PT on the Net Research

Stability Ball Training - Part 2

The effectiveness of the Stability Ball (SB) can be gauged by its increasing popularity and reported results. However, not all conditioning professionals agree on the efficacy of its use. One of the issues that opponents of SB training always bring up is the lack of “specific” scientific research on this type of training. Although specific research on the Stability Ball is practically impossible to find, there is abundant science that confirms the efficacy of its use. When reviewing the spine and trunk stabilization work done by Saal, Grabiner, Robinson, Hodges, Liebenson & Hyman and others, conclusions can easily be drawn which substantiate the use of the SB in spine rehabilitation and athletic conditioning.

One of the most interesting observations when viewing the anatomy of the spine is the deep segmental muscles involved in stabilization. These segmental muscles, such as the multifidus, play a very important role during the stabilization of functional movements.

Coaches and trainers use exercises such dead lifts, good mornings or squats to strengthen the spine. Yet, these traditional methods of strengthening the spine have not been effective in developing these very important spinal stabilizers. Although these exercises are effective for strengthening the hips and spinal erectors, the lordotic posture used during the execution of these lifts does not provide the ultimate stimuli for spinal stimuli development.

The SB allows gentle resisted flexion and extension of the spine, which allows the multi-segmental musculature to be fully engaged. Consequently, the development of these spinal muscles allows better postural control and greater efficiency in movement. Although the scientific literature may not explicitly illustrate this, it does not take a rocket scientist to realize that an individual with a functional spine will move better and be less likely to suffer an injury. I have seen my clients improve their squatting and lunging ability by 50 percent, without doing heavy squatting, lunging or leg pressing! I credit much of their improvement to the core stabilization work we perform using various modalities, including the SB.

The paraspinal group. These muscles are worked primarily by heavy lifts requiring isometric lordotic positions.

*The segmental musculature of the spine. Due to the positioning of these muscles, these muscles do not see significant work in isometric lordotic positions. Lighter flexion extension exercises are more effective for targeting this musculature

Symmetry of movement has also been identified in the literature as a very important aspect of spinal stabilization. Studies by Grabiner have indicated that strength alone does not necessarily correlate with normal function. Subjects with lower back pain (LBP) have consistently shown a lack of symmetry in paraspinal contraction during trunk extension. This lack of neuromuscular symmetry has been able to predict LBP in subjects who had tested normal on dynamometry. Many SB exercises require symmetrical contraction of the paraspinals for successful exercise execution. Asymmetrical contractions will cause the body to lose balance and roll off the SB. Balancing on the SB may require asymmetrical contractions, but they must be deliberate and controlled in order to maintain balance.

There is also a significant body of work demonstrating the importance of the deep abdominal musculature in providing trunk stabilization - particularly the transverse abdominals and obliques.

Rectus abdominus External Obliques Internal Obliques Transverse abdominus

*Notice the orientations of the fibers in the abdominal musculature. The transverse abdominus is the only one who has a horizontal orientation. Therefore it is the only one that is in a position to create the same support as a weight lifting belt (i.e., support the spine by increasing inter-abdominal pressure).

The works by Nachemson, Saal, Wirhed, Hodges and others describe the enormous loads on the spine during daily activities, and the roll the abdominal muscles play in stabilizing the spine during these activities. They all conclude that abdominal training is the cornerstone of any core stabilization program. This body of the research advocates isometric, dynamic and unstable training to develop the deep muscles of the abdominals involved in core stability. The stability ball allows one to implement a variety of exercises that require isometric stabilization, and even explosive contractions geared to activate the fast twitch fibers. The SBs unstable nature also provides perturbation stimulus, which has been shown to help preferentially recruit the deep abdominal musculature. Additionally, due to the SBs ability to roll in any direction, it provides training stimuli in all three planes of motion.

Vibration Research

Another area of research that may add some insight to the efficacy of SB training is that of Vibration Research. Vibratory stimuli has been show to have an impact on force production, as well as induce various tissue changes. The work by Bosco and Necking has shown that vibration training can increase power and induce hypertrophy. Although this studies are specific to precise and constant frequencies that can not be exactly simulated on the SB, the vibration induced by the SB during various exercises can not be automatically ruled ineffective. Additionally, the five sets of 90 to 120 second dose is not beyond the realm of a one-hour workout session partially using the SB. The duration of Bosco’s research was 10 days. Coincidentally, this is about the time when we start to see major improvements in stability and strength in our clients, athletes and non-athletes.

*The unstable nature of SB training, such as SB (hands on ball) push-up, creates a vibratory-like stimulus. I believe this stimulus provides the stabilization strength, and thus force production, we see in all our clients – in spite of the absence of continuous, heavy lifting.

The unstable quality of the ball has an impact on the neutralizers and stabilizers of any joint involved in a movement. For example, the stabilization required to maintain a push-up position (i.e., hands on the ball feet on the floor) recruits and develops the stabilizers and neutralizers of the shoulder girdle/joint in a way that a chest machine cannot. The improved joint function, due to this stabilization work, results in increased joint integrity, decreased injury potential and increased efficiency in force production. I have also seen improvements in my client’s bench presses with very little bench work. Most of my athletes do very little benching, yet they continuously improve in their bench press. I accredit this again to the stabilization work we do on the SB.

In conclusion, the research on stability ball use is not specific to its use. Rather, it describes beneficial training mechanisms targeted by its use. It is the responsibility of the conditioning professional to read through the scientific literature and extrapolate the knowledge they impart. Then, apply training principles that are based on science, but not necessarily explicitly described. Most successful training principles are not initially described by science anyway. They are developed and described by practitioners – science merely substantiates their efficacy. Therefore, beware of an overemphasis on the need for explicit scientific research – a lifetime may pass you by. Effective training methodology usually “feels” right and more important “makes sense.” The optimal criteria I try to strive for, when developing and implementing my training programs is:

  1. Have a strong basis in science, not necessarily described by it.
  2. Have a history substantiating its efficacy (i.e., be field tested).
  3. Make sense.
  4. Be “doable.”
  5. Be fun. Being results oriented, I personally don’t get too caught up in what came first “the chicken or the egg.” Consequently, I do not put too much emphasis on whether “science explained it before the practitioner used it effectively.”


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