The Double Tilt Ladder first appeared in the St. Louis Qualifying Round of American Ninja Warrior 6 and later appeared in the St. Louis City Finals that season. It consists of two sets of suspended tilting monkey bars. Competitors use their hands to move up the first set of monkey bars until their weight causes it to tilt, allowing them to continue down to the end. Once at the end of the first set of monkey bars they must swing to the second set and navigate it just as they did the first. At the end of the second set of monkey bars they must swing to the landing mat. In St.Louis, both ladders had 8 rungs. While in Orlando, the first ladder had 8 rungs, while the second ladder had 6 rungs.
The Double Tilt Ladder made a return in the Orlando Qualifying Round of American Ninja Warrior 7.