Kinetic chain

The kinetic chain is the idea that the body moves as a series of linked segments, so what happens at one joint affects the joints above and below it. The concept was borrowed from engineering and is now used across musculoskeletal and sports medicine, neurological rehabilitation and the design of prosthetics (Karandikar & Vargas, 2011). It is a way of thinking about movement, not a structure that shows up on a scan, and that is both its strength and its weakness.

Open and closed kinetic chain

The most precise use of the term is in exercise. In a closed chain exercise, the hand or foot pushes against something that does not move, such as the floor. In an open chain exercise, the hand or foot moves freely. Because the definition is clear, it can be tested. In knee osteoarthritis, a review of 13 trials found low-certainty evidence that closed chain exercise was slightly better than open chain for pain and function in the short term, with no clear difference in quality of life (Michael et al., 2025).

Where the kinetic chain idea gets loose

Outside exercise labels, “kinetic chain” is often used to mean any link between distant body parts: tight hips blamed for back pain, a stiff upper back blamed for a sore neck. Some of these links have been measured, and the results are more modest than the explanations that usually come with them.

Upper back and arm

In 34 healthy people, sitting slouched rather than upright reduced how far they could raise the arm out to the side by about 24 degrees on average, and arm strength at shoulder height was about 16% lower (Kebaetse et al., 1999). The people were seated, as most desk workers are, so this is a measured example of one region changing what another can do. More on that in shoulder pain from computer work.

Upper back and neck

In a trial of 54 people with chronic neck pain, adding mobility exercises for the thoracic spine to neck stabilisation exercises did not reduce pain more. It did lead to bigger improvements in posture, spinal mobility, neck disability and arm function (Kuzu et al., 2026). See thoracic spine mobility exercises.

Hips and lower back

A review of 24 studies found only very low-quality evidence that limited hip movement goes with non-specific low back pain; reduced inward rotation of the hip was the only consistent finding (Avman et al., 2019). Adding hip strengthening to back rehabilitation improved pain and disability by small amounts in five trials with 309 people (de Jesus et al., 2020). Related: hip stretches.

Hip and shoulder

In 30 sedentary young adults with shoulder impingement, compared with 30 matched controls, the gluteus maximus was less active and the latissimus dorsi more active during arm raising. The muscle activity was not meaningfully linked with pain or disability, so it shows a pattern, not a cause (Emara et al., 2026).

What the kinetic chain does and does not tell you

It is a fair reason for a physiotherapist to look beyond the place that hurts, and one reason to include the upper back when working on the neck, as the trial above did. It does not prove that a particular remote “weak link” is causing your pain. Most of the studies above are small or cross-sectional, and the effects, where they exist, are modest. The same caution applies to the related idea of muscle imbalance.