#130 Connecting the Hip to the Foot: Open vs Closed Chain Rehabilitation of the Lower Extremity


SUMMARY: The lower kinetic chain is a series of bony segments and joints interconnected and interrelated by soft tissue, all of which function together in coordinated patterns of movement. The majority of time the lower limb functions in a closed chain. Isokinetics, isotonics, plyometrics, eccentrics and isometrics are the different mode of exercises used in rehabilitation of the lower limb.

PRESENTER: Dr. Robert Donatelli is a board certified orthopaedic specialist. He has 20 years of experience in orthopaedic and sports rehabilitation and currently serves as the National Director of Sports Rehabilitation for Physiotherapy Associates. Dr. Donatelli serves as a consultant to the Philadelphia Phillies Baseball Team and serves as a member of the research committee for the Professional Baseball Athletic Trainers Society. Dr. Donatelli is a consultant to the ATP professional tennis tour and serves as the physical therapist for the Champions Tennis Tour, Masters Division of the ATP Tour. Dr. Donatelli has lectured throughout the United States, Canada, Finland, England and Australia on orthopaedic and sports rehabilitation topics. Dr. Donatelli is part of the editorial staff for Orthopaedic and Sports Physical Therapy and Manual Therapy journals. He also serves as a consultant to FootMaxx and Joint Active Systems. He has edited three textbooks: Physical Therapy of the Shoulder 3rd Edition, Orthopaedic Physical Therapy, 2nd Edition, and Biomechanics of the Foot and Ankle, 2nd Edition.

OBJECTIVES: The course reviews the mechanics of closed kinetic chain function during walking and running. Evaluation of lower limb will emphasize research findings comparing different strengthening mode, stabilization techniques, and foot orthotic intervention.

1) Understand the functional activities of the lower kinetic chain.

      1. Identify open vs. closed chain function during gait.
      2. Identify the posture of the foot and ankle during gait.
      3. Understand the posture of the pelvis during gait.
      4. Understand and define functional exercises.
      5. Identify treatment approaches for overuse injuries of the hip, knee and ankle
      6. Identify research studies comparing different strengthening exercises for specific muscle weakness of the lower extremity.
      7. Describe normal and abnormal mechanics of the foot and ankle.
      8. Demonstrate and perform a biomechanical foot evaluation.
      9. Demonstrate and practice foot orthotic fabrication.
      10. Describe foot orthotic prescription strategies.

FORMAT: This is a two day course.

AUDIENCE: Physical Therapists and Physical Therapy Assistants

AGENDA: 8:00 AM - 5:00 PM

Day One Day Two


  • Muscle strengthening of the lower extremity
  • Exercise to improve strength and function
  • Abnormal mechanics of the foot and ankle
  • Overuse injuries of the lower extremity
  • Open vs closed kinetic chain strengthening
  • Case study
  • Overuse injuries of the lower extremity
  • Biomechanics of gait
  • Biomechanics of the foot and ankle
  • Video analysis of gait
  • Biomechanical foot orthotics
  • Indications and prescription
  • Video cases lower kinetic chain dysfunction
  • Gait analysis and orthotic prescription
  • Footmax computerized system
  • Cases