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Overhead Throwers: An Interactive Workshop

The Kinetic Chain

Julio A. Martinez-Silvestrini, MDBoard Certified, Sports Medicine

Associate Clinical ProfessorTufts School of Medicine

Boston, MA

Medical DirectorBaystate Physical Medicine

and RehabilitationSpringfield, MA

@JulioMartinezMD

DisclosuresNone

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GoalsDefine the “kinetic

chain” as a conceptDiscuss the role of

kinetic chain dysfunction as a risk to develop shoulder injuries

Evaluation for the kinetic chain in the throwing athlete

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The Kinetic ChainThe concept

originated in 1875Franz Reuleaux,

Mechanical EngineerOverlapping segments

connected would create a system that allows the movement of one joint to affect the movement of another joint.

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The Kinetic ChainDr. Arthur Steindler

applied the concept to human movements in 1955.

The foot bone's connected to the leg bone. The leg bone's connected to the knee bone. The knee bone's connected to the thigh bone. Doing the skeleton dance.-The Skeleton Song (Dem Bones) 1800’s

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Thoracolumbar fasciaTransitional area which

transfer forces between the lower extremity and the upper extremity. Possible role in stability and spine proprioception.Attachments to the

anterior surface of the quadratus lumborum, transversus abdominis and muscles from the thoracolumbosacral region, erector spinae and gluteus maximus.

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Pectoralis

Core Hip extensors

Hip flexors

Ankle plantarflexors

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Kinetic Chain elements evaluation

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Core stability

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Hip flexors flexibility

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Hip abductors strength

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Functional evaluation Assessment of single

leg balanceCore proprioceptionEndurance

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PreventionPeriscapular and gluteal musculature

strengtheningCore stabilityShoulder and pelvic girdle flexibilityProprioceptive training

Upper and lower extremitiesAppropriate body mechanics and

adequate posture

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Proprioception

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References Bell DR, et al. Systematic Review of the Balance Error Scoring System. Sports Health: A Multidisciplinary

Approach May 2011 3:287-295 Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part I:

pathonantomy and biomechanics. Arthroscopy. 2003;404-420. Cavallo J, Speer KP. Shoulder instability and impingement in throwing athletes. Med Sci Sports Med.

1998;30(4):S18-25. De Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the

diagnosis of rotator cuff tears: A meta-analysis.Am J. Roentgenology. 2009;92(6):1701-1707. Dillman CJ, Fleisig GS, Andrews JR. Biomechanics of pitching with emphasis upon shoulder kinematics. J

Orthop Sports Phys Ther. 1993;18:402-408. Jobe FW, Kvnite RS. Shoulder pain in the overhand or throwing athlete: The relationship of anterior instability

and rotator cuff impingement. Orthop Review.1989;963-975. Kinesiology of the human body under normal and pathological conditions. Arthur Steindler, M.D., (Hon.)

F.R.C.S. Eng., F.A.C.S., F.I.C.S. Springfield, Illinois, Charles C. Thomas, 1955 Martinez-Silvestrini, JA, Micheo W. Shoulder pain in the throwing athlete. PM&R Knowledge Now.

http://now.aapmr.org/msk/disorders-upper-limb/Pages/Shoulder-pain-in-the-throwing-athlete.aspx. Electronic Publication. December 2012.

Reuleaux, Franz , and Alex B.W. Kennedy (ed.), and Alex B.W. Kennedy (trans.).Kinematics of Machinery : Outlines of a Theory of Machines. London: Macmillan and Co., 1876

Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports Phys Ther. 1993;18:365-378.

Zaremski JL, Krabak BJ. Shoulder injuries in the skeletally immature baseball pitcher and recommendations for the prevention of injury. PM&R. 2012;4:509-517.