’s low)<br />Strengthimbalance<br />Muscleweakness<br />Joint stiffness<br />…<br />
  17. 17. 17<br />podo congres - 2 okt 11<br />
  18. 18. PITFALLS KINETIC CHAIN<br />Wrist<br />Wrist<br />F<br />O<br />R<br />C<br />E<br />Elbow<br />Elbow<br />F<br />O<br />R<br />C<br />E<br />Shoulder<br />Shoulder<br />Trunk <br />and Back<br />Trunk <br />and Back<br />Legs<br />Legs<br />0<br />0<br />TIME<br />TIME<br />(Kibler, Gent 2003, adapted from Groppel)<br />"catch up"<br />18<br />podo congres - 2 okt 11<br />
  19. 19. KineticChain “Breakage”<br />Usually acquired:<br />Remote injury<br />Incomplete healing after injury<br />Muscle weakness or imbalance<br />Muscle inflexibility or joint stiffness<br />Improper mechanics<br />(Lintner 2008)<br />19<br />podo congres - 2 okt 11<br />
  20. 20. Mathematical model kineticchain in tennis (Kibler et al. 1995)<br />20% reduction in kineticenergyfrom the trunk<br />34% increase in velocity<br />70% increase in mass<br />To achievesamekineticenergy of the hand<br />"catch up"<br />20<br />podo congres - 2 okt 11<br />
  21. 21. KineticChain<br />podo congres - 2 okt 11<br />21<br />Conclusion<br />Chain is necessitybut…<br />Chain is difficult to evaluate<br />No “gold standard”<br />Less “evidencebased”<br />Trial and error…<br />
  22. 22. contents<br />Kineticchain<br />Principle<br />Condition<br />Disadvantage<br />Most common adaptation<br />Hip<br />Trunk<br />Shoulder<br />Crosschains<br />22<br />podo congres - 2 okt 11<br />
  23. 23. hip<br />podo congres - 2 okt 11<br />23<br />Commonadaptations<br />Decreasedflexibility (rotation-extension)<br />Decreasedabductionstrength (endurance)<br />Muscleimbalance (abductors-adductors)<br />Insufficientcontrol of localstabilizers<br />How do we test?<br />ROM (exo-endo-flexion-extension) / musclelength !!clinicalinvestigation!!<br />Muscletesting (trendelenburg)<br />Isokinetic-MMT<br />Functional tests: squat-lounge<br />Cools & Walravens 2007, Ellenbecker 2007, Vad 2003, Johansson & Cools 2010<br />
  24. 24. HIP<br />podo congres - 2 okt 11<br />24<br />
  25. 25. hip<br />podo congres - 2 okt 11<br />25<br />
  26. 26. hip<br />podo congres - 2 okt 11<br />26<br />Commonadaptations<br />Decreasedflexibility (rotation-extension)<br />Decreasedabductionstrength (endurance)<br />Muscleimbalance (abductors-adductors)<br />Insufficientcontrol of localstabilizers<br />How do we treat???<br />Mobilising-stretching in the chain<br />Restoremusclefunction<br />Muscle training <br />Analytical<br />Functional<br />Neuromuscularcoordination<br />
  27. 27. hip (mob/stretchingexc)<br />podo congres - 2 okt 11<br />27<br />
  28. 28. hip<br />28<br />podo congres - 2 okt 11<br />
  29. 29. Hip (neuromusccoord)<br />29<br />podo congres - 2 okt 11<br />
  30. 30. Hip (strength)<br />30<br />podo congres - 2 okt 11<br />
  31. 31. 31<br />podo congres - 2 okt 11<br />
  32. 32. Hip<br />podo congres - 2 okt 11<br />32<br />Commonadaptations<br />Decreasedflexibility (rotation-extension)<br />Decreasedabductionstrength (endurance)<br />Muscleimbalance (abductors-adductors)<br />Insufficientcontrol of localstabilizers<br />Influenceonother joints<br />Decreasing – increasingchain<br />Ankle<br />Foot<br />…<br />
  33. 33. Ankledistorsion<br />Evidencebased risk factors:<br />Posturalcontrol<br />Proprioception<br />General prevention<br />Stability training <br />Local<br />General<br />33<br />podo congres - 2 okt 11<br />
  34. 34. podo congres - 2 okt 11<br />34<br />Preventief effect “stability training”<br />“core stabilitymeasures” are predictivforlowerlimbinjuries<br />Leeton et al. 2004<br />
  35. 35. 35<br />podo congres - 2 okt 11<br />
  36. 36. 36<br />podo congres - 2 okt 11<br />
  37. 37. Ankledistorsion<br />Most important risk factor (prospectiveinvestigation):<br />144 youthsoccerplayer U11-U17<br /> playerswith a lateralfootunroll:<br />significant greaterchance<br />(Witvrouw, Thijs, Van Ginckel, De Bo)<br />37<br />podo congres - 2 okt 11<br />
  38. 38. trunk<br />podo congres - 2 okt 11<br />38<br />Commonadaptations<br />Decreasedflexibilitydorsalstructures<br />Decreased ROM extensionthoracicspine<br />Hypermobilitycervicalspine (compensatory)<br />Decreasedextensionstrength (endurance)<br />Muscleimbalanceabdominals-back<br />Decreased core stability<br />How do we test?<br />Sit and reach<br />ROM investigation (functional)<br />Muscletesting<br />Isokinetic test<br />Normalfysiological lordoses<br />Cools & Walravens 2007, Ellenbecker 2007, Vad 2003, Johansson & Cools 2010<br />
  39. 39. trunk<br />podo congres - 2 okt 11<br />39<br />
  40. 40. trunk<br />podo congres - 2 okt 11<br />40<br />Commonadaptations<br />Decreasedflexibilitydorsalstructures<br />Decreased ROM extensionthoracicspine<br />Hypermobilitycervicalspine (compensatory)<br />Decreasedextensionstrength (endurance)<br />Muscleimbalanceabdominals-back<br />Decreased core stability<br />How do we test?<br />Sit and reach<br />ROM investigation (functional)<br />Muscletesting<br />Isokinetic test<br />Normalfysiological lordoses<br />Cools & Walravens 2007, Ellenbecker 2007, Vad 2003, Johansson & Cools 2010<br />
  41. 41. trunk<br />podo congres - 2 okt 11<br />41<br />
  42. 42. trunk<br />podo congres - 2 okt 11<br />42<br />Commonadaptations<br />Decreasedflexibilitydorsalstructures<br />Decreased ROM extensionthoracicspine<br />Hypermobilitycervicalspine (compensatory)<br />Decreasedextensionstrength (endurance)<br />Muscleimbalanceabdominals-back<br />Decreased core stability<br />How do we test?<br />Sit and reach<br />ROM investigation (functional)<br />Muscletesting<br />Isokinetic test<br />Normalfysiological lordoses<br />Cools & Walravens 2007, Ellenbecker 2007, Vad 2003, Johansson & Cools 2010<br />
  43. 43. trunk<br />podo congres - 2 okt 11<br />43<br />Commonadaptations<br />Decreasedflexibilitydorsalstructures<br />Decreased ROM extensionthoracicspine<br />Hypermobilitycervicalspine (compensatory)<br />Decreasedextensionstrength (endurance)<br />Muscleimbalanceabdominals-back<br />Decreased core stability<br />How do we treat???<br />Mobilising-stretching in the chain<br />Restoremusclefunction<br />Muscle training <br />Analytical<br />Functional<br />Neuromuscularcoordinationstrenght crosschain<br />
  44. 44. podo congres - 2 okt 11<br />44<br />
  45. 45. podo congres - 2 okt 11<br />45<br />
  46. 46. podo congres - 2 okt 11<br />46<br />
  47. 47. podo congres - 2 okt 11<br />47<br />
  48. 48. podo congres - 2 okt 11<br />48<br />
  49. 49. podo congres - 2 okt 11<br />49<br />
  50. 50. Shouldergirdle<br />podo congres - 2 okt 11<br />50<br />Commonadaptations<br />GIRD idshoulder: decreasedflexibility<br />Muscleimbalance (IR>ER)<br />Protractionscapula<br />Alteredmusclerecruitmentscapula<br />How do we test?<br />GIRD- endorotation/ROM clinicalinvestigation<br />Muscletesting<br />Musclelength<br />Scapular setting<br />Trakis 2008, Dines 2009, Cools & Johansson 2010, Kibler 1996, Laudner 2007, Oyama 2008)<br />
  51. 51. podo congres - 2 okt 11<br />51<br />GIRD in the shoulder<br />
  52. 52. Shouldergirdle<br />podo congres - 2 okt 11<br />52<br />Commonadaptations<br />GIRD idshoulder: decreasedflexibility<br />Muscleimbalance (IR>ER)<br />Protractionscapula<br />Alteredmusclerecruitmentscapula<br />How do we test?<br />GIRD- endorotation/ROM clinicalinvestigation<br />Muscletesting<br />Musclelength<br />Scapular setting<br />Trakis 2008, Dines 2009, Cools & Johansson 2010, Kibler 1996, Laudner 2007, Oyama 2008)<br />
  53. 53. podo congres - 2 okt 11<br />53<br />Scapular setting<br />
  54. 54. Shouldergirdle<br />podo congres - 2 okt 11<br />54<br />Commonadaptations<br />GIRD idshoulder: decreasedflexibility<br />Muscleimbalance (IR>ER)<br />Protractionscapula<br />Alteredmusclerecruitmentscapula<br />How to treat<br />Mobilising/stretching<br />Strength training<br />Scapular setting<br />Integrationchain!!!!<br />
  55. 55. Shouldergirdle<br />podo congres - 2 okt 11<br />55<br />Muscularshortening<br />
  56. 56. Shouldergirdle<br />podo congres - 2 okt 11<br />56<br />Commonadaptations<br />GIRD idshoulder: decreasedflexibility<br />Muscleimbalance (IR>ER)<br />Protractionscapula<br />Alteredmusclerecruitmentscapula<br />How to treat<br />Mobilising/stretching<br />Strength training<br />Scapular setting<br />Integrationchain!!!!<br />
  57. 57. podo congres - 2 okt 11<br />57<br />
  58. 58. Cross chain<br />58<br />podo congres - 2 okt 11<br />A lot of sports movement have a cross chain<br />pattern!!!!<br />With influence from the decreasing and increasing chain...<br />
  59. 59. Cross chain<br />mov<br />59<br />podo congres - 2 okt 11<br />Compensations ... unavoidable???!!!<br />All tissues are ...<br />involved in the chain<br />and in the adaptations from the chain<br />
  60. 60. podo congres - 2 okt 11<br />60<br />Compensation<br />
  61. 61. podo congres - 2 okt 11<br />61<br />
  62. 62. Integration chain<br />62<br />podo congres - 2 okt 11<br />
  63. 63. CONCLUSION<br />podo congres - 2 okt 11<br />63<br />Knowledge and assessment of sportspecificadaptationson ALL levels of the kineticchain !!!<br />Flexibility + strength + motor control...<br />Investigate/Treatadaptationson ALL levels of the kineticchain<br />Integratekineticchainintoexercises - advice<br />
  64. 64. Questions??????????<br />64<br />podo congres - 2 okt 11<br />Thank you!!!!!!!<br />

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