Slacklining as therapy to address non-specific low back pain in the presence of multifidus arthrogenic muscle inhibition

Table 1 Interventions that counter the effects of arthrogenic muscle inhibition

Modulation of joint afferent discharge
Joint aspiration; intra-articular corticosteroid injection; nonsteroidal anti-inflammatory drugs; local anesthetic; cryotherapy; transcutaneous electrical nerve stimulation-TENS; electro-acupuncture; altering fluid distribution/capsular compliance
Muscle stimulation
	Voluntary activation	Involuntary activation
Direct	Therapeutic exercise; motor control exercise therapies: (1) Biofeedback/ultrasound guided; and (2) Individualized tailored hybrid convergence and divergence exercise-based approach of specific treatment of problems of the spine including: ‘movement system impairment’; ‘mechanical diagnosis and therapy’ (MDT); ‘integrated systems model’ incorporates ‘regional interdependence model’	(1) Neuromuscular electrical stimulation: (a) surgically implanted-effective; and (b) transcutaneous-ineffective; (2) Transcranial magnetic stimulation; and (3) Peripheral magnetic stimulation
Indirect	Therapeutic exercise: (1) Global/non-specific ‘core stabilization exercise’; and (2) Specific ‘core stabilization exercises’ including: ‘modern mind body’ incorporating: Yoga, Tai Chi, Qigong, Pilates, Alexander, Feldenkrais, Bounce-Back, Calisthenics, Gyrokinesis, Gaga, Core-Align and Human Harmony; and MDT	Slacklining—possibly, via reducing down regulatory inhibition

TENS: Transcutaneous electrical nerve stimulation.

Table 2 Slacklining progressive competency phases—5 stages and 20 steps[30]

Stage and steps	Description of position
1—Beginner: Stand	Each description of stages 1-4 is for the slackliner standing on a slackline of 3 m length at strong tension anchored at each end 25 cm above soft terrain such as sand or grass
1	Single leg stand—on the dominant leg
2	Single leg stand—on the non-dominant leg
3	Single leg stand—on dominant leg, other foot touching the side of the line 1 foot length in front of the weight-bearing foot
4	Single leg stand—on dominant leg, other foot touching the side of the line 1 foot length behind of the weight-bearing foot
5	Single leg on non-dominant leg, other foot touching the side of the line 1 foot length in front the weight-bearing foot
6	Single leg on non-dominant leg, other foot touching the side of the line 1 foot length behind of the weight-bearing foot
2—Moderate: Walk
1	Walk forward along the line with minimal to no pause between steps
2	Walk backward along the line with minimal to no pause between steps
3	Tandem stance with the dominant leg back or closest to the anchor point
4	Tandem stance with the dominant leg forward or furthest from the anchor point
3—Intermediate: Tandem
1	Tandem stance with the dominant leg behind, then turn or pivot 180° on both feet to the natural side so that the dominant then becomes forward
2	Tandem stance with the dominant leg forward then turn or pivot on both feet to the non-natural side so that the dominant leg is behind
3	Tandem stance with the dominant leg behind, then turn or pivot 180° on the dominant foot to the non-natural side so that the non-dominant foot crosses over and returns to the forward position
4	Tandem stance with the dominant leg in front, then turn or pivot 180° on the non-dominant foot to the non-natural side so that the dominant foot crosses over and returns to the forward position
5	Side stand ‘surf posture’—feet perpendicular to slackline and balance
4—Advanced: Squats
1	‘Surfer’ position and squat down feet perpendicular to the line approaching buttocks to the line
2	Squat in tandem, dominant leg behind—feet along the line approaching buttocks to the line
3	Squat in tandem dominant leg in front—feet along the line approaching buttocks to the line
4	Single leg squat all weight on the dominant leg—approaching buttocks to the line
5	Single leg squat all weight on the non-dominant leg—approaching buttocks to the line
5—Extreme	Without using arms, without sight, bouncing
Other—tricks: Performance	Heel raises, walking on toes, jumps, spins, somersaults on line or as dismounts
	External focus (e.g., throwing ball, juggling ball)
	Surfing (on very slack line) with oscillations or swinging perpendicular to the line

Slackline length and tension can be changed to modify the difficulty level.