The Kinetic Chain Gang, April 2009 issue

By
Robert Rinaldi, dpm
Posted March 24th, 2009

The human kinetic chain consists of a group of body parts that are linked together in a way that allows them to function. Like any chain, if the links are separated, rusty, or damaged, it will not function properly, and other parts of the chain might become damaged. The human kinetic chain’s activities may be open or closed. Open chain activities are those that involve the distal end of the chain to be free and not fixed in any manner. As examples let’s use the dog trainer, who is directing the activity of an animal with arm and hand motions. The hand is the distal end of the chain and it is entirely free to move in any direction. Similarly, a basketball player swinging his arms to block an opponent’s pass is free to move his arms and hands without impediment.
Closed chain activity involving these same athletes would be in the lower extremity. The dog trainer and basketball player are freely moving their arms and hands; however their feet, the distal end of the lower kinetic chain, are firmly connected to the ground, making the entire lower extremity a closed chain activity. You can easily envision how all these motions become intertwined.
“Dem Dry Bones,” by James Johnson, says it all: “The foot bone is connected to the leg bone, the leg bone is connected to the knee bone, the knee bone is connected to the thigh bone, the thigh bone is connected to the hip bone, and the hip bone is connected to the backbone.” Johnson understood rhythm when he wrote this classic. Perhaps he knew kinesiology as well.
HOW KINETIC CHAIN INJURIES OCCUR
Usually kinetic chain injuries are the result of overuse. We have often tagged foot hyperpronation as the epicenter of lower extremity injuries. The runner with hyperpronation will have increased stresses on the plantar fascia, Achilles tendon, knee, thigh, hip, and lower back. When the foot is attached to the ground, every link in the kinetic chain above it is affected. A closed chain kinetic injury can be predicted. Further complicating the injury process is the constant alternating from closed chain to open chain activity. When the foot strikes the ground, closed chain function begins with a vengeance as increased gravitational forces are applied to the athlete’s body weight. Once the foot leaves the ground and is flying forward, it is in an open chain activity and compensating motion must take place to realign the foot and leg for another attack on the hard surface about to be underfoot. The processes of open and closed chain activity is complicated by constant motion, and position and surface changes.
ENTER THE CHAIN GANG
There is a lot of evidence that athletes should be treated by a team of specialists. Calculating the mechanism of injury becomes the team’s first order of business. Without knowing how kinetic chain overuse and malfunction created an injury will sentence the athlete to re-injury and/or failure of a treatment plan to be successful. As a podiatrist who has been treating athletes for four decades, I know that working alone is not in the best interest of the injured patient. Examining gait patterns, foot and leg alignment, and imaging studies may simply not be enough. The patient may be presenting to me with foot pain, but the rusty link in the chain may be above the feet. A team that is composed of several medical disciplines can look at any overuse athletic injury and attribute the cause of injury to a malfunction in the kinetic chain.
My article Recognizing Iliotibial Band Syndrome (Vermont Sports, January, 2009) is a classic example of an overuse open and closed kinetic chain athletic injury. The person suffering from ITB syndrome will create compensating movement patterns that will affect motion from head to toe, so it is best diagnosed with good clinical exams, diagnostic imaging, gait analysis, range-of-motion studies, and team consultations. A treatment plan that can bring the athlete back to training and competition may include biomechanical control of the foot and leg with orthotics, trigger-point injection therapy, the attention of a certified athletic trainer, specialized physical therapy, and chiropractic realignment of structures that have attained mal-position for compensation.
OUR GANG
Athletes should look for groups of clinicians with varying backgrounds to treat overuse kinetic chain injuries. Vermont has an active population that loves the outdoors. Throughout the state there are groups of providers who have come together to treat athletes. You should be looking for these groups for all your health care needs.
Gifford Medical Center is an example of a medical group that practices thoughtful and progressive philosophy in regards to sports medicine, and over a few short years we have put together a team of specialist providers who are also athletes. Hank Glass, DC, has been practicing chiropractic sports medicine for 20 years. He was a member of the 2008 Olympic medical team that provided services to athletes at the Olympic trials in Eugene, OR. Peter Loescher, MD, completed a fellowship in sports medicine at the Eastern Oklahoma Orthopedic Center. The three of us work together at the Sharon Health and Sports Medicine Clinic and are backed up by a team that includes physical therapists who have special training in athletic injury rehabilitation, an in-house radiology department that includes MRI, a certified athletic trainer, a primary care provider, and appropriate nursing staff, and we are dedicated to preventing and treating athletic injuries. Every day our provider chain gang makes time to discuss cases, view diagnostic images, and discuss lab reports. This is an atmosphere that can help with treatment and prevention of athletic injury. We are using the gang’s different backgrounds and experiences to benefit the patient.
Which brings me to the gist of this article: In the future, our kinetic chain gang will share this column. You may see articles or opinions from Dr. Glass, Dr. Loescher, as well as myself and members of our entire staff.
Robert Rinaldi is a board-certified podiatrist and podiatric surgeon at the Gifford Medical Center in Randolph, VT. He is a fellow and a founding member of the American Academy of Podiatric Sports Medicine, and a podiatric consultant to the Dartmouth College track and cross-country teams. He is a former nationally ranked long-distance runner, having competed in 25 world-class marathons.
You can reach him at Gifford Sports Medicine and Surgery Clinics in Randolph, VT, or at the Sharon Health Clinic in Sharon, VT, 802-728-2490 or 802-763-8000 or at rrinaldi@giffordmed.org.