Journal Article Critique “A Kinetic Chain Approach for Shoulder Rehabilitation”

The journal article “A Kinetic Chain Approach for Shoulder Rehabilitation” explores the shoulder as part of a kinetic chain of the body. The shoulder is by no means an isolated independent part of the body, it is affected significantly by adjacent musculature and tissues, distant core stabilization muscles, and nerves with origins in the spine. This article goes into detail on the benefits of incorporating functional closed-kinetic chain (CKC) exercises into a shoulder rehabilitation program to improve shoulder strength, range of motion (ROM), and proprioception.

            I agree with most of what this article discusses on this stage of the rehabilitation process of the shoulder. It seems to be on par with the now widely accepted integrated views for rehabbing an unstable joint. Obviously this article is discussing treatment of the shoulder at a stage where the shoulder has been previously treated with PRICEM, immobilization if necessary (not complete because the shoulder must maintain some mobility), basic ROM exercises, and both isometric and simple open chain strengthening exercises. The more complex, sport specific, closed kinetic chain therapeutic exercises that this article mostly refers to should take place in the more advanced stages of  rehabilitation before they have been given approval to play. I agree with this popular rehabilitation process the article describes but I am definitely a strong believer in the importance of open chain kinetic exercises to reverse the atrophy that usually accompanies an injury and to ensure that at least there is basic neuromuscular proficiency before graduating to the more sport specific exercises. I would consider it crucial to strengthen the deltoids, rotator cuff muscles, trapezius, levator scapulae, and pretty much any major muscle group surrounding that injured shoulder joint. This will give the shoulder the regained strength and hypertrophy it needs to help stabilize the joint and more resistance to injury. Having stronger muscles surrounding the shoulder joint will also help reduce some of the forces placed on that joint. I would probably recommend doing more open chain strengthening exercises than most athletic trainers and would continue doing them throughout the sport specific rehabilitation phase and even the return to play phase to guarantee adequate muscle strength and bilateral symmetry. Examples of open kinetic chain exercises I would recommend include front raises (some with palms down others with supination), lateral raises, seated shoulder shrugs, row machine, and internal and external rotations.

            This article comes in after this solid foundation of strength and hypertrophy is regained while there is still pain free ROM. Not only will these exercises be more functional and mimic the sport being played, it will involve several of the important stabilizer muscles in the body. This article talks about activating shoulder musculature and strength from indirectly working the shoulder via leg and core exercises. I believe these will definitely help the shoulder recover as well as improve proprioception and confidence. This will also be good for general athletic health and performance because the core is your powerhouse and center of gravity necessary for balance. Examples of more sport specific closed kinetic chain exercises I would include in a shoulder rehabilitation plan would be medicine ball overhead/chest passes, throwing a ball, and jumping jacks or frog jumps stressing upper body involvement in the motion.  In conclusion, I would follow the protocol described in this article for any joint or muscle group in the body as long as there is very effective strengthening and ROM done prior.
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