A Kinetic Chain Approach for Shoulder

Journal of Athletic Training 2000;35(3):329-337
C by the National Athletic Trainers' Association, Inc

Rehabilitation
John McMullen, MS, ATC*; Timothy L. Uhl, PhD, ATC, PTt
*Lexington Sports Medicine Center, Lexington, KY; tUniversity of Kentucky, Lexington, KY

Abstract:
The goal of most athletic rehabilitation is to return the
athlete to the activity that caused the injury. Successful
shoolder rehabilitation depends on an understanding of
the cause of injury and a complete and accurate diagnosis
of the involved tissues. Therefore, a thorough understanding of
the physical demands of the activity is a prerequisite to making
a complete diagnosis and returning the athlete to safe, pain-free
participation.' The kinetic link model, a biomechanical model
used to analyze many sport activities, depicts the body as a
linked system of interdependent segments, often working in a
proximal-to-distal sequence, to impart a desired action at the
distal segment.23 This model illustrates the contribution of
the entire body during sport activities rather than focusing
on the action of individual segments. Normal, efficient motion
and muscle activation are believed to occur in a proximal-todistal
sequence.2'4'5 This proximal-to-distal sequencing should
be considered when attempting to restore function via a
rehabilitation protocol.
The shoulder pathology is the primary factor that determines
the therapeutic treatment. Traditional shoulder rehabilitation
after injury includes a phase of rest, control of inflammation,
and isolated muscle strengthening.6'7 Additional components
of shoulder rehabilitation programs are scapular-stabilization,
proprioceptive, and closed kinetic chain exercises. However,
these exercise regimens tend to isolate the involved tissue
initially while neglecting the contributions of the trunk andlower extremity. Clinicians recognize the need to address
the legs and trunk as contributors to shoulder function and for
general conditioning, but their protocols often integrate the
shoulder with the rest of the body late in the rehabilitation
process.67 In kinetic chain shoulder rehabilitation, the legs and
trunk are integrated into most of the shoulder exercises from
the onset. This reinforces normal movement patterns and
reduces the challenge of learning new movements during
rehabilitation.
We present an approach to shoulder rehabilitation that
integrates the kinetic link model and normal synergistic muscle-
activation patterns with proprioceptive neuromuscular facilitation
(PNF) principles. Rather than isolating the shoulder
and gradually incorporating the rest of the body, this approach
focuses on rehabilitating the entire neuromuscular system by
integrating multiple body segments throughout the process.
The segmental integration follows the proximal-to-distal
movement and muscle-activation sequence consistent with
biomechanical upper extremity function.2'5 Clinically, kinetic
chain rehabilitation has been effective in restoring shoulder
function when other methods of shoulder rehabilitation have
failed.