re: proper prescription when using the swiss ball

[jgreen]

To those who are experienced in prescribing the use of the swiss ball for individuals with LBP/decreased core stability (i.e. multifidus inhibition and/or atrophy):

From your experience do you feel that one would be able to achieve successful activation of the TA/multifidus by prescribing the use of a swiss ball (to soley gain activation) without out first achieving an active contraction of the TA/multifidus in more static positions (i.e crook lye/4pt kneel)???

For example, client who has been experiencing LBP, symptoms resolved (or nearly resolved), is told to buy a swiss ball and sit on it at home and or at the office instead of a chair. Instruction given on how to sit properly and to stabilize with lower abdomen.

Quest? will this provide adequate stimulus to automatically activate the TA/multifidus core stability

Any experienced feedback would be greatly appreciated!

[Bazza]

Dear J Geen
I am a chartered physio who uses the swiss ball on a daily basis both in clinical practice & exercise.

I feel that it is possible to achieve TrA/multifidus contraction when sitting on the ball as long as the patient has been shown how to find lsp neutral & providing that the ball is the correct size. Prof Janda has stated that the multifidus is very difficult to activate voluntarily, which means that the swiss ball is the ideal tool to achieve this as it is unstable. Swiss ball training & spinal stability is of special interest to me & I have been having very good results with using it on a variety of patients. I am hoping at some stage to do some research on the ball as there has been very little done to date. I have sold 5 balls for use as chairs for patients with lbp & each one has shown a huge improvement. I also feel that the ball is great when used prophalacticly,as Janda also states that if stability is increased by 50% it would reduce orthopaedic injuries by 80%

[karlyfinlayson]

any thoughs on ball prescription: burst vs anti-burst? and why as physios we are opting for the more dangerous choice?

[karlyfinlayson]

I am sitting on a mediball at the moment (the only type of ball I would recommend to a patient- due to its static loading capacity and anti-burst quality---something any patient with lbp would appreciated to prevent further injuries).
I believe that isolated/static TA and MF contractions are not required previous to use of a swissball!
4pt kneeling/crooklying etc are not funtional positions; thus carryover to everyday tasks is minimal; little feedback is available outside clinic environment for beginners(when positions aren't functional); and dynamic isolation occurs with the use of a ball regardless - hence the whole unstable base theory behind the ball-(just try it!)
However, a patient does needs accurate size prescription in order to achieve correct postural alignment for muscle stabilisation, and thus needs to be taught this correct posture and/or exercises by experienced professionals. I believe the ball is a great tool, and approve of its use for both prevention and rehab, but understand its usefulness is limited without proper education of techniques etc.

[karlyfinlayson]

Q. have many physios out there had much to do with paul chek courses etc?
what do you think of his ideas?

[NARSTR]

This can be tricky - some patients and PTs never really feel that they can 'get it right'. Bio feedback is helpful but I think it is moe useful to practise in isolation first. The person has to understand the theory and then increase awareness of TA and MF. If they are unsuccessful in this after trying hard, I would abandon movements in isolation and go for the swiss ball.
Incidentally, I am trying to teach martial arts instructor a) costal breathing and b)TA facilitation. Not going to be a success, I feel.