Closed and Open Chain Exercises as a Prelude to Knee and Hip surgery

Closed chain exercises are physical exercises performed where the hand (for arm movement) or foot (for leg movement) is fixed in space and cannot move. The extremity remains in constant contact with a stationary surface, usually the ground or the base of a fixed object. The opposite of closed chain exercises are open chain exercises. Closed chain exercises are considered safer and more “functional” compared to open chain exercises. Nevertheless, the two families of exercises can co-exist in enabling rehabilitation and strengthening objectives. Closed chain exercises are often compound movements, that generally incur compressive forces, while open-chain exercises are often isolation movements that promote more shearing forces. Closed chain exercises involve more than one muscle group and joint simultaneously rather than concentrating solely on one, as many open chain exercises do (single-joint movements), lending the former to more utilitarian and athletic activities. Open Chain Exercises allow the hand or foot freedom to move (like a chest press). These types of movements tend to isolate a single muscle group and a single joint. For example, the one joint involved during a leg extension is the knee and the muscle group it isolates is the quadriceps. Open chain exercises can be done with or without added weight, but when weight is added, it’s usually placed at the distal (far away) portion of the limb (like the ankle). Examples of open chain exercises include chest presses, biceps curls, leg curls, and leg extensions (with or without added weight). In Closed Chain Exercises the movements of hands or feet are in a constant, fixed position (usually on the ground) during the exercise (such as pushups). Closed chain exercises work multiple joints and multiple muscle groups at once. For example, a squat involves the knee, hip and ankle joints, and multiple muscles groups (quads, hamstrings, hip flexors, calves and glutes). Closed chain exercises can be done with body weight alone or with added weight. When external weight is added, it is usually rested across the back of the shoulders or the front of the chest, which is considered much safer than the “distal” placement of weight during open chain exercises. Examples of closed chain exercises include pushups, pull-ups, squats, and lunges, all of which can be done with or without added weight. These exercises are useful for several purposes and can either strengthen knee and hip muscles prior to replacement and may even be able to prevent the surgery completely. When exercising the various muscles it would be very helpful to use the most effective physical therapy products available. Specifically the TUTOR system of products (HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR) have been designed to strengthen and revitalize limb muscles that may have been compromised over time by arthritis, Parkinson’s disease, CP, MS, brain or spinal cord injuries, tendon transfers, complex regional pain syndrome and others. The TUTOR system consist of ergonomic wearable devices together with powerful dedication rehabilitation software. The system is indicated for patients in rehabiliation centers, private clinics and the home and can be supported by telerehabilitation. The TUTORs consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. Controlled exercise practice will help to prevent the devlopment of compensatory movement patterns. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. The TUTOR system is fully certified by the FDA and CE and is available for children as well as adults. See WWW.MEDITOUCH.CO.IL for more information.