By Juan Carlos Santana, MEd, CSCS

This section of the Stability Ball (SB) series will deal with the scientific literature that substantiates SB training.  We will also compare the findings of selected research with the observations we practitioners are witnessing everyday. 

The effectiveness of the Stability Ball 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 stability ball training always bring up is the lack of “specific” scientific research on stability ball 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 stability ball’s use 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 their development.  The stability ball 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%, 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 Stability Ball.

Symmetry of movement has also been identified in the literature as a every 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 Stability Ball may require asymmetrical contractions, but they have 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. 

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 SB’s unstable nature also provides perturbation stimulus, which has been shown to help preferentially recruit the deep abdominal musculature.  Additionally, due to the Stability Ball’s ability to roll in any direction, tit provides training stimuli in all three planes of motion.

Another area of research that may add some insight to the efficacy of Stability Ball 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 Stability Ball during various exercises can not be automatically ruled ineffective.  Additionally, the 5 sets of 90-120 second dose is not out of the realm of an 1 our 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 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 can not.  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 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 Stability Ball.

In conclusion, the research on Stability Ball use is not specific to its use.  Rather, it describes beneficial training mechanisms targeted by it 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.

Stability Ball Training Part III will discuss the concept of Stabilization Limited Training (SLT) and consider some of the basic guidelines and safety issues surrounding SB training.

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