Rehabilitation exercises post injury are a very important part of returning to activity. But what exercises should be done? How should exercises be selected to ensure they are appropriate for a return to the level of activity and function that the client desires? There shouldn’t be a “one size fits all” approach to rehabilitation exercises as everyone has different starting levels of fitness and their end goals are also unique. Movements can be described in a variety of ways. A movement can be an open or closed skill; a discrete, continuous or serial skill; or an open or closed kinetic chain skill. Each of these describe the type of environment the movement is performed in and the manner in which it is performed.
Open v closed exercises
Open skills are skills which are performed in an environment that is both variable and unpredictable. Skills that are performed in a competitive environment where there are opposition players are an example of open skills. It is unpredictable what the opponent is going to do. Closed skills are performed in an environment that is stable and predictable. An example of a closed skill may be firing a rifle at an indoor shooting range. It is unlikely that the environment is going to change in any way.
Open skills can be changed to closed skills by removing the unpredictable factors. For example, a lay-up in basketball is an open skill when performed in a competitive environment. If the defenders are removed, as well as team mates, the skill then becomes a closed skill. Closed skills can be extremely useful in the rehabilitation process as a controlled environment can be utilised while the individual is still recovering. You can then be progress the exercise towards an open skill as they return to full fitness.
Open v closed chain kinetic exercises
Next you have open and closed chain kinetic exercises. This categorisation is referring to the status of the end segment of the extremity. In a closed chain kinetic exercise the end segment is fixed, eg the feet when performing squats. Open chain kinetic exercises are those in which the end segment moves freely, eg the leg extension machine. Open chain kinetic exercises are primarily considered a self-directed activity or action that is performed until muscle failure occurs. The musculoskeletal load is abnormal compared to function as the load is controlled in ways that are inconsistent with normal joint function. Using the example of lower leg exercises again, the knee joint is designed to function under load with the feet fixed on the ground, rather than with the feet moving freely. This may lead to inappropriate feedback to the central nervous system due to the difference in the arthrokinematics.
Closed chain kinetic exercises facilitate normal proprioceptive feedback from the afferent mechanoreceptors. For stimulation of the mechanoreceptors close to the joint to occur, closed chain weight bearing is required. It also provides enhancement of joint play movements such as rolling, sliding and gliding, with a higher degree of carryover. The movements that are performed are also occurring on both sides of the axis of motion, as opposed to open chain kinetic exercises where only the segment on one side of the joint is generally involved. This also means that more functional movements can be performed in all three planes, using all the agonist, antagonistic and synergistic muscles of the movement. Closed chain kinetic exercises are also physiologically safe and less stressful than open chain exercises during rehabilitation, as biomechanical forces can be safely reproduced and controlled.
Discrete, continuous or serial skills
The third way to describe movements is as discrete, continuous or serial skills. Discrete skills are those with a definite beginning and end and are usually of brief duration. Examples include throwing and hitting skills. Continuous skills are those that have no particular beginning or ending, such as swimming, running or cycling. They are of a cyclic nature and generally of long duration. The third group are serial skills. These are a group of discrete skills strung together to make up a new, more complicated skill, such as a gymnastics routine. The order in which the skills are performed is critical for successful performance.
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