Sling exercise therapy

Last updated date: 07-Jan-2023

Originally Written in English

Sling Exercise Therapy


Thousands of individuals worldwide are impacted by major conditions such as low-back pain (LBP) and stroke. As a result, a very effective rehabilitation strategy is required. The most popular techniques used for musculoskeletal rehabilitation include hydrotherapy, electrotherapy, and exercise therapy. Sling exercise therapy (SET) is a promising treatment because of its low cost, efficiency, and ease of use. Furthermore, SET not only guarantees rapid recovery but also serves as a diagnostic tool for detecting biomechanical chain defects.

SET, in particular, is based on slings tied to a specific portion of the human body utilizing ropes and pulleys inside a sling system to help in the treatment of disabilities. There are two types of SETs. The first is a classic SET, which is typically used for uncomplicated training. While Neurac involves a high degree of neuromuscular activation, which leads to muscle strengthening, sensorimotor/balance improvement, increased range of motion (ROM), and pain alleviation, as well as clinical diagnosis for various deficits. SET, for example, has been shown in several trials to have a substantial influence on the restoration of muscular skeletal functioning following stroke and LBP, as well as enhancing breathing and chest expansion.

Furthermore, SET is capable of achieving many goals at the same time. It was claimed that Neurac technique-based training had a significant effect on pain reduction, improved balance, regression fatigability, and treatment of chronic neck pain.

Although SET has made significant success in rehabilitation institutions, there have been no previously documented assessments of SET experimental findings. In pursuit of this goal, this review will summarize the most important SET results in therapeutic and diagnostic applications. This includes the use of SET in rehabilitation following sports injuries, stroke, and LBP.


Conditions that Benefit from Sling Exercise Therapy

Back pain

Sling therapy started in the 1980s in Norway. Since then, it has gained in popularity for physical therapy for endurance athletes. However, sling therapy can provide relief for a range of health conditions that impact non-athletes, too. Here we cover just some of the conditions that suspension therapy can help with.

   1. Back Pain.

Suspension therapy may be the solution you're seeking for if you have back pain. It is a difficult physical therapy protocol that makes use of an anti-gravity suspension system. It can assist you in dealing with chronic back pain by strengthening your stabilizer muscles and core. Furthermore, it can be an effective therapy in the recovery from a back injury.

   2. Neck Pain.

Suspension treatment is commonly used to alleviate neck discomfort. The therapy can aid with tissue stretching as well as neck muscle strengthening. Suspension treatment is often used in combination with other physical therapy procedures to treat neck discomfort.

   3. Whiplash.

You may experience intense discomfort as a result of whiplash injuries. Sling therapy is a pain-free physical therapy approach that can assist cure and relieve pain in those who are currently suffering from an injury. Suspension therapy's Neuromuscular Activation, or Neurac, can stimulate your neuromuscular system and help you restore strength and stability after a whiplash injury.

   4. Joint Replacements.

Suspension therapy helps persons who have had joint replacement surgery to regain joint mobility. To achieve the best outcomes, your surgeon may often insist that you begin physical therapy as soon as possible following surgery. Sling treatment is frequently begun rapidly because to its little effect on joints when compared to other forms of physical therapy exercises.

   5. Parkinson’s Disease and Multiple Sclerosis.

Both Parkinson's disease and Multiple Sclerosis affect movement and the neuromuscular system. Depending on how far the condition has progressed, your options for physical treatment may be restricted. Suspension treatment strengthens the neuromuscular system, therefore it might be an important physical therapy for patients with neuromuscular diseases to maintain range of motion and mobility.

This is only a partial list of the problems that suspension treatment can help address. There are several different diseases for which it might bring relief, as well as demanding training possibilities for athletes to isolate certain motions.


Principles of Sling Exercise Therapy

Principle of Sling Therapy

 It works under the principle of: 

  • Friction. 
  • Pendulum. 
  • Gravity eliminating.

1. Friction: 

It happens when one surface slides across another. In the suspension, surfaces that are more smooth and slippery will be used, resulting in reduced friction and smooth and easy movement.

2. Pendulum:

When a threat is applied to a pendulum, heavy material is suspended by a weightless thread, resulting in to and fro movement. The term oscillation refers to a full swing.

During the oscillation, the pendulum's arc of movement creates a portion of the cone's base. The oscillation will continue until the force is neutralized. The resistance of the air and friction reduce the oscillation distance step by step.

To start the oscillation, a single muscular contraction is required. Some mechanisms are employed in suspension treatment to retain muscular properties, enhance range of motion, and strengthen muscles.

3. Eliminating gravity movement: 

If the person has the muscles power grade 2, can go for suspension exercise. If the muscle power is less than 2, It is difficult to perform the suspension therapy exercise by the patient himself. So, the patient should have minimal muscle contraction power of 2 to undergo suspension therapy exercises.

If the muscles power is above three, the patients can go for the gravity exercise instead of suspension therapy.


Types of Sling Exercise Therapy

Types of Sling Exercise Therapy

  • Axial suspension.
  • Vertical suspension.
  • Pendular suspension.

   1. Axial suspension:

  • Joint axis is taken as the point of the suspension.
  • The limb is supported by the slings above the axis of the joint.
  • If the movement is initiated the limb is moved both sides.
  • The part moves parallel to the floor.


  • Relaxation.
  • Maintain muscular property.
  • To Increase the blood circulation.
  • Increase the venous drainage.
  • Increase the lymphatic drainage.

   2. Vertical suspension

  • COG of the body part or the body is taken as a point of suspension.
  • Used to provide support to the body part of the patients.


  • To support the body part.
  • To reduce the pressure sore.

   3. Pendular suspension

  • The point of suspension should be shifted away from the joint axis.
  • Movement usually takes place against gravity.
  • Muscle will be getting resistance while moving if the axis is shifted opposite to that movement.


  • To strengthen the muscle.
  • To increase the muscle power
  • Increase the endurance.


Sling Exercise Therapy Parameters

Sling Exercise Therapy Parameters

There are several elements that may be used during SET to maximize its impact in both treatments and diagnostics. Rope level, vibration, and position are examples of these.

There are three primary types of supporting ropes: single, double, and pulley, all of which may be altered depending on the circumstance. For example, multi-point suspensions at various angles result in improved therapeutic effectiveness for a variety of patients. Furthermore, multi-point suspension stimulates the target muscles without causing discomfort because the bungees load the body weight, ensuring safety. This has several advantages. In comparison, single-point suspension provides less safety during activity and weight bearing.

It is important to note that the elasticity of the utilized cords during SET may be employed to aid or oppose muscular movements, allowing for easy restoration. Those are then altered based on the existing muscle strength to shorten the therapy duration. This is due to the fact that the patient's body is completely covered by the ropes, which reduces their tension while training.

Because of its unique ability to influence muscular contraction, vibration is another important aspect in SET. This has a significant effect on not just increasing muscular activity but also relieving pain. Furthermore, unlike the mat-exercise, introducing vibration throughout the SET increases muscular activation without causing discomfort.

During the SET, many positions are available to allow for the simultaneous training of multiple muscles. Furthermore, patients' positions might be adjusted to their specific needs, particularly those suffering from chronic conditions and/or significant accidents.

Furthermore, SET is appropriate for educating a group of patients at the same time to avoid the strange environment that may be created if patients are treated individually. This is not only socially desirable, but it also saves physiotherapists' time and effort.


Sling Exercise Therapy Advantages

Balance and Sensorimotor Training

      1. Balance and Sensorimotor Training

Balance is a complex motor skill shaped by the interaction of multiple sensory processes, environmental factors, and functional events. Impaired balance can have a negative impact on human mobility and/or muscular tone. Balance impairment is caused by a variety of conditions, including but not limited to muscular weakness in the lower limbs, shoulder, and back.

One of the most effective systematic tools for treating balance impairment through sensorimotor training is SET. This is accomplished by placing a closed kinetic chain on an unstable supporting surface to produce maximal sensory-motor stimulation.

Sensorimotor training on an unstable supporter, in particular, results in redistribution of muscle tone, activation of balance coordination, and increased sensory feedback via counterbalancing between the neurological and muscular systems. As a result, balance is restored by improving the motor system's feed-back responsiveness, co-contraction levels, and joint stability. Different studies have found that sensorimotor training on an unstable surface causes the activation of various co-contracted muscles such as the deltoid, triceps, and spine muscles. In comparison to traditional workout, this is more efficient and comfortable.

Notably, SET exercise is an efficient strategy for multi-planar balance training for improvement in the joints stability to enable maximum body balance that cannot be easily achieved through classical training methods.

In addition to aforementioned benefits, SET also plays a paramount role in protection of athletics injuries along with improvement in their performance. Most of the athletics injuries are usually resulting from decreasing their body balance that maybe diminished via balance exercise with assistance of the SET. For instance, the ankle sprain and acute knee injuries were declined by around (50%) and (54%) respectively upon usage of SET training. 

In addition, the athletics performances were tremendously improved including, throwing velocity, balance of Taekwondo players, and body-flexibility were improved significantly by SET. Most importantly, the balance rehabilitation process for the athletics through SET training is a fast and efficient therapy. This is owing to ability of SET to achieve simultaneous multi-target functions including balance restoration, enhancing proprioception, and muscles control.

      2. Diagnostic System:

SET can serve as a diagnostic platform for biomechanical chain problems. This is based on measuring muscle tolerance utilizing open and closed kinetic chain workouts and progressive weight-loading. This is accomplished through two key tests: holding time and weak link.

The holding time test, in particular, is used to assess the stability of the deep muscles by weight loading as a function of holding time in neutral posture. Reduced holding time relative to standard is an indication of muscular weakness at a certain posture, which should be the beginning point for muscle training using isometric exercises.

For example, chronic low back pain (CLBP) can be diagnosed by detecting the weakness of its correlated muscles through the holding time test. Compared with the traditional diagnostic routes such as manual muscles test and EMG, SET is more comfortable, facile, and low-cost.

The weak link test, on the other hand, comprises employing a closed kinetic chain in a progressive ladder system until the patient is unable to do the exercise correctly or feels discomfort. This is based on the observation of abnormalities during the interaction of deep stabilizer and superficial prime mover muscles. As a result, the therapy begins by modifying the dynamic motions to a level where the movement may be performed successfully and without pain.

Then, the muscles should be tested individually using an open kinetic chain exercises to determine the impairment’s site. For example, experience of severe pain during the trunk extension exercise and/or inability of patient to perform it, reflects the presence of one or more weak links in the lumbar spine region. It should be noticed that, for an accurate investigation, therapist should consider the fact that different muscles are responsible for the same movement during the closed kinetic chain exercise test. 

Eventually, the weak link test can be a prior step in the athletics rehabilitation to determine their muscle disorders swiftly along with identification of treatment method.

      3. Muscle Training:

SET is a reliable method of training muscles to improve their selective strengthening and activation capabilities. This is mostly determined by the type of SET exercise and the corresponding supporting surfaces. Several earlier research shown that SET has a significant effect on muscle training. Thus, SET may be used to produce maximum muscular activation during several workouts such as push-ups, back extensions, and knee extensions.

This is not only an effective but also a selective method since the therapist may exclude normal muscles during SET training by using suitable SET circumstances (e.g. positions, cords numbers and type). The findings demonstrated that the Neurac sling improved the muscular response patterns of CLBP patients, which is an important aspect of the rehabilitation approach. Furthermore, SET is ineffective in the presence of an acute stage of some diseases or injuries (e.g. Achilles tendon rupture).

The sling-based training in presence or absence of unstable surfaces is a unique tool for improvement of the muscle activation and its related function . For instance, most recently lee and coworkers systemically investigated the difference in the muscles activities during the plank position on stable ground (ST), unstable ground (US), and on suspension device (SL). 

The results reflected the superior efficiency of SET training (SL) on the electromyography activity of muscles including right external oblique (REO), left external oblique (LEO), left rectus abdominal (LRA), right erector spinal (RES), left erector spinal (LES), and right erector spinal (RRA) relative to US-plank and ST-plank.

     4. Pain Relief and Muscles Relaxation:

One of the most significant aspects of the recovery process is pain reduction. It is worth noting that, according to gate control theory, employing vibration with the SET plays a key role in pain alleviation. Vibration stimulation, in particular, reduces pain by interfering with pain signals sent to the brain. This is accomplished by activating the larger diameter A nerve fiber with non-noxious (e.g., vibration) stimuli, which then drives the closure of a neural "gate" to nociceptive signals upon stimulation of the mechanoreceptors, which include but are not limited to the Pacinian corpuscles, primary endings of the muscle spindle, and Meissner's corpuscles in the skin, subcutaneous tissues, and bone.

This is subsequently led to decrease the pain. In addition, SET is used successfully for treatment of pregnant women with a pelvic girdle pain, whiplash- associated disorders (WAD), and neck pain in post-traumatic stress disorder patients. 

     5. Range of Motion Restoration:

Prolonged diseases, such as infections and sport injuries, limit the mobility of the affected joints and muscles. This can be treated using a variety of physiotherapy techniques such as mechanical shock waves, electro-stimulation, and heat modalities, as well as specific exercises. With minimal discomfort, SET can successfully support different training processes necessary for range motion restoration (ROM).

For example, Gravity-eliminated (GE) entails moving the affected joints and muscles passively allowing their gradual stretching to increase ROM. 



Sling exercise

Sling exercise is a group of muscles that work together to form a sling." This sling subsystem is a collection of muscles that extends from your feet to your hips, core, and arms. There are multiple slings in your body, and studying the exercises that train them will help you gain real-world agility and strength.

Sling suspension can be used to treat disabilities caused by a variety of disease processes. Fractures, arthritis, amputations, strokes, and other neurological diseases are examples. Again, the key objectives are to restore and preserve joint mobility, strengthen weakening muscles, and stretch contractures.