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Closed Chain Vs Open Chain Exercises After ACL Reconstruction

Heard a pop on your knee when you land from a jump? Someone ran into your knees during soccer?

ACL reconstruction Diagram


What to do after ACL surgery?

The surgeon will most likely give you a protocol guideline to follow. However, what can you do to maximise your rehab and return to sport in good condition?

It is important to find a physiotherapist to guide you throughout the rehab. This is to ensure that you are exercising and your technique is correct so the ACL graft is not compromised. Also it is important to perform exercises in the prescribed repetition range to ensure that the tissues are not worked excessively. Initially we would like to focus on Range of motion (ROM) to achieve full ROM especially extension. After that we can strengthen the muscles around it by either OKC (later stage) or CKC exercises.


Closed kinetic chain (CKC) exercises vs open kinetic chain (OKC)

This is one of the most controversial topics in the ACL rehab scene. Closed kinetic chain is when the foot is planted on a surface during exercises. Whereas an open kinetic chain is when the injured leg is in the air while performing an exercise. An easy example of CKC would be squats when both feet are planted on the ground. An OKC exercise would be seated leg extension.


Should we use CKC or OKC during ACL rehab?

According to current evidence, there is limited evidence that OCK has an adverse effect on the rehab progress. Some studies have suggested that there are no tibial laxity changes even when OKC is commenced at week 4 while some other studies have. There is no solid evidence suggesting that there is improvement in pain, function and strength as well. The study shows that it is not harmful to perform OKC exercises.

However it is important to seek advice from physiotherapists or specialists before performing OKC exercises. This is because everyone’s goals are different and exercises should be tailored specifically for an individual.

By performing exercises and seeking guidance from a physiotherapist will definitely make your rehab easier and increase the rate of success. If there is still fear of performing OKC exercises, it is fine to stick with CKC and progress into OKC. Remember everyone’s goals and rate of progress is different. Try your best not to compare your ACL reconstruction rehab progress to someone else. This will only put pressure on yourself and try to catch up if you progress slower.


This information can be used to gain a better understanding of close chain and open chain exercises. To find out more about how we can help, or to book in for a consultation you can contact us via our Limp in Leap out Physiotherapy & Wellness contact us page, or book online here.

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