by JC Santana, M.ED., CSCS

Stability exercise balls have become a very popular tool within the clinical rehab setting. Their versatility allows their use with any population. Recently, stability exercise balls have become popular outside rehab settings. Their effectiveness in developing balance and core strength has earned them a spot in the world of athletic and functional conditioning.

Various strength and conditioning experts have designed a multitude of exercises covering the entire body with stability balls. The following exercise progressions are some of the exercises and progressions I have developed over the years. Omitted from this list are many rudimentary rehab exercises, as well as combination training where other pieces of equipment are used in conjunction with the exercise ball. Your imagination is the only limitation encountered when using this great conditioning tool.

Ball Selection
Selecting a stability exercise ball is simple. A properly sized exercise ball will allow you to sit on it with you knees and hip at 90 degrees. However, using different size balls will allow you more flexibility and variation with your stability ball training.

General Recommendations
The following recommendations will increase the safety and fun of working with the stability exercise ball.

1. Always exercise with a shirt – a sweaty body will slide off the ball which could cause an injury, especially if one falls while holding weights overhead.

2. Do not use any type of support or anchors for supporting limbs when training with the stability exercise ball. The whole idea is to train in an unstable environment.

3. When using external resistance, you must handle lighter loads than you would when training on a standard bench. Do not use high loads to failure with this type of training.

4. Spotters are recommended when using external resistance equipment. However, if you are using appropriate loads and form, minimal supervision is needed.

Body Alignment
Let’s talk about the body alignment in some of the fundamental exercise positions. Unless otherwise specified, a neutral alignment of the spine should be maintained when exercising.

1. Head (ball under hips) – The cervical spine, or neck, should not be hyper-flexed. Try to maintain it in the position used when you are standing - in a neutral position. Likewise, do not hyper extend the neck when exercising.

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 pelvic tilt. This protects the lumbar spine from hyperextension and requires exceptional abdominal and hip flexor strength. Notice the straight body alignment from head to toe.

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 knee. This test can then be advanced to two knees and eventually to an extended leg. If an individual cannot maintain a flat lower back during this test, they should not to perform exercises that risk lumbar hyperextension.

Prone Lever System (hip > knees > feet > two legs > one leg)
The lever system inherent to stability exercise ball training can take into account not only the core stability of an individual; it can also adjust the resistance applied to the extremities.

Push-ups
As the ball support goes further away from the arms, the demand for core stability is increased as well as the weight the arms must support. The longer the distance between the support points, in this instant the ball and arms, the harder the exercises will be.

Increased Neural Demand (Reducing Contact Area of Support)
Reducing the contact surface of any supporting limb can increase the neural demand of any exercise, especially where the legs contact the ball. 2 Leg support on the shins or insteps is the easiest, then proceed to 2 legs on ball of the foot, then 1 leg on ball of foot, and finally 1 leg on toes.

Leg Position for Stabilization Progression (two legs vs. one leg, wide vs. narrow)
The width of the support at the legs can also provide adjustments in the demand of an exercise. A wide leg position offers more support than a narrow position making the exercise easier. As the legs get closer to each other, there is less of a support base making the exercise harder. Ultimately 1 leg supported exercises are the hardest due to the additional support demands. Careful attention should be paid to stabilizing the hips in a stable and leveled position, preventing lumbar hyperextension and core or hip ration.

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 scapulas. An individual should be able to prevent scapular collapse to a retracted position. Ideally, a neutral scapula is desired during isometric support; however, protraction can be incorporated at the end of the chest pressing movements.

Exercise During Standing
When exercising in a standing position there are a few teaching cues which will help make the learning and training process flow smoothly.

1. 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. Always master 2 leg exercises before progressing to single leg exercises.

2. During one-leg exercises where the free leg is being supported by a ball, smaller balls require less flexibility from the adductors and hip flexors. Choose the smallest ball available to start. Then progress to larger balls, which require the greatest amount of flexibility.

3. Consistent with the lever system previously discussed for prone and supine exercises, the closer the ball is to the mainline of the body the less flexibility and stabilizing requirement. The closer the ball is to the foot the greater the requirement for stabilization and flexibility.

4. During one-leg exercises, start with “stationary”- free leg support. This requires less balance then the dynamic movement you will progress to.

Once you have advanced to the dynamic, one-leg exercises, a “foot to mid-lower-leg role” adds a bit of stability in terms of ball position. However, the action and speed of the exercise dominate the stability requirements. If you do not have perfect execution during this dynamic exercise the ball will role the “free leg” off.