Open vs Closed Kinetic Chain Exercise for the Upper Extremity

Effective rehabilitation demands a sophisticated understanding of how to optimize open and closed kinetic chain exercises. When an exercise program is paired with mTrigger biofeedback, clinicians and patients can see in real-time their muscle activation, movement quality, and explore the clinical implications of incorporating closed kinetic chain exercises into patient care.

When treating upper extremity conditions such as shoulder pain, elbow pain, rotator cuff (RTC)-related issues, wrist/hand tendinitis, and so on, it is important to address the cause of the dysfunction and not just the site of the symptoms alone.¹ For example, treating the entire upper extremity chain instead of just the shoulder. To do this well, the benefits of closed kinetic chain exercise must be explored.

Open Kinetic Chain vs Closed Kinetic Chain Exercise

Open kinetic chain (OKC) exercise is when the distal segment (i.e., hand) is free to move the resistance.^2,3 These types of exercises are very valuable for isolating single muscle groups and individual joints.² Some examples of open chain upper extremity exercises include bent-over row, horizontal/vertical press, triceps extension, prone T, and side-lying external rotation.

Closed kinetic chain (CKC) exercise is when the distal segment (ie: hand) is fixed and the body weight provides the resistance.^2,3 CKC exercises often target multiple muscle groups and incorporate multi-joint movements.²  This helps to provide greater overall stability and proprioception. Some examples of closed chain upper extremity exercises include push-ups, pull-ups, chin-ups, inverted rows, and triceps dips.

Popularity of Upper Extremity OKC Exercise

Currently, most rehab exercises for the upper extremity are done as OKC exercises for several reasons. First, OKC exercises have demonstrated the highest isolated EMG activity of the infraspinatus and other targeted rotator cuff muscles.⁴ Second, resistance bands and free weights do a good job of targeting the rotator cuff, but they lack the benefit of closed kinetic chain stability seen with CKC exercise.¹ Finally, it can be difficult to perform low rep/high intensity closed kinetic chain exercises for the upper extremity like we do in the lower extremity.³ For this reason, upper extremity CKC exercises are usually programmed with body weight for higher intensity and volume.³

Advantages of CKC Exercise

During human movement, energy is transferred from the lower extremities through the pelvis/trunk to the scapula and upper extremities.¹ In order to transfer this energy well, good stability of the scapulothoracic and lumbopelvic complex is crucial to address during rehab.¹ Research on closed kinetic chain exercise for the lower body has demonstrated massive advantages for improving proprioception, increasing muscle activation, and promoting better motor unit synchronization.² Research on CKC exercises for the upper extremity is showing similar results.^1–5 CKC exercises for the upper extremity help to enhance glenohumeral joint compression, which provides greater proximal joint stability and reduces the shear forces on the shoulder. ^3,4  In the early stages of rehab, axial loading of the upper extremity can help to restore joint proprioception (when safe, of course).⁴ Overall, closed kinetic chain exercises generate moderate to high muscle activation levels when measured by sEMG meaning when appropriate/safe, they will promote a higher level of strengthening.² In addition, CKC exercise will greatly increase core and proximal muscle activation required for successful exercise performance.²

The key to understanding the difference in exercise selection is using biofeedback to achieve it. A push-up done incorrectly will not necessarily have the desired muscle activation. This is where mTrigger becomes essential. Your outcomes will only be as good as the performance of your exercises, so why not use biofeedback to guarantee success?

Clinical Application

While open and closed kinetic chain exercises will both remain a constant in rehab programs, let’s look at some key points from the literature.

As rehabilitation programs advance, exercises ought to increase in complexity and be specifically tailored to the targeted objectives. The decision to perform a horizontal press or a push-up depends on many factors—but understanding how muscle activation levels differ and change between the exercises is a great place to start.  

When performing a horizontal press vs. a push-up, sEMG data demonstrates less activation of the upper trap and increased serratus anterior and external oblique activation during a push-up.²  Lower upper trap activation is often preferred during shoulder rehab exercises.

A chin-up exercise will exhibit more upper trap, lower trap, and serratus anterior activation than a seated lat pulldown.² A desired effect of making a rehab exercise more challenging.

An inverted row (which is often underutilized in rehab) has greater sEMG activation of the infraspinatus, serratus anterior, middle trap, and lower trap than a horizontal row.² We really should be using it more.

The infraspinatus works to stabilize the glenohumeral joint (GHJ) and function as a primary external rotator during shoulder external rotation exercises.⁴ During open chain external rotation exercises, the posterior deltoid is also activated, causing anterior humeral head translation, which is not ideal in terms of joint stability.⁴ When sEMG is used to compare OKC vs CKC muscle activation of the infraspinatus and posterior deltoid, exercises performed in the closed chain demonstrated significantly greater infraspinatus activity with less posterior deltoid activation than open chain exercises.⁴ With the addition of dual-channel mTrigger biofeedback to ensure greater muscle activation and proper form, this type of programming could make a huge impact for patients struggling with instability.  

Who Will Benefit?

Youth baseball players with subacromial impingement tend to lack strength and stability of the shoulder.⁵ A rehab program with CKC rehab exercises performed 2-3x/week for 8-12 weeks helped improve the stability, strength, and even throwing speed of little league baseball players with subacromial impingement syndrome.⁵

Softball players who performed a CKC training program demonstrated significantly greater improvements in throwing velocity, bench press performance, ER torque/power, and peak shoulder flexion power compared to the OKC training group.³

Summary

The integration of mTrigger biofeedback into CKC exercises represents a paradigm shift in rehabilitation. We know OKC exercises with biofeedback target muscle activation and precise control, but the multifactorial benefits of mTrigger biofeedback for CKC exercises cannot be overlooked. CKC exercises help to improve strength, stability, and dynamic control, and real-time monitoring is invaluable for patients’ long-term outcomes. By embracing CKC exercises for the upper extremity alongside biofeedback, clinicians can deliver exceptional patient-centered care that translates to real-world goals and sporting experience.

Identifying Movement Compensations

Hidden Gems of the mTrigger App

References

1. Oliver GD, Plummer HA, Gascon SS. Electromyographic Analysis of Traditional and Kinetic Chain Exercises for Dynamic Shoulder Movements. J Strength Cond Res. 2016;30(11):3146-3154. doi:10.1519/JSC.0000000000001389
2. Pozzi F, Plummer HA, Sanchez N, Lee Y, Michener LA. Electromyography activation of shoulder and trunk muscles is greater during closed chain compared to open chain exercises. Journal of Electromyography and Kinesiology. 2022;62. doi:10.1016/j.jelekin.2019.05.007
3. Prokopy MP, Ingersoll CD, Nordenschild E, Katch FI, Gaesser GA, Weltman A. Closed-kinetic chain upper-body training improves throwing performance of NCAA Division I softball players. J Strength Cond Res. 2008;22(6):1790-1798. doi:10.1519/JSC.0B013E318185F637
4. Kang MH, Oh JS, Jang JH. Differences in Muscle Activities of the Infraspinatus and Posterior Deltoid during Shoulder External Rotation in Open Kinetic Chain and Closed Kinetic Chain Exercises. J Phys Ther Sci. 2014;26(6):895. doi:10.1589/JPTS.26.895
5. Lee DR, Kim LJ. Internal- and External-Rotation Peak Torque in Little League Baseball Players With Subacromial Impingement Syndrome: Improved by Closed Kinetic Chain Shoulder Training. J Sport Rehabil. 2016;25(3):263-265. doi: 10.1123/jsr.2014-0333