Sports Medicine and Health Science 3 (2021) 252–253

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Sports Medicine and Health Science

Letter to the Editor

Kinetic chain disruption contributes to shoulder and elbow injuries

Keywords:
Shoulder injuries
Elbow injuries
Kinetic chain
Range of motion

The kinetic chain or link theory provides the basis for understanding increase in shoulder rotational velocity to produce the same amount of
and evaluating human movement patterns as well as the justification for force on the limb.4 Strength and agility deficiencies in these areas have a
using exercise training and recovery services that emphasise the whole detrimental effect on shoulder and elbow kinematics that would raise
body, despite the damage to a specific joint or anatomical structure. The injury risk. In the overhead throwing motion, failure of any links in the
motion of one segment affects all proximal and distal segments to the first kinetic chain has consequences for injury to the shoulder and elbow.
segment. The overhead throwing motion is produced and regulated by a Effective interaction of kinetic chain segments is required for optimal
sequential position and motion of the body, involving sequential acti- efficiency and injury prevention. These circumstances advocate a
vation, both in initiation timing and peak activation moving from the comprehensive assessment of the overhead throwing motion in an
lower extremities to the upper limbs. Since the throwing motion is an athlete including key tests and measures to evaluate hip and core func-
extremely rapid movement occurring within only 0.145 s, the efficient tion. Preventative programming is best designed and implemented as
synchronous sequencing of the body segments is critical for optimising part of the athlete's training programme to optimize the kinetic chain and
the efficiency of the kinetic chain. lower risk of injury and/or re-injury.
Sciascia et al.1 indicated that the kinetic chain is affected by multiple
factors, including core strength, hip strength and range of motion (ROM), Submission statement
scapular kinematics, shoulder strength and ROM, knee and ankle
mobility, and effective kinetic chains, showing reduced joint loads, This manuscript has not been published and is not under consider-
maximum speed, and maximum force output during throwing. ation for publication elsewhere.
Dysfunction of the kinetic chain during throwing increases stress on the
distal parts contributing to pathologies of the shoulder and elbow. Authors’ contributions
Kinetic chain dysfunction will decrease throwing performance while
increasing the injury risk in both the shoulder and elbow.1 Approxi- All authors listed have made a substantial and intellectual contribu-
mately 50% of the kinetic energy and force of the hip/trunk area con- tion to the work, and approved it for publication.
tributes to the entire throwing motion. Therefore, force and power
production are impaired by altered kinematic in this area, causing
increased stress in the distal limb segments. Conflict of interest
Robb et al.2 found that reduced hip ROM is strongly associated with
shoulder injuries and weak throwing mechanics in the dominant hip as We have NO affiliations with or involvement in any organization or
compared with the non-dominant hip. Moreover, Kibler et al.3 reported entity with any financial interest (such as honoraria; educational grants;
that insufficient hip ROM and poor balance have a major impact on the participation in speakers’ bureaus; membership, employment, consul-
ability of an athlete to transmit energy through the kinetic chain, tancies, stock ownership, or other equity interest; and expert testimony
contributing to impaired movement and increased stress on the shoulder or patent licensing arrangements), or non-financial interest (such as
and elbow. Several studies have found a link between overhead move- personal or professional relationships, affiliations, knowledge or beliefs)
ment injuries and poor lower extremity balance.3,4,5,6 in the subject matter or materials discussed in this manuscript.
The trunk is the essential structure for giving the upper limbs the
force created by the lower limbs. Proper trunk movement during References
throwing is critical, as this movement is integral to transferring energy to
distal body segments during the throwing motion. A 20% reduction in 1. Sciascia A, Thigpen C, Namdari S, et al. Kinetic chain abnormalities in the athletic
kinetic energy supplied to the arm from the hip and trunk allows a 34% shoulder. Sports Med. Arthrosc. Rev. 2012;20(1):16–21. https://doi.org/10.1097/
JSA.0b013e31823a021f.

https://doi.org/10.1016/j.smhs.2021.10.004
Received 3 October 2021; Received in revised form 16 October 2021; Accepted 18 October 2021
Available online 23 October 2021
2666-3376/© 2021 Chengdu Sport University. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.
Letter to the Editor Sports Medicine and Health Science 3 (2021) 252–253

2. Robb AJ, Fleisig G, Wilk K, et al. Passive ranges of motion of the hips and their 6. Chu SK, Jayabalan P, Kibler WB, et al. The kinetic chain revisited: new concepts on
relationship with pitching biomechanics and ball velocity in professional baseball throwing mechanics and injury. Pm &r. 2016;8(3):S69–S77. https://doi.org/10.1016/
pitchers. Am. J. Sports Med. 2010;38(12):2487–2493. https://doi.org/10.1177/ j.pmrj.2015.11.015.
0363546510375535.
3. Kibler WB, Ludewig PM, McClure PW, et al. Clinical implications of scapular dyski-
nesis in shoulder injury: the 2013 consensus statement from the ‘scapular summit’. Br. Qais Gasibat*, Tengku Fadilah Tengku Kamalden**
J. Sports Med. 2013;47(14):877–885. https://doi.org/10.1136/bjsports-2013-092425. Department of Sport Studies, University Putra Malaysia (UPM), Kuala
4. Garrison JC, Arnold A, Macko MMJ, et al. Baseball players diagnosed with ulnar Lumpur, Malaysia
collateral ligament tears demonstrate decreased balance compared to healthy controls.
J. Orthop. Sports Phys. Ther. 2013;43(10):752–758. https://doi.org/10.2519/ *
jospt.2013.4680. Corresponding author.
5. Culiver A, Garrison JC, Creed KM, et al. Correlation among Y-balance test–lower
quarter composite scores, hip musculoskeletal characteristics, and pitching kinematics **
Corresponding author.
in NCAA division I baseball pitchers. J Sports Rehabil. 2018;28(5):432–437. https://
doi.org/10.1123/jsr.2017-0111. E-mail addresses: drqaiss9@gmail.com (Q. Gasibat),
tengku@upm.edu.my (T.F. Tengku Kamalden).

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