A kinetic chain approach for shoulder rehabilitation.

OBJECTIVE: To introduce an approach to shoulder rehabilitation that integrates the kinetic chain throughout the rehabilitation program while providing the theoretical rationale for this program.
BACKGROUND: The focus of a typical rehabilitation program is to identify and treat the involved structures. However, in activities of sport and daily life, the body does not operate in isolated segments but rather works as a dynamic unit. Recently, rehabilitation programs have emphasized closed kinetic chain exercises, core-stabilization exercises, and functional programs. These components are implemented as distinct entities and are used toward the end of the rehabilitation program. DESCRIPTION: Kinetic chain shoulder rehabilitation incorporates the kinetic link biomechanical model and proximal-to-distal motor-activation patterns with proprioceptive neuromuscular facilitation and closed kinetic chain exercise techniques. This approach focuses on movement patterns rather than isolated muscle exercises. Patterns sequentially use the leg, trunk, and scapular musculature to activate weakened shoulder musculature, gain active range of motion, and increase strength. The paradigm of kinetic chain shoulder rehabilitation suggests that functional movement patterns and closed kinetic chain exercises should be incorporated throughout the rehabilitation process. CLINICAL ADVANTAGES: The exercises in this approach are consistent with biomechanical models, apply biomechanical and motor control theory, and work toward sport specificity. The exercises are designed to stimulate weakened tissue by motion and force production in the adjacent kinetic link segments.