PT on the Net Research

Stability Ball Training - Part 3


Stabilization Limited Training (SLT) is a term I coined for lack of imagination and talent coming up with cool acronyms. It simply refers to the type of strength training that limits force production to the strength and balance of the stabilizing structures (i.e., primarily the core and peripheral joints), not the isolated force capabilities of the prime movers. This has been called “functional training” by various conditioning specialists. However, I believe there is a slight theoretical difference between functional training and SLT. In order to maintain clarity and continuity, let’s take a moment to provide some operational definitions for terms we will use.

The above figure shows a very effective exercise for runners. Although the movement does not appear to be specific to running on first sight, it does mimic the horizontal force production in running. This exercise could be classified as SLT and Functional.

SLT matches the type of training performed on the Stability Ball (SB) perfectly. For example, if a person can perform eight repetitions with 45 pound dumbbells on bench presses, they will only get a fraction of that on a stability ball. Why? Due to the additional stabilization demands. Therefore, the individual is limited by the stabilization requirement not by the strength of the major chest musculature. Therefore, the name SLT applies quite nicely.

It's virtually impossible to handle the same amount of weight on a SB incline DB press as on a regular bench, especially with an alternating pattern.

The purpose of SLT is the same as all functional training, to reduce the deficit in force production caused by the additional stabilization. As the deficit in force production is reduced (i.e., you are able to perform as many reps on the Stability Ball as you do on a bench), the joint integrity and stabilization increases. This allows one to produce more force in familiar tasks (e.g., a standard bench press) or more challenging environments (e.g., the playing field).

Stability Ball Training Safety Considerations

1. Select a ball that allows you to sit comfortably.

The ball size that will allow the most amount of versatility in stability ball exercises will allow you to sit on it with your knees and hips at 90°. However, using different size balls will allow you more flexibility and variation with your SB training. The different ball sizes allow body weight to be shifted in the appropriate direction as to remove or add weight to any exercise. The size of the ball can also take into account for flexibility differences amongst users.

In this chest and abdominal stretch (pictured above), the more pronounced curvature of the smaller ball make the stretch more severe. The larger the ball, the less risk of hyperextension of the spine, especially with people who are limited in this flexibility (e.g., geriatrics).

2. Always exercise with a shirt.

Although several SB exercise videos show their models exercising without a shirt or in tank tops, exercising with these garments increase the chances for injury. Exercise will naturally cause sweating. A sweaty body can easily slide off the ball, causing serious injury, especially if one falls while holding weight overhead. A shirt will also keep the spreading of germs and bacteria to a minimum. If the SB is being used in the gym setting, keeping it clean with soap and water will also maintain proper sanitary conditions in the training environment and prevent the spread of germs and bacteria amongst clients and gym members.

3. Do not use any type of support or anchors when training with the SB.

The whole idea is to train in an unstable environment. The additional weight that can be handled when stabilizing the ball adds to the risk of an accident. I recommend training in an unstable training environment. That is why I use the SB. If I need to train higher volumes with more aggressive intensities, I use the stable environment provided by a bench.

4. Handle lighter loads than when training on a standard bench.

I do not recommend using high loads to failure during SLT on the SB. It’s virtually impossible and does not promote to proper execution. An accident due to fatigue or technique error, while on a stability ball, can happen too fast even for a spotter to correct. The exercise should terminated at first sign of technique error or fatigue.

5. Spotters are recommended when using external resistance on the SB

However, if you are using appropriate loads and good form, minimal supervision is required. Even moderate loads will provide significant stabilization stimuli. Remember that training should be fun and is ultimately a process for performance enhancement – it is not a contest to see who can handle the most weight!

Basic Teaching Cues and Recommendations

Unless otherwise specified, a neutral alignment of the spine should be maintained when exercising. This is especially critical when it comes to the lumbar spine. The key is to try to prevent the core musculature from disengaging and allowing a hyperextension of the lumbar spine during compression or flexion loading. A “neutral spine” is preferred when exercising, although occasionally we will ask for a posteriorly tilted pelvis during specific movements, like a push up or roll out. This is done to teach preferential recruitment of specific musculature and safety. After proper core stabilization is mastered during the exercises, we no longer insist on a posterior pelvic tilt during the execution prone exercises.

Robinson defines a neutral spine as “a position or range of movement defined by the patient’s symptoms, pathology and current musculoskeletal restrictions. It is a position in which a vertical force exerted through the spine allows equal weight transference to the weight bearing surfaces (e.g., in sitting – the ischial tuberosities, in standing – the feet).” It should be noted that a neutral spine is an ideal concept, defined differently by various authorities. A neutral spine is also different from person to person, therefore don’t get too caught up the “exactness” of the definition and just use the concept!

When suspended in prone positions that load flexion of the spine (e.g. push-up or roll-out position), an attempt to maintain a posterior pelvic tilt engages the lower abdominals and prevents the lumbar spine form hyper-extending. Although maintaining a “neutral spine” position during such exercises will provide adequate protection to the lumbar spine, the position is “too close for comfort” and can easily result in lumbar hyperextension in a fatigued state. Especially for beginners, a posterior pelvic tilt provides better stimuli to the lower abdominals and hip flexors, and affords “more room for error.” If you look at most of our clients exercising in a prone position, you will see a natural line at their lumbar spine.

Notice that neither Diane nor I have a posterior pelvic tilt during these push ups. We are able to maintain a neutral pelvic line during the exercise.

Body and SB Positioning

Now let’s take a close look at each body part and offer some general recommendations for positioning:

Head (ball under hips)

The cervical spine or neck should not be hyper flexed or extended. Try to maintain it in the position used when you are standing - in a neutral position. A general exception to this would be if the head needs to be move to avoid hitting a surface, like a push up with your feet on the ball (i.e., the neck may extend a bit more to realize a deeper push up and avoid your face from hitting the ground). (See above picture)

2. Core (ball under hips, knees and feet progression)

When performing exercises where the body is suspended in the prone position between two distal support-points, it is imperative that the core be strong enough to maintain a posterior or neutral pelvic tilt. This protects the lumbar spine from hyperextension and requires exceptional abdominal and hip flexor strength. Strive for a straight body alignment from head to toe. (See above picture).

3. Abdominal strength and tests

A simple method of assessing abdominal strength is to check if a person can maintain their lower back flat to the ground when lifting one bent knee and foot off the ground. This test can then be advanced to two knees and eventually to extended leg(s). A ruler can be used to assure the lumbar spine is in contact with the ground at all times. Insert the ruler under the lumbar spine and have the individual pinch the ruler against the ground. If you can pull the ruler out during the test the lower abdominals have not been able to maintain a posterior pelvic tilt (i.e. has not maintained a flat lower back) – this means lower abdominals are relatively weak. If an individual cannot maintain a flat lower back during this test, they should not to perform exercises that risk lumbar hyperextension, such as the rollouts (i.e., loaded flexion in a prone position).

4. Protraction/Retraction

Finally, exercises requiring the arms to support the weight of the body demand optimal integrity of the shoulder complex. The key element to look for is proper stabilization of the scapula and thoracic complexes. An individual should be able to prevent scapular “collapse.” Holding a slightly, retracted (i.e., pre-stretched) position will allow more force production on a bench press, especially since the bench supports the scapulas and prevent their separation from the rib cage. During pronated -SLT on the stability ball, the ability to produce maximum force is superceded by joint stabilization. Therefore, a stable sacpular complex is needed for optimal performance. Retraction and protraction can be emphasized in an isolated manner to teach recruitment patterns and can then be incorporated in normal pressing mechanics.

This retracted position can be part of deliberate retraction and protraction exercises. However, this position should be avoided when stabilizing the shoulder complex during presses (e.g., push ups).

5. Standing Exercises

When exercising in a standing position, there are a few teaching cues that will help to make the learning and training process flow smoothly. During wall slides, the middle of the Stability Ball should be at about the belt line. This ball position will provide adequate support when in the bottom position of a squat.

When performing free standing, single leg exercises, smaller balls require less flexibility on the part of the trailing leg’s hip flexors. However, a deeper squat is possible with the smaller balls, placing a higher strength demand on the part of the ground leg hip extensors. Larger balls require greater hip flexor flexibility but reduce the range of motion, placing less emphasis on strength.

Obviously, a two-leg position of any exercise should be mastered before a one-leg version is attempted.

(Top) notice the beginning position of the ball. This "belt line" position allows proper stabilization and balance throughout the exercise.
(Below) Single leg exercises require less flexibility when smaller balls are used. However, they allow a deeper squat that requires more strength.

The next article will address the lever system inherent to SB training. We will explore the progressive nature of this lever system and how to apply it to increase intensity to SB training. The next section will also look at some of the complimentary equipment we have used over the year to make SB training more versatile.

References:

  1. 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.
  2. 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.
  3. Blievernicht, J. Balance: Course Manual. Chicago, IL 1996.
  4. Boehme, Regi, OTR. Improving Upper Body Control. Tucson: Therapy Skill Builders, 1988.
  5. 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.
  6. Brody, Liz. “ The Axler: A Workout That’s Really on the Ball.” Shape. April 1993: 86-93.
  7. Carrie, Beate, P.T. “ Swiss Ball Exercises.” PT Magazine. September; 92-100. 1993.
  8. Carrie, Beate, P.T. and Linda Felix, P.T. “ In Consideration of Proportions.” PT Magazine. April 1993: 59.
  9. Carter AT: Piriformis syndrome: A hidden cause of sciatic pain. Athl Training 1988; 23(3):243-245. 1975
  10. Chek P. Scientific Back Training: Correspondence Course Manual. Paul Chek Seminars. LaJolla, CA 1994.
  11. Chek P. Swiss Ball Exercises for Athletes I-III. Paul Chek Seminars. Encenitas, CA 1997.
  12. Chek P. Scientific Abdominal Training. Correspondence Course Manual. Paul Chek Seminars. Lajolla, CA 1992.
  13. Chek P. Strong ‘N’ Stable Swiss Ball Weight Training Series, Vol. 1-3. Paul Chek Seminars. Encenitas, CA 1997.
  14. Clark, M. “Functional Leg Training”. NSCA Annual Conference, presentation. Kansa City, Missouri, 1999.
  15. Clark, M. “Foundations for Function”. Learn by Doing Seminar Series, Coral Gables, Florida, 1999.
  16. Cooper, Douglas. Dynamic Stabilization Exercises for the Lower Back. Portland: Douglas Cooper, 1992.
  17. Creager, Caroline C. Theraputic Exercises Using the Swiss Ball. Boulder: Executive Physical Therapy, 1994.
  18. 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.
  19. Dominguez, Richard H, MD, Gajada Robert. Total Body Training. New York: Warner Books, 1982.
  20. Farfan HF. Effects of torsion on the intervertebral joints. Can J Surg 1969;12:336-341
  21. Farfan HF. Musculature mechanism of the lumbar spine and the position of power and efficiency. Orthop Clin North Am 1975; 6:135-144
  22. Farfan, H. F., Biomechanics of the Lumbar Spine in Managing Low Back Pain, Kirkaldy Willis, W.H., Ed. New York: Churchill-Livingston,1983.
  23. Foley, Erin. Personal Communication. Archivist, Robert L Parkinson and research Center. April 21, 2000.
  24. Fox, Charles P., ed. Old-Time Circus Cuts. New York: Dover Publications. 1979.
  25. Gambetta, V., "Building the Complete Athlete," (Course Manual), 1996.
  26. Gambetta, V., Clark, M., “ A formula for function”, Training and Conditioning, 8(4):24-29, 1998.
  27. Gambetta, V., Gary, G., “Following a functional path”, Training and Conditioning, 5(2):25-30, 1995.
  28. Gomez, Niska. Somarhythms: Developing Somatic Awareness with Large, Inflatable Balls.” Somatics. Spring/Summer, 1992. Pp12-18.
  29. Grabiner M. et al. Decoupling of bilateral paraspinal excitation in subjects with low back pain. Spine. 17(10):1219-1223. 1992.
  30. Granhed H, Jonson R and Hansson T. The loads on the lumbar spine during extreme weight lifting. Spine. 12(2): 146-149. 1987
  31. Gray, G.W., "Chain Reaction Festival," (Course Manual), Adrian, Michigan. Wynne Marketing.1996.
  32. Headley BJ: The “Play-Ball” Exercise Program. St. Paul. Minnesota, Pain Resources, Ltd., 1990.
  33. Hodges, P.W. , Richardson, C.A. Inefficient Muscular Stabilization of the Lumbar Spine Associated with Low Back Pain. Spine, 21(22):2640-2650, 1996.
  34. 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.
  35. Hypes, Barbara. Facilitating Development and Sensorimotor Function: Treatment with the Ball. Minnesota: P Press, 1991.
  36. Klien-Vogelbach, Suzanne. Theraputic Exercises in Functional Kinetics. Germany: Springer-Velag, 1991.
  37. Koes BW, Bouter LM, Beckerman H, et al. Physiotherapy exercises and back pain: a blinded review. BMJ. 1991; 302;1572-1576.
  38. Kucera, Maria. Gymnastik mit dem Hupfball (Exercise with the GymBall). 5Th Edition. Stuttgart: Gustav Fischer Verlag, 1993.
  39. Maurer, H. (no date) Gymnastik Ball. A Handout. 7112 Waldenburg zur Ausbildung von; Gymnastiklehrerinnen F.M.B.H.
  40. 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.
  41. Multiple Muscle Systems; Biomechanics and Movement Organization. Edited by Jack M. Winters and Savio L-Y Woo. pg 252-253
  42. Nachemson A, Morris JM. In vivo measurements of intradiscal pressure. J Bone Joint Surg Am.;46:1077-1080. 1964
  43. Nachemson AL: Disc Pressure measurements. Spine. 6;93-97, 1981.
  44. Nachemson, A. The load on the lumbar disks in different positions of the body. Clin Orthop.;45:107-112. 1966
  45. Nachemson, A.L., The Lumbar Spine, An Orthopedic Challenge. Spine 1:59, 1976.
  46. 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.
  47. 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.
  48. Pace JB: Commonly overlooked pain syndromes responsive to simple therapy. Postgrad Med; 58(4):107-113.
  49. 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
  50. Porterfield J.A. and DeRosa C. Mechanical Low Back Pain. Philadelphia: W.B.Saunders Co. 1991
  51. Posner-Mayer, J. Swiss Ball Applications for Orthopedic and Sports Medicine. Denver: Ball Dynamics International, Inc. 1995.
  52. Rathke, F., Knupfer, H. (no date) Exercise Ball: Exercising tool for child development. A handout. Stutttgart. Municipal Center.
  53. Robinson, R. The New Back School Prescription: Stabilization Training Part I. Occupt Med. 7(1):17-31. 1992.
  54. Saal J. Dynamic Muscular stabilization in the Nonoperative treatment of lumbar pain syndromes, in Orthopedic Review Vol. XlX No. 8 Aug 1990.
  55. Saal J. et al. Non operative management of herniated cervical intervertebral disc with radiculopathy. Spine,. 21(16). 1996
  56. Santana, JC. The Essence of Stability Ball Training, Vol I-II. Optimum Performance Systems, Boca Raton, Florida, 1999.
  57. 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.
  58. Sieg, K., Adams, S. Illustrated Essentials of Musculoskeletal Anatomy. Gainsville, Fl. Megabooks, Inc. 1985.
  59. Sweet, Waldo E. Sport and Recreation in Ancient Greece: A sourcebook with Translations. New York: Oxford University Press, 1987.
  60. Wirhed, R. Athletic ability and the anatomy of motion. Wolf Medical Publications. 1990.
  61. Wolpaw, J.R., Braitmman, D. J., Seegal. Adaptive plasticity in the primate spinal reflex: initital development. J Neurophysiology. 50:1296-1311, 1983.
  62. Wolpaw, J.R. Acquisition and maintenance of the simplest motor skill: investigation of CNS. Med. Sci. Sports Exerc. 26(12):1475-1479, 1994
  63. Zetterberg C, Andersson GBJ, Schultz AB: The activity of individual trunk muscles during heavy physical loading. Spine 12:1035-1040, 1987
  64. Ziethen, Karl-Heniz, Allen, Andrew. Juggling: The Art and Its Artists. Berliniwerner Rausch & Werner Luft. 1985.