I often hear the terminology open-packed and close-packed joint positions used in the clinic. In general, clinicians know to mobilize in the open-packed position and avoid manipulation in a close-packed position, but what else should we know about these terms? Is there any other clinical significance to the open v. close-packed positions? In this post I will review these 2 positions and discuss the clinical relevance of each.
How Should PT's Interpret Open vs Close-Packed Clinically?
As I mentioned above, it is important to start your joint assessment and treatment in the open-packed position. Since the joint has the most available room for movement, mobilizations are best tolerated in this position. For example, the open-packed position of the knee is 25 degrees of flexion. The close-packed position is full extension. At 25 degrees of flexion the knee is loose- one can assess varus and valgus ligament stress testing or check tibial IR/ER mobility in this position. Biomechanically, the knee is 'unlocked.' Following an injury, the body favors this position because there is space for swelling and other fluid to accumulate within the joint. As the patient's ROM improves, pain decreases, and the swelling subsides, the clinician can start to mobilize the joint in other positions of flexion and extension as needed.
Additionally, understanding the open and closed packed positions is essential when performing manipulations. We want to manipulate a joint in the open-packed position, but often times we cannot target a specific joint unless we lock out or close-pack the surrounding joints. For example, when performing a prone SIJ distraction manipulation, the hip needs to be placed in extension, abduction, and internal rotation. These three movements are the close-packed position of the hip joint. You must lock out the hip so you do not manipulate it when you are targeting the SIJ.
Each joint has a different open and close packed position and being able to quickly recall that position will make you a more efficient clinician. If you do not understand the open and close-packed positions of regional joints, the specificity of your techniques will decrease.
5/8/2016 10:52:30 am
U mentioned that we need to put the hip in abduction to perform sij distraction. So how do you put the hip in abduction?
5/25/2016 01:51:08 pm
5/30/2019 12:12:05 pm
12/30/2016 03:38:31 pm
If your legs are together, just bring them away from midline (like what you'd do in a jumping jack)
5/30/2019 12:10:05 pm
Ahmad, if you do not know how to abduct your hip,,,, you definitely should NOT be performing joint distractions
12/13/2018 12:05:03 pm
Is the full body close-packed position prone, with legs and arms extended/abducted, wrists extended, and ankles dorsiflexed (like a swimmer's position)?
9/18/2019 11:37:59 pm
ok so how adduct, in?
2/16/2020 02:03:09 am
If you want to adduct right leg, u should first slightly abduct the opposite leg ( left leg ) then you move the right leg toward the other leg to be able to adduct it
2/23/2020 09:50:32 am
the close packed position is not the position pf congruency
5/9/2020 02:47:12 am
Hi Ahmed, I believe you got that from another website, is that correct?
5/28/2021 12:46:58 pm
Hi thanks a lot and i'm PT also, so can you give me another specific example like this ::
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