CKC exercises more effective than conventional therapy in improving function in DRF rehabilitation: study

Distal radius fractures (DRFs) are common upper extremity injuries that often result in pain, limited mobility, and impaired proprioception. While conventional rehabilitation typically targets range of motion (ROM) and strength, closed kinetic chain (CKC) exercises may offer additional benefits by enhancing neuromuscular control and proprioception. Menek and Dansuk conducted a study to investigate the effects of CKC exercises on pain, function, proprioception, and ROM in individuals recovering from conservatively treated DRFs.

Forty individuals with conservatively treated DRF were randomly assigned to either the CKC group (n = 20) or the conventional group (CP) (n = 20). Both groups participated in a six-week rehabilitation program after cast removal. Outcome measures included Visual Analog Scale for activity-related pain (VAS-Activity), active ROM (flexion/ extension), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and joint position sense (JPS).

Key findings of the study were:

• Both groups demonstrated significant improvements in all outcomes after six weeks (p < 0.05). However, the CKC group showed greater improvements across all domains.

• Specifically, JPS improved by 6.75° ± 3.21° in the CKC group compared to 4.95° ± 2.88° in the CP (Cohen d = 2.05), exceeding the minimal clinically important difference (MCID) of 5°.

• DASH scores decreased by 37.11 ± 10.27 points in the CKC group and 18.15 ± 9.61 in the CP (Cohen d = 3.46 vs. 1.77), both surpassing the 10-point MCID.

• Wrist extension increased by 44.00° ± 13.01 (CKC) versus 30.10° ± 11.42 (CP) (p < 0.001), and flexion by 52.50° ± 14.81 (CKC) vs. 39.20° ± 14.21 (CP) (p < 0.001).

• VAS-Activity scores improved by 5.35 ± 2.04 (CKC) and 3.40 ± 1.52 (CP) (Cohen d = 2.60 vs. 1.72), both exceeding the 2-point MCID threshold.

The authors concluded – “This study demonstrated that CKC exercises were more effective than conventional physiotherapy in improving JPS, upper extremity function (as measured by the DASH questionnaire), wrist ROM, and activity-related pain (assessed via the VAS) in individuals recovering from DRFs. These findings suggest that CKC exercises enhance proprioceptive input and neuromuscular control, thereby improving JPS and functional performance. Moreover, the increased joint loading and co-contraction during CKC exercises may contribute to reductions in pain and improvements in ROM, supporting their clinical utility. While the integration of CKC exercises into rehabilitation protocols appears to yield measurable improvements in proprioceptive function, pain management, and upper extremity functionality in individuals with DRF, further long-term follow-up studies are essential to validate the sustainability and external validity of these outcomes.”

Further reading:

Investigating the effects of closed kinetic chain exercises on joint position sense, functionality, range of motion, and pain in individuals with distal radius fracture: a randomized controlled trial

Menek and Dansuk BMC Sports Science, Medicine and Rehabilitation (2025) 17:137

https://doi.org/10.1186/s13102-025-01195-2