Biodynamics and Human Performance Ceneter

 

A Randomized Prospective Training Study of Open Kinetic Chain and Closed Kinetic Chain Perturbation Training in Subjects with Shoulder Pain


Authors: Ewin, WC, King, JE, Kirksey, AM, Bringman, D, Wilcox, A, Reimann, BL, Davies, GJ

Institution: Biodynamics and Human Performance Center. Armstrong Atlantic State University. Savannah, GA.

Ewin, WC, King, JE, Kirksey, AM, Davies, GJ, Bringman, D, Wilcox, A, Riemann, BL. A Randomized Prospective Training Study of Open Kinetic Chain and Closed Kinetic Chain Perturbation Training in Subjects with Shoulder Pain (Research Poster accepted at APTA-CSM, San Diego, CA., 2013). JOSPT. 43(1):A90 (Abst.-OPO2226), 2013

Abstract


Purpose: To determine whether open kinetic chain (OKC) or closed kinetic chain (CKC) perturbation training in the upper extremity (UE) has an effect on various functional outcomes in subjects with shoulder pain. The results can be incorporated into training methods by physical therapists and patients individually for injury prevention or rehabilitation. We hypothesize that both OKC and CKC training groups will show statistically significant improvements in outcome measures.

Methods: 23 volunteers (17 females, 6 males, age: 29.1±10.1yrs, height: 1.69±0.1m, weight: 77.6±18.8kg) were randomly allocated into OKC or CKC training groups. Measurements were taken prior to the training program and at the conclusion. These measures included: hand-held dynamometry (HHD), one-arm seated shot-put, upper extremity CKC test, IR/ER isokinetics at 180° and 300°, and joint angle replication. The subjects performed exercises twice a week for eight weeks, with a progression of 2-10% per week. The OKC group performed the Bodyblade®, reverse prone catch, wall dribble, and manual perturbations. The CKC group performed BOSU® ball rockers, step-up arm walks, clap push-ups, and manual perturbations.  A HHD pilot study was performed prior to training to determine inter-rater reliability.

Results: The ICC’s HHD pilot study inter-rater reliability was upper trap (0.923), supraspinatus (0.966), serratus anterior (0.865), middle trap (0.910), lower trap (0.879), and rhomboids (0.964).  A paired t-test was used to assess pre/post differences of each outcome measure (p <0.05 is significant).  Significant results were found with HHD with OKC and CKC (<0.002 and <0.006 respectively).  Significant results were found with CKC UE stability test with OKC and CKC (0.000 and 0.001 respectively).  Significant results were found in the CKC group with ER isokinetic at 180° (0.034).  Significant results were found in the OKC group with IR isokinetic at 300°, ER isokinetic at 300°, seated shot-put, and SPADI (0.003, 0.007, 0.006 and 0.000 respectively).  A one-way ANOVA was assessed using SPSS (IBM, Armonk NY) to determine if there was any significance between groups, no significant results were found.

Conclusion: It is unclear whether either OKC or CKC perturbation training in the shoulder is more beneficial for UE strength, proprioception, stability, power and pain.  However, the OKC group showed significant improvements in an 8 week training program in HHD, proprioception, isokinetic strength at select speeds, UE stability, power, and pain.  The CKC groups showed improvements in an 8 week training program in HHD, isokinetic strength at select speeds, and UE stability.

Clinical Relevance:  Based on our findings, either OKC or CKC perturbation training to the painful shoulder may be used prophylactically or as rehabilitation.  The authors recommend incorporating OKC and CKC exercises as a multi-modal approach.

 

National Meeting Presentation:

Ewin, WC, King, JE, Kirksey, AM, Davies, GJ, Bringman, D, Wilcox, A, Riemann, BL. A Randomized Prospective Training Study of Open Kinetic Chain and Closed Kinetic Chain Perturbation Training in Clients with Shoulder Pain. Research presentation at Alpha Eta National Allied Health Honor Society Student Symposium. Orlando, Fl., October 2012

International Meeting Presentation:

Davies, GJ, Ewin, WC, King, JE, Kirksey, AM, Bringman, D, Wilcox, A, Reimann, BL. A Prospective Randomized Training Study of Open Kinetic Chain and Closed Kinetic Chain Perturbation Training in Subjects with Shoulder Pain. Research Platform Presentation. 4th International Congress of Shoulder and Elbow Therapists. Nogoya, Japan, April 11-13, 2013