The Swiss Ball : Theory, Basic Exercises and Clinical Application

I have known Beate Carriere for several years and have always been impressed by her deep understanding of the whole field of physiotherapy. In our discussions her questions and comments have been inspiring and demonstrate that her knowledge is not only based on reading but rather on life-long clinical practice and experience. Thus, it is no wonder that her book is excep­ tional, presenting the physiology, the pathophysiology, and a technical description of recommended exercises and their clinical application - and not as general recommendations but with con­ vincing examples. All three of the sections are written in clear, understandable language. The author discusses the use of the Swiss ball; however, she did not limit herself to a technical description. Instead she set out to discover the underlying physiological mechanisms and has succeeded in showing how a knowledgable physiotherapist can contribute to the development of physiotherapy as a science. Though based on the concept of S. Klein-Vogelbach, Beate Carriere has added so many of her own exercises, descriptions, and explanations that we are justified in speaking about the Carriere concept of using the Swiss ball. What I appreciate in particular is her critical view and attempt to see the patient and his problems from all possible aspects. Therefore, she does not consider the Swiss ball program the one and only means of treat­ ment but incorporates other approaches as well.

1 History of the Swiss Ball.- 1.1 Introduction.- 1.2 History of Literature on the Swiss Ball.- References.- 2 Neuroanatomical, Neurophysiological, and Physiological Bases: A Hypothesis.- 2.1 Brain Stem and Reticular Formation.- 2.2 Cerebellum.- 2.3 Vestibular System.- 2.3.1 Vestibular Nuclei.- 2.3.2 Visual and Auditory Tracts.- 2.4 Hypothalamus.- 2.5 Thalamus.- 2.6 Basal Ganglia.- 2.7 Autonomic Nervous System.- 2.8 Limbic System.- 2.9 Sensorimotor System.- 2.10 Physiological Responses.- 2.10.1 Valsalva Maneuver.- References.- 3 Motor Learning.- 3.1 Stages of Learning.- 3.2 Knowledge of Result, Knowledge of Performance.- 3.3 Feedback.- 3.4 Clinical Applications: Examples.- 3.5 Plasticity of the Brain.- References.- 4 Practical Considerations.- 4.1 Ball Conditions.- 4.1.1 Exercise Surface.- 4.1.2 Cleaning the Ball.- 4.1.3 Pressure in the Ball.- 4.1.4 Size of the Ball.- 4.2 Safety Conditions.- 4.3 Precautions, Contraindications.- References.- 5 Points of Observation.- 5.1 Ball-Floor.- 5.2 Ball-Body.- 5.3 Body-Floor.- 5.4 Base of Support.- 5.5 Bisecting Plane.- 5.6 Body Distances.- 5.7 Hinged Joints.- 5.8 Continuing Movement and Buttressing.- References.- 6 Exercise Terminology and Muscle Activity.- 6.1 Exercise Terminology.- 6.1.1 Body Segments.- 6.1.2 Potential Mobility.- 6.1.3 Dynamic Stabilization.- 6.2 Variations of Muscle Activity.- 6.2.1 Parking Function.- 6.2.2 Supporting Function.- 6.2.3 Free-Play Function.- 6.2.4 Bridging Activity.- 6.2.5 Hanging Activity.- 6.3 Primary Movement, Actio-Reactio.- 6.4 Conditio-Limitatio.- References.- 7 Planning of Exercises, Screening, Evaluation, and Treatment.- 7.1 Evaluation.- 7.2 Muscle Strength and Range of Motion.- 7.2.1 Hip Extensor and Flexor Muscles: Testing Strength in Side-Lying Position.- 7.2.2 Hip Extensor Muscles: Testing Strength in Supine Position.- 7.2.3 Hip Extensor Muscles: Testing Strength in Prone Position.- 7.2.4 Hip Abductor and Adductor Muscles: Testing Strength in Supine Position.- 7.2.5 Hip Abductor and Adductor Muscles: Testing Strength in Side-Lying Position.- 7.2.6 Combination of Movements in Several Planes.- 7.3 Back Extensor and Trapezius Muscles: Testing Strength.- 7.4 Triceps Brachii Muscle: Testing Strength.- 7.5 Abdominal Muscles and Hip Flexor Muscles (Iliopsoas): Testing Strength in Sitting Position.- 7.5.1 Abdominal Muscles and Hip Flexor Muscles: Testing Strength in Supine Position.- 7.5.2 Combination of Strengthening Abdominal and Hamstring Muscles.- 7.5.3 Abdominal Muscles: Testing/Strengthening in Prone Position.- 7.6 Evaluating Alignment.- 7.6.1 Supine Position with the Swiss Ball Under One Leg ..- 7.6.2 Common Patterns of Deviation from Normal Alignment of Femur, Lower Leg, and Foot.- 7.6.3 Sitting on a Bench/Chair and with the Swiss Ball Placed Under the Feet.- 7.6.4 Sitting on the Swiss Ball.- 7.6.5 Sitting on the Swiss Ball and Taking Steps Until Reaching Supine Position on the Swiss Ball.- 7.7 Evaluating Quality of Movement and Dissociation of the Lower Extremities.- 7.7.1 Supine Position, Both Legs on the Swiss Ball.- 7.7.2 Supine Position, One Leg Resting on the Swiss Ball ..- 7.7.3 Supine Position with Alternate Leg Movements.- 7.7.4 Prone Position Over the Swiss Ball.- 7.8 Testing Balance.- 7.8.1 Balance Deficits.- 7.8.2 Screening Balance.- 7.9 Identifying Neurotension Problems and Treatment.- 7.9.1 Prone Position over the Swiss Ball.- 7.9.2 Supine Position over the Swiss Ball.- 7.9.3 Supine with the Legs on the Swiss Ball.- References.- 8 Assistive Devices.- 8.1 Sitfit and Swiss Ball.- 8.2 Foam Roll and Swiss Ball.- 8.3 Swiss Ball and Thera-Band.- 8.4 Swiss Ball and Dumbbells.- 8.5 Swiss Ball as an Assistive Device in Manual Therapy.- References.- 9 Exercise Descriptions.- 9.1 “Cowboy”.- 9.2 “Scale”.- 9.3 “Indian Fakir”.- 9.4 “Donkey Stretch Yourself”.- 9.5 “Stretch Myself”.- 9.6 “Sea Gull”.- 9.7 “Hula-Hula, Forward/Backward”.- 9.8 “Hula-Hula, Side to Side”.- 9.9 “Salamander”.- 9.10 “Swing”.- 9.11 “Duck”.- 9.12 “Crab”.- 9.13 “Trot”.- 9.14 “Sea Urchin”.- 9.15 “Goldfish”.- 9.16 “Walking on Hands”.- 9.17 “Push Me-Pull Me”.- 9.18 “Figurehead”.- 9.19 “Scissors”.- 9.20 “Mermaid”.- 9.21 “Carrousel”.- 9.22 “Perpetual Motion”.- 9.23 “Pendulum”.- 9.24 “Rock’n Roll”.- 9.25 “Move My Leg”.- 9.26 “Easter Bunny”.- 9.27 “Well Figure”.- 9.28 “Cocktail Party”.- 9.29 “Dolphin”.- 9.30 Summary of Exercises.- References.- 10 Intensive and Acute Care.- 10.1 Introduction.- 10.2 Applications.- 10.3 Selection of Patients.- 10.3.1 Neurology.- 10.3.2 Cardiology.- 10.3.3 Medical/Surgical.- References.- 11 Orthopedic and Sports Medicine.- 11.1 Introduction.- 11.2 After ACL Reconstruction.- 11.2.1 1-3 Weeks After ACL Reconstruction.- 11.2.2 3 Weeks After ACL Reconstruction.- 11.2.3 More than 5 Weeks After ACL Reconstruction.- 11.2.4 Adaptation of Exercises.- 11.3 After Shoulder Injuries and Surgeries.- 11.3.1 Introduction.- 11.3.2 Acute Nonsurgical Shoulder Injury.- 11.3.3 The “Frozen” Shoulder (Adhesive Capsulitis).- 11.3.4 After Surgical Repair of the Shoulder.- 11.3.5 Additional Exercises for the Shoulder.- 11.4 Posture.- 11.4.1 Introduction.- 11.4.2 Postural Deficits.- 11.5 Dysfunctions of the Back.- 11.5.1 Introduction.- 11.5.2 Treatment Goals.- 11.5.3 Treatment Examples.- 11.6 Scoliosis.- 11.6.1 Introduction.- 11.6.2 Treatment Goals and Approaches.- 11.6.3 Treatment Examples.- References.- 12 Medical/Surgical Outpatient Care.- 12.1 Surgical Patients.- 12.1.1 Introduction.- 12.1.2 Evaluation.- 12.1.3 Treatment Approach.- 12.1.4 Treatment Examples.- 12.2 Medical Patients.- 12.3 Osteoporosis.- 12.3.1 Introduction.- 12.3.2 Treatment Approach.- 12.3.3 Treatment Example.- 12.4 Ankylosing Spondylitis.- 12.4.1 Introduction.- 12.4.2 Treatment Approach.- 12.4.3 Physical Therapy.- 12.4.4 Swiss Ball Exercises in AS.- References.- 13 Neurological Outpatient Care.- 13.1 Introduction.- 13.2 Symptoms.- 13.2.1 Cerebellar Injuries.- 13.2.2 Parkinson’s Disease.- 13.2.3 Cerebral Vascular Accidents.- 13.2.4 Multiple Sclerosis.- 13.3 Restoration of Function.- 13.3.1 Plasticity of the Brain.- 13.3.2 Limbic System Function.- 13.3.3 Swiss Ball Application to Aid Recovery of Motor Function.- 13.4 Physical Therapy in Neurological Deficits.- 13.4.1 Evaluation.- 13.4.2 Treatment Approach.- 13.5 Physical Therapy in Parkinson’s Disease.- 13.5.1 Group Exercises.- 13.5.2 Treatment Approach.- 13.5.3 Exercise Examples.- 13.6 Physical Therapy After Cerebral Vascular Accidents.- 13.6.1 Evaluation.- 13.6.2 Treatment Approach.- 13.6.3 Exercise Examples.- 13.7 Physical Therapy in Multiple Sclerosis.- 13.7.1 Evaluation.- 13.7.2 Treatment Approach.- 13.7.3 Exercise Examples.- 13.8 Physical Therapy in Muscular Dystrophy.- 13.8.1 Introduction.- 13.8.2 Treatment Approach.- 13.9 Physical Therapy in Cerebral Palsy.- 13.9.1 Introduction.- 13.9.2 Treatment Approach.- 13.9.3 Exercise Examples.- References.- 14 Incontinence.- 14.1 Introduction.- 14.2 Tanzberger Concept for Functional Exercises of the Pelvic Floor.- 14.3 Anatomy of the Pelvic Floor.- 14.3.1 The Three Layers of the Pelvic Floor.- 14.3.2 Innervation of the Pelvic Floor Muscles.- 14.3.3 Muscle Physiology of the Pelvic Floor.- 14.4 The Pelvic Floor and its Functional Connections.- 14.4.1 Functions.- 14.4.2 Training Functional Connections of the Pelvic Floor to Thorax and Legs.- 14.5 Medical Conditions Which May Require Pelvic Floor Exercises.- 14.5.1 Gynecological Applications.- 14.5.2 Urological and Proctological Applications.- 14.6 Retraining the Pelvic Floor Muscles.- 14.6.1 Preconditions for Functional Exercise of the Invisible Pelvic Floor Muscles.- 14.6.2 Treatment Considerations for Sphincter Muscle Weakness.- 14.6.3 Treatment of Descending Diaphragm Pelvis with Gaping Urogenital Hiatus (Postpartum).- 14.6.4 Performance and Sequence of Exercises for Treatment of Incontinence.- 14.6.5 Effect of the Bouncing Movement.- 14.6.6 Observation of Movements During Pelvic Floor Exercises.- 14.6.7 Final Observation and Practical Results.- 14.7 Description of Swiss Ball Exercises.- 14.7.1 Exercises in the Sagittal Plane.- 14.7.2 Exercises in the Frontal Plane.- 14.7.3 Rocking/Bouncing Movements.- 14.8 Exercise Examples.- 14.8.1 “Roll-On”.- 14.8.2 “Right Stop-Left Stop”.- 14.8.3 “Sit Upright and Roll Toward the Wall”.- 14.8.4 “Lean Forward and Roll Toward the Wall”.- 14.8.5 “Draw a Urethra”.- 14.8.6 Variation with the Thera-Band.- 14.8.7 “Kick and Kick”.- References.- 15 Preventive Applications.- 15.1 Introduction.- 15.2 Evaluating Postural Alignment in Healthy Persons.- 15.3 Applications to Prevent Injury of the Musculoskeletal System.- 15.4 Treatment Examples.- 15.4.1 A Dental Hygienist.- 15.4.2 Musicians.- 15.4.3 Desk/Computer Workers.- 15.4.4 The Swiss Ball in Schools.- 15.4.5 Relief of Aches and Pains in Health Professionals.- References.