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Redcord NEURAC

Norwegian Evidence based concept focused on core stability functional assessment and training

andrzej sulimierski

on 25 November 2012

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Transcript of Redcord NEURAC

Progression ladder! Neurac concept Redcord equipment NEURomuscular ACtivation (NEURAC)
Evidence based practice
follows latest development.
Science shows:
pain and/or inactivity can disturb signals sent to the muscles from the brain.

Disturbance can lead to impaired muscle interaction causing some muscles to be overloaded and painful.

Neurac Testing - to identify dysfunctions and muscular imbalances. Neurac testing Weak Link Neurac Treatment

focuses on correcting the Weak Links reducing the strain on the overloaded muscles.

Often immediate pain relief and/or improved function can be achieved. Neurac Treatment aims to be pain free and without negative side effects.

The treatment requires motivation and concentration from you as a patient.

The exercises can be both hard and challenging but should always be performed controlled and with good movement quality.

To obtain long term treatment effects individual exercise for maintenance is recommended.

•Low back pain and pelvic girdle pain
(DH, instability, decreased endurance/strength of core muscles)

•Neck pain and headache
(alternate muscle balance)

•Shoulder / arm dysfunction
(eg impingement and Tennis Elbow)

•Leg dysfunction
(eg patellofemoral pain syndrome) Neurac treatment is indicated
for musculoskeletal condition such as: 04 September 2012
Guthrie RJ, Grindstaff TL, Croy T, Ingersoll CD, Saliba SA.

The effect of traditional bridging or suspension-exercise bridging on lateral abdominal thickness in individuals with low back pain.
Journal of Sport Rehabilitation 2012;21:151-60

04 September 2012
Kang H, Jung J, Yu J.

Comparison of trunk muscle activity during bridging exercises using a sling in patients with low back pain.
Journal of Sports Science and Medicine 2012;11:510-15

04 September 2012
Park J, Grindstaff TL, Hart JM, Hertel JN, Ingersoll CD.

Knee-extension exercise’s lack of immediate effect on maximal voluntary quadriceps torque and activation in individuals with anterior knee pain.
Journal of Sport Rehabilitation 2012;21:119-26

04 September 2012
Huang JS, Pietrosimone BP, Ingersoll CD, Arthur L. Weltman A, Saliba SA.

Sling Exercise and Traditional Warm-Up Have Similar Effects on the Velocity and Accuracy of Throwing. Journal of Strength and Conditioning Research 2011; 25(6):1673-9

Dannelly BD, Otey SC, Croy T, Harrison B, Rynders C, Hertel J, Weltman A.

The effectiveness of traditional and sling exercise strength training in novice women.
Journal of Strength and Conditioning Research 2011;25(2):464-71

Saeterbakken AH, Van Den Tillaar R, Seiler S.

Effect of core stability training on throwing velocity in female handball players. The Journal of Strength and Conditioning Research 2011;25(3):712-18

Muceli S, Farina D, Kirkesola G, Katch F, Falla D.

Reduced force steadiness in women with neck pain and the effect of short term vibration.
J Electromyogr Kinesiol 2010;21(2):283-90

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

Foss P, Orpana A, Foss AM.

”Rehabilitation of people with fibromyalgia – short and long term effects”.
Fibromyalgibladet 2010;2:18-24

Vasseljen O, Flademark AM.

Abdominal muscle contraction thickness and function after specific and general exercises: A randomized controlled trial in chronic low back pain patients. Manual Therapy 2010;15:482-9

Unsgaard-Tøndel M, Fladmark AM, Salvesen Ø, Vasseljen O.

Motor Control Exercises, Sling Exercises, and General Exercises for Patients With Chronic Low Back Pain: A Randomized Controlled Trial With 1-Year Follow-up.
Physical Therapy 2010;90(10):1426-40

Huang JS, Pietrosimone BP, Ingersoll CD, Arthur L. Weltman A, Saliba SA.

Sling Exercise and Traditional Warm-Up Have Similar Effects on the Velocity and Accuracy of Throwing. Journal of Strength and Conditioning Research 2011; Epub ahead of print

Kirkesola G.

Neurac – a new treatment method for chronic musculoskeletal pain.
Tidsskriftet Fysioterapeuten 2009:76(12)16-25.

Marovino T.

Neuromuscular Training In Pain Management.
Practical PAIN MANAGEMENT, November/December 2008.

Prokopy et al

Prokopy, MP, Ingersoll, CD, Nordenschild, E, Katch, FI, Gaesser GA, Weltman A.
Closed-kinetic chain upper-body training improves throwing performance of NCAA Division 1 Softball players.
Journal of Strength and conditioning 22(6): 1790-1798, 2008

Schmoll S, Hahn D, Schwirtz A.

Die Behandlung von chronischenm LWS-Smerz mithilfe des S-E-T-Konzeptes (Sling-Exercise-Therapy). Bewegungstherapie und Gesundheitssport 2008;24:1-8.

English title: Treatment of low back pain and effectiveness of Sling-Exercise-Therapy (S-E-T). The study is only abailable in German.

Tsauo J.Y., Cheng, P.F and Yang, R.S.

The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: a preliminary-report. Clin Rehabil 2008; 22; 448

Objective: To investigate the effects of a sensorimotor training programme in osteoarthritic patients.
Benefits from implementing Redcord equipement:

Requires little space

Easily adapted to meet individual needs

Economical to install

Proven research effectiveness

The equipment is used by physical therapists in 40+ countries worldwide and by eighty percent of all physical therapists in Norway. 20 years experience
Redcord --> Neurac
(Neuromuscular Activation)

Treatment method for:
acute and chronic musculoskeletal pain
and muscle dysfunction

normal function through
sensorimotor stimulation + corrective exercise. Redcord and Neurac for therapists Why should I use it?

-DEEP / CORE muscle activation
-proprioception improvement
-injury prevention
-functional strengthening Redcord - Neurac concept is useful for:
- rehabilitation
- sport functional training
- fitness
- injury prevention program how to use Redcord for rehabilitation?

Closed Kinematic chain Open kinematic chain

- posture--> Lx, Cx endurance / setting - improve mobility
- prevent instability-->core strengthening - decrease pain
- relax global muscles-->core strengthening - improve joint lubrication
- proporioception improvement - improve ROM Why does it work?

Unsteady system of suspension

By maintaing adequate spine setting we can stimulate/educate deep muscles.

Switch off global muscles to
switch on deep muscles Close
chain Open
chain Neurac principles useful for pre & post spinal surgery + regards to the limitations of each kind of surgery So far you won't find any protocols with Redcord for post op.

However progress that you can make is a lot faster than with regular exercise schemes in these situations. Post op protocols and NEurac - Redcord Start early on with
pendular movements

Especially in shoulder surgeries
(tendon repairs, instabillity repairs etc)

after SPINE surgeries
CKC accelerates the
recovery amazingly. Content
Neurac for ?
Neurac basis
Weak links - assessment
Progression ladder -RX
Workshops NEURAC
(Neuromuscular Activation)

High levels of neuromuscular stimulation,

to activate “de-activated” or
partially“de-activated” muscles by
restoring signals flow from the
central nervous system. Neurac principles:
4 main NEURAC elements suspension Exercises

- closed kinematic chain-body weight bearing ex's

unsteadiness-controlled instability provided by ropes Perturbation

controlled vibration to increase unsteadiness

programmed vibrations Redcord STIMULA Workload

-precise grading of exes

-NEuromuscular challenge-gradually increased Pain free approach

-no provocation

- no increase of existing pain Andrzej Sulimierski,PT
Neuro Spinal Hospital
Dubai 2012 Assessment + Treatment

A Weak Link:
deficit within the biomechanical chain that produces a musculoskeletal dysfunction.

The deficits can be impaired neuromuscular control, impaired functional stability, reduced muscle force.

Needs elastic cord support to perform correctly Level 1:
Severe Weak Link

Cannot perform correctly with elastic cord support
Average level
Can perform correctly without elastic cord support Weak Link assessment
specific for Pelvis - back region Advanced level
Can perform correctly with
arms on chest Neurac Method Summary Neuromuscular stimulation
• Closed kinetic chain
• Unsteady base of support
• Perturbation
• Unloading
• Use of voice
• Concentration Optimize neuromuscular control

• Eliminate or reduce pain
• Integrate local and global muscle activity
• Restore normal ROM
• Restore functional movement patterns Treatment
• Individualized treatment:
• Focus on correcting Weak
Links identified during
Neurac Testing Indicated by Neurac Testing
• Local Motor Control (1)
• Myofascial Chains (2) High Workload
• Long holding time
• 4-6 repetitions per set (2) Weak Link,
Plevis and Back protocol

3D evaluation protocol in various starting positions.
core muscles / myofascial chains

Movement quality and function.
5 standardized levels of difficulty,
to pass a level =without provoking pain.

Scoring at level 3 is expected for a person without musculoskeletal complaints.

The right and left side of the body are tested separately for
comparison. Supine Pelvic Lift Level 5: Athletic level

Can perform correctly with arms on chest and balance cushion between scapulae Consider:
symetric movement!
Pelvis leveled
Normal lordosis
No side bending or rotation of body
Both scapulae on surface 3D slings =challenge the neuromuscular system and motor programs.

body-weight as resistance.
closed kinetic chain exercise

multi segmental movements +underlying core control

This type of training enhances:
-dynamic joint stability,
-muscle co-activation
-muscle synergies. Redcord Suspension Exercise
Basic Principles Standardized progression principles to adjust the level and workload of each exercise:
1. Alter lever arm

2. Alter body position in relation to suspension point

3. Alter height of straps or slings

4. Alter degree of unsteadiness

5. Perform additional movements

6. Add extra weight Redcord Suspension Exercise

focuses on optimizing neuromuscular control.

High effort and a low number of repetitions per set. guidelines for exercise intensity:

- 2-4 sets
- 3-6 repetitions
- 30-60 seconds rest between sets next level
When the patient can perform the desired number of repetitions at the last set with good quality of movement Introducing a new exercise
start at a level where the individual can perform the movements correctly without provoking pain. Always initiate exercises in the neutral position to create a clear and repeatable starting point for the patient. Gradually progress each exercise according to the patient’s functional level.
Make sure that each repetition is performed with good movement control.

Body part:
Lower back, pelvis, and hip region

Neuromuscular control and functional stability of lumbar spine,
pelvis and hip region, excluding hamstrings involvement
Focus on dorsal myofascial chains

Impaired neuromuscular control, Impaired functional stability
Decreased and/or painful range of motionFatigue, stiffness, discomfort, or pain

Prime mover:Gluteus maximus

Other key muscles:
Transversus abdominis, internal oblique, external oblique, multifidus, erector spinae Supine
Bridging Prone Bridging Side-Lying Hip
Abduction Side-Lying
Hip Adduction Starting test positions from
Back/Pelvis assessment protocol International approach from NORWAY utilized in 40 + countries.

Targets Intraspinal muscle for:
- endurance
- core strengthening
- Spine stability
- pain reduction Supine Pelvic Lift - Optimize neuromuscular control
- Restore normal range of motion
- Reduce or eliminate pain Neurac
education Level 2:
Moderate Weak Level 4: Level 3: • 26 year old man, physical therapist
• Acute low back pain after lifting a patient in 2001
• MRI with no pathological findings
• Severe low back pain for one year
• Chronic pain with about 20 acute episodes per year
• Acute episodes always related to lifting situations at work
• About to change profession because of these problems CASE Study Findings and Solutions

1. Restricted active back movements in all directions.
2. All movements and tests provoked pain, without clear pathology.
3. Neurac testing revealed impaired function of the local
stabilizing system in the lower back with compensatory global muscle activity.
4. Weak link related to left gluteus medius was identified.

1. A prone lumbar setting was chosen initially to increase activity
in deep stabilizers of the lower back.
2. Side-lying hip abduction was performed to activate gluteus medius.
3. Supine pelvic lift was used to integrate local and global
muscle activity and to optimize neuromuscular control of
the lower back and the entire core region. Solutions: Main Findings: What Characterizes
Long Term Low Back or Neck Pain ?

Altered Neuromuscular Control
Impaired Proprioception
Altered Postural Control +Muscular Dysfunction
Changes in Structure - Fatty Infiltration Summary: Redcord Advantage


• Redcord exercises show significantly higher cocontraction muscles

• Proximal stability for functional activities performed insupported unstable position
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