When is the patient truly “ready to return,” a.k.a. kinetic chain homeostasis

Abstract

Postsurgical rehabilitation is charged with restoring anatomical and physiological musculoskeletal function. Successful outcomes are achieved when the body is treated as a unit, focusing on the interactions of all body segments rather than isolated structures. A rehabilitation approach which is comprehensive by design is known as the kinetic chain approach of rehabilitation. The kinetic chain is characterized by sequenced physiologic muscle activations in the upper and lower extremities which result in the execution of an integrated biomechanical task. Impairment of one or more kinetic chain links (anatomical segments) can create dysfunctional biomechanical output leading to impeded return to activity following surgery. When deficits exist in the preceding links, they can negatively affect the shoulder. Postsurgical rehabilitation of the shoulder should involve evaluation for and restoration of all kinetic chain deficits that may hinder kinetic chain function. Rehabilitation programs focused on eliminating kinetic chain deficits and soreness should follow a proximal-to-distal rationale where lower extremity impairments are addressed in addition to the upper extremity impairments.