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The Swiss Ball: Aka Gym, Stability Ball

Chiropractor, Dr. Alexander Jimenez provides an update into the latest research on the benefits of working with the Swiss ball.

The ball, which is also known as a fitness center or stability ball, has become an integral part of the physiotherapy practice and the traditional gym setting. Some still perceive the Swiss ball to be a gimmick, whilst others rely on it as being essential for handling low back disorders and increasing trunk control.

Low back pain is indicated to be a common criticism in 60-80% of the population and 60-86\% of the group will experience more than 1 episode(1). Studies have suggested that back stability exercise is successful in reducing low back pain compared to general exercise in the brief term(two). The Swiss ball has shown to be effective in improving control of the back stability muscles in healthy and low back pain inhabitants(3). Research exploring changes in low back pain correlating with core muscle action whilst is lean. The purpose of the text is to review the current research pertaining to the usage of this Swiss ball and this tool may influence core stability purpose. The Swiss ball is used by physiotherapists and trainers worldwide to ease the equilibrium muscles of the back to enhance core control. These ‘core’ muscles, that are active across the lumbopelvic and hip complicated, include shallow and deep muscles (Table 1). The deeper muscles provide stability to the inactive structures (vertebrae, intervertebral discs and ligaments) of the lower back while the shallow muscles alleviate trunk motion. For optimal pain-free movement to happen, both the shallow and deep core muscles must engage in unity together with simultaneous timing and tension (4). Failure of these muscles to activate sequence might result in compromise movement function and back pain.

Core Muscle Recruitment

Researchers at the California State University studied the muscle activity (electromyography, EMG) of the significant trunk muscles through eight Swiss ball exercises (decrease press-up, pike elevator, inverse plank tuck/jack-knife with and without turning, seated march, board roll-out, prone hip extension left and right) and also contrasted to a classic floor-based abdominal pinch(4). The rectus abdominis, internal and external oblique, latissimus dorsi, lumbar paraspinals and rectus femoris were normalized with a maximal voluntary isometric contraction (MVIC) and also measured using surface EMG. Eighteen (nine male and eight female) healthy participants were assessed in each one of the Swiss ball positions.

The results of the study suggested that the plank roll-out (Figure 1) and pike elevator (Figure 2) were significantly more effective in activating the trunk muscles. The board roll-out elicited a mean EMG signal of the upper rectus abdominis of MVIC that is 63%, lower rectus abdominis of 53 percent MVIC, external MVIC and internal oblique of 46% MVIC. The pike lift elicited an average EMG signal of the rectus abdominis of 46 percent MVIC, lower rectus abdominis of external oblique of 84% MVIC, MVIC and oblique of 56% MVIC. The EMG activity of the trunk muscles was recorded at the whilst at the march position and the floor established collapse of 7-8% MVIC respectively. In addition, the activity of the lumbar paraspinal muscles has been relatively low with 10% MVIC action through each of the exercises.

The outcomes of the study suggested that the plank roll-out (Figure 1) and pike exercises (Figure 2) were more successful in activating the inner and external obliques and the lower and upper rectus abdominis. The research, though useful, is restricted as it lacks dimension of these deeper stabilisers such as the multifidi or even the transverse abdominis.

Researchers from Poland published an article measuring rectus abdominis, external oblique and inner diaphragm with transverse abdominis during Swiss ball bridging in prone, supine and side, lying on both unstable and stable surfaces(5). This prospective study quantified the back muscle activity of thirty-three healthy guys, in each of the positions, by surface EMG and the results indicated the back muscles were more active during Korean chunk likely extending (plank). The MVIC of each of those muscles were rectus abdominis 44.7%, external oblique 54.7percent, and inner oblique with transverse abdominis 36.8percent. Supine bridging in comparison on a surface produced MVIC of action. From the preceding two studies a conventional board exercise on the ball with all the knees on or off the ground is suggestive of becoming one of the best in engaging back muscle activity(4, 5).

Single and double leg squatting exercises are recommended for patients with knee pain and other lower limb ailments. The gluteus medius and maximus feature, through its own attachment, to increase stability through the hip and knee more complex(6). Researchers studied the effects of double and single squatting on gluteal maximus and medius activity using both a baseball match against the wall and in position (Figure 3)(7). An observational study quantified the surface EMG of the gluteal muscles in nineteen healthy participants (11 male, 8 female) throughout the squat period. Single leg squatting was completed using the participant standing to the wall.

The results indicated that there was considerably greater maximus and medius muscle activity during single leg compared to dual leg squatting as quantified as % MVC (Table 2). The outcomes found a substantial difference with activation together with the Swiss ball, in comparison glute med, during single leg squat and without a ball, in the max activity. An increase in muscle activity was observed whilst using the Swiss ball although a significant difference wasn’t noted in the med.


The lumbar multifidus muscle was recognized as an important stabilizer of the lumbar spine(8). The fibers originate in also the lamina of the vertebrae and the process and descend towards the anus where they fit whilst crossing as many as five segments. The fibers attach in the inferior edge of the process and also the border lamina of the fascia and attach distally in the process and facet joint capsule of the vertebrae at least 2 degrees below. The fibers are active whilst the moment arm isn’t possessed by the fascicles that are deeper and so assist in control.

A research study recently published in Physical Therapy in Sport studied the muscle activity of the lumbar multifidus during sitting exercises whilst on either a stable or unstable surface using the Swiss ball (3). A cross-sectional layout, of 40 patients, 20 healthy and 20 with chronic low back pain (CLBP), found that the lumbar multifidus was more active during sitting exercises on the Swiss ball in both healthful and CLBP groups compared to steady surface was. The results, although optimistic, should be viewed with care as muscle activity was measured using ultrasound with no execution of electromyography (EMG). Pain levels weren’t recorded in this particular research and so no correlation between low back pain reduction and increased action. But, it does indicate that sitting offers assistance for using the Swiss ball for a chair and is successful in both cohorts.

The Swiss Ball As A Seat

It is not uncommon for a Swiss ball to be used instead of a conventional desk chair in an office or staff meeting to manage pain and improve muscle control. This method has been questioned by some as the caliber of the research in pertaining to this way is constrained. A research paper published in the Journal of Canadian Chiropractic Association provided two case studies on the usage of sitting on a Swiss ball through daily tasks (9).


The research indicates that the Swiss ball is effective in enhancing control of the core stability muscles in a variety of positions. The quality of the available evidence is limited at additional and present research, using random allocation, should endeavor to quantify to get a correlation between core muscle activity and pain decrease. It is desirable to use reviews and randomized controlled trials at which possible is also important to review case studies to monitor the effects of an intervention. The case studies described, provide evidence of how the Swiss ball might be used in handling CLBP. The Swiss ball is a and readily available to use in the house, gym or work place along with the study available is due to its addition for both healthy and low back pain.


1. The American Academy of Physi Med and Rehabili, Feb 2010, 2, 142-146.

2. Plosone, 2012, 7, 12, 1-7.

3. Phys Thera In Sport, 2014 – http://www.

4. J of Ortho and Sports Phys Thera, May, 2010, 40, 5, 265-276.

5. Phys Thera in Sport, Aug 2014, 15, 3, 162-168.

6. Surgic and Radiologic Anatomy (Dec) 2004; 26, (6), 433 – 446

7. Phys Thera in Sport, Feb, 2014, 15, 1, 39-46.

8. Spine, 2002, 27, 2, F29-F36.

9. J Can Chiropr Assoc, Mar, 2007, 51, 1: 50-55

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The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to contact us. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: phone: 915-850-0900 Licensed in: Texas & New Mexico*