Swiss ball exercises

The exercise ball (or Swiss ball or physio ball) is a versatile piece of exercise equipment available to help people with back pain. In particular, many Swiss ball exercises are designed to bring movement to the spine in a controlled manner to help keep the discs nourished. Moving the vertebrae helps nourish the discs in the spine by increasing blood flow around the disc and by causing the water to flow in and out of the disc.

For all forms of exercise, it is advisable to see an appropriately trained and licensed physical therapist, occupational therapist, chiropractor, exercise physiologist or physical medicine and rehabilitation physician (also called a physiatrist). Depending on the specific diagnosis and level of pain, the exercises with the ball will be very different, and appropriately trained spine specialists (e.g. certified in exercise ball technique) play a critical role in both developing the right exercise program and providing instruction on correct form and technique. Additionally, the local gym or fitness center is often a good place to find an individual certified in exercise ball technique. The National Strength and Conditioning Association also has videos, CDs, and books of exercises. A certified individual, video, or book will also be able to provide helpful information in terms of which muscles are being utilized and which muscles are necessary to achieve specific goals with the exercise ball.

The difficulty of exercises with the Swiss ball will vary for each person and will challenge areas of inflexibility. Typically, a physical therapist or other spine specialist will have the patient start using an exercise ball with small, gentle movements, such as the following:

Pelvic isolation with the exercise ball

Rock back-and-forth - Sit on the exercise ball with arms to the sides or on hips. Slowly do a pelvic tilt, pulling stomach muscles in and moving hips slightly toward the front to flatten the small of the back (reduce lordosis) (see Figure 3). Return to the neutral position on the exercise ball. Arch small of the back slightly and move hips slightly toward the back. Return to neutral position on the exercise ball. When comfortable with these movements on the Swiss ball, do them continuously back and forth for 10 repetitions.
Rock side-to-side - Sit on the exercise ball with arms to the sides or on hips. Slowly shift weight slightly to the right. Return to the neutral position. Slowly shift weight to the left. Return to neutral position on the exercise ball. When comfortable with these movements, do them continuously side to side for 10 repetitions.
Circles - A more advanced exercise for the Swiss ball, start in the front/pelvic tilt position and slowly shift weight around in a circular motion, 3 times clockwise and 3 times counterclockwise.

Spine rotation with exercise balls

Sitting on the exercise ball, raise arms straight to front; without twisting at the spine, move both arms across the body to the right, bending the left elbow and keeping arms at shoulder height; move both arms to the left, bending left right elbow. Repeat 5 times to each side.
Add head movement to the arm movement by turning the head to the opposite direction from the arm movement, still without twisting at the spine. Repeat 5 times to each side.
Increase the difficulty by spreading feet slightly and twisting the spine in the direction of the arm movement, straightening the opposite knee and rocking forward slightly on the ball as necessary.

Mobility and stretching with the exercise ball

Sitting on the exercise ball with arms to sides, slowly walk feet out and lean back slightly, rolling ball to the upper back; raise arms over head and straighten knees to arch over the ball, moving it to the mid-spine and touching the hands to the floor. Hold stretch for 10 seconds before bending knees, bringing arms down and rolling to start position. Repeat 3 times.
Kneel with hands on the exercise ball; use hands to roll the exercise ball out from body, keeping back flat until hips and knees are at 90 degrees and back, head and arms are straight; roll the exercise ball slightly from side to side, 5 times on each side.
Kneel with chest resting on the exercise ball; roll forward and straighten knees, with ball at chest level, relax around the ball to stretch the upper spine.

Extension exercises with the Swiss ball

Lumbar extension - Place lower chest/stomach area over the exercise ball with legs straight, spread apart for stability and feet flexed up on toes (or with legs together and feet against a wall); rest hands on side of the ball, but do not use arms to push up; slowly lift head and chest off the ball as far as is comfortable, squeezing shoulder blades while lifting; return to start position. Repeat 5 times. For a harder exercise, place hands behind head or straighten arms above head (see Figure 4)
Bridge - Lay flat on the ground with legs straight. Place both legs together on the exercise ball at the calf area with arms at sides and hands flat on the floor; tighten and lift the buttocks up off the floor to straighten the back, keeping abdominal muscles tight and hold for 5 seconds. Return to start position. Repeat 3 to 5 times.
Bridge with leg - make this exercise more difficult by lifting one leg at a time 1 to 2 inches off the Swiss ball.
Bridge with arm - even more difficult, lift arms off the floor while bridging over the exercise ball.

There are literally hundreds of different exercises that one can do using exercise balls, or exercise balls in conjunction with other proprioception exercises to include the BOSU ball balance trainers, Dynadiscs, BAPS Boards, Pods, Therabands, weights, weighted balls, medicine balls, and many more. The above list describes a number of the more commonly prescribed exercises that may be used to help patients with low back pain.