Athletic Kinetic Chain Concepts in Nerve and Vascular Injuries

  • Mark A. Harrast
  • Nayna Patel

The kinetic chain concept originated in 1955 when Stendler described human kinesiology in terms of closed kinematic links.1 In this theory, body segments are considered rigid, overlapping segments in series connected by movable joints. With this conceptual framework, Stendler noted differences in muscular recruitment patterns and joint motions when the distal segment (foot or hand) is fixed compared to when it is freely movable. In the closed chain (distal segment fixed), the movement of one joint is typical and thus predictable based on the movement of the other joints in series.


Ulnar Nerve Thoracic Outlet Syndrome Cubital Tunnel Kinetic Chain Tibial Internal Rotation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Steindler A. Kinesiology of the Human Body. Springfield, IL: Charles C Thomas; 1955.Google Scholar
  2. 2.
    Putman CA. Sequential motions of body segments in striking and throwing skills: description and explanations. J Biomechanics 1993;26:125–35.CrossRefGoogle Scholar
  3. 3.
    Feltner ME, Dapena J. Three dimensional interactions in a two segment kinetic chain. Part I: General model. Int J Sport Biomech 1989;5:403–19.Google Scholar
  4. 4.
    Toyoshima S, Hoshikawa T, Miyashita M, et al. Contribution of the body parts to throwing performance. In: Biomechanics IV. Baltimore: University Park Press; 1974:169–74.Google Scholar
  5. 5.
    Fleisig GS, Barrentine SW, Escamilla RF, Andrews JR. Biomechanics of overhead throwing with implications for injury. Sports Med 1996;21:421–37.PubMedCrossRefGoogle Scholar
  6. 6.
    Zattara M, Bouisset S. Posturo-kinetic organization during the early phase of voluntary upper limb movement. 1: Normal subjects. J Neurosurg Psychiatry 1988;51:956–65.CrossRefGoogle Scholar
  7. 7.
    McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train 2000;35:329–37.PubMedGoogle Scholar
  8. 8.
    Hirashima M, Kadota H, Sakurai S, et al. Sequential muscle activity and its functional role in the upper extremity and trunk during overhead throwing. J Sports Sci 2002;20:301–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Marshall RN, Elliott BC. Long axis rotation: the missing link in proximal to distal segmental sequencing. J Sports Sci 2000;18:247–54.PubMedCrossRefGoogle Scholar
  10. 10.
    Elliot B, Marshall R, Noffal G. The role of upper limb segment rotations in the development of racket head speed in the squash forehand. J Sports Sci 1996;14:159–65.CrossRefGoogle Scholar
  11. 11.
    Kibler WB, Standaert CJ. Functional restoration: return to training and competition. In: Frontera WR, Herring SA, Micheli LJ, Silver JK, eds. Clinical Sports Medicine: Medical Management and Rehabilitation. Philadelphia: Saunders; 2007:273–83.Google Scholar
  12. 12.
    Kibler WB, Livingston B. Closed kinetic chain rehabilitation for upper and lower extremities. J Am Acad Orthop Surg 2001;9:412–21.PubMedGoogle Scholar
  13. 13.
    Kibler WB. Closed kinetic chain rehabilitation for sports injuries. Phys Med Rehabil Clin N Am 2000;11:369–84.PubMedGoogle Scholar
  14. 14.
    Grood ES, Suntay WT, Noyes FR, Butler DL. Biomechanics of the knee-extension exercise: effect of cutting the ACL. J Bone Joint Surg Am 1984;66:725–34.PubMedGoogle Scholar
  15. 15.
    Wilk KE, Naiquan Z, Glenn SF, et al. Kinetic chain exercise: implications for the anterior cruciate ligament patient. J Sport Rehabil 1997;6:125–40.Google Scholar
  16. 16.
    Arms SW, Pope MH, Johnson RJ, et al. The biomechanics of the anterior cruciate ligament rehabilitation and reconstruction. Am J Sports Med 1984;12:8–18.PubMedCrossRefGoogle Scholar
  17. 17.
    Lefever SL. Closed kinetic chain training. In: Hall CM, Brody LT, eds. Therapeutic Exercise: Moving Toward Function. Philadelphia: Lippincott Williams & Wilkins/Walters Kluwer; 2005:283–307.Google Scholar
  18. 18.
    Hunt GC. Peripheral nerve biomechanics: application to neuromobilization approaches. Phys Ther Rev 2002;7(2):111–21.CrossRefGoogle Scholar
  19. 19.
    Butler D. Mobilisation of the Nervous System. Melbourne: Churchill Livingstone; 1991.Google Scholar
  20. 20.
    Kostopoulos D. Treatment of carpal tunnel syndrome: a review of the non-surgical approaches with emphasis in neural mobilization. J Bodyw Mov Ther 2004;8(1):2–8.CrossRefGoogle Scholar
  21. 21.
    Devita P, Hortobagyi T, Barrier J. Gait biomechanics are not normal after ACL reconstruction and accelerated rehabilitation. Med Sci Sports Exerc 1998;30:1481–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vasc Surg 2007;46(3):601–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Kenal LA, Knapp LD. Rehabilitation of injuries in competitive swimmers. Sports Med 1996;22:337–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Lindgren KA. Conservative treatment of thoracic outlet syndrome: a 2-year follow-up. Arch Phys Med Rehabil 1997;78:373–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Aoki M, Takasaki H, Muraki T, et al. Strain on the ulnar nerve at the elbow and wrist during throwing motion. J Bone Joint Surg Am 2005;87:2508–14.PubMedCrossRefGoogle Scholar
  26. 26.
    Wright TW, Glowczewskie F, Cowin D, Wheler DL. Ulnar nerve excursion and strain at the elbow and wrist associated with upper extremity motion. J Hand Surg [Am] 2001;26:655–62.CrossRefGoogle Scholar
  27. 27.
    Kincaid JC. AAEE Minimonograph #31: the electrodiagnosis of ulnar neuropathy at the elbow. Muscle Nerve 1988;11(10):1005–15.PubMedCrossRefGoogle Scholar
  28. 28.
    Akalin E, El O, Peker O, et al. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil 2002;81:108–13.PubMedCrossRefGoogle Scholar
  29. 29.
    Kinoshita M, Okuda R, Abe M. Tarsal tunnel syndrome in athletes. Am J Sports Med 2006;34:1307–12.PubMedCrossRefGoogle Scholar
  30. 30.
    Trepman E, Kadel NJ, Chisholm K, Razzano L. Effect of foot and ankle position on tarsal tunnel compartment pressure. Foot Ankle Int 1999;20:721–6.PubMedGoogle Scholar
  31. 31.
    Kibler WB, Herring SA, Press JM. Functional Rehabilitation of Sports and Musculoskeletal Injuries. Gaithersburg, MD: Aspen; 1998.Google Scholar
  32. 32.
    Sherman KP. The foot in sport. Br J Sports Med 1999;33:6–13.PubMedCrossRefGoogle Scholar
  33. 33.
    Touliopolous S, Hershman EB. Lower leg pain: diagnosis and treatment of compartment syndromes and other pain syndromes of the leg. Sports Med 1999;27:193–204.PubMedCrossRefGoogle Scholar
  34. 34.
    Bong MR, Polatsch DB, Jazrawi LM, Rokito AS. Chronic exertional compartment syndrome: diagnosis and management. Bull Hosp Joint Dis 2005;62:77–84.Google Scholar
  35. 35.
    Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc 2000;32:S4–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Mark A. Harrast
    • 1
  • Nayna Patel
    • 2
  1. 1.Department of Rehabilitation Medicine, Department of Orthopaedics and Sports MedicineUniversity of WashingtonSeattleUSA
  2. 2.Physical Medicine and RehabilitationCore Orthopaedic Medical CenterEncinitasUSA

Personalised recommendations