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The Lower Kinetic Injury Chain: A Musculoskeletal Biomechanical Perspective into Lower Extremity Injury and Modalities to Remediate them

Keith Chittenden

The aim of this article is to highlight the importance of interventions for successful recovery from an injury sustained in the lower kinetic chain. The article is intended to give a background and understanding to the general population, working professionals, athletes, military personnel, first responders or anyone that has experienced pain and discomfort from a lower extremity injury about the biomechanical intricacies of the lower extremity and how injury affects each component. The kinetic chain is a musculoskeletal biomechanical theory on how the lower extremity moves within itself to produce movement such as walking, running, standing and sitting. Within these movements, each component of the kinetic chain has an effect on each component which surrounds the joint. When injury occurs in the musculoskeletal system there is a cumulative injury cycle effect throughout the kinetic chain. The cumulative cycle affects the skeletal, muscular, and articular systems and will impair move In summary, the cumulative injury cycle can impede function and lower kinetic chain performance. During and after an injury, it is important to remain active and mobile as much as possible. Interventions such as osteopathic/myofacial manual therapy treatment and corrective exercises are good modalities to use to help alleviate pain (both chronic and acute), but also to reduce the effects of the lower extremity kinetic chain from becoming stuck in the inflammatory or proliferative phase of healing. Being stuck in one of the 2 phases of the injury cycle contributes to the cumulative injury of the area that is being injured and causes prolonged recovery. In addition, stretching and self-myofacial release (SMR) can benefit a person in maintaining flexibility within the human movement system. A duration of as little as 10 minutes devoted to SMR (up to a minute on each extremity, the back and chest) can increase flexibility, decrease accumulation of adhesions formed on muscle fibers and prevent stiffness and changes in muscle fiber (degenerative changes) caused from sedentary lifestyle. Both OMT/MMR and corrective exercise treatment are underutilized in majority of outpatient clinics and therefore needs to be strongly emphasized for all practitioners to learn, especially if the goal of the practitioner is to decrease pain/discomfort and to increase functional mobility within their patient populations. Mobility and proper conditioning of the musculoskeletal system equates kinetic chain functionality and good health throughout the extremity in the lower extremity. Treatment modalities need to focus on the specific area of injury. The modalities can be in the form of stretching, manual osteopathic treatment (OMT)/ Manual myofacial release (MMR), therapeutic/corrective exercise programming. Research supports eccentric exercises effectiveness in helping retrain the body back into conditioning for sports or every-day-functionality. These treatment modalities have the greatest effect on correcting and stopping the cumulative injury cycle in the lower kinetic chain.