The protocol also included stretch of posterior
capsule and Pectoralis minor stretch.The rationale behind
the closed-chain framework is to maximize the ability of
the inhibited muscles to activate. This involves placing the
extremity in a closed-chain position, emphasizing normal
activation patterns, and focusing on the muscle of interest
by deemphasizing compensatory muscle activation. Closed
chain exercises such as the low row was performed as the
short lever positioning in conjunction with the pelvis and
trunk, facilitates lower trapezius and serratus anterior co
activation which decreases the activation of the upper
trapezius. Typically, during soft tissue pathology, closed
chain exercises are implemented early in the rehabilitation
process. There are 3 components which make usage
of closed kinetic chain exercise advantageous in early
rehabilitation. Firstly, the exercise environment can be
controlled. This allows the focus to be taken away from
the arm as an integrated unit with high dynamic demands
and place it in a stable, axially loaded, and static setting.
Secondly, closed chain exercises are ideal for working “at”
specific ranges of motion compared to working “through”
a range of motion which helps to provide a “snapshot”
within the full arc of normal motion. Finally, closed chain
exercises allow the rotator cuff and scapular musculature to
be unloaded by decreasing the amount of force generated
and stress applied to the involved soft tissues. These type
of exercises are best suited for re-establishing the proximal
stability and control in the links of the kinetic chain such as
the pelvis and trunk. Open chain exercises, which generate
greater loads in comparison to closed chain activities,
should be utilized later in rehabilitation programs due to
their increased demand on the soft tissue due to the longer
arm levers [15].
Based on the above studies, recommendation of closed
kinematic chain exercises and kinetic chain concept of
exercise intervention incorporated in early stages have
proved beneficial. This protocol assisted in reducing pain,
disability of activities of daily living by maintaining the
force couple of scapula altered due to muscle imbalance
and inhibition.