Suspension Based Physical Therapy for the Endurance Athlete
By Dr. Kate Mihevc Edwards PT, DPT, OCS
Suspension exercise training improves functional movement patterns more effectively than traditional exercise by creating a challenging and pain free environment for movement re-training. Numerous research studies have demonstrated the effectiveness of suspension exercise training in improving back pain, neck pain, shoulder pain, and activation of local spinal stabilizer muscles (see references 1-5).
For those of you who haven’t heard of Redcord it is a suspension exercise system developed in Norway that is utilized by physical therapists to challenge and improve the neuromuscular system. The term NEURAC (short for NEURomuscular ACtivation) is a method of treatment using the Redcord suspension exercise equipment to regain neuromuscular control and function. I have found Redcord NEURAC treatment to be a tremendous tool for evaluating and treating triathletes and runners. It allows me to address the entire kinetic chain and be creative based on their individual needs.
Frequently at my practice in Atlanta we see many orthopedic and sports related injuries, however we specialize in treating runners and triathletes. These endurance athletes often have a variety of injuries from overtraining, weakness, inhibition, instability, or poor mechanics. While they tend to be strong and phenomenal competitors, testing these athletes on the Redcord suspension system often reveals weakness throughout their kinetic chain.
During treatment, Redcord gives me the ability to challenge their muscle strength and stability dynamically, while integrating coordination of several muscle groups and body systems. For example, if a triathlete or swimmer comes into my clinic with a shoulder injury it is likely they over use their upper body to compensate for their inability to properly “kick.” By suspending them from the ceiling, as if they were in a pool, I can teach them to properly kick on the Redcord suspension exercise system. The suspension allows us to work on hip and trunk rotation while coordinating hip and leg adduction, extension and flexion respectively while in a pain free, supine or prone position. We can also incorporate breath control, using the slings as biofeedback to improve their diaphragm-pelvic floor piston.
Much like swimmers, runners frequently struggle with pain secondary to poor biomechanics and form. However, for many runners it can be difficult figuring out what “good running posture” feels like. The ropes and slings used with the Redcord suspension exercise system allow the patient to work on posture and lean while in an offloaded (partial body weight) position. This will give them real-time feedback about what they should and should not be feeling when out running. Redcord can also be useful to work on single leg mechanics and fascial line stability including glute strength. Imagine being able to train one side of your body to stabilize and extend while the other moves into triple flexion (hip, knee and ankle flexion), like we do in running, but in a completely controlled and pain free environment.
Runners and swimmers aren’t the only ones who will benefit from suspension exercise training. Vibration from riding a bike on uneven surfaces such as gravel or cobblestone travels from the bike into the arms and ultimately the neck and back. This vibration can challenge deep stabilizer muscles and can lead to injury if the cyclist’s stabilizing muscles are not firing correctly. For the cyclist, the instability of suspension exercise training improves deep stabilizer muscles by adding a component of balance and proprioception that is required while riding a bike.
If typical rehab or strengthening exercises don’t seem to be helping you it may be because you haven’t been tapping into the right systems. Strengthening with the use of suspension is a much more challenging way to re-train the muscles and coordination after injury. The addition of instability, balance, coordination and vibration mimic more functional and realistic movement strategies than doing a clamshell exercise or even a single leg squat. When the body is offloaded with slings and bungees it can tap into deep stabilizing system without allowing you to over-recruit other muscles groups unnecessarily.
The beauty of a suspension exercise training system, especially Redcord, is that it’s easily modifiable through slings and bungees to treat people of all abilities. By providing assistance to off-load body weight when initially learning or re-learning movement patterns individuals can come back from injury more quickly and possibly decrease further injury down the road. If you have been struggling with typical overuse injuries it may be time to try suspension exercise training.
Dr. Kate Mihevc Edwards is a board certified orthopedic physical therapist in Atlanta who specializes in the treatment of runners, triathletes and other endurance athletes. She is highly trained in the Redcord NEURAC treatment method, along with Pilates based exercises, trigger point dry needling and Selective Functional Movement Assessment (SFMA). Dr. Edwards also has extensive training in running medicine and manual medicine. She owns and operates the Precision Performance and Physical Therapy center located in Atlanta, Georgia. For more information about Dr. Kate Mihevc Edwards, please visit http://precisionperformanceatl.com
1. Lee S wk, Kim SY. Effects of hip exercises for chronic low-back pain patients with lumbar instability. Journal of Physical Therapy Science 2015;27(2):345-8
2. Kim SY, Kang MH, Lee DK, Oh JS. Effects of the Neurac® technique in patients with acute-phase subacromial impingement syndrome. Journal of Physical Therapy Science 2015;27(5):1407-9
3. Saliba SA, Croy T, Guthrie R, Grooms D, Weltman A, Grindstaff TL. Differences in transverse abdominis activation with stable and unstable bridging exercises in individuals with low back pain. North American Journal Of Sports Physical Therapy 2010;5(2):63-73
4. Yun K, Lee S, Park J. Effects of closed chain exercises for the lumbar region performed with local vibration applied to an unstable support surface on the thickness and length of the transverse abdominis. Journal of Physical Therapy Science 2015;27(1):101-3
5. Yun S, Kim YL, Lee SM. The effect of neurac training in patients with chronic neck pain. Journal of Physical Therapy Science 2015;27(5):1303-7