// Back health on the ball - Gentle exercise for clients with back pain or weakness

by Lisa Westlake

Back pain affects 80 per cent of Australians at some stage in their adult life. The underlying pathology and degree of discomfort and disability varies. Similarly, the duration can vary, ranging from days to years and for many there are significant physical, emotional and social consequences.

Fitness instructors who understand back health and injury can assist in the management or prevention of back pain with appropriate exercises. With 8 out of 10 people experiencing back pain, the law of averages tells us that fitness professionals must be commonly working with a number of sufferers. Furthermore, it indicates that we should be doing all we can to decrease this shocking percentage via exercise prevention. It is vital to recognise that it is not the instructor’s role to assess, diagnose or treat back problems – rather, they should work with doctors, physiotherapists and other health practitioners. While exercise is important for those managing chronic low back pain, instructors should refer any client with an acute (new) or unexplained back problem for investigation and management before commencing exercise.

The role of the fitness instructor is two-fold; management and prevention. This first of a two-part article aims to assist instructors to develop a repertoire of fitball exercises and modifications for clients with existing back problems. Part two of the article will aim to provide a range of back health exercises that can be included into regular training programs to assist in the prevention of back conditions and keep our clients backs in action. Remember that every back and every back condition is different, so no single exercise is right for everyone. Encourage clients to listen to their bodies and always work within the recommendations of the treating physician or therapist.

Back pain or injury is often caused by a combination lifestyle issues. Poor posture and repetitive positions and activities all play a role in the development of joint stiffness, muscle imbalances and lack of flexibility. Compromised core stability is also closely related to back pain. The consequence is loss of integrity of the structures that support the spine, which leads to aches, pains or weakness. In this state, a sudden movement or load can be ‘the straw that breaks the camel’s back’.


• Poor posture, repetitive activities and positions of daily life
• Immobility or stiffness
• Compromised core stability
• Muscle imbalance with anterior muscles stronger and being used more than posterior muscles groups
• Decreased flexibility in specific muscle groups that then exacerbate poor posture.

Four different elements contribute to back health and should each be included in back exercise programming. These are, mobility to maintain free movement of the pelvic girdle, shoulder girdle and spine; core stability to provide support of the spinal segment during activity; posterior muscle strengthening to counterbalance the frequently stronger and over-used anterior muscles; and flexibility to elongate commonly tight muscles such as pectorals and hip flexors.

1. Mobility
2. Core stability
3. Posterior muscle strength
4. Flexibility.

The fitball is a fantastic tool for promoting back health, providing a range of exercise possibilities to train stability, posterior muscle strength, mobility and flexibility. It can also provide a participant or client with a safer alternative to sometimes unsuitable moves in a class or gym floor situation. Not all ball exercises are appropriate for clients with back pain however; some, such as abdominal curls, are not recommended, while others like prone extension options or supine bench press on the ball, should be used selectively.

The following ball exercises address the four elements of back health and are ‘gentle’ options for clients coping with back pain or just starting out on the ball.


Keeping the lower back mobile with simple rhythmical movements such as pelvic tilts and hip circles on the ball is a great way to release stiffness, tension or pain caused by activities such as long periods of sitting.

• Sit tall with the feet hip-width apart and out a little from the ball
• Turn the upper body to the left, reaching the right arm across
• Repeat to the right
• Continue slow and smooth rotations side to side x 5 in each direction.


Core stability exercises can be performed in several positions on the ball. Maintaining neutral spinal alignment while performing simple arm or leg actions on the ball is an excellent way to train the core.


• Sit tall on the ball, with the feet hip-width apart
• Engage the core by gently drawing the lower abdomen towards the lower back
• Slowly raise one foot forward to extend the knee, focusing on maintaining neutral spine
• Simultaneously raise the arms sideways to shoulder height, turning palms upwards and drawing the shoulder blades gently downward
• Hold this for 5 slow breaths, lower and repeat on second side
• Repeat each side x 3.

Progression: Add rotation by turning the upper body towards the side of the extended leg, keeping the legs and the ball still and stable.

Fitball hovers or planks require stabilisation of the shoulder girdle, spine and pelvic girdle. While regular hovers often place too much load on a weak or painful back, the gentle kneel and lean engages the same muscles with less stress or risk of exacerbation.

KNEEL AND LEAN (photo 3)

• Kneel upright on the floor with hands resting lightly on the ball in front of the body
• Draw the shoulders gently downwards and engage the deep abdominals
• Now bend the elbows to bring the body towards the ball,
and hold the position for 5 slow breaths
• Repeat x 3
• Focus on keeping the shoulders down, hips straight and neutral spinal alignment as breathing continues normally.


• Lie supine on the floor with legs on the ball and arms resting by the side on the floor
• Engage the core and slowly lower right leg to touch the foot to the floor
• Use the core muscles to keep the back and pelvis stable; do not let back arch or pelvis rotate.
• Check that the arms, neck and other leg remain relaxed and that breathing is normal
• Repeat on the second leg
• Repeat each leg x 5
• To increase the challenge, lift arms off the floor and rest them across the chest.

• Seated on the ball, slowly roll down and walk the feet out until shoulder blades rest on the ball. Lay the head back to the ball and lift hips
• Neck should be in line with the spine and hips and body should be horizontal
• Keeping both feet on the floor, carefully shift weight from one foot to the other, focusing on keeping the hips level. Shift slowly side to side x 10
• Lower the hips and raise head off the ball, then slowly roll back to upright

Strengthening posterior muscles helps to manage or prevent problems associated with muscle imbalances. The ball, in this position, supports the lower back and pelvis and provides space for full range of movement of upper and lower limbs.


• Lie prone over the ball with the feet firmly on the ground and chest slightly raised so there is minimal weight through the hands
• Raise one arm forward to shoulder height and hold for 3 slow breaths before repeating on second arm.

Progression: Raise the opposite arm and leg simultaneously.


Muscle tightness that commonly compromises posture and back health occurs in the hip flexors and pectorals, often as a result of sitting for prolonged periods with our arms forward at the computer or steering wheel. Numerous stretches are possible on the ball, one example being the seated hip flexor stretch.


• Sitting with the feet wide stand up, turn around and sit back down sideways onto the ball, turning the back foot and raising the heel off the ground. Roll the ball forward to gently stretch front of the hip.
• Add a simple pectoral stretch by raising the arms to shoulder height, palms facing upwards, lightly drawing them backwards
• Hold for 10 slow breaths then stand up
• Sit facing front and repeat to the other side.


Lisa Westlake, BAppSc (physio)

Lisa has worked in the health and fitness industry for over 20 years. Australian Fitness Network named her Fitness Instructor of the Year in 2000 and Presenter of the Year in 2003. Through her business, Physical Best, Lisa combines physiotherapy and fitness to create classes and programs for a variety of ages, levels and abilities, and is well known for her work in developing the Fitball program in Australia. Visit www.physicalbest.com for more details.

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