Back care: A concern for fitness professionals

Approximately 80 percent of the American population will experience back pain at some time in their lives. Back pain is attributed to poor posture, incorrect body mechanics and imbalance of flexibility and strength in postural muscles. Too much sitting, not being aware of back care on the job, or in everyday life, causes muscle strain and disc problems.

Since the 1900s, prior to the industrial revolution, physical activity such as milking cows, hand-washing clothes and chopping firewood was normal in everyone's lifestyle. Yet, today's society suffers from years of inactivity at home and on the job. Computer technology forces many of us to sit for hours at a time. Absorbed in our work, we forget to maintain erect neutral posture. The majority of our population doesn't know what neutral posture is, much less how to achieve it.

"Our culture, because of supporting sitting as we do, is generally not conditioned for unsupported spinal alignment," says Posner-Mayer. "Posture is not a conscious activity. But, it can be taught." She says it's a matter of developing "postural endurance" or enough repetition of neutral spinal alignment that, eventually, your body will automatically remember.

"We realized there was a need for an exercise tool to educate the public about back care," says Zappala. "So, four years ago, we began developing Fit-ball programming for the home and health club. Our goal is to train consumers about back care and injury prevention. Even if only used for strengthening and stretching, it's a great tool and develops 'muscle smarts' or neuromuscular training at a subconscious level that develops balance and neutral posture."

Neutral posture

"Neutral posture is neither an excessively arched back (maximum anterior tilt), nor a flat back (maximum posterior tilt). It is somewhere in-between -- a very strong position that allows the natural curves in the lumbar, thoracic and cervical regions," says Brooks. "Neutral alignment helps avoid a concentration of compression and sheering forces to the discs." He adds that there is no exact or perfect neutral posture; it varies from one person to the next. So, the first step when learning ball exercises is to begin with neutral posture.

Functional movement

Functional movement (the ability to move and respond without restriction) is dependent on how we move with gravity. Ball exercises teach people to use the ball with gravity for dynamic movement, to enhance movement not only for sports and fitness, but to complement everyday tasks.

According to Brooks, function movement includes such tasks as lifting techniques at work, playing with children, carrying groceries, gardening and yard work, and recreational pursuits. "Because the surface is unstable on the ball, you are constantly challenged to maintain posture and to think about it throughout movements. Over time, your body develops a subconscious ability to remain in good posture throughout the day."

Exercises

As with any fitness program, professionals should provide proper instruction and demonstrate technique. Always provide options to modify exercises. Manuals provided with the balls outline simple options to accommodate everyone with more advanced options once proper technique is mastered.

The ball facilitates several modes of strength, flexibility and balance. "As you work with the ball, you find it is especially effective in strengthening the abdominal and lower-back muscles for trunk stability," says Brooks. "The abdominals, back and gluteal muscles work to hold joints in proper position, and the spine in alignment with pelvic stability. This decreases stress to ligaments, discs and joint structures. Even while training other muscles, the trunk musculature simultaneously works to balance and stabilize the body."

For too long in the fitness industry, we've concentrated on developing only core muscles in the front of the body: the abdominals. Now, the ball allows us to introduce back exercises in safe progressions to facilitate muscle balance, therefore promoting better posture for functional movement.

There are hundreds of ball exercises from which to choose. The ones that follow are my personal favorites for developing trunk stability and proprioception. As with any exercise program, warm up for eight to 10 minutes before beginning exercise, cool down, then stretch. Keep in mind that these exercise versions are the simplest and within the capabilities of most people. More difficult options are available, but these should be mastered first.



Seated: Base position -- a necessary starting point to discover "neutral posture" before beginning ball program

Supine trunk curl for the frontal abdominals

Prone opposition arm/leg raise for back muscles

Prone push up

Supine hip extension -- great trunk stability exercise

The issue of bouncing

Although bouncing on the ball is only a small part of ball training, there are conflicting opinions as to whether someone should bounce for cardiovascular fitness. Posner-Mayer, one of the first Americans to use and teach the benefits of the ball, recommends bouncing for very-low-level cardiovascular exercise. "Therapists and doctors have used the ball for years," she says. "Neurosurgeons assign patients having undergone back disc surgery to ball therapy. One of the first things they do is bounce. The ball encourages automatic alignment of the spine. Ball movement makes changes in posture and co-activates abdominal and back muscles to stay in balance."

According to Day, it depends on the individual. "When you move in a car, run or walk, bouncing is normal," he says. "Bouncing is a part of functional movement. If I bounce someone on the ball, if they suffer no adverse reaction, we will continue as long as the patient enjoys it. In our profession, to say you absolutely shouldn't do a certain type of movement is not realistic. Each individual is different. Fitness professionals need to understand that no movement or exercise should ever be etched in granite as an absolute do or don't. I suggest leaving it open. If it's fun with no adverse effects, and if you can increase the level of activity to a steady state, do it." Although Day admits there is hardly any research on bouncing, he says the bottom line is to get a ball and try it.

Physical therapist Tom Purvis, a well-known fitness industry researcher, suggests excessive bouncing with poor alignment could damage the spine. But, he says, joint nutrition (which is achieved by alternating compression and relaxation of the discs) should be the result of controlled motion of the spine in all planes of movement. And, although joint nutrition is important, "the risk of mechanical stress on the spine by uncontrolled bouncing far outweighs any potential effectiveness for low-level cardiovascular training effect." Resist-A-Ball experts insist there are many other effective cardiovascular exercises. "Stick to what we know for sure," says Brooks, "that using the ball for controlled core stability, flexibility and balance are the best bets until more research is available."

All sources for this article agree, however, that it's vitally important to properly assess each person's ability on the ball and the appropriateness of the exercises. Fitness professionals should look for a program that provides sound education about proper mechanics and appropriate uses, and client screening is imperative.

Conclusion

It's conceivable that one ball per person is enough to condition the entire body for strength, endurance, coordination and balance. However, in our industry, less isn't necessarily better. With emphasis on wellness programming and preventive health maintenance for a less-active population, as well as lifelong fitness and cross training for the active population, the balls are already taking their place next to steps, slideboards, elastic tubing and boxing gear. But, what will club members derive the most benefits from over time? More important, what will keep them motivated at home, as well as at the club? I'll put my money on the ball, especially when our goal is to attract the larger population which is intimidated by exercise.

As diverse as the uses are, each person finds a unique reason to get on the ball. As Day says, "It's the nuances of the exercises that make them successful. The practitioner must be creative. The exercises must be challenging and appealing so people will do them."


Benefits of using the ball

More than 25,000 balls were sold in the physical therapy industry in 1994 for uses from back surgery to hand therapy to neurological disorders, and even for the physically challenged. Some specific benefits to fitness instructors and personal trainers include:


non/low-impact exercise

promotes functional movement for everyday life

challenging for all fitness levels

fun

improves dynamic balance, coordination and body awareness

activates postural/spinal muscles

promotes correct posture

improves confidence

inexpensive

good for home, office, fitness facility

great for group and individual exercise


History of the ball

You may know these balls as "Swiss balls" because their use today in physical therapy clinics around the world originated in Switzerland in the 1900s after Susan Klein-Vogelbach, P.T., first used them to rehabilitate orthopedic and neurological injuries for proprioception and muscle stabilization. (Klein-Vogelbach is responsible for developing the theory of functional kinetic movement.)

Several U.S. companies distribute these balls under various company names, in different colors, sizes and shapes. However, all the balls are made by two Italian companies: Ledraplastic and Ledragomma. Some distributors of these balls include Physio Ball, Gynmastik Ball, Gym Ball, Gymnik Ball, Swiss Ball, FitBall and Resist-A-Ball.


Use and storage of the ball

Stability balls come in all sizes and colors, and are inexpensive -- ranging from about $15 to $60 each. When you buy in large quantities, the cost goes down. Look for durability, and make sure you choose the right size. When sitting on the ball, hips and knees should align at a 90-degree angle. Individuals under 5 feet tall need a 17-inch (45 cm) ball; 5 feet to 5 feet, 7 inches a 21-inch (55 cm) ball; 5 feet 8 inches to 6 feet 2 inches a 25-inch (65 cm) ball, and 6 feet 3 inches and over a 29-inch (75 cm) ball. For proper inflation and ball care, see the instructions that come with the ball.

Industry experts agree that using the ball is so exciting and fun, that storage is not really a concern. Many facilities have constructed plastic piping storage units. Some even keep the balls lying around the weight-room to encourage non-group exercisers to use them for stretching.


Study results of the ball

A recent study at Columbia University in New York provided valuable exercise-adherence results. The experimental group participated in the exercises seated on balls, while a control group participated in the same exercises on a chair. Both exercised for the same duration. Results showed that those who exercised on chairs experienced no significant cardiovascular gains, while the experimental group did. Also, at the end of the study, the experimental group expressed interest in continuing the exercise program, and all but one of the control group expressed the interest to exercise on a ball instead of a chair.