Liu Yaming, Li Bing, Wu Fengxian, Feng Chenglong, Wang Lejun, Chen Bin, Niu Wenxin
Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Room 2210, No. 2209 XingGuang Rd, SongJiang Disc, 201619, Shanghai, China.
Laboratory of Biomechanics and Rehabilitation Engineering, School of Medicine, Tongji University, Room F101, No. 1239, SiPing Rd, YangPu Disc, 200331, Shanghai, China.
BMC Sports Sci Med Rehabil. 2025 Aug 30;17(1):260. doi: 10.1186/s13102-025-01311-2.
Therapeutic climbing (TC) is an emerging physical therapy with demonstrated benefits for musculoskeletal rehabilitation, but its impact on upper-limb muscle activity remains unclear. Existing research predominantly focuses on healthy individuals, leaving muscle recruitment strategies in patients with upper-limb injuries largely unexplored. This study aims to investigate upper-limb muscle activity in patients with unilateral upper-limb injuries and healthy individuals across six TC exercises.
Eleven patients with right upper-limb fractures and 15 healthy controls were recruited. The electromyographic temporal patterns, activation intensity, bilateral symmetry, and synergy patterns of anterior deltoid (AD), posterior deltoid (PD), biceps brachii (BB), triceps brachii (TB), pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) were assessed during elbow and knee flexion-extension exercises and four sequential climbing exercises.
AD, BB, and PT exhibited greater activation during climbing, while TB was more active in elbow flexion-extension (p < 0.05). Climbing showed lower similarity ([Formula: see text] = 0.72, lag = -3.40%) than flexion-extension (0.80, 1.36%), which was influenced by climbing sequences: starting with the injured side resulted in 0.85 similarity and 1.71% delay, while starting with the uninjured side reduced similarity to 0.6 and increased delay to 7%. Patients exhibited lower activation intensity than controls in AD (p = 0.048), BB (p = 0.017), TB (p = 0.006), and PT (p < 0.01), and greater asymmetry, especially in PT (p < 0.01). Two synergy patterns explained the > 94% variance in both groups. Patients showed altered synergy patterns with increased AD and reduced forearm activation intensity during climbing (p < 0.05).
Patients exhibited delayed muscle activation, decreased activation similarity and intensity, as well as specific compensatory patterns, which were related to both the injury locations and the types of exercises performed. Flexion-extension exercises are more suitable for early rehabilitation. Climbing exercises require greater muscle activation, with climbing starting from the injured side being more suitable for advanced rehabilitation stages. However, injury-induced compensation must be carefully considered in program design.
治疗性攀岩（TC）是一种新兴的物理治疗方法，已证明对肌肉骨骼康复有益，但其对上肢肌肉活动的影响尚不清楚。现有研究主要集中在健康个体，上肢损伤患者的肌肉募集策略在很大程度上未被探索。本研究旨在调查单侧上肢损伤患者和健康个体在六种TC练习中的上肢肌肉活动情况。
招募了11名右侧上肢骨折患者和15名健康对照者。在肘部和膝部屈伸练习以及四个连续的攀岩练习过程中，评估了三角肌前束（AD）、三角肌后束（PD）、肱二头肌（BB）、肱三头肌（TB）、旋前圆肌（PT）、桡侧腕屈肌（FCR）和尺侧腕屈肌（FCU）的肌电图时间模式、激活强度、双侧对称性和协同模式。
在攀岩过程中，AD、BB和PT表现出更大的激活，而TB在肘部屈伸时更活跃（p < 0.05）。攀岩的相似性（[公式：见正文] = 0.72，延迟 = -3.40%）低于屈伸（0.80，1.36%），这受到攀岩顺序的影响：从受伤侧开始导致相似性为0.85，延迟为1.71%，而从未受伤侧开始则将相似性降低到0.6，延迟增加到7%。患者在AD（p = 0.048）、BB（p = 0.017）、TB（p = 0.006）和PT（p < 0.01）中的激活强度低于对照组，并且不对称性更大，尤其是在PT中（p < 0.01）。两种协同模式解释了两组中> 94%的方差。患者在攀岩过程中表现出协同模式改变，AD增加，前臂激活强度降低（p < 0.05）。
患者表现出肌肉激活延迟、激活相似性和强度降低以及特定的代偿模式，这与损伤部位和所进行的练习类型有关。屈伸练习更适合早期康复。攀岩练习需要更大的肌肉激活，从受伤侧开始攀岩更适合晚期康复阶段。然而，在方案设计中必须仔细考虑损伤引起的代偿情况。
