Swiss Ball bridging exercises for core stability

essential principle

• "the tail must not wag the dog" = must not loose control over the 'neutral zone' of the spine

therefore the peripheral musculature may need to be long and strong, whereas the core (stabilizing) musculature may require endurance

Good exercise prescription takes into account whether the person is functionally unstable due to weakness, stiffness or hyperlaxity

• must begin from a point of stability and gradually work to points of instability
• under optimal conditions it requires up to 16 weeks to develop good endurance and 6- 12 weeks to develop strength
• co-ordination and timing of core muscle synergistic interaction may be essential
  • Transverse Abdominis
  • Internal Oblique
  • Latissimus Dorsi
  • Multifidus
  • Piriformis
  • Obturators
  • Gluteals
  • Iliacus
• REMEMBER stability is only functional if it controls active range of movement without reducing the degrees of freedom to such an extent that movement becomes inefficient and hence non-optimal.
• control is dynamic like a pendulum always oscillating and returning to its starting position which means that postural sway and purtubations are important
• muscle lengthening and shortening should be viewed in a manner similar to the stretch-shortening cycle of an elastic band whereby the conversion of potential energy to kinetic energy is in a continuous cycle.
• improved stability should NOT come at the expense of excessive pathological joint compressive forces

if the prime movers (eg hamstrings, iliopsoas, rectus femoris, pectoralis major) are to move the body without creating damaging torques to the vertebrae

Examine the pelvic control of the deep hip flexors, deep hip rotators - remember these are endurance, low threshold muscles and therefore may need several repetitions of movement to ascertain any compensatory use of ballistic, fast twitch, superficial muscles such as upper gluteus maximus, external obliques, rectus abdominis, rectus femoris and hamstring muscles.

Control over low threshold loading needs to be attained before Swiss Ball bridging exercises are implemented

(link to anatomical picture of back muscles)

remember to use your 'clinical reasoning' process to determine the relevance of specific findings to the entire clinical picture

core stability with rhythmic stabilizations

core stability with transverse abdominis work + knee flexion/extension

theratubing may be used in functional movement patterns (e.g. emphases on the powerful movement of a swimming stroke or the aspect of the stroke which is taxing the core stability the most)

additionally, the peripheral nerves need to be able to move amongst the tissue with which they interface

core stability with straight leg raising (SLR)

hip extension through gluteal work, without losing the 'neutral zone' of the spine (tight hip flexors or rectus femoris may prevent good lumbo-pelvic alignment)

functional theratubing exercises whilst stabilizing on the Swiss Ball

• with the deep joint stabilizing muscles providing the stability, the 'prime movers' may provide the 'action'

• generally speaking the stabilizing muscles of most peripheral joints are one joint muscles with an endurance function ('shunt muscles'). These muscles are usually close to the joint, however in the spine and scapula they cross more than one joint (e.g. Transverse Abdominis, Internal Oblique, Trapezius, Serratus Anterior, Iliacus, Obterators, Gluteus Medius and Minimus, inferior Gluteus Maximus, Quadratus Femoris)

• the prime movers are the muscles which lend power to the movement e.g. Hamstrings, Rectus Femoris, Superior Gluteus Maximus/ITB/Vastus Lateralis, Rectus Abdominis and External Oblique.  Therefore when designing an exercise regime the client must begin with good muscular stability before commencement of training of the prime movers.

• rotation is essential for ADL, however it must be controlled by synergistic action between muscles

• frequently, clients compensate for lack of stability by increasing the speed at which they do the task.  This then leads to further in-coordination, poor timing between muscles, loss of synergy, and more dysfunction.

Evaluation of functional and neuromuscular changes after exercise rehabilitation for low back pain using a Swiss ball: a pilot study.

Exercise Rehabilitation Clinic, Department of Sport and Exercise Science, University of Auckland, Auckland, New Zealand.

Marshall PW, Murphy BA: J Manipulative Physiol Ther. 2006 Sep;29(7):550-60.

OBJECTIVE: The purpose of this pilot study was to use a multidimensional model to evaluate deficits in patients with low back pain (LBP) over the course of a 12-week rehabilitation program using the Swiss ball. METHODS: A within-subjects, repeated-measures design based at the University exercise training clinic was used. Twenty patients with chronic nonspecific LBP (12 men, 8 women; symptom duration, 4.8 years; 38.8 +/- 12.1 years old; height, 1.76 +/- 0.06 m; weight, 76.15 +/- 7.21 kg) participated in this study. Self-report measures were the Oswestry Disability Index, Visual Analog Scale, Medical Outcomes 12-Item Short Form Health Survey, and Self-Efficacy For Exercise Scale. Physiologic measures were electromyography measurement of feedforward muscle activation, flexion relaxation phenomenon, myoelectric fatigue, endurance capacity measured by the Sorenson test, and a modified sit-up test. Individuals performed 12 weeks of progressive exercise periodized every 4 weeks using a Swiss ball. Outcome measures were assessed at baseline, 4 weeks, 8 weeks, 12 weeks, and at a 3-month follow-up. Repeated-measures analysis for variance for time differences and regression analysis for variance in Oswestry scores were performed. RESULTS: The Oswestry score for self-reported disability significantly decreased over the intervention (F(4,14) = 19.456, P < .001). Significant improvements in pain and disability maintained to the 3 months of follow-up. There were significant changes in perceptions of physical and mental well-being, erector spinae fatigue, and flexion relaxation measures. Change in flexion relaxation explained 38% of the improvement in Oswestry scores at the 12-week measurement. CONCLUSIONS: This study showed that the Swiss ball may be successfully used in a rehabilitation context for patients with LBP. This pilot study has used a novel approach to assess improvements during a rehabilitation program, which may be used in the future to explain differences between different treatment modalities.

Core Muscle Response Times and Postural Reactions in Soccer Players and Nonplayers

BORGHUIS, AREND JAN; LEMMINK, KOEN A. P. M.; HOF, AT L.

Medicine & Science in Sports & Exercise. 43(1):108-114, January 2011.

Abstract:

ABSTRACT: Decreased core stability has been suggested to be associated with a higher occurrence of lower extremity injuries and low back pain. In a physical contact sport like soccer, direction-specific muscle reflex responses are crucial in maintaining core stability. Delayed core muscle response times repeatedly have been reported in patients with low back pain, but no study has compared core muscle reflex latencies and postural control between soccer players and less active nonplayers.

Purpose: The goal of this study was to investigate whether soccer players will exhibit shorter average core muscle reflex latencies along with less postural sway in response to a sudden trunk perturbation compared with nonplayers. A second goal was to see whether postural control measures are a valid, more practical alternative for the use of surface EMG in measuring reflexive core neuromuscular control.

Methods: Sudden trunk loading in the frontal and sagittal plane was used in 10 high-level amateur soccer players and 11 less active nonplayers to study core muscle reflex latencies, using surface EMG of six major trunk muscles. Simultaneously, kinematic response data of a balance seat were obtained using gyroscopes measuring seat angular velocity.

Results: Soccer players demonstrated shorter reflex latencies compared with nonplayers for the rectus abdominis, erector spinae, and externus obliquus muscles in response to sagittal plane perturbations. These shorter reflex latencies went along with greater seat movement in response to sudden trunk loading, with moderate correlations between the two measures.

Conclusions: The results showing shorter reflex latencies and greater balancing movements for soccer players add to the debate whether more postural sway is an appropriate indicator of having less neuromuscular control.

Last update : 17 December 2010