New Meta-Analysis:
Sling Exercise & Back Pain

Sling Exercise Therapy (SET) has proven to significantly reduce pain and disability in people with chronic low back pain, according to a new systematic review and meta-analysis published in the reputable Journal of Strength and Conditioning Research [1]. This study provides the strongest evidence yet that SET—the core of Redcord’s Neurac Method—is an effective and evidence-based treatment for chronic back pain. The SET and Neurac method were first described by Redcord [2,3].

Conclusion

The U.S. researchers concluded that SET is an effective treatment for reducing pain and disability in people with chronic low back pain. Compared to motor control training and lumbar stabilization exercises, SET showed superior outcomes in pain relief and functional improvement. It also provided significant benefits over no treatment and was at least as effective as general exercise for pain and disability. Notably, SET outperformed all comparison groups in core muscle activation, strength, and thickness, making it a compelling option for rehabilitation. The overall evidence quality ranged from very low to moderate.

Results

• Pain Reduction: SET significantly reduced pain compared to no treatment (MD -1.05, 95% CI: -2.82 to -0.71) and was superior to motor control training (MD -4.13, 95% CI: -7.82 to -0.45). However, compared to general exercise, the effect was not significant (MD -0.14, 95% CI: -0.58 to 0.87).

• Disability Improvement: SET improved disability outcomes more effectively than motor control training (MD -3.19, 95% CI: -4.63 to -1.76) and no treatment.

• Muscle Activation & Strength: SET significantly enhanced core muscle activation and strength more than both no treatment and general exercise, particularly improving transverse abdominis activation and trunk extensor strength.

• Methodological Quality: The overall evidence quality ranged from very low to moderate in the included trials.

Background

Chronic low back pain (CLBP) is one of the most common musculoskeletal conditions, leading to disability and a reduced quality of life worldwide. Traditional treatments—including general exercise, motor control training, and stabilization exercises—are widely used, but no single method has emerged as the definitive best approach.

Sling Exercise Therapy (SET), which frequently utilizes suspension systems like the Redcord Workstation and methods as Neurac, has been proposed as a promising alternative. By engaging neuromuscular activation while maintaining a pain-free environment, Neurac SET may offer distinct advantages over conventional treatments.

Methods

The team of U.S. researchers conducted a systematic review and meta-analysis, analyzing 12 studies with a total of 631 participants. The studies compared SET to general exercise, motor control training, lumbar stabilization, and no treatment. The primary outcomes measured were pain, disability, and muscle function. To assess effect sizes, researchers used the Hopkins scale, and the Cochrane Risk of Bias tool was applied to evaluate methodological quality.

What This Means for Your Practice

For clinicians treating chronic low back pain, SET presents a valuable therapeutic approach. Its ability to progressively challenge patients while ensuring pain-free movement makes it both safe and effective for rehabilitation. Additionally, SET allows for individualized treatment, addressing neuromuscular kinetic chain deficits commonly found in patients with CLBP.

Bottom Line

Sling Exercise Therapy is an effective intervention for chronic low back pain, offering unique advantages in pain reduction, disability improvement, and core muscle activation. If you have not considered integrating SET into your practice yet, now may be the time.

Scientific Summary Version

Original Title Sling Exercise in the Management of Chronic Low Back Pain: A Systematic Review and Meta-Analysis

By Christian Drummond, Valeriya Lebedeva, Kaitlin Kirker, and Michael Masaracchio

At Department of Physical Therapy, Long Island University, Brooklyn, New York

Background 

Non-specific Chronic low back pain (NS-CLBP) is a leading cause of disability worldwide. Various treatment modalities exist, including general exercise, motor control training, and lumbar stabilization exercises. Suspension-based interventions, such as sling exercise therapy (SET), are designed to optimize neuromuscular activation while reducing pain, but their comparative effectiveness remains debated.

Aims 

The systematic review of Drummond et al. [1] aimed to evaluate the effectiveness of SET in reducing pain and disability, as well as improving core muscle function, compared to other interventions in patients with NS-CLBP.

Methods 

A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases searched included PubMed, PEDro, Cochrane Library, EMBASE, and CINAHL. Studies included randomized controlled trials (RCTs) and prospective cohort studies assessing SET for NS-CLBP. The primary outcomes were pain, disability, and muscle function. Effect sizes were estimated using the Hopkins scale, and the quality of evidence was assessed using the Cochrane Risk of Bias tool and GRADE framework.

Results

• Pain: SET significantly reduced pain compared to no treatment (MD -1.05, 95% CI: -2.82 to -0.71) and motor control training (-4.13, 95% CI: -7.82 to -0.45). Compared to general exercise, the effect was nonsignificant (-0.14, 95% CI: -0.58 to 0.87).

• Disability: SET showed significant improvement in disability over motor control training (-3.19, 95% CI: -4.63 to -1.76) and no treatment.

• Muscle Function: SET improved core muscle activation and strength more than general exercise and no treatment. It significantly enhanced transverse abdominis activation and trunk extensor strength.

• Methodological Quality: The overall level of evidence in the trials ranged from very low to moderate.

Discussion

SET appears to be a promising intervention for managing CLBP. Its advantage over motor control training and lumbar stabilization in pain relief and functional improvement suggests that SET may be a better initial treatment option. However, it was not significantly different from general exercise on pain and disability, indicating that both modalities may be suitable depending on patient preference and therapist expertise. Still, the ability of SET to provide pain-free exercises while improving neuromuscular activation, strength, muscle thickness, and onset beyond all comparisons may contribute to its clinical utility.

An advanced SET approach, the Neurac method, building on high dose of SET, while adding de- and re-loading elastic cords and vibrations, has shown especially large effects on balance and pain [4]. Localized vibration therapy, important in Neurac SET, has proven large effects alone on pain and disability in yet another Meta-Analysis [5].

Conclusion 

SET is an effective intervention for chronic low back pain, particularly when compared to motor control training and no treatment. It improves pain, disability, balance, and muscle function, supporting its use in rehabilitation programs. Future research should focus on methodological rigor, long-term outcomes, and response of subgroups of patients.

References

1. Drummond, C., et al., Sling Exercise in the Management of Chronic Low Back Pain: A Systematic Review and Meta-Analysis. J Strength Cond Res, 2021. PubMedID 34570056 https://pubmed.ncbi.nlm.nih.gov/34570056/

2. Kirkesola, G., Neurac - a new treatment method for long-term musculoskeletal pain. Fysioterapeuten, 2009. 76(12): p. 16-25. English version: http://cdn1.sourze.se/cdn.zitiz.se/userfiles.cdn.zitiz.se/z/caea9cc5-b663-44ec-b91d-cccabcafc571/Neurac%20Article%20Fysioterapeuten%20200912.pdf , Norwegian version: https://www.fysioterapeuten.no/neurac---en-ny-behandlingsmetode-for-langvarige-muskelskjelettplager/123559

3. Kirkesola, G., Sling exercise therapy (S-E-T): a total concept for exercise and active treatment of musculoskeletal disorders. Fysioterapeuten, 2000. 12(6): p. 7. English version: [link in progress]

4. Kim, J.H., et al., The effect of the neurac sling exercise on postural balance adjustment and muscular response patterns in chronic low back pain patients. J Phys Ther Sci, 2013. 25(8): p. 1015-9.

5. Li, Q., et al., Vibration therapy to improve pain and function in patients with chronic low back pain: a systematic review and meta-analysis. J Orthop Surg Res, 2023. 18(1): p. 727. https://pubmed.ncbi.nlm.nih.gov/37752526/