search for




 

The Effects of Therapeutic Climbing on Shoulder Muscle Activity according to the Inclination of the Climbing Wall
J Kor Phys Ther 2018;30(3):84-89
Published online June 30, 2018;  https://doi.org/10.18857/jkpt.2018.30.3.84
© 2018 The Korea Society of Physical Therapy.

Eun-Jeong Kim, and Se-Hun Kim

Department of Physical Therapy, College of Health Science, Dongshin University, Naju, Korea
Se-Hun Kim E-mail ptsehun@gmail.com
Received May 8, 2018; Revised June 12, 2018; Accepted June 19, 2018.
This is an Open Access article distribute under the terms of the Creative Commons Attribution Non-commercial License (http://creativecommons.org/license/by-nc/4.0.) which permits unrestricted non-commercial use, distribution,and reproduction in any medium, provided the original work is properly cited.
Abstract

Purpose:

Therapeutic climbing has become very popular today, with it being reported as a new method for preventing and treating orthopedic trauma to the shoulder joint. However, objective studies on its effects on the musculoskeletal system are still lacking. The objective of the present study was to investigate the effects of wall inclination during therapeutic climbing on the muscle activity around the shoulder joint.

Methods:

In this study, the participants performed movements at three different inclination angles of 0°, +15°, and -15°. sEMG was performed to measure the activities of five different muscles around the shoulder joint (biceps brachii, serratus anterior, upper trapezius, middle trapezius, and lower trapezius muscles).

Results:

Biceps brachii muscle showed a significant increase at -15°, as compared to 0° (p<0.01), and the serratus anterior also showed a significant increase at -15°, as compared to 0° (p<0.05). Moreover, the middle and lower trapezius muscles also showed a significant increase at -15°, as compared to 0° (p<0.001). Compared to 0°, all muscles showed decreased values at 15°, but the differences were not statistically significant (p>0.05).

Conclusion:

Therapeutic climbing may be a new therapeutic approach that can increase muscle strength and coordination in the sensory nervous system, since it can be used as a tool that promotes active movement by altering wall inclination and causing the user to generate movements according to the existing situation.

Keywords : Therapeutic climbing, Shoulder muscle activity, Inclination
INTRODUCTION

Sports climbing is a whole-body exercise that requires the use of both hands and both legs, where the exercise effect varies depending on how the hand and foot holds are held and for how long. It can build muscle strength, muscle endurance, cardiopulmonary endurance, and flexibility, and thus, it can be used to train body coordination, speed, agility, balance, and quickness.1

Therapeutic climbing that utilizes these elements was first introduced in the early 2000s by Dr. Rene Kittel of Germany through the Potsdam model. In recent times, this novel therapeutic approach, which uses the motions involved in artificial wall climbing, has been applied in the field of physical therapy to treat not only orthopedic disorders, but also trauma, neurologic, and mental disorders.2

Therapeutic climbing has the characteristic ability of simultaneously stimulating muscle strength, agility, and coordination, and as a result, there is an increasing trend of its use in treating patients with orthopedic disorders and injuries.3 The shoulder joint has the largest range of motion in the human body and is most susceptible to dislocation and subluxation, where chronic shoulder pain represents a typical musculoskeletal disorder that can cause symptoms such as shoulder pain, limited range of motion, or functional impairments.4,5

Patients with shoulder impingement syndrome or rotator cuff injury showed limited scapular upward rotation, posterior tilt, and internal rotation of the shoulder. Patients incapable of scapular upward rotation showed greater limitations in internal rotation of the shoulder, which created greater shoulder joint instability.6 Movement of the shoulder joint is controlled by the force couple involving the upper trapezius, lower trapezius, and serratus anterior to generate upward scapular rotation supraduction. However, when this force collapses, kinetic changes occur in the scapula, resulting in abnormal scapular movement and narrowing of the subacromial space that can cause impingement syndrome, affecting the muscle activities in the head and neck areas.7,8

The first step in shoulder rehabilitation must be comprised of exercise that can normalize the activity of force couple of the scapular muscles and return the scapula to its normal position at rest. Based on such rationale, exercise that can reduce the activity level of the upper trapezius and induce activation of the middle trapezius, lower trapezius, and serratus anterior should be selected for shoulder stability exercise.9-11

To effectively apply rehabilitation training, it is necessary to have a training method that can increase the exercise effect and targets muscle activation. The level of difficulty for exercises can be increased or decreased by altering the intensity of the exercise. The level of difficultly of therapeutic climbing can be adjusted by altering the positions of the hand and foot holds, point of body contact fixed on the wall, and wall inclination.12 However, studies on changes in such difficulty levels of training have been limited to static therapeutic climbing exercise for the leg and trunk muscles.13,14

Moreover, most studies have examined the effects of therapeutic climbing training on psychological effects and improvement effects on fitness and functional performance, while analyses on changes in muscle activities at specific angles based on wall inclination during climbing are still lacking. Accordingly, the objective of the present study was to conduct a comparative analysis on the changes in muscle activities of biceps brachii, serratus anterior, upper trapezius, middle trapezius, and lower trapezius muscles based on wall inclination during therapeutic climbing.

METHODS

1. Participants

The present study included 30 men. No participants had any physical defect that would affect the study results, had any pain related to musculoskeletal disorders in the past six months, or had any visual or hearing impairment that would interfere with their ability to adjust the wall inclination. Prior to the study, the participants received sufficient explanation on the objective and methods of the study, and those who voluntarily gave their consent to participate in the experiment were included.

2. Methods

For observation of muscle activities around the shoulder area during climbing based on different wall inclination, the climbing wall inclination angles were set to 0° (vertical), 15° (positive inclination), and -15° (negative inclination) (Figure 1). The movements performed during therapeutic climbing consisted of diagonal climbing with unilateral adduction and external rotation, as presented by Rene Kittel,15 and the movements were performed with the inclination already adjusted (Figure 2).

Fig. 1.

The climbing wall inclination angles(a.0°, b. +15°, c. -15°).


Fig. 2.

Movement of therapeutic climbing(diagonal climbing with unilateral adduction and external rotation)


3. Muscle activity measurement

BTS FreeEMG 1000 system (Bioengineering, Inc., Italy) was used to measure muscle activity in the biceps brachii, serratus anterior, and upper, middle, and lower trapezius muscles. To reduce skin resistance against surface-electromyography (sEMG) signals, hair on the attachment area was removed and the area was scrubbed 2-4 times with an abrasive to remove any dead skin, after which, rubbing alcohol was used to clean the skin (Table 1).16

Muscle attachment

Muscle   Attachment
Biceps brachiiMiddle area of biceps brachii
Serratus anteriorBelow the armpits, front of latissimus dorsi muscle, 4-6th ribs
Upper trapeziusMidpoint between C7 and posterior acromion
Middle trapeziusMiddle of spinous scapula and spinous process on the same horizontal plane
Lower trapeziusApproximately 3 cm lateral to spinous process located on the same line as the scapula with external rotation of the shoulder joint

The collected data were sent over a wireless LAN communication system (WiFi) to a wireless router connected to a computer by LAN cable and the automatically-displayed values of the original data from MYOLAB (software, BTS Co., Italy) were used in pocket EMG.

Each measurement lasted 12 seconds, but the measured values from only 10 seconds were used by excluding the first and last second. Three repeated measurements were taken, and the mean measured values were used. Here, for the reference values for standardization, three repeated measurements were taken while maintaining maximum muscle activity in each muscle for 5 seconds during maximal voluntary isometric contraction (MVIC) while manual resistance was applied. After processing the 5-second data by RMS, the mean EMG signal over 3 seconds was used as 100% MVIC, after excluding the first and last second.17

During the MVIC measurement, the participants performed the movements while in the standing position with their legs spread shoulder-width apart and their palms pointing forward. The measurements were taken after training the participants to prevent compensation while performing the movements. The movements were performed with manual resistance applied in the opposite direction of the movement by each muscle. The movements involved 90° elbow flexion with forearm supination on a bench for the biceps brachii muscle, internal rotation, together with scapular upward rotation after 90° abduction and external rotation of the shoulder for the serratus anterior muscle; scapular elevation after posterolateral extension of the neck for the upper trapezius muscle; and scapular descent with the shoulder flexed above the head for the middle and lower trapezius muscles.18

4. Statistical methods

The experimental data were analyzed using SPSS ver. 12.0 for windows (SPSS Inc., Chicago, IL, USA). All data were tested for normal distribution using the Shapiro-Wilk test, while descriptive statistics were used for general characteristics of the participants. For comparisons of differences between the groups, significance testing was performed using one-way ANOVA. A Post-hoc test was performed using the Tukey’s multiple range test. For testing of statistical significance, the significance level was set to α = 0.05.

RESULTS

1. General characteristics of the participants

The participants in the present study consisted of 30 men, whose mean age, height, and weight were 26.4± 6.7 years, 175.7±7.5 cm, and 72.7±12.4 kg, respectively (Table 2).

General characteristics of subjects (n = 30)

Age (yr)Height (cm)Weight (kg)
26.4± 6.7175.7± 7.572.7± 12.4

Values are presented as mean±standard deviation.


2. Significance testing by each angle for changes in muscle activity

Assessment of the changes in muscle activity showed significant differences in the biceps brachii, middle trapezius, and lower trapezius muscles (p< 0.01), and the serratus anterior muscle also showed a significant difference (p< 0.05). Post-hoc test results showed that the biceps brachii muscle showed a significant increase at -15°, as compared to 0° (p< 0.01), and the serratus anterior also showed a significant increase at -15°, as compared to 0° (p< 0.05). Moreover, the middle and lower trapezius muscles also showed a significant increase at -15°, as compared to 0° (p< 0.001). Compared to 0°, all muscles showed decreased values at 15°, but the differences were not statistically significant (p> 0.05) (Table 3).

A comparison of muscle activity in each group (%MVIC)

+15°-15°p
Biceps brachii6.83 ±4.155.76±3.8413.75± 7.43**0.008
Serratus anterior4.58±3.413.15± 2.828.13± 5.37*0.025
Upper trapezius2.44±0.862.03±0.575.67±2.350.970
Middle trapezius8.72±6.716.34±3.2221.69± 12.83***0.003
Lower trapezius16.73 ± 10.6214.68±8.4124.63± 13.69***0.000

Values are presented as mean±standard deviation. Tested by one way ANOVA.

Post-hoc was tested by Tukey’s multiple range test 0°-+15°, -15°

*p<0.05,

**p<0.01,

***p<0.001).


RESULTS

1. General characteristics of the participants

The participants in the present study consisted of 30 men, whose mean age, height, and weight were 26.4± 6.7 years, 175.7±7.5 cm, and 72.7±12.4 kg, respectively (Table 2).

2. Significance testing by each angle for changes in muscle activity

Assessment of the changes in muscle activity showed significant differences in the biceps brachii, middle trapezius, and lower trapezius muscles (p< 0.01), and the serratus anterior muscle also showed a significant difference (p< 0.05). Post-hoc test results showed that the biceps brachii muscle showed a significant increase at -15°, as compared to 0° (p< 0.01), and the serratus anterior also showed a significant increase at -15°, as compared to 0° (p< 0.05). Moreover, the middle and lower trapezius muscles also showed a significant increase at -15°, as compared to 0° (p< 0.001). Compared to 0°, all muscles showed decreased values at 15°, but the differences were not statistically significant (p> 0.05) (Table 3).

DISCUSSION

Pain in the shoulder joint can occur from musculoskeletal disorders caused by improper movement and overuse during physical activities, and shoulder pain represents the second most-common pain after lower back pain.19 Physical therapy interventions used in clinical practice to resolve shoulder pain includes approaches such as exercise therapy, self-stretching exercise, proprioceptive neuromuscular stimulation, group and home exercise programs and taping therapy.19-21

Compared to other rehabilitation exercise, therapeutic climbing requires a greater level of active participation by the patient, which has been reported to be effective in increasing muscle strength, mobility, and whole-body coordination.22 Moreover, therapeutic climbing has become very popular today, with it being reported as a new method for preventing and treating orthopedic trauma to the shoulder joint. However, objective studies on its effects on the musculoskeletal system are still lacking.23,24

The objective of the present study was to investigate the effects of wall inclination during therapeutic climbing on the muscle activity around the shoulder joint. In this study, the participants performed movements at three different inclination angles of 0°, +15°, and -15°. sEMG was performed to measure the activities of five different muscles around the shoulder joint. The biceps brachii, serratus anterior, middle trapezius, and lower trapezius muscles showed increased muscle activity at -15°, as compared to 0°, however, the upper trapezius did not show any significant increases in muscle activity. Moreover, although there were decreases in values in comparison between 0° and +15°, the differences were not statistically significant.

Regarding muscle activity, MVICs of - 20%, 21-40%, and 41-60% indicate low, moderate, and high muscle activity, respectively, while MVIC > 60% indicates very high muscle activity.25 In the study by Martin Pühringe et al.26 that compared shoulder muscle activity according to hand grip shape and inclination, the muscles around the shoulder joint showed low or moderate activity when the wall inclination was vertical or negative during therapeutic climbing, based on the report that such movement was appropriate for the initial stage of rehabilitation. Those findings were consistent with the results of the present study.

In the study by Cho et al.27 that investigated the changes in the time of muscle onset in the anterior deltoid, posterior deltoid, pectoralis major, and upper trapezius according to body tilting angle during push-up motion, the upper trapezius muscle contracted first at 0° and 30°, while muscle recruitment appeared in the order of anterior deltoid, posterior deltoid, and pectoralis major. The study reported that to generate a strong force, truncal stabilization was needed before the push-up motion, and as a result, muscles associated with the spine contracted first. In the present study, based on the characteristics of posture and motion associated with hanging on the therapeutic climbing wall, muscle activity in the middle and lower trapezius muscles appeared higher than in the upper trapezius muscle to allow the shoulder to maintain a neutral position and achieve spinal stability, and this appeared at the highest level, an inclination of -15°.

A study by Shin et al.28 that compared muscle activity according to active/passive trunk tilting using a three-dimensional dynamic postural balance exercise machine reported that the muscles were used more optimally in the active mode than in the passive mode, because in the active mode triggered the ability of the user to accurately reach the desired angle and direction and maintain that position, as well as bodily coordination in the sensory nervous system involving the muscular, visual, and vestibular systems. Moreover, during body tilting, the muscles on the side opposite to the direction of tilt are activated, resulting in an interaction between the body position and movement conditions which achieves control over body balance. This can serve as evidence that therapeutic climbing may be a new therapeutic approach that can increase muscle strength and coordination in the sensory nervous system, since it can be used as a tool that promotes active movement by altering wall inclination and causing the user to generate movements according to the existing situation.

In the present study, the muscles around the shoulder were more active at an inclination of -15° than 0°, which is believed to be the result of arm muscles being used more than leg muscles during the climbing movement. It is also believed that at an inclination of +15°, muscle activity in the muscles around the shoulder decreased since a greater percentage of leg muscles were used for climbing. The findings in the present study may be used in future studies to prove various effects of therapeutic climbing, but for now, the findings are expected to be used as reference data to select therapeutic methods in clinical practice.

The limitations in the present study included the small study population, and thus, it would be difficult to generalize the findings. Moreover, the measurements were limited to just three inclination angles, and the study also did not conduct detailed testing on muscle recruitment order and usage rates through simultaneous measurements of the arm and leg muscles. It is believed that future studies should examine muscle activities in different body parts during movements at various inclination angles.

ACKNOWLEDGEMENTS

This research was supported by the Dongshin University research grants.

References
  1. Kim HJ. The effect of strength training on the performance of sports climbing athletes. Chosun University. Dissertion of Master's Degree; 2017.
  2. Kohl B. Therapeutisches klettern untersuchung der auswirkungen eines klettertrainings an personen mit rückenschmerze“n, unveröffentliche diplomarbeit an der leopold –franzensuniversität Innsbruck. Psychologie und Sport wissenschaften 2005.
  3. Engbert K, and Weber M. The effects of therapeutic climbing in patients with chronic low back pain: a randomized controlled study. Spine 2011;36:842-9.
    Pubmed CrossRef
  4. Good CR, and MacGillivray JD. Traumatic shoulder dislocation in the adolescent athlete: advances in surgical treatment. Curr Opin Pediatr 2005;17:25-9.
    CrossRef
  5. Cools AM, Dewitte V, and Lanszweert F et al. Rehabilitation of scapular muscle balance: which exercises to prescribe?. Am J Sports Med 2007;35:1744-51.
    Pubmed CrossRef
  6. Ludewig PM, and Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. The J Orthop Sports Phys Ther 2009;39:90-104.
    Pubmed KoreaMed CrossRef
  7. Bae SS, Kim BJ, and Lee KH. A study of muscle imbalance of head, cervical and shoulder region. J Kor Phys Ther 2001;13:769-76.
  8. Bae SS, Choi JW, and Chung HA et al. Biomechanical analysis of scapular pattern in proprioceptive neuromuscular facilitation. J Kor Phys Ther 1999;11:65-9.
  9. Cools AM, Struyf F, and De MK et al. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med 2014;48:692-7.
    Pubmed CrossRef
  10. Ellenbecker TS, and Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med 2010;44:319-27.
    Pubmed CrossRef
  11. Wilk K, Reinold MM, and Dugas JR et al. Current concepts in the recognition and treatment of superior labral (slap) lesions. J Orthop Sports Phys Ther 2005;35:273-91.
    Pubmed CrossRef
  12. Pühringer M, Strutzenberger G, and Leitl D et al. Possibilities of altering arm and shoulder muscle activation in a static therapeutic climbing exercise through arm position, hand support and wall inclination. Eur J Sport Sci 2017;17:1212-9.
    Pubmed CrossRef
  13. Park BJ, Kim JH, and Kim JH et al. Comparative analysis of trunk muscle activities in climbing of during upright climbing at different inclination angles. J Phys Ther Sci 2015;27:3137-9.
    Pubmed KoreaMed CrossRef
  14. Grzybowski C, Donath L, and Wagner H. Association between trunk muscle activation and wall inclination during various static climbing positions: implications for therapeutic climbing. Sportverletzung Sportschaden 2014;28:75-84.
    Pubmed
  15. Rene Kittel. Therapeutisches klettern das praxisbuch. Bad Feilnbach 2015:58-9.
  16. Kim SC. The effect of strengthening exercise of trapezius and serratus anterior on pain and muscle activation for spinal cord injury patients with functional shoulder impingement syndrome. Yong-In University. Dissertion of Master's Degree; 2012.
  17. Soderberg GL, and Knutson LM. A guide for use and interpretation of kinesiologic electromyographic data. Phys Ther 2000;80:485-98.
    Pubmed
  18. Cram JR, Kasman GS, and Holtz J. Introduction to surface electromyography. Maryland: Aspen; 1998.
  19. Bjelle A. Epidemiology of shoulder problems. Baillieres Clin Rheumatol 1989;3:437-51.
    CrossRef
  20. Lim WS. The effects of scapular pattern and hold-relax technique of pnf on the rom and vas in frozen shoulder patients. Daegu university. Dissersion of Master's Degree; 2002.
  21. Kwag KI, Seo EK, and Kim TY. The effects of group exercise, manual therapy and home exercise on pain, range of motion and function in patient with adhesive capsulitis. J Kor Phys Ther 2016;28:101-5.
    CrossRef
  22. Lee MH, and Park RJ. The effects of taping therapy on the rom and vas in adhesive capsulitis. J Kor Phys Ther 2003;15:223-38.
  23. Muehlbauer T, Stuerchler M, and Granacher U. Effects of climbing on core strength and mobility in adults. Int J Sports Med 2012;33:445-51.
    Pubmed CrossRef
  24. Buechter RB, and Fechtelpeter D. Climbing for preventing and treating health problems: a systematic review of randomized controlled trials. Ger Med Sci 2011;9:1-9.
  25. Grzybowski C, and Eils E. Therapeutic climbing –barely explored but widely used. Sportverletzung Sportschaden 2011;25:87-92.
    Pubmed CrossRef
  26. Tucci HT, Ciol MA, and de Araújo RC et al. Activation of selected shoulder muscles during unilateral wall and bench press tasks under submaximal isometric effort. J Orthop Sports Phys Ther 2011;41:520-5.
    Pubmed CrossRef
  27. Pühringer M, Strutzenberger G, and Leitl D et al. Possibilities of altering arm and shoulder muscle activation in a static therapeutic climbing exercise through arm position, hand support and wall inclination. Eur J Sport Sci 2017;17:1212-9.
    Pubmed CrossRef
  28. Cho YH, Kim SO, and Choi JH. The differences of shoulder muscle activity onset time according to body tilting angle in push-up exercise. J Korean Soc Phys Med 2015;10:175-81.
    CrossRef
  29. Shin SH, Yu M, and Jeong GY et al. The assessment on electromyography of trunk muscle according to passive and active trunk tilt exercise of 3-d dynamic postural balance training system. J Korean Soc Precis Eng 2013;30:331-9.
    CrossRef


October 2018, 30 (5)
Full Text(PDF) Free

Social Network Service
Services

Cited By Articles
  • CrossRef (0)

Funding Information