Back-to-Back | Newsletters | Spine Forum | Back Pain Radio | Patient questions | Spine Directory | Links
Search
Spine-health.com medical experts on the air
Back Pain Radio show summaries
Spine fusion surgery vs. artificial disc replacement
Comparing spinal fusion with artificial disc replacement
Is lumbar fusion surgery a reliable procedure?
Deciding on artificial disc replacement surgery
Disc nucleus replacement surgery
Choosing the best spine surgeon for your back pain
Chiropractic care for low back pain
Back pain and ergonomics
> Exercise balls, home gym equipment and Graston Technique
Workplace ergonomics and office chairs
Neck pain symptoms, causes and diagnosis
Treatment for neck pain
Managing stress, depression and chronic back pain
Improving patient outcomes in spine medicine
Related information

Specific exercise strategies

The importance of abdominal exercise and back exercise

Exercise ball therapy for low back pain

Choosing the right exercise ball

Swiss ball exercises

Scar tissue and pain after back surgery

The Graston Technique: a new manual therapy for back pain

Back-to-Back: Using exercise to help your back

Spine-health.com medical experts on the air - Back Pain Radio

Exercise balls, home gym equipment and the Graston Technique

Spine-health.com expert featured on Back Pain Radio
Exercises for a healthy back don’t have to be performed solely in a gym or with a physical therapist - they can also be done inexpensively and conveniently in the home, using fitness equipment such as an exercise ball or Bosu, tubing and weights. However, as discussed in this radio show transcript, it’s important to consult a trained professional before starting any new exercise program.

Thomas Hyde, D.C., a chiropractor in Florida and a medical advisor and contributing author for Spine-health.com, and Grant Cooper, M.D., host of Back Pain Radio, discuss proper use of exercise balls for fitness, other home exercise equipment and the Graston Technique on the April 4, 2005 show.

Transcript of Back Pain Radio show on exercise balls and home gym equipment
Below is the transcript summary from the Back Pain Radio show on home exercise equipment, swiss exercise balls and Graston Technique, broadcast on April 4, 2005.

Dr. Cooper: Tell us, what is the Swiss exercise ball, and how can it be used to help treat low back pain?

Dr. Hyde: The Swiss exercise ball, I believe, was first introduced in Switzerland a number of years ago through a physical therapy group there, and they started using it to help build what they call the ‘core body muscles’ to help stabilize the spine. There are a whole series of exercises that can be utilized on this ball. The balls typically hold 400 to 600 pounds. They’re like a large beach ball, if you will, but made of a more resilient product than a regular beach ball.  

Dr. Cooper: Can you describe some of the exercises that people do on these large balls?

Dr. Hyde: Yes. We start people off basically just sitting on the ball in a relaxed position, and the ball has to be positioned for them so that the quadriceps, or the thigh muscles, are parallel to the ground. That’s the correct height, and they come in different sizes, like 53 centimeters and 65 centimeters, etc. Once you have it properly fitted for someone, they can start off sitting, they’ll bounce on the ball very gently, and that causes the disc to actually imbibe water when they do that.

Dr. Cooper: Imbibe water? You mean bring water into it.

Dr. Hyde: To drink water, to bring water into that disc, and it causes the joints in the back to kind of move up and down a little bit. Once they start doing that, we’ll have them just plant their feet so that they’re stable, then they roll the ball forwards or backwards, in other words, to bend over or bend backwards, and then we have them move the ball sideways and then in circumduction where they’re going one way in a circle and then the other. We progress from that to more complicated exercises, where they may bounce on the ball and then raise one foot at a time and then the other as they bounce in a synchronous motion. Then from that, we’ll go on into more complicated things, where they’ll lie across the ball, face down, and then we’ll put them into what we call a cross-crawl pattern where they’ll raise one arm and the opposite leg. Then face up, where they’ll actually arch their back over the ball. Or, we may have them sitting on it doing weight training or lying face up and doing “flys” with weights or with tubing. There are just hundreds and hundreds of exercises that can be done on the ball.

Dr. Cooper: What are the advantages of using the ball as opposed to doing some of these exercises without the ball?

Dr. Hyde: The ball provides something we call proprioception. What that means is, basically, where a person’s hand or foot is in relationship to space. There are little tiny nerve endings called proprioceptors that provide feedback from these body parts back to the brain, and say ‘hey, you know, your arm is out here at 45 degrees’ or that kind of thing. That’s the advantage of the ball – the ball causes you to fire the proprioceptors in the body, and in this case, if you’re sitting on it or doing some of these exercises, it will fire the proprioceptors in the back muscles or the abdominal muscles, the quadriceps or the thigh muscles or other muscles, just depending on what weight or what exercises you’re doing at that particular time.

Dr. Cooper: And what’s the advantage of training these proprioceptor muscles in our bodies?

Dr. Hyde: One of things it does is, when you fire those proprioceptors, it helps you in a number of ways. For an example, let’s take a basketball player or a football player who has chronic ankle problems. If we get them to work on the proprioceptors, in other words, doing exercises where they’re standing on one leg or standing on something that we’ll get to in a while, called a Bosu (Both Sides Up), or a DynaDisc, or things like that or even a towel that’s folded up, that causes them to have to balance better. You’ll be surprised how many of these elite athletes cannot stand on one leg very well. So we get them to start firing the proprioceptors. The same thing would happen with the back. If we get someone with a back problem to start utilizing this ball and firing those proprioceptors, it’s a way to help stabilize the lower back.

Dr. Cooper: So, if I work backward, is one of the problems that contributes to back pain that we haven’t trained our muscles - does that contribute to the back pain?

Dr. Hyde: Absolutely. That’s one of the reasons we work the proprioceptors. Sometimes people forget that you have to work the other group of muscles, what we call the antagonist to that, and that’s the abdominal muscles. And we know that sometimes doing a regular sit-up will aggravate someone, so one of the ways we can do it is almost like a modified crunch on the ball, where you’ll actually lie back on the ball and you’ll crunch on that ball. It really makes the back feel good, it does not put a great deal of pressure on it but you still have to bounce on that ball and fire those proprioceptors at the same time.

Dr. Cooper: Is this something then that you would recommend to people without back pain, as well, as a way of preventing back pain?

Dr. Hyde: Absolutely. I would, without question. I’ve been using the ball personally, probably for greater than 15 years. Even though I’m a chiropractor and I’ve done all kinds of things – I was a former power lifter, and most power lifters will have back pain. I had something called facet syndrome, which was like an inflammatory process in the joints in the back. For years I had that. Once I began doing those Swiss ball exercises, my back pain went away very quickly, and let me knock on wood, I haven’t had any since 1995 (that’s the last episode I’ve had). So, I’ve been using that ball a long time with excellent results.  

Dr. Cooper: That’s terrific. Do you use it everyday, or how often do you use it?

Dr. Hyde: Well, my wife thinks that it’s a just part of my body, I use it so often.

Dr. Cooper: That’s great. So, it’s not one of those pieces of equipment that ends us sitting in the basement.

Dr. Hyde: Absolutely not. They’re very inexpensive, you can deflate it, put it in your suitcase, take it around the world with you, and you can blow it up if you have enough lung capacity (it’s really not that difficult). They have little small hand pumps for about $5, so you can blow it up anywhere you go. It’s a great way to exercise anywhere you go. You go to a hotel – and those of us who travel a lot, you need these kinds of things. They’re very inexpensive to utilize.

Dr. Cooper: You can bring it with you.

Dr. Hyde: I use it constantly.

Dr. Cooper: Now, it sounds like something that in the beginning, at least, it would be helpful to have somebody show you the exercises. Is that right, or is this something you can pretty much pick up on your own?

Dr. Hyde: No, actually, I recommend first talking with someone who is certified (and there are actually courses where individuals can go to become certified) in the use of the ball and the many different features that are offered with the ball. And I highly recommend that you get an expert to teach you to begin with, because you actually could injure yourself if you don’t find someone who knows what they’re doing and appropriately instruct you.

Dr. Cooper: It’s important to find someone who has training with the ball.

Dr. Hyde: That’s correct, and there are a number of people around. You could certainly go to some of the local gyms and find out who is available, and also the National Strength and Conditioning Association has videos, they have CDs, and they have books with the exercises in it. Some of them are very well put-together, by the way, and they’ll describe which muscles you’re utilizing and which muscles are necessary for whatever you’re trying to obtain, whatever your goals may be on that ball.

Dr. Cooper: Interesting. But, still, it’s advisable to actually get someone to walk you through it, at least initially.

Dr. Hyde: I agree with that 100%.

Dr. Cooper: You mentioned something called the Bosu. Can you talk a little bit about that and maybe some other low-tech rehab equipment that might be useful?

Dr. Hyde: Yes. I tell people they don’t necessarily have to always go to a gym and/or spend a lot of money to get a great workout. You can do it at home in a very small area, with very low-tech, low expense. The Bosu is ‘Both Sides Up’. It’s very much like a Swiss ball, as you can imagine, basically cutting that ball in half and having a base on it that’s generally a plastic or a hard plastic on the bottom, so that the bottom is flat and then you have the ball on the top. It’s filled with air, and you can fill it to different amounts of pressure so that it’s either soft or it’s hard, and then you can do exercises on that.

For an example, you can stand on it with both feet together and spread them out a little bit. You can do all kinds of other exercises, such as aerobic exercises, where you’ll come on and off that ball sideways. If you want to do your skiing practice, you can stand on it with your feet together and twist as if you were skiing downhill with it. You could stand on it with one foot and balance with it. You can also use the Swiss ball behind your back up against the wall, put your feet on the Bosu and do squats with it (single-leg or double-leg squats). You can also do your sit-ups on that in the crunch fashion that I mentioned before; use it in place of the ball. It’s more stable if the bottom’s on the ground, so those people that have difficulty, initially, with balance with the ball, you just simply use the Bosu. You can also sit on it, you can do exercises with tubing, and you can do weight exercises on it.  Then, if you flip it up the other way, so that the flat side is up, you can also stand on that side, so that the ball will rock underneath you. Or, you can do upper extremity, where you would actually grab the plastic… and then you can do push-ups on it, so you have to balance your upper body when you do the push-ups.

Dr. Cooper: So you can combine strength, aerobic and also proprioceptive training with these different pieces of equipment.

Dr. Hyde: All at one time. And, in addition to the Bosu, you have tubing (what we call ‘surgical tubing’), which comes in different colors representing different strengths, from very light and easy to the black, which is very hard. There are things that we call the DynaDiscs, which are maybe 10 inches or so in diameter and these are filled with air again. There are also some that are a high-compression foam that you could utilize. Again, these things cost you very little money, and you can work out virtually any part of the body with them. Very simple, very easy, but they’ll give you a great workout.

Dr. Cooper: And you can create this in your home for a small little gym if you wanted to.

Dr. Hyde: That’s correct.

Dr. Cooper: Wonderful. Are there trainers of the Bosu and this other equipment, the same way that there are people certified in the Swiss exercise ball?

Dr. Hyde: Yes, there are. And, again, I would highly recommend before you begin any exercise program, regardless of how simple it may sound, that you should consult someone who is considered an expert.

Dr. Cooper: Both for safety and to make sure that you get the most out of the work that you’re putting into it.

Dr. Hyde: Yes.

Dr. Cooper: What’s the Graston Technique?

Dr. Hyde: That’s an interesting technique. It is a series of six patented stainless steel instruments shaped with convexities and concavities. Each of the instruments has a beveled edge on it, and they’re designed to break up adhesions and scar tissue. Examples where the instrument would be used include the presence of a plantar fascitis or a lateral epicondylitis, meaning tennis elbow, or golfers’ elbow on the inside of the elbow, anything like that, even back disorders. The Graston instruments are designed to be moved at about a 30 or a 60 degree angle in the direction of the beveled edge. Then you search in every quadrant of the clock to see if there are any adhesions that you will actually feel through these instruments. They really act like a stethoscope to allow you to feel more than you can with your hands alone.

Dr. Cooper: Interesting. Who is trained to do the Graston Technique? Are people specially trained? Is this something that physicians are trained in, such as chiropractors?

Dr. Hyde: Yes, that’s a very good question. This began, actually, with a lot of research done at Ball State Memorial Hospital and Ball State University in Indiana, and it began with a physical therapist. There was a physical therapist who had a very serious knee injury, and another guy who was not a physician, who had a knee injury, who was a tool and die maker. When he was having a technique called cross friction massage (that was really, I guess, brought into practice by a very famous orthopedic surgeon), he was dismissed from his physical therapy work, but when he would use his own finger or thumb it became tired. Then he started using a pencil eraser, then he went from that to a wooden instrument that he carved, then he made one out of metal. Then he treated the physical therapist and both of them got better and they weren’t sure why. They took it over to the university and had some research done and what they found out, that indeed, it does break up the scar tissue. It helps to form or create an abundance of new fibroblasts being laid down, and they’re laid down in a parallel fashion, so that’s how the new tissue is regenerated, if you will, once you break up the old tissue.

Dr. Cooper: Interesting. Has there been any research done on the Graston Technique and low back pain?

Dr. Hyde: Actually, there is a study right now that we’re trying to have done. There was one, originally, at the Texas Back Institute, and it was done by a chiropractor named Dr. John Triano, who also happens to be on Spine-health.com.

Dr. Cooper: Yes, I talked to Dr. Triano before (on the 3/28/05 Back Pain Radio show “Ergonomics in the office”).

Dr. Hyde: Right, he did a study on post-lumbar fusion. We’ve got another one that we’re looking at, because we want to know what happens to the multifidii or the deep muscle groups, when you do something superficially. Why do these people with deep back pain get better when you use this technique, knowing that those muscles might be 5 to 6 inches down from the surface? We’re looking at deep needle insertion, and seeing what happens there with an EMG study.

Dr. Cooper: Is there anyone that is not a good candidate for the Graston Technique, who has back pain or musculoskeletal problems? Are there people you would recommend not to for safety or other reasons?

Dr. Hyde: Yes, there are a number of contraindications for that. It would not be recommended for someone with metastatic carcinoma, other types of spinal diseases or spinal cancer, pregnant women, or someone with kidney disorders. We don’t do it on the low back, of course.

But you asked me about those who are trained – the MDs and the PTs were first, and then they started with the Occupational Therapists. We now train trainers and chiropractors and DOs (doctors of osteopathy). We’re looking into podiatry. We’re often asked about massage therapists, but at the present time, they’re not training massage therapists.

Listen to Back Pain Radio
To hear the complete 19-minute audio archive transcript of this show segment on Back Pain Radio, please click here.

Transcript published April 19, 2005

Additional disclaimer: Spine-health.com does not offer medical advice or treatment. This information does not replace the physician-patient relationship, and the information is not medical advice or treatment. It should only be considered as a physician's opinion. Patients should always seek the advice of a trained health professional for back pain or any health condition. Please note that the contents of this section have not been peer reviewed by Spine-health.com’s Medical Advisory Board.

 

© 1999-2005 Spine-health.com
The information in Spine-health.com is not intended as a substitute for medical professional help or advice but is to be used only as an aid in understanding back pain and neck pain. A physician should always be consulted for back pain or any health problem. Spine-health.com provides links to other organizations as a service to our readers and is not responsible for the information, services, or products provided by these web sites, health professionals, or companies. See Terms and Conditions and Privacy Policy.
Home | Newsletter | About Us | Contact Us | Site Map | Find a Doctor | Clinical Trials
About us Contact us Marketplace Back talk Research Topics Find a doctor