By Davis Y. Koh, DPT, MBA, GCS, RKC, CSCS
For the past decade, the Battling Ropes fitness system has come into a great deal of popularity among professionally ranked athletes, celebrities, trainers, and strength conditioning specialists covering many different sports. One area that is growing in the use of battling ropes is in the field of physical therapy and rehabilitation. The Battling Ropes system has become for me, personally, an integral part of rehabilitation for a variety of injuries and diagnoses. The Battling Ropes system is much more than a wrist, hand, or shoulder exercise and much more than a sports/physical fitness piece of equipment. I use Battling Ropes system for almost every body part, from the pediatric to the geriatric patient, and from the workers’ compensation patient to the professional athlete. I use the ropes in neuro-rehabilitation for my stroke and brain injury patients, cardiac rehabilitation for my post-open heart surgery patients, work hardening/work conditioning for my workers’ compensation patients and to assist in treating age-related diseases such as Lewy Body disease and Alzheimer’s for my geriatric patients. The reason why I incorporated the Battling Ropes into my physical therapy practice was because of its 2-vector force principle, inherit low risk of injury to my patients over traditional weights, the unique challenges the ropes provide to traditional physical therapy exercises, and the ease of incremental progression during a patient’s rehabilitation progression. The Battling Rope system also provides a unique set of new rehabilitation and corrective exercises in its own right that challenges my patients in new and different ways.
For starters, these weighted ropes minimize the risk of injury compared to when using traditional free weights. Battling Ropes provide a form of non-impact weight resistance exercise through various wave patterns that I like to begin with before advancing patients to other high-impact weight resistant exercises. Also, the relative light weight (the 1.5” 50’ rope is approx. 23 lbs.) and distribution of that weight over a long surface area makes it a safe alternative for overhead weight training and peace of mind that the rope can be dropped at any time. Thus, if a rope is accidently dropped, it will cause little or no harm to a patient. This is especially important when working with a brain injury or stroke patient where the risk of a dumbbell falling on the patients’ foot or head with overhead activities is higher due to decreased motor control. The same goes when working with my geriatric patient with age-related disease processes such as osteopenia or rheumatoid arthritis.
One of my favorite aspects of the Battling Ropes system is the 2 vectors of force direction it creates: one direction of force pulling away from the patient as well as a downward force from the pull of gravity on the weight of the ropes. This causes multiple contractions to two, three, or four muscle groups at the same time as well as challenge the dynamic balance and stabilization of 
the patient. It also creates a new twist to common exercises. The Turkish Get Up with the Battling Ropes, for example, can now have an additional direction of force going in either direction from the left, the right, or from behind or front as they perform the exercise. This really helps me challenge my patients with balance/asymmetrical stabilization issues. This principle also helps me utilize the ropes when doing reactive neuromuscular training made popular by therapists like Gray Cook and others. The 2-vectors of force direction helps when I use the ropes with physical therapy exercises such as PNF patterns, pendulum exercises, and wand exercises. I can also employ different types of movement prep exercises for the shoulder, back, and core such as ones I call ‘hummingbird’, ‘wall angels’, ‘iron cross’, ‘airwaves’ and ‘tug-of-war’ that have proved helpful for my shoulder and back patients.
Creating velocity with different wave patterns helps me challenge certain muscles different from other weight training pieces of equipment. For example, by creating constant high frequency, low amplitude wave pattern exercises like the ‘blender’ or the ‘running man’ the core is challenged in unique ways for my runners. Another example would be to use disassociation exercises using a traditional rope routines combined with the 3 levels of core exercises.
For my spinal cord injury patients who are wheelchair bound or patients who’ve undergone surgeries for a joint replacement or a lower extremity fracture, the battling ropes system provide an excellent opportunity to increase cardiac and overall aerobic strength while they are without the use of their lower extremities. The patients can receive a tremendous amount of cardiovascular conditioning and core strengthening through these ropes. The ropes also allow patients who are temporarily disabled (e.g. a patient with a compound fracture in their leg, or their leg is in a long leg cast) to still maintain core and upper body strength and conditioning while they try to wait for their bones to heal.
For my patients with Alzheimer’s or dementia, research has shown that the hippocampus (the memory center of the brain) can shrink an average of 2% per year. Conversely, new research is coming out where the hippocampus can actually grow in size by incorporating more complex exercises into the care of patients with this disease. Therefore, the more complex and diverse the exercise is, the greater the ability of the brain to actually grow in size at the hippocampus region counteracting the shrinking of the hippocampus in patients with advancing Alzheimer’s and/or Alzheimer’s type symptoms. The rope system allows therapists to create different types of wave patterns combined with lower body exercises to create very complex exercises when working with patients such as these. An example is a patient of mine with Lewy Body Dementia who I began working with Battling Ropes a few months ago. On his latest evaluation with the Head of Neurology at UCLA, the patient’s wife told me that his neurologist was amazed at his progress from when he first came to UCLA and is now in the top 1% of any patient with his diagnosis he’s seen at this stage of his disease process with regard to functional independence.
Another aspect of physical therapy and rehabilitation is the need to incrementally increase weight resistance quickly and efficiently for a patient going through rehab. Especially in the early or acute phase of their rehabilitation, progress can be as little as 1-2 lbs of weight at a time. Machines like the Keiser air machines can change in resistance in very small increments but can be expensive for some clinics. Other machines like the cable machine or dumbbells can have increments of 5-10lbs between weights which are too big of a gap for some patients. The ropes can act like a less expensive version of the Keiser, allowing for those small increments of weight to be added to the patient based on the amount of length of the rope that is used. The patient, for example, using 20 ft. of rope vs. 21 ft. of rope from its anchor will make a difference in their shoulder press, wrist curls, or other exercises in their rehab protocol. I can make the difference in weight by utilizing even smaller increments. This is especially important for my neurological patients trying to regain motor control where improvements can literally be 1-2 lbs at a time.
Because of its design, the Battling Ropes also becomes my foam roller as well. I utilize the ropes in exercises and self-mobilization techniques much like how we use our normal foam rollers. They are especially effective for T-spine segmental mobilizations as well as glutes and TFL self-mobilizations. They can also act as balance platforms when doing different exercises such as the front squat. These and other applications mentioned above are but a few examples of how I utilize the Battling Ropes in my physical therapy practice.
In my experience, I have found that the Battling Ropes is a critical piece of equipment that fills a specific niche from other traditional exercise equipment. The two vector force principal creates a dynamic need for activation of multiple stabilization muscles as well as core strengthening. Battling ropes create a great advantage by being able to progress a patient 
in smaller increments than other traditional weights. The ropes also provide another avenue of conditioning for my brain injury, paralytic and lower extremity surgical patients who cannot use their lower extremities at the early phase of their rehabilitation. The ropes system creates a whole new set of dynamic rehabilitation exercises that complement traditional weight resistance exercises. Finally, battling rope exercises, especially in a physical therapy setting, are one of the safest weight resistance exercises that also minimize the risk of injury to the patient when using it. Applying Battling Ropes into physical therapy treatments for my pediatric, neuro-rehabilitation, cardiac rehabilitation, and geriatric patient treatments have made a significant impact on speed of recovery and return to their prior level of function. I highly recommend the Battling Ropes system into any physical therapy program. For any further questions please contact me at davis@kohpt.com .
