the EXTRA tough, Australian Swiss Ball

Research Update No. 1

mediBall - why is it useful for seating?

Mechanical low back pain (MLBP) has been described as the 'flu' of the musculoskeletal system. It is wide-spread and is responsible for more time-off-work than any other condition. Though MLBP is frequently multifactorial and is often difficult to diagnose, most episodes of MLBP settle within 6 weeks, regardless of treatment. There is, however, a 60-80% recurrence rate of MLBP (Hides et. al.). Additionally, approximately one tenth of cases of acute MLBP do not resolve and are at risk of becoming chronic pain conditions.

Pain is by definition the most dominant feature of this condition, but a number of other features are common, which can be both pre-disposing factors for, and a result of, MLBP. These features include inadequate muscle control / stabilisation and poor posture.

The following are proposed mechanisms by which the Mediball may be useful in managing or preventing MLBP.

Pain

Movement in a pain-free range of motion (ROM) stimulates mechanoreceptors and thereby exploits a natural mechanism of pain inhibition (Melzack & Wall, Wyke). Due to the inherent instability of the Mediball, sitting on it requires continual postural correction during functional tasks. This postural correction, being mid-ROM and of a small amplitude is likely to be pain inhibitory. Also, some patients are reluctant to move their low back following a painful episode. Sitting on the Mediball is a gentle encouragement to mobilise in a controlled manner.

Muscle control/stabilisation

Currently there is considerable interest in the role of transverse abdominus and multifidus muscles as stabilisers of the low back (Richardson/Jull). There is recent evidence to show that low back stabilisation training can positively affect recovery from MLBP (Hides et. al.). Use of the Mediball encourages active seating postures and thereby offers a highly functional opportunity to reinforce active stabilisation. The Mediball can also be used as part of a spinal stabilisation exercise program (Hyman & Liebenson, AOK Health Systems).

Posture

A fundamental constraint on retraining posture is the difficulty of avoiding unhelpful habituated postures. We all tend towards habituated postures when our attention is distracted by functional tasks (Garlick). The Mediball encourages a lordotic lumbar spine position, both as a means of centering one's centre of mass over the ball and also as a means of providing a stable pelvic base on which to balance one's upper body. An undesirable slump position is discouraged by sitting on the Mediball, as this posture increases the ball's instability. The Alexander Technique suggests that a lordotic lumbar spine in sitting may be determinative in setting good posture in other regions of the spine.

The static loading of passive lumbar spine structures may be one of the causes of MLBP, such as in the McKenzie Postural Syndrome (Oliver et. al.). The continual gentle postural correction required whilst sitting on the Mediball reduces the static loading on any one structure.

Sitting Comparison

Static Sitting

Dynamic Sitting
Bad Posture

Slumped
  • Static Posture discourages movement
  • Static Loading of Spinal Structure
  • Reduction of circulation to spinal structure
Proper posture

Lordotic
  • Active posture promotes stabilization
  • Reduction of Static Loading
  • Encourages circulation to spinal structure

References:

German Association of Back Schools Mediball Back Care Program, AOK Health Systems Garlick The Lost Sixth Sense: a medical scientist looks at the Alexander Technique. Biological & Behavioural Sciences Printing Unit, The University of NSW, 1990 Hides, Richardson Multifudus recovery is not automatic following resolution of acute first & Jull episode low back pain, Spine (in press) Hyman & Liebenson Spinal Stabilisation exercise program. In Spinal Rehabilitation: A Manual of Active Care Procedures, ed by Liebenson, Williams & Watkins, 1996 Melzack & Wall Pain Mechanisms: a new theory. Science 1965 Oliver, Lynn & Lynn An Interpretation of the McKenzie Approach to Low Back Pain, in Physical Therapy of the Low Back, ed by Twomey & Taylor, Churchill Livingston, 1987 Richardson & Jull Muscle control - Pain control. What exercises would you prescribe? Manual Therapy 1995 Wyke The Neurology of Low Back Pain, in The Lumbar Spine and Back Pain, ed by Jayson, Pitman Publishing, 1985 medi5

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