Heavy ropes, Indian clubs, foam pads and blocks, exercise balls, balance discs, foam rollers, gravity-training devices, elastic therapeutic tape, and posture clothing are among the low-tech products physical therapists say they are now using to help their patients with everything from balance and strength building to sports-specific rehab.

One trend in the progressive exercise products realm seems to be toward simplicity, according to Michael Turner, PT, OCS, MTC, FAAOMPT, who is also a personal trainer and owner/manager of OrthoSport Hawaii.

Turner works with clients using suspension trainers, such as Fitness Anywhere’s TRX and Lifeline USA’s Jungle Gym, which he says are adaptable enough to be used by 85-year-old clients but still can be challenging for competitive gymnasts. PTs can work with patients in the office and teach them how to use the trainers at home and when they are traveling.

“Because you’re in a fairly stiff body position trying to control your trunk and at the same time your arms are moving around on this unstable surface, you have to have a pretty good amount of core stability and trunk control,” Turner says. “So it’s very good for treating multiple muscle groups at a time.”

Turner also uses heavy ropes or Battling Ropes with patients. These are long, 1.5-inch-diameter ropes that are attached to a wall or an anchor, and the client holds one end in each hand. Clients use their bodies to try to create a wave in the rope — either using both arms, alternating their arms, by crisscrossing or even moving the ropes from side to side.

There also are shorter ropes that the patient will twirl and work toward a continuous, flowing motion, which will encourage diagonal and rotational movement of the trunk, Turner says. “We use that to train runners who are very stiff and having poor trunk rotation,” he says. “We know that for an efficient run, you have to have some rotation to your lumbar spine.”

Another device Turner expects to see gain in popularity is the Indian club, which was used originally for ceremonial dances and picked up as exercise equipment in the late 19th century. Turner says the clubs are moved in patterns, from simple side swinging to complicated twirling patterns. “With different movement patterns, it’s very ballistic, very pendular, rhythmic, rotating, swinging diagonal movement patterns that are very natural for the human body,” he says. “It’s a very nice way to stimulate faster movement. It’s a nice thing to work in on the later end of your sport-specific type rehab.”

Providing Instability

Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert. MDT, says some of these products are useful for closed-chain exercises in which the patient stands or kneels on various surfaces to improve balance and core strength. Wilmarth, who is the chief of physical therapy at Harvard University Health Services, says exercise mats of different thicknesses and foam balance pads and blocks of varying firmness are used to provide instability. Once on the unstable surface, people’s bodies aren’t as strong, Wilmarth says, and they have to work harder and build their core strength, whether it’s the abdomen, back extensors or in the legs.

According to Wilmarth, these exercises are useful for treating hip, knee or ankle problems and many back problems. “The hip is one of those areas that was somewhat ignored for a while, and I think people are realizing more and more now that you have to really get the stability there for standing, weight bearing,” Wilmarth says. “It used to be just core abdominals, and that was the big thing for strengthening. Now you want to make sure you’re getting the quadratus lumborum, the hip muscles, the gluteo muscles working and not just the abdominals and the quads.”

Wilmarth says PTs can use steps to help patients work all those muscles, while paying close attention to form and posture.

Other progressive exercise products PTs are using with patients are exercise balls, including Bosu balls, and balance discs. Wilmarth says people can use the Bosu-type balls for standing, stepping or even upper back, posterior shoulder exercises. Like exercise balls, Wilmarth says, people can use the inflatable discs to practice keeping a neutral position and work the core while sitting at a desk.

“With the balls, it tends to be either all or nothing for people,” she says. “They sit on the Swiss balls all day long, and that’s too much; they get tired. If they have these little discs, then at some point they can sit on it for an hour, do some exercises, take it away and even put it under their feet.”

Pilates Products

Christine Romani-Ruby, PT, MPT, ATC, and founder of Phi Pilates, says she is seeing good results for patients using a new machine called the CoreAlign. She says the machine works well for patients with neurological issues, foot problems or in the geriatric population because they tend to have very stiff feet, and the CoreAlign helps loosen the foot. The machine, which was developed by a PT, has pedals that allow patients to glide and to shift their weight easily. Romani-Ruby gives an example of an 82-year-old longtime client who developed knee pain and was going to undergo surgery. She says he started doing exercises on the CoreAlign machine and after three weeks, had reduced the pain to the point that he canceled his surgery.

Another product Romani-Ruby says is especially useful with older clients — who are often thinner — is a softer foam roller. Because clients lie on the rollers, the softer foam makes it much more comfortable, she says.

Romani-Ruby says she often uses Pilates rings with patients. The ring, which has handles on the inside and outside, provides assistance for patients when doing Pilates matwork. The rings work for pelvic floor exercises and shoulder stretches for athletes, Romani-Ruby says. She also uses them when working with ballerinas on strengthening their hips.

“It’s a way to help the client draw in the correct muscles. Instead of using their bigger muscles, they’ll use their core muscles more with the ring,” she says. “Because of its shape and its design, I can use it for something as simple as sit to stand.” By using the Pilates ring, Romani-Ruby says, the client can prevent medial collapse, which is common in older people. She says some PTs take the rings when visiting nursing homes to have patients use it when getting out of a wheelchair.

Jennifer Gamboa, DPT, OCS, MTC, president and director of clinical services at Body Dynamics Inc. in Arlington, Va., also heavily uses Pilates equipment, in which springs create the resistance, for therapeutic exercise or to help hold a patient in a particular position. “We use it to either progress exercise,” Gamboa says, “or we use it at the rehab end of it, where we’re really doing joint mobilization, soft tissue mobilization, and assisted stretching and assisted strengthening. Now the springs are acting as an extra set of hands for us.”

Gamboa uses the gravity training system from Total Gym — mechanical and electronic versions — with many of her clients. The system uses gravity, the person’s body weight and a glide board to provide resistance.

“You can move through multiple planes at the same time, so you’re not strapping yourself into a single unit to move a single joint in a single plane,” Gamboa says. “You can move through three planes of movement, which is more functional, and you can work on transitions from one plane into the next plane.”

She says they use the system for very fit people and for those who are compromised. The electronic version allows PTs to make the transitions by clicking a button, which allows people with disabilities such as Parkinson’s disease or multiple sclerosis to exercise without moving from one piece of equipment to the next.

Taping Tricks

The popularity of elastic athletic tape jumped in popularity after the 2008 Olympic Games in Beijing, when people saw many athletes using the different, bright colors of tape. The elastic tape can help to facilitate the use of certain muscles, or to relax certain muscles, based on how PTs set it, Wilmarth says. The tape also can be left on for several days, even during showers.

“It works really well with swelling, acute ankle sprains,” Wilmarth says. “It helps with the circulation underneath.” Wilmarth prefers to cut her own to get an exact fit on each individual patient. But she says the precut options, such as SpiderTech tape, are good for people who don’t have time to cut their own, are just learning to use the tape, or for athletes who might not be traveling with a trainer.

Beyond the athletic uses, Wilmarth uses the tape to help people who sit at computers all day for postural retraining. She says the tape can help bring people back into a more neutral position instead of slouching, which helps with neck, upper-back and lower-back pain.

Posture clothing, such as shirts and tights made by Alignmed Inc., is another new option for people who need to work on maintaining a neutral position, Romani-Ruby says. The clothing “reminds you” of the correct posture, without being stiff like a brace, she says. The pants are designed to help with patella problems, and Romani-Ruby says she got the shirt to use herself to be more conscious of the position of her shoulders. The compression shirt includes bands of nonstretch fabric to help the body adjust to a balanced posture, according to the company’s website.