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Biomechanics of the knee during closed
kinetic. chain and open kinetic chain
exercises
RAFAEL F. ESCAMILLA. GLENN S. FLEISIG. NIGEL ZHENG. STEVEN W. BARRENTINE. KEVIN E. WILK. and
JAMES R. ANDREWS
American Sports Medicine Institute, Birmingham,AL 35205
ABSTRACT
ESCAMILLA, R. F., G. S. FLEISIG, N. ZHENG, S. W. BARRENTINE, K. E. WILK, and J. R. ANDREWS. Biomechanics of the
knee during closed kinetic chain and open kinetic chain exercises. Med.Sci. Sports Exerc., Vol.30, No.4, pp. 556-569, 1998. Purpose:
Although closed (CKCE) and open (OKCE) kinetic chain exercises are used in athletic training and clinical environments, few studies
have compared knee joint biomechanics while these exercises are performed dynamically. The purpose of this study was to quantify
knee forces and muscle activity in CKCE (squat and leg press) and OKCE (knee extension). Methods: Ten male subjects performed
three repetitions of each exercise at their 12-repetition maximum. Kinematic, kinetic, and electromyographic data were calculated using
video cameras (60 Hz), force transducers (960 Hz), and EMG (960 Hz). Mathematical muscle modeling and optimization techniques
were employed to estimate internal muscle forces. Results: Overall, the squat generated approximately twice as much hamstring
activity as the leg press and knee extensions. Quadriceps muscle activity was greatest in CKCE when the knee was near full flexion
and in OKCE when the knee was near full extension. OKCE produced more rectus femoris activity while CKCE produced more vasti
muscle activity. Tibiofemoral compressive force was greatest in CKCE near full flexion and in OKCE near full extension. Peak tension
in the posterior cruciate ligament was approximately twice as great in CKCE, and increased with knee flexion. Tension in the anterior
cruciate ligament was present only in OKCE, and occurred near full extension. Patellofemoral compressive force was greatest in CKCE
near full flexion and in the mid-range of the knee extending phase in OKCE. Conclusion: An understanding of these results can help
in choosing appropriate exercises for rehabilitation and training. Key Words: CLOSED KINETIC CHAIN, OPEN KINETIC CHAIN,
MUSCLE ACTIVITY, PCL, ACL, PATELLOFEMORAL, TIBIOFEMORAL, JOINT FORCE
I n 1955, Steindler (54) defined two types of exercises: CKCE-such as squat, leg press, deadlift, and power-
closedkinetic chain exercises(CKCE) and openkinetic clean- havelong beenusedas coreexercisesby athletesto
chain exercises(OKCE). In a CKCE, the tenriinal or enhanceperformance in sport. (11,27) These multi-joint
distal segmentis opposedby "considerableresistance";in a exercisesdevelopthe largestand most powerful musclesof
OKCE, the distal segment is free to move without any the body and have biomechanicaland neuromuscularsim-
externalresistance.If the.externalresistanceis fixed from ilarities to many athletic movements,such as running and
moving, the system is "strictly and absolutely closed." jumping. RecentlyCKCE havebeenusedandrecommended
Thesecategoriesare often found to be inaccurate01;con- in clinical environments,such as during knee rehabilitation
fusing (44). To reduce confusion, Dillman et al. (16) pro- following anterior cruciate ligament (ACL) reconstruction
posedthree categoriesof exercises:a fixed boundarycon- surgery (22,33,38,43,44,50,67,68).
dition with an externalload (e.g.,leg presswhereseatslides It is difficult to comparetibiofemoral compressiveforces
and the foot plate is fixed), a movable boundary with an during the squat between various published studies since
externalload (e.g., leg presswhere the seatis fixed and the some studies modeled both external forces (e.g., gravity,
foot platemoves),and a movableboundarywith no external ground reaction, inertia) and internal forces (e.g., muscle,
load. In this study CKCE of the leg are defined as exercises bone, ligament) (3,13,36,42), while others modeled only
in which the feet are fixed from moving and OKCE of the external forces (1,20,58). Furthermore,only three of these
leg are those with no external resistancefor movementof studies specified the direction of the tibiofemoral shear
the feet. force (36,41,58), making it. difficult to determine which
cruciate ligament was loaded. All three of these studies
found moderateposterior cruciate ligament (PCL) tensile
0195-9131/98/3004-0556$3.00/0
forces at higher knee angles(00 = full knee extension)and
MEDICINE & SCIENCE IN SPORTS & EXERCISE(!) minimum ACL forces at smaller knee angles.Exact knee
Copyright @ 1998 by the American College of Sports Medicine angleswere statedin only one of thesestudies(58). Only
Submitted for publication September 1996. one known study quantified patellofemoral compressive
Accepted for publication August 1997. forcesduring the squatexercise(46). However,the squatsin
556
this study were performed isometrically. There are no 0-90 knee flexion range).The subjectshad a meanheight
known studies that have quantified tibiofemoral or patel- of 177 :!: 9 cm, a meanmassof 93 :!: 15 kg, and a meanage
lofemoral compressiveforces during a dynamic leg press of 29 :!: 6 yr. All subjectsperformed CKCE and OKCE
exercise,althoughSteinkampet al. (55) did quantify patel- regularly in training and had no history of knee injuries or
lofemoral compressiveforcesduring an isometric leg press knee surgery. Before participating in the study, informed
at 0, 30, 60, and 90 knee flexion. consentwas obtainedfrom eachsubject.Bilateral symmetry
OKCE, such as seatedknee extension and knee flexion was assumed,thus force, video, and electromyographic
exercises,are viewed as single joint, single muscle group (EMG) data were collecte.dand analyzedon the subject's
exercises.These exercisesappearto be less functional in left side.
terms of many athletic movementsand primarily serve a Testing setup. Each subjectwas testedperformingtwo
supportive role in strength and conditioning programs. CKCE (the squat and leg press) and one OKCE (knee
Moreover,the useof OKCE in clinical settingsappearsto be extension).A standard20.5 kg Olympic barbell,disks(Stan-
diminishing (44,50). dardBarbell) and a Continentalsquatrack wereus~dduring
Two known studieshavequantified patellofemoralcom- the squat. Each subject squattedwith his left foot on an
pressiveforcesduring thekneeextensionexercise.Kaufman AMTI (Model OR6-6-2000, AdvancedMechanicalTech-
et al. (26) quantifiedpatellofemoralcompressiveforce dur- nologies,Inc., Watertown,MA) force platform, andhis right
ing a dynamic knee extension,while Steinkampet al. (55) foot on a solid block (Fig. 1).
quantified patellofemoralcompressiveforces during an iso- A ,:,ariableresistanceleg pressmachine(Model MD-117,
metric kneeextensionat 0, 30, 60, and 90 knee flexion. Body Master, Inc., Rayne, LA) was used during the leg
Several isometric (7,22,33,41,69)and dynamic (26,67) pressCKCE. An AMTI force platform for the left foot and
studieshave shownthat during the knee extensionexercise, a solid block for the right foot were mountedon a custom-
the ACL is loaded at knee anglesless than 60, increasing ized leg pressplate as shown in Figure 2. The force plat~
as knee angle decreases.Conversely,the posterior cruciate form, solid block, andleg pressplate all remainedstationary
ligament (PCL) is loaded at knee angles greaterthan 60. throughout the lift, while the body moved away from the
Understandingand comparing knee forces and muscle feet.
activity in different exercisesis essential for determining A Hogganvariable resistanceseatedknee extensionma-
how to achieveoptimal balanceof muscle force, ligament chine (Model 2055, HogganHealth Industries,Draper,VT)
tension, and joint compression.Lutz et al. (33) compared was used during the knee extension OKCE. A load cell
knee forces and muscle activity in CKCE (simulated "leg (Model LCCA-500, Omega Engineering, Inc., Stamford,
press" in an upright position, as in performing a step-up CT) was installed to directly measureforce applied by the
exercise)and OKCE (kneeextensionand knee flexion), but left leg onto a resistancepad (Fig. 3).
these exerciseswere performed isometrically. In our pre- Sphericalplastic balls.(3.8 cm in diameter)coveredwith
liminary study,tibiofemoralcompressiveforces andmuscle reflective tape were attachedto adhesivesand positioned
activity during dynamicCKCE (leg press,squat)andOKCE over the following bony landmarks:medial and lateralmal-
(kneeextension)were quantifiedand compared(64). While leoli of the left foot, upper edgesof the medial and lateral
the study reported tibiofemoral compressive and shear tibial plateau of the left knee, posterior superior greater
forces, the model did not considerdifferencesbetweenpa- trochantersof the left andright femurs,and lateral acromion
tellar tendon force and quadricepstendon force; further- of the left shoulder.In addition, a 1 cm2piece of reflective
more, tensile forces in the PCL, ACL, and patellofemoral tape was positionedon the third metatarsalheadof the left
joint were not quantified. Hence,no study has thoroughly foot.
describedknee biomechanicsduring dynamic CKCE and Four electronically synchronized high-speed charged
OKCE. The purpose of this study was to quantify and couple device (CCD) cameras(Motion Analysis Corpora-
comparecruciateligamenttensileforces, tibiofemoral com-
pressive forces, patellofemoral compressive forces, and
muscle activity aboutthe knee during dynamit CKCE and
OKCE. Internal muscleforces were calculated to estimate
the actualforcesacrossthe articulating surfacesof the knee.
CLOSED AND OPEN KINETICCHAIN EXERCISES Medicine & Science in Sports & Exercise 557
the opportunity to ask questions.In addition, a subject's 12
repetition maximum (12 RM) was determined for each
exercise by using the most weight he could lift for 12
consecutiverepetitions.The mean 12RM loadslifted during
the squat,leg press,and knee extensionwere 146.5 :t 39.0
kg, 146.0 :t 30.3 kg, and 78.6 :t 18.2 kg, respectively.
While performing the squat and leg pressduring both the
pretest and the actual testing session,each subject used a
stanceand foot position normally used in training.
Before the testing sessionbegan,the force platforms and
load cell were calibrated and their positions were deter-
mined. To determine three-dimensionallocations of the
force platforms, video data were collected from 2 cm2
pieces of reflective tape positioned on each of the four
Figure 2- Testing setup for leg press exercise.
comers of both force platforms. The three-dimensionallo-
cations of each comer of the force platform were then
derived in global coordinates.For the knee extensionexer-
tion, Santa Rosa, CA) were strategically positioned around cise, a reflective marker was permanently attachedto the
each subject. These cameras collected 60 Hz video data load cell. Therefore,the location of the foot relative to the
from the reflective markers positioned on the body. Images force platform or load cell and the location of the three-
from these cameras were transmitted directly into a motion dimensionalreaction force vector acting on the foot or .leg
analysis system (Motion Analysis Corporation), were able to be determined.All threeexercisesoccupiedthe
EMG data from the quadriceps, hamstrings, and gastroc- samefilming area;consequently,video and force datawere
nemius musculature were quantified with an eight channel, collected from all trials (i.e., repetitions)from one exercise
fixed cable, Noraxon Myosystem 2000 EMG U (Noraxon before setting up for the next exercise.The order of per-
USA, Inc., Scottsdale, AZ). The amplifier bandwidth fre- forming the exerciseswas randomly assignedfor eachsub-
quency ranged from 15-500 Hz, (14,65) with an input ject. Testing procedureswere explained to each subject
voltage of 12 VDC at 1.5 A. The mput impedance of the before testing commenced.Each subject was allowed to
amplifier was 20,000 kfl, and the amplitude of the raw perform as many warm-up sets as needed; however, to
EMG as recorded at the electrodes was expressed in milli- prevent fatigue, the subjectswere instructednot to warm up
volts. The common-mode rejection ratio was 130 Db. in excessof 60% of their 12 RM pretestweight. For both the
The skin was prepared by shaving, abrading, and clean- warm-up and testing sets,each subject restedlong enough
ing. A model 1089 mk II Checktrode electrode tester (UF!, until he felt completely recovered from the previous set.
Morro Bay, CA) was used to test the contact impedance Becauseof the submaximalweight lifted, the low setsand
between the electrodes and the skin, with impedance values repetitions performed, and the high fitness level of the
less than 200 kfl considered acceptable (14). Most imped- subjects,fatigue was assumedto be negligible.
ance values were less than 10 kfl. Each subject's stancewidth in CKCE was measuredwith
Blue Sensor (Medicotest Marketing, Inc., Ballwin, MO) a grid overlaid on the squatand leg pressforce platforms.
disposable surface electrodes (type N-OO-S) were used to The meanstancewidth (insideheel to insideheel)was40 :t
collect EMG data. These oval shaped electrodes (22 mm 8 cm for the squat and 34 :t 14 cm for the leg press.A
wide and 30 mm long) were placed in pairs along. the goniometer was used to measureforefoot abduction (i.e.,
longitudinal axis of each muscle or muscle group tested,
with a center-to-center distance between each electrode of
approximately 2-3 cm. One electrode pair was placed on
each the following muscle locations in accordance with
procedures from Basmajian and Blumenstein (6): 1) rectus
femoris, 2) vastus lateralis, 3) vastus medialis, 4) biceps
femoris, 5) medial hamstrings (semimembranosus/semiten-
dinosus), and 6) gastrocnemius.
EMG, force, and video data collection equipment were
electronically synchronized. EMG. and force data were col-
lected by an ADS analog-to-digital system (Motion Analy-
sis Corporation) at 960 Hz. The 960 Hz sampling rate was
chosen to time match the EMG and force data with the 60
Hz video data.
Data collection. Each subject came in for a pretest 1
wk before the actual testing session. At this time the exper-
imental protocol was reviewed and the subjects were given Figure 3--Testing setup for knee extension exercise.
CLOSED AND OPEN KINETIC CHAIN EXERCISES Medicine & Science in Sports & Exercise 559
terior translationof the leg, while a posteriorshearforce was Narici et al. (40), PSCA for each muscle was calculated.
a posteriorforce the thigh appliedto the leg to resistanterior ThesePSCA werethen scaledfor eachindividual subjectby
translationof the leg (33). An anteriorshearforce is resisted using the ratio of the subject'sbody weight andthe average
primarily by the PCL, while a posterior shear force is 75 kg body weight reportedby Narici et al. (40)
resistedprimarily by the ACL (10). Unfortunately,anterior Tensile force in the quadricepstendonwas the summation
and posteriorshearforce definitions are inconsistentamong of all four quadricepsforces.To calculateforce generatedin
studies(26,33,55).Resultanttorque applied by the thigh to the vastusintermedius,the averageof EMG data from the
the leg was separatedinto three orthogonal components. other three quadricepswas used. Since the patellar tendon
Becauseof the small magnitudesin valgus-varustorqueand force changeswith knee flexion and extension,tensileforce
internal-external rotation torque, only extension-flexion in the patellar tendonwas calculatedasa function of patellar
torquewasanalyzed.Resultantforce, torque,andEMG data tendonforce andkneeangle(60,61).Torquecreatedby each
were then expressedas functions of knee angle. For each muscle or tendon was the product of the its moment arm
trial, data from the three repetitions were averaged. (23) and its force. Assuming that ligamentsand bonescre-
Model for ligament and bone force- To estimate ated negligible torque at the knee, the resultant torque
tibiofemoral compressiveforces, cruciatetensileforces,and sho~ld equal the summation of torque produced by the
patellofemoralcompressiveforces in OKCE and CKCE, a patellar tendon,medialhamstrings,bicepsfemoris, andgas-
biomechanicalmodel of the sagittal plane of the knee was trocnemius:
developed(Fig. 5). Since the lateral and medial collateral
ligaments play minor roles in stabilizing the knee joint 1m= Tpc + Tmh + ~f + T.
during kneeflexion andextension,they werenot includedin Since the accuracyof estimatingmuscle forces depends
this model. on accurateestimationof PSCA, maximum voluntary con-
Becauseof the slow speedof musclecontractionduring traction force per unit PCSA, and the EMG-force relation-
the exercisesperformed, the total force (F) producedby a ship, the torqueequilibrium equationshownabovemay not
muscle was assumedto be equal to the product of the be satisfied.Therefore,the total force (F) was modified by
maximumforce the musclecould produceandEMG activity a coefficient (c): F = c * (0" * PCSA) * (EMG/MEMG).
expressed as a fraction of the maximum EMG value Values for each muscle's coefficient were determined
(MEMG) recordedduring MVIC. Maximum muscleforce with the optimization routine presentedbelow. Each coef-
was equal to the product of physiological cross-sectional ficient was initially set at one and adjustedwith the Davi-
area(PCSA) and maximum voluntary contractionforce per don-Pletcher-Powellalgorithm. (45) With this algorithm,
PCSA (0").Hence,F = (0" * PCSA) * (EMG/MEMG).
coefficients were constrainedby an upper and lower limit
Maximum voluntary contraction force per PCSA was and were determined so that the summation of muscle
assumedto be 40 N-cm-2 for the quadricepsand35 N-cm-2 torque (2.Tm) equaledthe resultanttorque.
for the hamstring and gastrocnemius (12,21,25,39,40).
OM
PCSA datafrom Wickiewicz et aI. (63) were usedto deter- min f(c,) = ~
;- +A(T,.. ~Tm;)
mine the ratios of PCSA betweendifferent muscles.Using
theseratios and the 160 cm2 quadricepsarea reportedby Once muscle forces were corrected,tibiofemoral compres-
sive force and PCUACL tensileforce were found using the
following force equilibrium equations:
Of,
CLOSED AND OPEN KINETIC CHAIN EXERCISES Medicine& Sciencein Sports& Exercise 561
all exercises,approximately3000 N of maximumtibiofemo-
ral compressiveforce was produced (Table 3). Maximum
tibiofemoral compressiveforce was producedbetween53-
93 knee angle in CKCE and between 39-57 in OKCE
(Table 3).
PCL/ ACL tensile forces. For all exercises,PCL ten-
sile forces generally increasedwith knee flexion and de-
creasedwith kneeextension(Fig. 9). In CKCE, the PCL was
always in tension.In OKCE, the PCL was in tensionwhen
the knee angle was greaterthan 25, while the ACL was in
tension when the knee was near full extension (15-25).
Peak PCL tensile forces were approximately 2000 N in
CKCE and approximately 1000 N in OKCE (Table 3).
Patellofemoral compressive forces. Patellofemoral
compressiveforces generally increasedwith knee flexion
and decreasedwith knee extension (Fig. 9). However, in
OKCE patellofemoralcompressiveforce decreasednearfull
flexion. OKCE produced significantly greater forces than
CKCE at knee angleslessthan 57, while CKCE generated
significantly largerforcesthan OKCE at kneeanglesgreater
than 85 (Table 2). Maximum patellofemoraIcompressive
force was between 4000-5000 N for all three exercises KneeAngle (tieg)
(Table 3).
Figure 8-Mean and SD of resultant force and torque during squat
(A.),leg press (~, and knee extension (e). Compressiveforce, anterior
shear force, and extension(+ )/flexion( -) torque are shown.
DISCUSSION
The aim of this study was to comparekneebiomechanics
during dynamic OKCE and CKCE throughouta continuous joint forces and torqueswere calculated,but thesecalcula-
rangeof motion. Both the knee flexing and knee extending tions consideredonly the external and inertial forces and
portions of each exercisewere examined.Muscle activity torques acting on the foot and leg. To identify the contri-
for all of the major knee muscleswere measured.Resultant bution of individual ligaments and articulations,a biome-
chanicalmodelof the kneewasdevelopedmodelinginternal
muscleforces and torques.While this model has numerous
uncertaintiesassociatedwith current biomechanicaltech-
niques, the results provide valuable insight regardingspe-
cific hard and soft tissue structures.
It is difficult to compareresultswith otherstudiesbecause
of methodologicalvariancesamongstudies.Severalstudies
u involved maximum isometric contractionsat selectangles,
;;
:E (33,42,43,46,53,55,69),while other studies involved dy-
~ namic movements(3,13,26,36,41,58).Furthermore,noneof
"'
OJ
:p thesedynamicstudiesspecifiedthe percentof eachsubject's
~
u
maximum load in which they performedtheseexercises.In
<
.. this study a typical 12 RM intensity wasemployed,which is
U
In
'"
approximately equivalent to 70-75% of each subject's 1
:E RM (35). Performing 8-12 repetitionsis a commonrepeti-
tion schemethat many physical therapy, athletic training,
and athletic programsadhere.to for strengthdevelopment
(56,57). Since the same relative weight was used for all
exercises(i.e., 12 RM), ligamentoustensile forces and tib-
iofemoral and patellofemoralcompressiveforces were able
to be comparedwith eachother.
From Table 3, the SD among maximum tibiofemoral
compressiveforces,ACL and PCL tensileforces,andpatel-
Knee Angle (deg) lofemoral compressiveforces were quite high. This was
largely a result of the high variability in each subject's 12
Figure 7-Mean and SD of hamstring and gastrocnemius muscle ac-
tivity during squat (~), leg press (8), and knee extension (8), expressed RM. In thesewell trained lifters, thosesubjectswith higher
in percentage of maximum voluntary isometric contraction (%MVIC). body weight usually had a higher 12 RM than subjectswith
562 OfficialJournalof the AmericanCollegeof SportsMedicine http://www.wwilkins.com/MSSE
lower body weight. The subjects' body weight ranged from TABLE2. Significantdifferencesin PCLtensileforces. tibiofemoralcompressive
forces,and patellofemoralcompressiveforces amongthe knee extension(KE), leg
approximately 70-110 kg, while their 12 RM squat ranged press(LP),andsquat(SO)exercises.
from approximately 100-220 kg, their 12 RM leg press
ranged from approximately 100-180 kg, and their 12 RM
leg extension ranged from approximately 60-90 kg.
Muscle activity. Averaging over the entire exercise,
Kneeflexing 15-29 KE>SQ&LP
OKCE generated approximately 45% more rectus femoris 71-95 SQ&LP>KE
activity than CKCE, while CKCE generated approximately Knee extending 15-25 KE>SQ
15-27 KE>LP
20% more vastus medialis activity and approximately 5% PCL
more vastus lateralis activity than OKCE. These findings are Kneeflexing 15-33 LP>KE
in agreement with Signorile et al. (52) who found signifi- 33-45 SQ&LP>KE
61-69 SQ&LP>KE
cantly more vasti activity during the squat exercise than 69-95 LP>KE
during the knee extension exercise. This suggests that Knee extending 15-95 SQ&LP>KE
27-79 SQ>LP
OKCE may be more effective in developing the rectus Patellofemoral
femoris, while CKCE may be more effective in developing Kneeflexing 15-47 KE>SQ&LP
the vasti muscles. However, this may be true only at specific 85-95 SQ&LP>KE
Knee extending 15-57 KE>SQ&LP
ranges of knee motion. From Table I, rectus femoris activity 89-95 SQ & LP > KE
j
! 2000 Numerousstudieshave shown that the EMG magnitude
td
r-
1000 with eccentricwork is much lessthan the EMG magnitude
0
during an equal amountof concentricwork (4,8,28,29,58).
2000
'-,..] 1-.-'
This was true in this study,asquadricepsactivity was lower
during knee flexing (eccentricwork) than during knee ex-
~ ..J 1500
(,
tending (concentricwork).
~
OJ
~
1000 ~,
. ; Previous studies have demonstratedthat co-contraction
0 - 500
u.
betweenthe quadricepsand hamstrings occur in OKCE
1')-- r
O'T-"" (5,17). These studieshypothesizedthat co-contractionbe-
-500
tweenthe quadricepsandhamstringshelp stabilize the knee
5000
and therebyminimize potential tensileloading to the ACL.
4000
3000 1, L ~ ,'\ Similar to datafrom Lutz et al. (33), this studyfound greater
co-contractionbetween the quadricepsand hamstrings in
~ 2000 Y CKCE comparedwith that in OKCE. The greatestdiffer-
~ encein hamstring activity betweenCKCE and OKCE oc-
100~ ~~ ~
20 40 60 80 -80 -60 -40 -20 curred during knee extending.
flexion extension
Figure 7 shows that peak hamstring activity during the
Knee Angle (deg) squatwas approximately35% of a MVIC during the knee
flexing phaseand approximately50% of a MVIC during the
Figure 9-Mean and SD of forces during squat (A), leg press (8), and
knee extension (8). Tibiofemoral compressiveforce, PCL( + )/A CL( - ) knee extendingphase,with peakvaluesoccurring near 50
tensile force, and patellofemoral compressiveforce are shown. knee angleduring both phases.In contrast,peak hamstring
Medicine & Science in Sports & Exercise 563
Kneeflexing 2192:!:930@81 3011 :!:693@93 3017:!: 1511 @ 39"
PCl
Kneeflexing 1635 ~ 369@95. 1593:!:316@95 801 :!: 221 @ 83"
Knee extending 1868 ~ 878@63. 1866:!: 383 @95 959 :!: 300 @ 79"
ACL
Kneeflexing 0 0 142:!: 258@ 15.
Knee extending 0 0 158:!:256@15.
Patellofemoral
Kneeflexing 4548:!: 1395 @85. 4780:t1194@91 3724:!: 1940@87.
Knee extendina 4042:!: 955@95. 4991 :t 1352@91 4846:!: 2453 @ 75.
activity from squatdatafrom Stuartet al. (58) was approx- namic barbell squathas also beenobservedby Stuart et al.
imately 20% of a MVIC during both the knee flexing and (58).
kneeextendingphases,with peakvaluesoccurringnear 30 In CKCE the gastrocnemiuscontractedeccentrically to
kneeangleduring both phases.Theselower EMG hamstring control the rate of dorsiflexion during knee flexing and
magnitudesby Stuart et al. are probably a result of their contracted concentrically to cause plantar flexion during
subjectslifting a lower percentageof their 1 RM compared kneeextending.Sincethe foot wasfree to move and wasnot
with subjects in the current study. The similar hamstring restrained in OKCE, minimal g~strocnemiusactivity was
activity they observedbetweenthe knee flexing and knee presumed.On the contrary, higher than expected values
extendingphasesof the lift is contraryto the resultsfrom the were observedthroughout the range of knee motion. This
currentstudy,which showedsignificantly greaterhamstring higher activity may be causedby a propensityto plantar flex
activity during knee extending. Since the hamstringsare the ankle while performing the knee extensionexercise.A
biarticulatemuscles,it is difficult to delineatethesemuscles more plausible explanationis that the biarticulate gastroc-
during the squatas performing eccentricwork during knee nemius co-contractedwith the hamstringsto help stabilize
flexing and concentric work during knee extending.They the knee while performingthe OKCE. Since the hamstrings
may actuallybe working isometricallyduring both phasesof and gastrocnemiusboth cross the knee posteriorly, they
the squat,since they are shorteningat the knee and length- provide posterior knee stabilization during knee move-
ening at the hip during knee flexing and lengtheningat the ments. Since a shear force component from the patellar
kneeandshorteningat the hip during kneeextending.If they tendonattemptsto translatethe leg anteriorly relative to the
are indeed working eccentrically during knee flexing and thigh at knee anglesless than 60, (26,67) the higher gas-
concentrically during knee extending, as is traditionally trocnemiusactivity observedat lower knee anglesmay help
believed, then our results would be in accord with other resist this translation.
studiesthat have showndecreasedactivity during eccentric Resultant forces and torques, Resultant compres-
work and increasedactivity during concentricwork (8,29). sive forces were equal to 1~1times body weight (BW) in
Data averagedduring the entire phaseshowsthat the leg CKCE and nonexistentin OKCE. It is still unclear when
pressproducedslightly morehamstringactivity thanOKCE, compressiveforce magnitudesbecome detrimental to the
while the squat produced approximately twice as much knee joint. The maximum compressiveforce of 1.1 times
hamstringmuscleactivity as the leg pressand OKCE. Con- BW in CKCE is considerablylessthan the maximum com-
sequently,the squatsmay be more effective in hamstring pressive force of 2.0 times BW that has been calculated
development than the leg press and leg extensions.The during slow running at 3 m's-l (2).
greaterhamstring activity producedduring the squatexer- Resultantshearforce direction is important since it pro-
cise was primarily a result of the hamstringsrole in con- vides insight concerningtensile loading to the cruciate lig-
trolling hip flexiQn during knee flexing and producinghip aments.Butler et al. (10) haveshownthat the ACL provides
extensionduring knee extending. 86% of the total resistanceto anterior drawer and the pos-
During the leg pressand OKCE, a relatively small flexor terior cruciateligament(PCL) provides approximately95%
torque is generatedabout the hip; therefore,minimal ham- of the total restrainingforce to posteriordrawer. Two squat
string activity is need to extend the hip (44). The antago- studies found shearforce magnitudesthat were similar to
nistic hamstring activity during the squat provides greater those found in the current study (1,36). Of these, only
stability againstanterior displacementof the leg relative to Meglan et al. (36) specifiedshearforce direction. Like the
the thigh, thus reducing potential tension in the ACL and resultsfrom this study,they found anteriorshearforces (i.e.,
increasingtension in the PCL. This is consistentwith the PCL tensile force) throughout the knee flexing and knee
findings of the current study.During the mid-rangeof knee extending phasesof the squat. Stuart et al. (58) also ob-
extendingin the squatwhenhamstringactivity wasgreatest, servedPCL tensileforces causedby shearforces generated
PCL tension was also greatest.A similar pattern of higher during the dynamic barbell squat. Similar to the current
hamstringactivity andgreateranteriorshearforce (i.e., PCL study, the shearforcesgeneratedduring the squat progres-
tensile force) during the knee extending phaseof the dy- sively increasedthroughoutknee flexing and progressively
564 Official Journal of the American College of Sports Medicine http://www.wwilkins.com/MSSE
decreasedthroughoutknee extending.The higher resultant the knee joint cannot be determined. When a individual's
shear force magnitudesfrom the current study compared PCL is, weak, caution should be taken when performing
with the magnitudesin Stuartet al, is primarily becausethe OKCE and CKCE at higher knee angles, sioce PCL tensile
subjectsfrom the currentstudyuseda higher percentof their forces were greatest at these positions. PCL tensile forces
1 RM. Some physicians,therapists,and coachesfeel that were greatest for all exercises during knee extending.
large shearforcesproducedin CKCE and OKCE may have Peak ACL tensile forces in OKCE were approximately
deleteriouseffectson the knee.However,maximum anterior 0.20 times BW and occurred at 15 knee angle. This mag-
shearforces were only 0.67 times BW in CKCE and 0.44 nitude and knee angle wer~ similar to results reported during
times BW in OKCE. This is considerably less than the other studies involving the knee extension exercise
maximum anterior shear force of 1.0 times BW that has (26,33,42,53,69). The large" compressive forces produced
been reportedduring slow running at 3 m's-l (2). Further- during these small knee angles may aid the ACL in knee
more, running is often performedat a greaterfrequencyand stabilization. The presence of ACL tension because of pos-
duration comparedwith that at CKCE and OKCE, greatly terior shear force appears somewhat contradictory, since a
increasingknee injury potential causedby excessiveshear- resultant anterior shear force (i.e., PCL tensile force) was
ing forces being applied to the knee during each stride. produced in OKCE. However, muscle force contributions
Knee extensortorquesaregeneratedin CKCE and OKCE are not included in the resultant force calculations. These
primarily to overcomethe load being lifted. The quadriceps forces reflect only the effects of gravity, inertia, and the
are the primary muscle group that generatesthis knee ex- post~riorly directed external force acting on the leg by the
tensortorque,contractingeccentricallyduring the kneeflex- resistance pad. The external force of the resistance pad
ing phaseto control the rate of knee flexion and concentri-- attempts to translate the leg posteriorly relative to the thigh,
cally during the knee extendingphaseto overcomeforces which alone would load the PCL. PCL tensile and muscle
due to gravity. Extensor torquesvalues and patternswere forces are primarily responsible for resisting this external
similar to values and patternsreported in numerousother force by applying an anteriorly directed force "to the leg
studies (30,31,42,58,66).No known studies have reported relative to the thigh. The quadriceps, via the patella tendon,
knee extensortorquesduring an isotonic leg press or iso- exerts an anteriorly directed force on the leg between ap-
tonic knee extensionexercise. proximately 0-65 knee angle and a posteriorly directed
Tibiofemoral compressive forces. Tibiofemoral force when the knee is flexed greater than approximately
compressiveforceshavebeendeterminedto be an important 60 (23). In contrast, the hamstrings exert a posteriorly
factor in stabilizing the knee by resisting anteroposterior directed force throughout the knee range of motion. When
translational movementdue to shear forces (24,34,51,68). the anterior force component of the patella tendon force
With internal mu~cle forces estimated,these forces were exceeds the posterior force components of the hamstrings
approximately three times the resultant tibiofemoral com- and external resistance, a net anteriorly directed force is
pressiveforces (i.e., tibiofemoral compressiveforces due to applied to the leg, which is primarily resisted by the ACL
~xternaland inertial forcesonly). With muscleweaknessof (10). Since there is much more quadriceps activity than
fatigue, compressiveforces decrease,which may compro- hamstrings activity during the knee extension exercise, the
mise knee stability. Compressiveforces may be especially ACL can potentially be loaded at knee angle less than
importantwhenthe kneeis nearfull flexion; for this is when approximately 60, This ACL loading between 0-60 knee
the greatestPCL tensile forcesoccurred.It remainsunclear angle has been conflrIned experimentally (26,33,42,53,69).
how much compressiveforce is desirableand when it pro- For an individual with a weak ACL, caution should be taken
ducesadverseeffects.When the knee was near full flexion, when performing OKCE when the knee is near full exten-
tibiofemoral compressiveforces were greater in CKCE. sion, as this is when ACL loading occurs. This is consistent
Thesedata are consistentwith results from Lutz et al. (33), with previous studies comparing CKCE and OKCE
which also demonstratedgreater compressive forces in (33,44,48).
CKCE comparedwith thosein OKCE. Furthermore,a sim- Patellofemoral compressive forces. High patel-
ilar tibiofemoral compressiveforce pattern during the bar- lofemoral compressive forces, which can potentially cause
bell squat has been observedby Stuart et al. (58). high stresseson the undersurface of the articular cartilage of
PCL/ ACL tensile forces. PCL tensile forces were the patella, are believed to be the initiating factors for
generatedin CKCE throughoutthe knee flexing and knee patellofemoral dysfunction (e.g., chondromalacia) and sub-
extending phasesand were also generatedin OKCE be- sequent osteoarthritis. Magnitudes and knee angles associ-
tween 25-95 knee angle.Peak force was 1.5 to 2.0 times ated with peak force were similar to results reported during
BW in CKCE and approximately 1.0 times BW in OKCE. other studies involving OKCE and CKCE exercises
These magnitudesand knee angles were similar to shear (13,26,41,46,53,55).
force resultsreportedin previousstudiesinvolving dynamic Similar to the current study, Steinkamp et al. (55) had
movement (3,26,36,41),but higher than results in studies male subjects perform knee extension (OKCE) and leg press
involving isometric contractions(33,42,43,53,69).It is dif- (CKCE) exercises using their 10 RM. However, they per-
ficult to comparePCL tensile forces among studies, since formed these exercises isometrically at 0,30,60, and 90
most other studiesdid not model muscleand cruciate liga- knee angles. Results between studies pro!iuced both simi-
mentousforces; hence,the actual articulating forces across larities and differences. Force patterns between studies were
CLOSED AND OPEN KINETIC CHAIN EXERCISES Medicine & Science in Sports & Exercise 565
similar during the leg press, with forces progressivelyin- pressive force per contact area between the patella and
creasingas knee angleincreased(Fig. 9). In addition, peak femur) may be the most important factor in patellofemoral
forces during knee extensionswere similar and occurredat dysfunctions,suchaspatellofemoralchondromalacia.Using
similar knee angles.Although peak forces also occurredat patellofemoralcontact areasof 1.5 cm2 for 0 knee angle,
similar kneeanglesduring the leg press,the peakforce from 3.1 cm2for 30 kneeangle,3.9 cm2for 60 knee angle,and
Steinkamp et al. (55) was approximately twice the peak 4.1 cm2 for 90 knee angle, Steinkampet al. (55) demon-
force calculatedin the current study.This large discrepancy stratedthat patellofemoralstresswas greatestat the lowest
is surprising, especially ,since their subjects lifted less knee angle (0) during the knee extension exercise and
weight than the lifters in the current study. The different greatestat the highestknee angle(90) during the leg press.
typesof kneeextensionand leg pressmachinesusedamong However, these data should be interpreted with caution
studiesmay explain some of this variance.How these ex- since the patella is not in contactwith the femoral trochlea
ercises were performed (i.e., isometric vs dynamic) may at 0 kneeangle(i.e., terminalkneeextension).Patellofemo-
alsoexplainsomeof the incongruity in forcesgenerated.For rat stresstypically beginsat approximately 10 knee angle,
example,there are no inertial forces during isometric exer- which is when the patella beginsto glide onto the articular
cise,while inertial forcescanexist during dynamicexercise, surfaceof the femoral trochlea.Steinkampet at. (55) furth~r
althoughthey are small whenweight training exercisessuch demonstratedthat patellofemoralstresswas less during the
as the squatare being performed (30). In addition, inertial leg press at knee angles less than 48, which is a more
forces may have affectedthe shapeof the curvesfrom both functional knee anglerange in humanmovementand loco-
studiesduring the knee extensionexercise.Although forces motion comparedto knee anglesbetween48 and full knee
during kneeextensionsincreasedat lower to mid-rangeknee flexion. Applying thesepatellofeII}oralcontactareasto data
angles and decreasedat higher knee angles, the slope of from the current study yielded patellofemor~lstressvalues
thesecurvesare quite different. Force datafrom Steinkamp at comparablekneeangleswith patellofemoralstressduring
et al. is nearly identical at 0, 30, and 60 knee angle the leg press progressively increasing as knee angle in-
(approximately4000 N), increasingonly slightly from 0 to creased,peakingat approximately90 kneeangle.This is in
60, and then dropping sharply to 0 N at 90. In sharp agreementwith datafrom Steinkampet al., which displayed
contrast, force data from the current study was approxi- the same general pattern of progressiveincreasing patel-
mately 1000 N, 2000 N, and 4000 N at 15, 30, and 60, lofemoral stressas knee angle increased.However, a dis-
respectively.Theseincongruitiescan partially be explained parity occurred during the knee extension exercise. Data
by consideringthe inertial characteristicsthat exist during from Steinkampet al. show that patellofemoral stresspro-
the knee extending phase of the knee extensionexercise gressivelydecreasedas knee angleincreased,peaking at 0
(Fig. 9). Forceswere initially low at high knee angles(i.e., knee angle. In contrast, patellofemoral stress during the
at the start of the exercise)as the subjectsbeganexerting knee flexing phasein the current study progressively in-
force againstthe resistancepad. Subsequently,from approx- creasedfrom approximatelyfull knee extensionto approx-
imately maximum knee flexion to knee mid-rangethe sub- imately 60 knee angleand then progressivelydecreasedat
jects acceleratedthe leg and forces increasedproportion- higher knee anglesas the knee continuedflexing (Fig. 9).
ately. From approximately mid-range until full knee Similarly, patellofemoral stressduring the knee extending
extension,the leg beganto acceleratein the oppositedirec- phaseprogressivelyincreasedfrom approximatelyfull knee
tion (i.e., slow down or decelerate)to preventthe kneefrom flexion to approximately60 knee angle and progressively
forcefully hyper extending;hence,forcesdecreasedpropor- decreasedat lower knee angles as the knee continued ex-
tending. Since the patellofemoralcompressiveforce curve
tionately.
In contrast to data from Steinkamp et al. (55), patel- from Kaufman et at. (26) had the samegeneral sh~peand
lofemoral compressiveforce data from Kaufman et al. (26) magnitude as that in the current study, it is deducedthat
during an isokinetic knee extensionare remarkablysimilar patellofemoralstressdatais similar in the study of Kaufman
(both in shapeand magnitudes)to the kneeextensionpatel- et at. and the current study.Thesepatellofemoralstressdata
lofemoral compressiveforce data displayed in Figure 9. demonstratethat patellofemoral stresspatterns differs be-
Patellofemoralcompressiveforce datafrom both Kaufman tween isometric knee extension s (55) and dynamic knee
et al. and the current study progressively increaseduntil extensions(26). Thesefindings are contrary to what many
approximately70 knee angle, and then progressivelyde- rehabilitation specialistsbelieve concerningthe knee exten-
creasedasthe kneecontinuedflexing. In addition, the 600/s sion exercise.It appearsthat the current thinking in many
usedby Kaufmanet al. was approximatelythe samerate of rehabilitation settingsis that patellofemoralstressis highest
kneerotationusedby the subjects.inthe currentstudy.It can at full kneeextension,especiallybetween0-30 knee angle,
be concludedthat thesetwo dynamic studiesinvolving the which is in accordwith isometric knee extensiondata from
knee extension exercise produced quite a different patel- Steinkampet al. (55). However, since patellofemoral data
lofemoral compressiveforce pattern compared10 knee ex- from both the current study and from Kaufman et at. (26)
tensionstudiesinvolving isometric contractions(46,53,55). have implied that patellofemoral stressmay be greater at
Although patellofemoralcompressiveforce was greatest higher knee angles (i.e., 60-70 knee angle) during a dy-
at higher knee anglesduring both the knee extensionsand namic knee extension,the current views on patellofemoral
leg press, patellofemoral stress (i.e., patellofemoral com- stressand patellofemoral rehabilitation may need rethink-
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