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. 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)
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)
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
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 podo congres - 2 okt 11
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
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
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
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
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
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 Neuromuscularcoordinationstrenght crosschain
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
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