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ABSTRACT
STENSDOTTER, A.-K., P. W. HODGES, R. MELLOR, G. SUNDELIN, and C. HÄGER-ROSS. Quadriceps Activation in Closed and
in Open Kinetic Chain Exercise. Med. Sci. Sports Exerc., Vol. 35, No. 12, pp. 2043–2047, 2003. Purpose: For treatment of various
knee disorders, muscles are trained in open or closed kinetic chain tasks. Coordination between the heads of the quadriceps muscle is
important for stability and optimal joint loading for both the tibiofemoral and the patellofemoral joint. The aim of this study was to
examine whether the quadriceps femoris muscles are activated differently in open versus closed kinetic chain tasks. Methods: Ten
healthy men and women (mean age 28.5 ± 0.7) extended the knees isometrically in open and closed kinetic chain tasks in a reaction
time paradigm using moderate force. Surface electromyography (EMG) recordings were made from four different parts of the
quadriceps muscle. The onset and amplitude of EMG and force data were measured. Results: In closed chain knee extension, the onset
of EMG activity of the four different muscle portions of the quadriceps was more simultaneous than in the open chain. In open chain,
rectus femoris (RF) had the earliest EMG onset while vastus medialis obliquus was activated last (7 ± 13 ms after RF EMG onset)
and with smaller amplitude (40 ± 30% of maximal voluntary contraction (MVC)) than in closed chain (46 ± 43% MVC). Conclusions:
Exercise in closed kinetic chain promotes more balanced initial quadriceps activation than does exercise in open kinetic chain. This
may be of importance in designing training programs aimed toward control of the patellofemoral joint. Key Words: ELECTRO-
MYOGRAPHY, WEIGHT BEARING, COORDINATION, PHYSICAL THERAPY, PATELLOFEMORAL
T
here is a considerable debate regarding the relative basis for selection of each exercise regime is based on the
efficacy of open (OKC) and closed kinetic chain hypothesis that there are physiological differences between
(CKC) exercise for increased strength and control of these strategies and that one strategy may lead to greater
the knee muscles. In general, open kinetic chain (OKC) improvements in specific physiological variables.
exercises are single joint movements that are performed in Several rationales for CKC exercises have been pre-
nonweight bearing with a free distal extremity. In contrast, sented. First, CKC has been argued to be more “functional”
CKC exercises are multi-joint movements performed in as it simulates the role of lower limb muscles in daily
weight bearing or simulated weight bearing with a fixed activities (1,6). For instance, rectus femoris (RF) shortens
distal extremity (22). Although clinical trials suggest that across the knee and lengthens across the hip in walking and
the functional outcome from programs that incorporate climbing stairs due to simultaneous knee and hip extension.
these exercise strategies are similar (11), there is a tendency Second, it has been argued that proprioceptive feedback
toward better results in terms of strength (2) and functional
differs between CKC and OKC tasks, perhaps due to com-
(28) performance enhancement from CKC exercise. The
pression from body mass in CKC (14) and pressure under
the foot (13). Third, CKC exercise has been suggested to
Address for correspondence: Ann-Katrin Stensdotter, Department of Com-
produce less shear force between the tibiofemoral joint
munity Medicine and Rehabilitation, Physiotherapy, Umeå University, S- surfaces as co-contraction of the hamstrings will counteract
901-87 Umeå, Sweden; E-mail: anki.stensdotter@physiother.umu.se. the anterior tibial shear force generated by the quadriceps
Submitted for publication December 2002. (16). Thus, from a biomechanical perspective, it is likely
Accepted for publication July 2003.
that CKC knee exercise places less strain on the anterior
0195-9131/03/3512-2043 cruciate ligament (15,16), although the placement of the
MEDICINE & SCIENCE IN SPORTS & EXERCISE® body center of mass above the axis of the knee joint deter-
Copyright © 2003 by the American College of Sports Medicine mines how the quadriceps and hamstrings co-contract
DOI: 10.1249/01.MSS.0000099107.03704.AE (18,27). Fourth, the interrelationship between patellofemo-
2043
ral joint forces and contact area differs between the two
tasks. In closed chain tasks, such as squatting, compressive
forces are augmented with increased knee flexion as greater
torque develops as a product of the lengthening lever arm
between the knee joint and the body’s center of mass when
it moves further posterior to the joint axis. However, this
compressive force is distributed by greater contact between
the patella and femur. In contrast, in OKC exercise the joint
stress increases from 90° flexion as the knee extends (5,8) as
a result of the greater torque produced by the lengthening
lever arm when the center of mass of the leg and eventual
load around the ankle moves. Finally, it has been argued that
the coordination of the knee muscles may vary between the
tasks. For instance, electromyographic activity of vastus
medialis has been suggested to be greater in closed chain
tasks than in open chain tasks (7). One study has investi- FIGURE 1—Placement of surface EMG electrodes. The angle between
gated onset times for the different portions of the quadriceps the electrode placement and the long axis of the femur (thin line) and
in CKC and OKC under different loading conditions and the approximate distance from the supra patellar border: VMO 4 cm,
VML 15 cm, VL 8 cm, and RF 15 cm. Polar distance for electrodes was
joint angles but failed to find significant difference (12). 22 mm. The ground electrode was placed over the tibia inferior to
Despite the argument that coordination of the lower limb patella.
muscles may be influenced by closed or open chain tasks,
for the reasons presented above, there is limited direct
Procedure. Subjects sat on a firm plinth with the hip
evidence of differences in recruitment. The present study
flexed to 90° and knee flexion 30° from full extension.
was designed to investigate this question by comparison of
Ankle joint position was kept at 90°. The pelvis was firmly
recruitment of muscles in a simple reaction-time knee ex-
strapped to the plinth. This position was used as it repre-
tension task performed in both OKC and CKC. This task
sented a mid range position and allowed the joint position to
was selected as it allowed us to control relevant aspects of
be kept constant between tasks. Knee extension efforts were
the activity. Specifically, we were interested in whether the
performed as a reaction-time task in two different condi-
onset and initial amplitude of muscle activity of different
tions. For OKC, the strain gauge was connected from the
portions of the quadriceps would differ between these tasks.
plinth to a strap around the ankle, approximately 10 cm
proximal to the malleoli and isometric knee extension ef-
forts were made against the resistance of the cable. In the
METHOD CKC task, the strain gauge was incorporated into an inelas-
tic belt that passed around the trunk support of the plinth and
Subjects. Ten healthy subjects, three males and seven under the sole of the foot (Fig. 2). Isometric extension
females, (mean age 28.5 ± 0.7, mean height 171 cm ±8.5, efforts were performed by pushing the foot into the belt.
mean weight 64 kg ±15.6) participated in the study. Sub- Subjects were instructed to respond as quickly as possible
jects were excluded if they had a current or previous record (by either extending the knee or pushing into the belt de-
of knee pain, trauma, surgery, or other joint disease or were pending on condition) in response to an auditory stimulus
involved in competitive sports. The tests were performed in and to use a moderate effort. Twenty repetitions in sets of 10
agreement with the Declaration of Helsinki and informed were performed for each condition and subjects were al-
written consent was obtained from the subjects. The study lowed 0 –30 s of rest between each repetition and 2–3 min
was approved by the institutional research ethic committee.
Electromyography. EMG activity of vastus medialis
obliquus (VMO), vastus lateralis (VL), vastus medialis lon-
gus (VML), and RF was recorded with surface electrodes (5
mm disks, Grass, U.S.) placed approximately in parallel
with the muscle fibers over the muscle bellies, based on a
modification of standard proposed by Zipp (30). The dis-
tances and angles were measured for optimal electrode
placement (Fig. 1). The skin was carefully prepared by
rubbing with abrasive gel and alcohol. EMG data were
amplified 2000 times, filtered between 20 and 1000 Hz
(Neurolog, UK) and sampled at 2 kHz using Power1401 and
Spike2 software (CED, UK).
Force recordings. Knee extension force was measured FIGURE 2—Experimental setup. Subjects where seated with 90° hip
flexion and 30° knee flexion (from full extension). A strap was placed
with a strain gauge (Validyne, U.S.). Force data were am- over the hip. Arrows indicate direction of force applied by subject
plified and sampled at 1 kHz with the EMG data. against the resistance of the strain gauge.
QUADRICEPS ACTIVITY IN KINETIC CHAIN TASKS Medicine & Science in Sports & Exercise® 2045
a delayed onset of activity in VMO relative to VL, when
ascending and descending stairs, by 16 and 19 ms, respectively
(4). In nonsymptomatic subjects, there is no difference in onset
time for VMO and VL in these same tasks. These findings are
supported by other similar studies, however, with smaller time
differences (7,26,29). Degree of decreased reflex response time
in VMO and duration of symptoms have been reported to be
the only factors that significantly predict the outcome of train-
ing intervention for this patient group. Shorter reflex time of
VMO predicts a better functional outcome (28).
Clinical implications. Seemingly small time differ-
ences (5–10 ms) appear significant for the central nervous
system to coordinate muscle activity for a certain task. Even
with the same joint configuration, the net mechanical effect
of different loading conditions requires the central nervous
FIGURE 5—Group mean (SEM) for EMG amplitude normalized to system to adjust the strategy accordingly (9). For instance,
MVC. VMO had greater amplitude in CKC than OKC. RF showed
greater amplitude in OKC than CKC. * P < 0.05.
recent biomechanical studies have indicated that a delay in
VMO onset of 5 ms has significant consequences for patel-
lofemoral joint mechanics in terms of increased peak and
plitude was greater compared with OKC, in which its average lateral contact force (17). In addition increased
onset of activity was later. Rectus femoris had greater relative contribution of VMO force produces a reduction in
EMG amplitude in OKC when it was the first muscle lateral patellofemoral joint loading (17). The findings from
active compared with a smaller amplitude in CKC where the present study, particularly regarding onset and activity
its EMG onset was later. This may suggest that the initial of the VMO may have clinical implications for how to
relative contribution of muscles with early onset of activity design training intervention programs for patients suffering
is larger than for the muscles with later onset of activity. from PFPS. For knee rehabilitation in general, CKC exer-
The differences in EMG onset and amplitude for RF in cises have been promoted in favor over OKC, because CKC
the two conditions may be explained by its nature as a two- exercises are considered more functional, safe, and effective
joint muscle. In OKC where the force is directed up- ward, (19,21). Exercises designed to remedy muscular imbalances
the contribution of RF is increased, presumably as a result as described for PFPS should be particularly aimed at VMO.
of its dual function as a knee extensor and hip flexor. In Our study shows in healthy subjects that CKC promotes
CKC, where the force is directed downward, this is more more simultaneous quadriceps activity and earlier onset and
akin to hip and knee extension. Indeed the subjects had to be greater amplitude in EMG activity for VMO than does
firmly strapped down during testing conditions, to prevent OKC. To what extent this also applies to PFPS needs to be
extension at the hip in CKC. On the contrary, in OKC there investigated. We compared OKC and CKC tasks under
was less tendency to extend at the hip. isometric conditions in identical positions, seated with the
The result from our study shows that CKC provides more hip in 90° and 30° knee flexion from full extension, with
simultaneous activity in the different portions of the quadriceps moderate force exertion. However, activation patterns may
muscle than OKC, with earlier onset and greater amplitude of be different for OKC and CKC as other biomechanical
EMG activity in VMO. Because muscle function has signifi- conditions apply for dynamic conditions with different joint
cant impact on the biomechanics of the knee joint, CKC tasks angles and loading conditions. Evaluation of CKC training
may provide more optimal loading conditions for the patel- intervention has showed that for patients with patellofemo-
lofemoral joint due to more central tracking of the patella (20). ral pain, more selective VMO activation can be obtained in
A mediolateral muscular imbalance in force production closed kinetic chain exercises at 60° knee flexion (23).
(3,7,24) and timing (4,26,29) has been suggested by several Hodges and Richardson (10) reported greater VMO activity
authors as important factors contributing to malalignment of in CKC, which could be further augmented by additional hip
the patella. Malalignment affects the pressure distribution be- adduction. Even though CKC in PFPS may elicit earlier and
tween patella and femur. In vitro and modeling studies of greater VMO activity than OKC exercises, this may not
forces show increased lateral pressure as tension from the
guarantee a normalization of VMO activity in other activi-
VMO is decreased (20). The main cause for patellofemoral
ties. It also remains to be investigated whether and to what
pain syndrome (PFPS) is believed to be lateral tracking and/or
extent an eventual normalization of VMO activity in an
tilt of patella in the femoral groove. Weakness of the knee
exercise condition has a carry over effect to daily activity
extensors and atrophy of vastus medialis muscle are common
with improvement of physical function and reduced pain.
findings (25). Patients with this syndrome also show a decrease
in VMO activity relative to VL. In knee extension the ratio This project has been funded by the National Health and Medical
between VMO and VL activity increases closer to full exten- Research Council of Australia, Sør-Trøndelag University College,
sion, whereas the ratio in nonsymptomatic subjects remains Trondheim, Norway, Trygg Hansa’s Research Foundation, Sweden,
Faculty of Medicine and Odontology, Umeå University, Sweden, and
steady (3,24). For onset of muscle activity, PFPS patients show The Swedish Research Council (no. 220-3-02).
QUADRICEPS ACTIVITY IN KINETIC CHAIN TASKS Medicine & Science in Sports & Exercise® 2047