We have all heard that the foot bone is connected to the knee bone, the knee bone is connected to the hip bone, etc. This, in essence, is the lower extremity Kinetic Chain. The term “Kinetic Chain” originated in 1875 by Franz Reuleaux, a mechanical engineer and president of Berlin Royal Technical Academy. Often referred to as the father of kinematics, he suggested that if a series of overlapping segments were connected with pin joints, the interlocking joints would create a system that would allow the movement of one joint to affect the movement of another joint within the Kinetic Chain.
Then in 1955, Dr. Arthur Steindler, an orthopedic surgeon and faculty member at the University of Iowa, adapted this concept to human movement. Dr. Steindler proposed that the extremities be viewed as a series of rigid, overlapping segments and defined the Kinetic Chain as a “combination of several successively arranged joints constituting a complex motor unit.” He classified movements within these segments as being primarily open and closed.
An open Kinetic Chain is defined as a combination of successively arranged joints in which the terminal segment can move freely. An example of an open Kinetic Chain exercise would be a seated leg extension. In a closed Kinetic Chain, the distal segment meets considerable external resistance and restrains movement. Examples of closed Kinetic Chain exercises are squats and lunges.
Chiropractic literature and research is filled with examples of the lower extremity Kinetic Chain incorporated into Chiropractic practice. The lower extremity Kinetic Chain begins with the feet. Modernized Chiropractic, the first Chiropractic textbook written by Drs. Smith, Paxton and Langworthy and published in 1906, had an entire chapter devoted to adjusting the foot and ankle. Even Dr. H. Gillet of Motion Palpation Institute said, ”The base of the spine is not the sacrum, it is the ischia in the sitting posture, and the feet in the standing position.”
D.D. Palmer, in his 1910 book The Chiropractor’s Adjustor, wrote, “Chiropractors adjust any or all of the 300 joints of the body, more particularly those of the spinal column.” And on the next page he states, “Why adjust the lumbar for displacements in the joints of the foot?”
In addition, a small study entitled Chiropractic management of the Kinetic Chain for the treatment of hip osteoarthritis: an Australian case series was published in the Journal of Manipulative and Physiological Therapeutics in 2010. It found that all patients diagnosed with hip osteoarthritis had decreased WOMAC scores and increases in hip range of motion after Chiropractic management.
As a student, it is important to understand that the nature of pronation is bilateral and asymmetrical. In an article by Dr. Robert Kuhn, the asymmetrical nature of pronation will contribute to a pelvic tilt when the body is functional or weightbearing, along with a leg length imbalance when the patient is non-weightbearing.
Therefore, it is necessary in most cases to create a level foundation via the use of functional orthotics.
Though there are multiple methods for the Chiropractor to choose from, it appears that examining, appropriately adjusting and stabilizing, plus utilizing rehabilitative exercises on feet, knees and hips will result in better outcomes for the Chiropractic patient with regards to the lower extremity Kinetic Chain. You can remember this process by committing the following acronym to memory: ASR, Adjust Stabilize and Rehabilitate.
- Belgian Chiropractic Research Notes. 11th edition. H. Gillet, DC, M. Liekens, DC, Procedure manual by Charles M. Rollis, DC, 1984. MPI. P. 85–86
- Palmer DD: The Chiropractor’s Adjustor, The Science, Art, and Philosophy of Chiropractic. 1910, Portland Printing House, Portland, Oregon. P. 853 & 854
- Journal of Manipulative Physiological Therapeutics. 2010 Jul–Aug;33 (6):474-9. doi: 10.1016/j.jmpt.2010.06.004
- Arthur Steindler. Kinesiology: Of the Human Body Under Normal and Pathological Conditions. First edition.