McMullen and Uhl in 2000 published an interesting piece on using the kinetic chain concept to rehabilitate shoulder injuries. Laying the frame work, they discuss how the body integrates movement proximal to distal to apply force or velocity to an object (racket, ball) or a player (boxing, wrestling). When a shoulder is injured, the proximal mechanical and neurological factors are impaired, thus weakening the entire chain which will extend distally. Consider the classic baseball pitcher who must maximize force transfer from his body to his wrist while performing shoulder horizontal adduction and internal rotation. If the shoulder itself is incapable of transmitting the forces, then no amount of skill will make up for it.
The authors argue that by expanding on PNF theory and closed kinetic chain exercises, they can re-educate the neuromuscular system of the shoulder proximal to distal to speed up return to play. They go on to explain that if scapular muscle control is poor, it can either indicate a problem with the neurological system and control or with the muscular system and inherent tension. Many therapists report seeing patients with very tight upper trapezius and pectoralis minor muscles which can lead to poor scapular control. Keeping in mind, the rotator cuff’s job is to stabilize the gleno-humeral head during dynamic motion; the cuff itself must be maintained and likely strengthened throughout treatment.
They go on to detail a list of exercises with photos to explain how to stabilize a scapula and move from local movement to full arm and full body movements. They include guidelines on using these exercises and how to apply them in the clinic.
The authors followed up in 2001 with a far more detailed guideline for use and again in 2002, analyzing the inter-rater and intra-rater reliability to test scapular movement and argued for a more standardized approach to shoulder testing.
Unfortunately, no data was at that time collected concerning how using kinetic chain exercises compared to standard rehabilitation would fair. This is an exciting concept and falls in line with ideas of Dr. Bookspan, Dr. Sahrmann and many of the leading researchers in using movement and exercise to rehabilitate injuries.