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Old 18-03-2012, 09:13 AM   #1
Kaspars
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Default Sling therapy

The technique is quite widely used here in Latvia, though it doesn't seem to be that popular on other parts of the world I have to conclude after doing a bit of a research. Couln't find any evidence on the subject either.

Have you had any experience with this? Any idea how it might or might not affect the brain?

Thank you in advance

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Old 18-03-2012, 10:53 AM   #2
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you might need to give us a bit more info on "sling therapy" as I've never heard of it
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Old 18-03-2012, 12:06 PM   #3
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"Sling exercise therapy" would the proper translation it appears.

I found some sort of a trial here:

http://www.medicaljournals.se/jrm/co...77-0049&html=1

Doesn't look too promising, though like I said it's been used widely in here, mostly used for chronic back pain.
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Old 18-03-2012, 08:00 PM   #4
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Hi Kaspars

I think I am correct to say that this is the likes of Red Cord. Personally I would not see this as a treatment per se but rather, if anything, an approach to exercise. Is it a good one? - probably no better than any other although it may allow some things to be done more efficiently than others.

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ANdy
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Old 18-03-2012, 08:14 PM   #5
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Hi Kaspars

Sling therapy was widely used in the 1950s and into the 1960s in Australia to relieve pain and allow easier movement, passive or active.
It was abandoned in favour of active movement to promote strengthening of muscles; as far as I know that is still the situation.

It may help to relax a patient if there is a lot of pain, but there are other ways to reduce pain which don't require apparatus or passive movements.

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Old 22-03-2012, 08:39 PM   #6
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Thank you for your responses Andy and Nari!
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Old 23-03-2012, 01:29 AM   #7
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Looks like TRX for therapy.

Eric
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Old 16-05-2012, 06:25 PM   #8
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Hello Kaspars!

As I work in a clinic where there are about 40 slings hanging around and it is our main tool for exercises, I guess I'm in a position to make some comments First up on slings in general and then some on how we use it in the clinic.

Quote:
Originally Posted by amacs View Post
I think I am correct to say that this is the likes of Red Cord. Personally I would not see this as a treatment per se but rather, if anything, an approach to exercise. Is it a good one? - probably no better than any other although it may allow some things to be done more efficiently than others.
Red Cord (previously called Therapy Master) has been involved in Sling Exercise Therapy for many years and has a solid foothold in Norway. They try to do a fair bit of research, like the whiplash trial you linked to and have been holding courses in the use of slings for many years. Though I have not taken them myself, 3 collegues in the clinic have gone through their courses some years back. There seems to be a focus on identifying weak links and then training them/firing inactive muscles, sometimes with an obscene amount of slings used to unload just the right amount.

They have something called a Redcord Stimula(direct link to pdf where you can also see the unloading via slings), which is sending vibration through the ropes. Reduced force steadiness in women with neck pain and the effect of short term vibration
Litterature list http://www.redcord.com/ArticleListing_2011.aspx?m=222

My understanding of this is, from what I can remember from reading a paper some years ago and what I think Neurac is based on, is that vibration may have a positive effect on a "non-optimally functioning" nervous system and be a hindrance for a "normal" nervous system when doing a given exercise (re: Diane's recent anecdote of the gym manager with a stroke). The extra sensory input and the novelty are the key factors, I would guess, for "firing muscles" and decreasing pain output.

There is also R.O.P.E.S and Jungle Sports, in addition to Redcord and TRX, and probably more, for suspension training/sling training/S-E-T(sling exercise therapy)

Then onto how we use it in the clinic... It is a VERY versatile tool for exercise, and much more than the pendulum-type exercises Nari refers too, although they still have their place at times. One such example being supine, with an arm in each sling and then making snow angles for people with shoulder pain/impingement type problems. Super combination of novelty as well as them being put in possibly the most non-threatening context you can get. The good thing about using the slings for this, as opposed to Cory's "wall snow angles", which I've also tried, is that this is in a very relaxed position, requires almost no effort and you can gradually move from movement in the plane of the scapula into pure abduction by adjusting the slings as needed. It can create an awesome window of opportunity to show that decompressive surgery is not necessarily the only option

We use it primarily as part of an active approach to therapy with exercise and self-efficacy as a big part and we use it for most anything from:

The women's health PT doing both individual and group sessions for peri partum pelvic pain. Doing for instance partially unloaded 1 legged standing exercise (sprinter) for this group, even though its contraindicated in most guidelines , is useful, amongst other things Stuge, 2004

to

Neurological patients, like MS or Stroke, sometimes with vibration and sometimes not. A "standing plank" exericise with the arms in the slings and slightly leaning forward can be really good for stroke patients to find their center, as they will swivel around slightly if not. I guess as a mix between learning to crawl and stand at the same time it is good for the nervous system

Sporters get some unique challenges as well, like this one for swimmers

A lot of the patients that come for S-E-T have an idea that it is “really good for training the small/deep muscles” but as with any tool it comes down to how, why and when you use it. I’m sorry to let a few people down with a few details about their views on S-E-T as well as that of the deep muscles.

So I’ll just finish up with a list of reasons in no particular order of why I like to work with slings:
  • It requires a fair bit of body awareness and motor control to do many of the exercises which are full body to a greater or lesser extent. This could of course also be construed as negative, as in you could do something simpler on the floor (and sometimes you would to progress into standing), but…
  • Infinite variability and easy adjustments both of load and difficulty, with or without limiting axis of movement (Add a climbing rack and you’ve got way more angles to come from)
  • Slings are an instable surface
  • Slings are a stable surface (e.g. Britt Stuge reporting that many of her patients in her PhD felt that having both legs resting in a wide sling while doing a bridging exercise as “safe and supportive”, paraphrased)
  • Applying vibration (we use a 30ish year old hand held massage device vibrating at 50 Hz instead of the expensive Redcord one ) for extra sensory input in whatever loaded position you would like.
  • Virtually any exercise at your disposal (except for maybe maximal lower limb strength, but then we aren’t really talking about the patient in pain, are we? And you can go elsewhere to do weighted squats if explosive body weight exercises aren’t enough)


There is probably more, but this post seems way too long as it is hehe. I’m happy to discuss whatever good or bad in more detail if anyone wishes.

Nicolay Morland, PT
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Old 16-05-2012, 07:27 PM   #9
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Thanks Nico,

It sounds novel, but not necessary, I way to promote improved awareness of motion with less distractions of friction, or fear of weakness.
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Old 16-05-2012, 08:10 PM   #10
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Thanks Nico I would love to see a pic of your clinic, esp if you have the climbing rack modification. Sounds interesting.

Eric
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Old 16-05-2012, 10:47 PM   #11
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Quote:
climbing rack modification
I would like to know a bit more about that too

ANdy
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Old 17-05-2012, 02:15 AM   #12
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Quote:
Originally Posted by Milehigh View Post
Thanks Nico I would love to see a pic of your clinic, esp if you have the climbing rack modification. Sounds interesting.

Eric
Sure thing! I'll grab some when I come in Friday morning (national holiday tomorrow )
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Old 20-05-2012, 01:38 PM   #13
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OK, I'm back with some pictures...

I'll start with the view from the entry, as setting the context is so important.



The clinic is set in the 4th floor of a 100 year old factory building, so the above is not what people usually expect, but it's a nice symbolism in and of itself I guess People are met with a wide area, natural light and with people working actively one on one with a PT or by themselves in the nearest area, or a group session in gym furthest away. To the right there is an opening past the desk to a an area with elliptical trainers and bikes and off of that are the sound proof treatment rooms.

As for the climbing rack "modification"



Choose your height and pull the slings through there. Straight out, straight up from the bottom to an outstretched hand in a standing position or whatever your clinical reasoning dictates.

Here's an image off a version of I guess the gluteus medius wall press-exercise.



Read a discussion on that here on SS a while back, and after having tried the 3 versions in the article, I have to say that this way "fires the muscles" a lot more. I used a moveable "pole" to act as a person, and it's positioned a little too far away, but you stand sideways on the incline board with your body entire body tilted a few degrees (as per the incline board) and you lift 1 leg (lifting the outer one is harder than liftting the inner one). Can also do 1 legged squats and the like if you prefer.

Going with what (I think) Redcord would say about this way of working, is that you would do this first (though I'm pretty sure the course material would say do it with a sidebridge) and then go and do the sprinter exercise.



A lot of the pregnant women with trendelenburg have real issues with the sprinter, but when "firing" the gluteus medius in the climbing rack for a few reps, they do a lot better. Of course there are many ways to do this, I'm just trying to give an example of how we'd utilize it (picture is from a newspaper article on training during pregnancy from last week and they used a picture from our old locale). The slings provide a nice support and for the patient it feels like a safe way of doing this (though they are hesitant to trust the slings at first), even for people with a risk of dislocating a hip

After taking the pictures I also started thinking about The Sounds of the Clinic-thread. It was so calm and relaxing at 8:30 when I had finished with my first patient and she was off on her own doing some exercises. In the gym 2 other PTs had just started quietly working with their patients. There were 2 gym members in for an early morning workout doing their thing by themselves. The radio was off, the focus was on and really the only sounds were that of the 3 or 4 ladies in their 50s meeting up 30 mins early to a group session and the little swush-swush of the bikes/elliptical trainers coupled with their laughter a little ways off from the sling area. That's another positive thing with slings; no CLANG CLANG!
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Old 20-05-2012, 10:44 PM   #14
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I like the idea of the sling. Is this basically just changing the moment arm on the leg to help someone "find" their glute med? In other words, would this be the same thing as having someone side lying on therapy table and having assistance lifting the leg thereby accessing the glute med?
Would anyone care to comment on the relative neurological/neuromatrix impact of having someone assist you lifting the leg vs. learning to do it without outside guidance via the sling? Are we simply talking moment arms and force or is their an actual advantage to "being more upright?
Nathan
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Old 21-05-2012, 04:25 PM   #15
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Nathan,

I prefer to teach a person to use/ train / a muscle in the position of function. I 've seen peoplecwho are able to lie on their side, and raise their leg to the ceiling, and are unable to control the position of the pelvis as they walk. Strengthening/ training in standing presents a more realistic challenge to the individual's motor planning which should result in better integration of the glut medius, ankle, knee, trunk musculature. In addition the visual and vestibular systems will be stimulated.
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