As with most valuable experiences, the information presented in this article series is meant to inspire and encourage you. Much of the information I will present has come about through bold exploration and creative implementation by our predecessors in this area of conditioning. As they were intrinsically inspired to take a "toy" and adopt it to a clinical environment, this text aims to inspire the reader to always look for the "diamond in the rough." The next "stability ball" could be right under your nose.
Many times, tradition is based on success. However, much of this tradition is based on "clinically unexamined, passed down" information or the typical "that’s the way it’s always been" rationale. In order to separate fact from fiction, one must always be willing to ask the "why" of tradition. Therefore, a secondary purpose of this article series is to stimulate critical thinking, the type of thinking that invokes curiosity and exploration of possibilities, the thinking that leads to the constant examination of traditional training principles.
This article series will also introduce a concept of training we have coined as "Stabilization Limited Training" (SLT). This type of training is characterized by limiting prime mover force production and by developing the strength of the stabilizing structures. SLT was developed like most training modalities we use today - first it was used successfully and then it was described.
Strength and conditioning leaders often propose many innovative training ideas, and professional journals constantly provide a plethora of ingenious training modalities. However, most of the thrust behind articles remains the introduction and description of the training modality, not its integration into a traditional training program. This article series will provide a comprehensive approach to Stability Ball (SB) Training as well as an integration model. Extensive examples of protocols and their place within traditional training models will also be provided within this series.
A Brief History
One of the most versatile pieces of equipment used today by conditioning professionals is the Stability Ball (i.e., Swiss balls, Fitballs, Physioballs, etc.). SBs have had long-standing success in the world of clinical rehabilitation. However, due to their effectiveness in developing balance and core strength, athletic trainers, coaches, personal trainers and physical education teachers have begun to integrate them into their programs. Now, they have become wildly popular in the world of athletic and functional conditioning.
The history of the SB originates back to the early 1960s. It was made by an Italian toy maker, Aquilino Cosani, and sold primarily in Europe as the Gymnastik. In 1981, Cosani started a new company called Gymnic. These two companies are still in Italy and are the major suppliers of SBs throughout the world.
The SBs clinical application by Dr. Susan Klein-Vogelbach, a Swiss PT, can be traced back the 1960’. Through a series of classes, seminars and clinical workshops, the SB made its way to the San Francisco area in the 1980s. Since the 1980s, the SB has slowly gone from the rehabilitation setting into the fitness and athletic arena. Paul Chek was one of the pioneers in evolution of the Stability Ball as a performance enhancement tool. He was one of the first to use the SB, in the late 1980s, to rehabilitate and condition elite athletes. Due to the success and growing popularity of SBs, the last decade has seen the birth of various programs developed to educate professionals on their use.
In Europe, SBs have been used in schools as chairs. The benefit of this type of application has been reported as improved focus, concentration, handwriting skills, better understanding of class material and better organizational skills. There are several pilot studies in the US using the SB in schools. The preliminary data is consistent with that found in Europe.
Diversity of Settings, Populations and Applications
Once limited to the rehabilitation and clinical setting, the SB has permeated to all sectors of the health and fitness community. In clinics, they are still used to provide gentle proprioceptive stimuli for individuals recovering from surgery. John Leonard is one of Florida’s finest PTs. He says, "The SB we have found probably to be our most versatile piece of equipment. Its fun, colorful and everybody from our pediatric patients to our geriatric patients literally finds the SB to be something unique that they can generate some enthusiasm about. The unique thing about the SBs is that they utilize the neuromuscular system in a way no other exercise equipment I have come across has." SBs incorporate the use of:
- Multiple muscle systems
- Neurologically induced muscular responses
- A normal and natural process of balance
- The body’s own normal processes, to establish and restore balance
From the clinical setting, the SB made its way to the sports arena in the 1990s. Therapists with athletic backgrounds realized that the SB could be applied more aggressively to actually enhance the performance of athletes. Now, the stability ball can be found in just about every professional strength facility. Articles featuring popular athletes using the stability ball have made their way into conditioning magazines, furthering the SBs popularity.
As the popularity of the SB grew, it also started to make its way into fitness conferences. As professionals using the SB delivered educational presentations, personal trainers immediately saw it as a tool to enhance client interest and performance. Personal trainers have now brought the SBs into commercial training facilities. Just about every commercial gym now has at least one stability ball. Some have even developed group classes.
Due to the Stability Ball’s popularity within the rehabilitation and fitness industry, they have also made their way into the private sector. Although the initial home use might have been rehabilitation, the stability ball is now used by many as a chair for their office, for regular strength training and for play. Most, if not all, of my clients have them at home and regularly use them to keep their core functioning at its optimum.
The next section of this series will deal with the science and practice behind the SB. We will look into the scientific efficacy behind the SB and compare that to anecdotal observations we practitioners are experiencing. Following sections will deal with exercise selection and programming.
- Anderson GBJ, Bogduk N, Deluca C, et al; Muscle: Clinical perspectives on Low Back Pain. New Perspectives on Low Back Pain. Edited by JW Frymoyer, SL Gordon. Park Ridge, IL, American Academy of Orthopedic Surgeons, pp. 293-334, 1989.
- Aosaki, T., et al. Responses of tonically active neurons in the primate’s striatum undergo systematic changes during behavioral sensorimotor conditioning. J Neuroscience, 14(6): 3969-3984, 1994.
- Blievernicht, J. Balance: Course Manual. Chicago, IL 1996.
- Boehme, Regi, OTR. Improving Upper Body Control. Tucson: Therapy Skill Builders, 1988.
- Bosco, C., Cardinale, M., Tsarpela, O., Colli, R., Tihanyi, J., Dullivard, S., Viru, A. The influence of whole body vibration on jumping performance. Biology of Sport. 15:157-164, 1998.
- Brody, Liz. “ The Axler: A Workout That’s Really on the Ball.” Shape. April 1993: 86-93.
- Carrie, Beate, P.T. “ Swiss Ball Exercises.” PT Magazine. September; 92-100. 1993.
- Carrie, Beate, P.T. and Linda Felix, P.T. “ In Consideration of Proportions.” PT Magazine. April 1993: 59.
- Carter AT: Piriformis syndrome: A hidden cause of sciatic pain. Athl Training 1988; 23(3):243-245. 1975
- Chek P. Scientific Back Training: Correspondence Course Manual. Paul Chek Seminars. LaJolla, CA 1994.
- Chek P. Swiss Ball Exercises for Athletes I-III. Paul Chek Seminars. Encenitas, CA 1997.
- Chek P. Scientific Abdominal Training. Correspondence Course Manual. Paul Chek Seminars. Lajolla, CA 1992.
- Chek P. Strong ‘N’ Stable Swiss Ball Weight Training Series, Vol. 1-3. Paul Chek Seminars. Encenitas, CA 1997.
- Clark, M. “Functional Leg Training”. NSCA Annual Conference, presentation. Kansa City, Missouri, 1999.
- Clark, M. “Foundations for Function”. Learn by Doing Seminar Series, Coral Gables, Florida, 1999.
- Cooper, Douglas. Dynamic Stabilization Exercises for the Lower Back. Portland: Douglas Cooper, 1992.
- Creager, Caroline C. Theraputic Exercises Using the Swiss Ball. Boulder: Executive Physical Therapy, 1994.
- Cresswell, A.G., Oddsson, L., Thorstensson, A. The influence of sudden perturbations on trunk muscle activity and intra-abdominal pressure while standing. Exp Brain Res, 98:336-341. 1994.
- Dominguez, Richard H, MD, Gajada Robert. Total Body Training. New York: Warner Books, 1982.
- Farfan HF. Effects of torsion on the intervertebral joints. Can J Surg 1969;12:336-341
- Farfan HF. Musculature mechanism of the lumbar spine and the position of power and efficiency. Orthop Clin North Am 1975; 6:135-144
- Farfan, H. F., Biomechanics of the Lumbar Spine in Managing Low Back Pain, Kirkaldy Willis, W.H., Ed. New York: Churchill-Livingston,1983.
- Foley, Erin. Personal Communication. Archivist, Robert L Parkinson and research Center. April 21, 2000.
- Fox, Charles P., ed. Old-Time Circus Cuts. New York: Dover Publications. 1979.
- Gambetta, V., "Building the Complete Athlete," (Course Manual), 1996.
- Gambetta, V., Clark, M., “ A formula for function”, Training and Conditioning, 8(4):24-29, 1998.
- Gambetta, V., Gary, G., “Following a functional path”, Training and Conditioning, 5(2):25-30, 1995.
- Gomez, Niska. Somarhythms: Developing Somatic Awareness with Large, Inflatable Balls.” Somatics. Spring/Summer, 1992. Pp12-18.
- Grabiner M. et al. Decoupling of bilateral paraspinal excitation in subjects with low back pain. Spine. 17(10):1219-1223. 1992.
- Granhed H, Jonson R and Hansson T. The loads on the lumbar spine during extreme weight lifting. Spine. 12(2): 146-149. 1987
- Gray, G.W., "Chain Reaction Festival," (Course Manual), Adrian, Michigan. Wynne Marketing.1996.
- Headley BJ: The “Play-Ball” Exercise Program. St. Paul. Minnesota, Pain Resources, Ltd., 1990.
- Hodges, P.W. , Richardson, C.A. Inefficient Muscular Stabilization of the Lumbar Spine Associated with Low Back Pain. Spine, 21(22):2640-2650, 1996.
- Hodges, P.W., Richardson, C.A., Jull, G. Contraction of the Abdominal Muscles Associated with Movement of the Lower Limb. Phys Ther, 77:132-14, 1997.
- Hypes, Barbara. Facilitating Development and Sensorimotor Function: Treatment with the Ball. Minnesota: P Press, 1991.
- Klien-Vogelbach, Suzanne. Theraputic Exercises in Functional Kinetics. Germany: Springer-Velag, 1991.
- Koes BW, Bouter LM, Beckerman H, et al. Physiotherapy exercises and back pain: a blinded review. BMJ. 1991; 302;1572-1576.
- Kucera, Maria. Gymnastik mit dem Hupfball (Exercise with the GymBall). 5Th Edition. Stuttgart: Gustav Fischer Verlag, 1993.
- Maurer, H. (no date) Gymnastik Ball. A Handout. 7112 Waldenburg zur Ausbildung von; Gymnastiklehrerinnen F.M.B.H.
- Miller DJ: Comparison of electromyographic activity in the lumbar paraspinal muscles of subjects with and without chronic low back pain. Phys Ther 65:1347-1354, 1985.
- Multiple Muscle Systems; Biomechanics and Movement Organization. Edited by Jack M. Winters and Savio L-Y Woo. pg 252-253
- Nachemson A, Morris JM. In vivo measurements of intradiscal pressure. J Bone Joint Surg Am.;46:1077-1080. 1964
- Nachemson AL: Disc Pressure measurements. Spine. 6;93-97, 1981.
- Nachemson, A. The load on the lumbar disks in different positions of the body. Clin Orthop.;45:107-112. 1966
- Nachemson, A.L., The Lumbar Spine, An Orthopedic Challenge. Spine 1:59, 1976.
- Necking, L., Dahlin, L., Friden, J., Lundborg, G., Thronell, L. Vibration-induced muscle injury: An experimental model and preliminary findings. J. Hand Surg. 17:270-274. 1992.
- Necking, L., Lundstrom, R., Lundborg, G., Thronell, L., Friden, J. Skeletal muscle changes of short term vibration. Scan. J. Plast. Reconstr. Surg. Hand Surg. 30:99-103. 1996.
- Pace JB: Commonly overlooked pain syndromes responsive to simple therapy. Postgrad Med; 58(4):107-113.
- Paruidge MJ, Walters CE. Participation of the abdominal muscles in various movements of the trunk in man, an EMG study. Physical Therapy Review;39;791-800. 1959
- Porterfield J.A. and DeRosa C. Mechanical Low Back Pain. Philadelphia: W.B.Saunders Co. 1991
- Posner-Mayer, J. Swiss Ball Applications for Orthopedic and Sports Medicine. Denver: Ball Dynamics International, Inc. 1995.
- Rathke, F., Knupfer, H. (no date) Exercise Ball: Exercising tool for child development. A handout. Stutttgart. Municipal Center.
- Robinson, R. The New Back School Prescription: Stabilization Training Part I. Occupt Med. 7(1):17-31. 1992.
- Saal J. Dynamic Muscular stabilization in the Nonoperative treatment of lumbar pain syndromes, in Orthopedic Review Vol. XlX No. 8 Aug 1990.
- Saal J. et al. Non operative management of herniated cervical intervertebral disc with radiculopathy. Spine,. 21(16). 1996
- Santana, JC. The Essence of Stability Ball Training, Vol I-II. Optimum Performance Systems, Boca Raton, Florida, 1999.
- Seroussi RE, Pope MH: The relationship between trunk muscle electromyography and lifting moments in the sagittal and frontal planes. J. Biomech . 20: 135-146, 1987.
- Sieg, K., Adams, S. Illustrated Essentials of Musculoskeletal Anatomy. Gainsville, Fl. Megabooks, Inc. 1985.
- Sweet, Waldo E. Sport and Recreation in Ancient Greece: A sourcebook with Translations. New York: Oxford University Press, 1987.
- Wirhed, R. Athletic ability and the anatomy of motion. Wolf Medical Publications. 1990.
- Wolpaw, J.R., Braitmman, D. J., Seegal. Adaptive plasticity in the primate spinal reflex: initital development. J Neurophysiology. 50:1296-1311, 1983.
- Wolpaw, J.R. Acquisition and maintenance of the simplest motor skill: investigation of CNS. Med. Sci. Sports Exerc. 26(12):1475-1479, 1994
- Zetterberg C, Andersson GBJ, Schultz AB: The activity of individual trunk muscles during heavy physical loading. Spine 12:1035-1040, 1987
- Ziethen, Karl-Heniz, Allen, Andrew. Juggling: The Art and Its Artists. Berliniwerner Rausch & Werner Luft. 1985