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      Cadeia cinética aberta e fechada: uma reflexão crítica Translated title: Open and closed kinetic chain: a critical reflection

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          Abstract

          INTRODUÇÃO: Desde 1973, quando Steidler procedeu à transposição dos princípios de cadeia cinética aberta e fechada da mecânica para a reabilitação, muitos estudos têm sido feitos sobre as consequências dos exercícios envolvendo tais cadeias, mas pouco tem se estudado sobre a validade de tal definição, seus benefícios e riscos. A comunidade da reabilitação associou a definição de CCA e CCF a alguns exemplos clássicos de exercícios, sem questionar se os componentes envolvidos na definição eram suficientes para estabelecer este conceito. MÉTODO: As autoras realizaram uma revisão bibliográfica que incluiu artigos com o conceito de cadeia cinética aberta e fechada e livros de cinesiologia, mecânica e dinâmica, buscando aproximações e divergências na definição e nos conceitos. RESULTADOS: Na mecânica as cadeias abordadas são cinemáticas e não cinéticas e a transposição desses conceitos para a reabilitação foi literal, favorecendo o uso dos termos como sinônimos, mesmo existindo uma diferença entre eles: a cadeia cinemática não considera as forças causadoras do movimento ou do equilíbrio, já a cadeia cinética as considera. O termo cadeia cinética aberta não é mencionado na mecânica. CONCLUSÕES: Todos os exercícios envolvendo apenas uma articulação deveriam ser chamados exercícios isolados e o termo cadeia cinética fechada deveria ser dividido em três categorias: cadeia cinemática fechada, cadeia cinemática restrita e cadeia cinemática, concordando com o grau de liberdade de cada cadeia. Sugere-se que esses termos deveriam ser usados para descrever exercícios de múltiplas articulações, concordando com o grau de liberdade de cada exercício.

          Translated abstract

          INTRODUCTION: Since 1973 when Steindler transcribed the principles of closed and open kinetic chain from the mechanics to the rehabilitation world, many studies have been conducted about the consequences of the exercises involving both types of kinetic chains, however there hasn't been a lot of studies concerning the validity about its definition, its benefits and risks. The community rehabilitation have associated the definition of closed and open kinetic chain, to some classic exercises without questioning if the components involved in definition was enough to establish such concept. METHOD: Authors have made a bibliography revision that included articles with the definition of kinetic chains, books of kinesiology, dynamic and mechanics searching a correlation some approximations and disagreements in the definition and concepts. RESULTS: The mechanics chains mentioned are the kinematic chains and not kinetic chains and the transposition of this concepts to the rehabilitation was literary, favoring the use of terms as synonyms, even existing a difference between them: the kinematic chain doesn't consider the causing forces of movement or balance, however the kinetic chain has considered them. The term open kinematic chain is not mentioned in mechanics. CONCLUSIONS: All the exercises involving only one joint should be called isolated exercises and the term closed kinematic chain should be divided into three categories: closed kinematic chain, restrained kinematic chain and kinematic chain, in accordance to the degree of freedom of each chain. It is suggested that these terms should be used to describe multi joint exercises in accordance to the degree of freedom of each exercise.

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          Kinetic chain exercise in knee rehabilitation.

          Rehabilitation is recognised as a critical component in the treatment of the anterior cruciate ligament (ACL) injured athlete, and has been the subject of intense research over the past decade. As a result, sound scientific principles have been applied to this realm of sports medicine, and have improved the outcome of both surgical and nonsurgical treatment. Possibly the most intriguing of these principles is the use of the kinetic chain concept in exercise prescription following ACL reconstruction. The hip, knee, and ankle joints when taken together, comprise the lower extremity kinetic chain. Kinetic chain exercises like the squat recruit all 3 links in unison while exercises such as seated quadriceps extensions isolate one link of the chain. Biomechanical assessment with force diagrams reveals that ACL strain is reduced during kinetic chain exercise by virtue of the axial orientation of the applied load and muscular co-contraction. Additionally, kinetic chain exercise through recruitment of all hip, knee, and ankle extensors in synchrony takes advantage of specificity of training principles. More importantly, however, it is the only way to reproduce the concurrent shift of 'antagonistic' biarticular muscle groups that occurs during simultaneous hip, knee, and ankle extension. Incoordination of the concurrent shift fostered by exercising each muscle group in isolation may ultimately hamper complete recovery. Modifying present day leg press and isokinetic equipment will allow clinicians to make better use of kinetic chain exercise and allow safe isokinetic testing of the ACL reconstructed knee. Reconstruction of the ACL with a strong well placed graft to restore joint kinematics, followed by scientifically sound rehabilitation to improve dynamic control of tibial translation, will improve the outcome after ACL injury.
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            Open Versus Closed Chain Kinetic Exercises After Anterior Cruciate Ligament Reconstruction

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              Accelerated rehabilitation after anterior cruciate ligament reconstruction.

              Presented at the 15th annual meeting of the AOSSM, Traverse City, MI, July 1989. Address reprint requests to: K. Donald Shelbourne, MD, Methodist Sports Medicine Center, 1815 North Capitol Avenue, Suite 530, Indianapolis, IN 46202.To overcome many of the complications after ACL reconstruction (prolonged knee stiffness, limitation of complex extension, delay in strength recovery, anterior knee pain), yet still maintain knee stability, we developed a rehabilitation protocol that emphasizes full knee extension on the first postoperative day and immediate weightbearing according to the patient's tolerance. Of 800 patients who underwent intraarticuar ACL patellar tendon-bone graft reconstruction, performed by the same surgeon, the last 450 patients have followed the accelerated rehabilitation schedule as outlined in the protocol. A longer than 2 year followup is recorded for 73 of the patients in the accelerated rehabilitation group. On the 1st postoperative day, we encouraged these patients to walk with full weightbearing and full knee extension. By the 2nd postoperative week, the patients with a 100 degrees range of motion participated in a guided exercise and strengthening program. By the 4th week, patients were permitted unlimited activities of daily living and were allowed to return to light sports activities as early as the 8th week if the Cybex strength scores of the involved extremity exceeded 70% of the scores of the noninvolved extremity and the patient had completed a sport-specific functional/agility program. The patient database was compiled from frequent clinical examinations, periodic knee questionnaires, and objective information, such as range of motion measurements, KT-1000 values, and Cybex strength scores. A series of graft biopsies obtained at various times have revealed no adverse histologic reaction. The evidence indicates that in this population, the accelerated rehabilitation program has been more effective than our initial program in reducing limitations of motion (particularly knee extension) and loss of strength while maintaining stability and preventing anterior knee pain. J Orthop Sports Phys Ther 1992;15(6):256-264.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                fm
                Fisioterapia em Movimento
                Fisioter. mov.
                Pontifícia Universidade Católica do Paraná (Curitiba )
                1980-5918
                December 2010
                : 23
                : 4
                : 641-650
                Affiliations
                [1 ] Pontifícia Universidade Católica do Paraná Brazil
                [2 ] Universidade Positivo Brazil
                Article
                S0103-51502010000400014
                10.1590/S0103-51502010000400014
                a43da6fa-8017-4484-973d-61ac82616328

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0103-5150&lng=en
                Categories
                ORTHOPEDICS
                REHABILITATION

                Orthopedics,Physiotherapy
                Closed kinetic chain,Open kinetic chain,Kinematic chain,Functionality,ACL rehabilitation,Cadeia cinética aberta,Cadeia cinética fechada,Cadeia cinemática,Funcionalidade,Reabilitação do LCA

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