Starting an Exercise Ball Program

Many treatment programs for low back pain incorporate use of an exercise ball (also called a stability or fitness ball) to strengthen the core muscles in the stomach and back that support the spine. Exercise ball exercises clearly work and have been adopted in non-rehabilitation exercise programs by athletes and fitness buffs looking to cross-train and strengthen their core muscles.

This article provides several simple steps to choose, get familiar with, and benefit from using an exercise ball on a regular basis.

Choosing the right exercise ball

Physical therapist, exercise trainers, chiropractors and other professionals have constructed several guidelines to use when selecting the proper exercise ball size.

When sitting upright on an exercise ball:

1.       Feet should be flat on the floor with an even weight distribution.

2.       Knees should be level or slightly lower than the pelvis – creating an angle of 90 degrees or slightly greater at the hips and knees (thighs parallel to ground or pointing down slightly).

3.       Pelvis, shoulders and ears should be in a vertical line; the body should not be leaning in any direction as a counter balance. Bouncing up and down lightly will usually produce this alignment.

Exercise balls generally come in five different diametrical sizes to be accordingly used by people of differing body compositions.

It is important to note that height alone is not the only factor in determining ball size. Because the exercise balls are flexible and offer resistance, weight is also an important factor.

A general guideline for height correspondence to diameter of exercise ball is as follows (assuming average body weight is proportional to height):

Ball diameter	Your height
45cm	5’ and under
55cm	5’1” -5’8”
65cm	5’9” -6’2”
75cm	6’3” -6’7”
85 cm	6’8” and taller

If body weight to height or larger than the average proportion, sitting on the exercise ball will compress it down more, so try using the next larger exercise ball size in order to maintain the 90-degree rule. Another factor to keep in mind is that most exercise ball sizes have some adjustability to them. If the angles at the hips and knees are much greater than 90 degrees, some air can be released to compensate and vice versa.

Bear in mind, releasing air from the exercise ball will cause it to lose air pressure. As the ball flattens out, this will actually make it more stable, as it has a larger contact area with the resisting surface and the body. This means that stabilizing and balancing exercises will become easier and will lose some effectiveness.

Exercise balls also lose pressure because of stretching from regular usuage. Therefore, as the ball ages, it may require further inflation. On the other hand, adding excessive air to the exercise ball will increase the difficulty of balancing and stabilizing, as the contact area decreases.

Starting an exercise ball program

Just siting on an exercise ball is active and requires the core body muscles to work to hold the body upright and balance on the ball. Until sitting on the exercise ball feels comfortable, it is often a good idea to not have the ball fully inflated;a slightly deflated exercise ball is more stable.

·         Sit in the center of the ball with both fee firmly on the ground about shoulder width apart, if this is difficult, than us a wider stance.

·         The knees should be in line over the ankles

·         Shoulders should be in line over the body (not hunching forward) and the head squarely over the next (not leaning forward).

One can easily sit on the exercise ball while working at a desk or computer workstation and use it as an alternative to a tradition office chair. Others prefer to sit on it while watching television. Whatever the use, sitting on an exercise ball as some point of the day is helpful to strengthen the core muscles that support the spine.

Beginning stretches

There are several stretches that are easy to do when starting to use an exercise ball. These stretching exercises help with proprioception, of the sense of the position or parts of the body relative to the rest of the body and with balance. Each of these stretches should be done slowly 8 to 12 times.

·         Move the hips from side-to- side. While sitting on the exercise ball (as described above) and keeping the knees still, move the hips gently from side to side. Pause for a second as the end of each sideways movement to allow for a gentle stretch.

·         Move hips from front – to –back. While keeping the knees still, place hands on the knees and rotate the hips forward by tucking the buttocks first under the pelvis and then push them out behind the pelvis. All the motion should be limited to the hip area, not the knees or chest. 

Does Stress Cause Back Pain?

Could my back pain be caused by stress?

No one would disagree that having back and neck pain causes stress, but what about the other way around? Could stress be the primary cause of back pain?

How does stress cause back pain?

There are a variety of theories about the causes of stress related back pain. Importantly, the overriding tenet in all of these theories is that psychological and emotional factors cause some type of physical change resulting in the back pain.

In most theories of stress related back pain, the pain cycle continues and is exacerbated as the pain leads to the patient becoming timid and anxious about daily activities. The pain cycle is characterized by:

                The patient becomes unnecessarily limited in many functions of daily life, as well as leisure activities

                This decrease in activities is due to the patient’s fear of the pain and injury

                This fear may be made worse by admonitions from doctors (and/or family and friends) to “ take it easy” due to some structural diagnosis (which may actually have nothing to do with the back pain)

                The limitations in movement and activity lead to physical reconditioning and muscle weakening, which in turn leads to more back pain

Of course, this cycle results in more pain, more fear, and more physical de-conditioning along with other reactions such as social isolation, depression and anxiety.

The diagnosis of stress related back pain.

The diagnosis of stress related back pain is often made by a through medical history and physical exam. Patients must be cautious in trying to self diagnose stress related back pain, as there may be a serious medical condition (such as a spinal tumor or infection) causing the pain. A good medical examination can usually rule out the more serious structural causes of back pain in a great majority of patients.

For cases of stress-related back pain, the history of onset of back pain is often quite variable. The pain may start with an identifiable incident or it may start insidiously. For instance, it is not uncommon for the pain to start with an incident such as a lower back sprain or strain, only to have it continue as the result of emotional factors long after the injury has healed.

In many cases there may be MRI findings such as a “disc bulge” or “degenerative disc disease” when stress-related back pain is the actual culprit. In theses instances, the MRI findings are not clinically significant and ultimately determined not to be the cause of the pain.

The overall characteristics of stress related back pain include symptoms such as: back pain and or neck pain, diffuse muscle aches, muscle tender points, sleep disturbance and fatigue, in many stress- related back pain cases, patients complain of the pain “moving forward”

In general, symptoms of stress related back pain are similar to those of fibromyalgia. 

Treatments for stress-related back pain.

The multidisciplinary approach to treating stress related back pain includes evaluation of physical,emotional cognitive and environmental factors in all types of back pain problems and develops treatments for each aspect. Thus the multidisciplinary formulation will look at the relative contributions of the following  factors :

•                      physical including de-condition and weak muscles, nerve irritation, etc

•                      emotional including depression, anxiety, anger ,etc

•                      cognitive such as negative thoughts, pessimism, hopelessness, etc.

•                      environmental such as loss of job, financial problems, etc.

This approach then develops a treatment program based upon how much each factor is thought to be influencing the pain. A mulch-disciplinary program may include such treatments as:

•                      treating the physical factors using stretches and exercises recommended by you chiropractor

•                      treating the physical and emotional factors through appropriate medications (often including anti-depressants or muscle relaxants)

•                      treating the emotional and cognitive factors through psychological pain management techniques and biofeedback

The idea of multidisciplinary treatment of back pain has been around for at least 25 years. It has been shown to be quite successful; although, the key factor in treatment outcome is the motivation of the patient to complete a rehabilitation approach.