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Open and Closed Kinetic Chain Exercises for Strengthening in ACL Rehabilitation

Strength of the quadriceps and hamstring muscle groups is one of the key components in determining an athlete’s readiness to return to running after they have an ACL reconstruction surgery.  In order to improve muscular strength efficiently, a number of different exercises are utilized that can be either open kinetic chain or closed kinetic chain exercises.

An open kinetic chain exercise is an exercise where the part of the body furthest away (usually the foot or the hand), is not loaded but rather free or not fixed to an object or to the floor.  An example of open kinetic chain exercise used in ACL reconstruction rehabilitation would be seated knee extensions for quadriceps recruitment where the lower leg below the knee is moving up and down against resistance.

A closed kinetic chain exercise is an exercise where the part of the body furthest away is loaded or fixed against an object.  An example of a closed kinetic chain exercise used in ACL reconstruction rehabilitation would be a squat where your feet are fixed to the floor and the rest of the chain above (knee/hip/trunk) moves.

A recent study by the International Journal of Sports Physical Therapy (IJSPT) was conducted to determine whether early intervention of open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises improved quadriceps and hamstring strength more than just CKC exercises in athletes recovering from an anterior cruciate ligament reconstruction (ACLR) surgery .

The study included 15 athletes who had undergone an ACL reconstruction surgery with a hamstring autograft (used part of the athlete’s hamstring tendons to create a new ACL).  They were divided into two groups:  The first group performed both OKC and CKC exercises and the second group performed only CKC exercises. Quadriceps and hamstring strength testing was performed at 3 months post-operation with an isokinetic device. Results showed that the OKC + CKC exercise group demonstrated increased quadriceps and hamstring strength compared to the CKC exercise group without increasing graft laxity.

The conclusion of this study suggests that early implementation of OKC exercises and CKC exercises in ACL reconstruction rehabilitation allow for improved quadriceps and hamstring strength at 3 months post-operation, which could allow an athlete to return to running sooner than later and contribute to a more complete and efficient rehabilitation when attempting to return to sport.

At Omaha Physical Therapy Institute, we implement both OKC and CKC exercises early on in the rehabilitation process in order to maximize an athlete’s strength and neuromuscular control to allow for a safe, confident, and comfortable return to their sport.

Ashlie Eckmann, PT, DPT


See page 7-8 in the document below for abstract:



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