Exercise balls can be used with many patients, including women with pelvic floor pain.

There are all kinds of uses for balls, bands, rollers, boards, and other rehab accessories in the physical therapy setting. Improving muscle strength, tone, balance, posture, range of motion, and stability; treating or preventing injuries; avoiding muscle atrophy—these are some of the goals that can be integrated into your patients’ exercise or therapy routines. Let’s take a look at a few specific products on the market, how PTs are using them in practice, and the trends or what’s new on the horizon.

ASSESSMENT

Lucinda Jagger, MEd, CSCS, CEP, manager at the Canadian Sport Centre Pacific (www.pacificsport.com) in Whistler, British Columbia, works with national athletes and their teams. “They’ll come in, and the first thing we will do is a sport-readiness or functional assessment,” she explains. “Sport readiness is done by one of our strength and conditioning coaches, and it’s fairly basic for a junior-type athlete.” A physiotherapist will do a functional assessment, and that determines what kind of state the athlete’s body is in functionally. From there, during the first training phase and depending on what level the athlete’s body is at, a remedial program may be incorporated.

Jagger sees a lot of injuries during competition season. “The remedial program lasts anywhere from 3 to 8 weeks, strictly addressing some of the muscle imbalances or muscle-length issues that might be going on,” she notes. She works closely with PTs for exercise recommendations and the rehab accessories/equipment needed to help with strengthening, loosening of muscles, rotator cuff issues, and range of motion, among other things.

“We identify these areas as either chronic or acute. If they’re chronic, such as when an athlete has tightness in the hip, for example, certain exercises will be moved into their warm-up and cool-down,” she says. “Once they fix things up, we want to maintain that so we’re going to get them in the gym, the forces are going to be much higher, they might start sprinting, and their body’s going to be fairly overloaded. We still have to keep an eye on the areas prone to injuries, so that’s where all the balance tools come into play.”

On a side note, some of the Olympic athletes used the training center in February during the Winter Games. There was a small gym-base available where the athletes were staying.

The Canadian Sport Centre Pacific, in partnership with the national network of Canadian Sport Centres and BC network of Pacific Sport Centres, delivers sport performance programs to help athletes and coaches win medals for Canada. Working in support of their national and provincial sport partners, the Canadian Sport Centre Pacific is creating a stronger system for the development of athletes, coaches, integrated support teams, and sport performance facilities.

“Each patient starts with an initial evaluation by a physical therapist,” adds Gini Fite, PTA, ATC, and daily operations coordinator, Sports Rehab & PT (www.kcsportsrehab.com) in Overland Park, Kan. “At that evaluation, the therapist will determine what he or she feels the primary problem that needs to be addressed is, along with the MD’s recommendation,” she says. “He/she will then come up with a plan of care. Based off this plan of care, treatment is determined.” This could mean modalities, manual therapy, or more of an exercise-based approach. “I can tell you that our clinic bases a lot of our treatment on closed kinetic-chain rehab and a functional-based approach to therapy.”

SPECIFIC EXERCISES AND ACCESSORIES

Exercise balls are often used in physical therapy and come under lots of names like Swiss balls, balance balls, birth balls, body balls, fitness balls, gym and gymnastic balls, physioballs, Pilates balls, Pezzi balls, sports balls, stability balls, Swedish Balls, therapy balls, and yoga balls.

Beate Carrière, PT, CIFK, at Evergreen Physical Therapy Specialists in Pasadena, Calif, specializes in pelvic pain treatment in women and utilizes the exercise ball extensively with her patients. “If you have a painful pelvic floor because it’s too tight, you want to stretch it out,” she says. Carrière teaches her clients how to squeeze the pelvic floor and coordinate the breathing with the exercise ball.

“To unload the pelvis,” she explains, “they lie on their backs, put their feet on the ball, and gravity pulls away from the pelvic floor. In different positions they can lie on their belly on the floor and support themselves with their arms, leaning downward.” In addition, Carrière says the patients are upright and the weight of the intestines pushes on the pelvic floor. One can lie on her back, put her feet up, lift her hips up, and use a pillow for support so there’s no weight.

While sitting, the ball can be used to mobilize the spine in all directions by leaning sideways. “The ergonomic nervous system is running parallel to the spine, and if you have pain, you don’t move the spine very much. This way, you’re moving it in a more comfortable position,” she says. Exercises with the Swiss ball, for example, can strengthen the abdominal muscles such as leaning over and pulling up the knees to where you’re almost kneeling on the ball.

Carrière also recommends sitting on the ball, sliding to the side, and lowering one pelvis/sitting bone and doing a stretch on that side or in a diagonal direction. The ball allows movement in all positions. She likes using the double ball, too, because it’s more stable for people who are afraid of losing their balance. There’s the forward-and-back motion, but it can’t roll away from you. A seat can be added to allow for more stretching of the pelvis. A wedge can be used as well, if there’s not enough mobility. For the more advanced who want a challenge, one can stand and balance on the ball.

Carrière gets her equipment from Ball Dynamics (www.balldynamics.com), located in Longmont, Colo. She is particularly happy with the company’s customer service. “They make a dependable product and are very helpful,” she says. “They donated balls for me when I did volunteer work, and a live person is on the phone whenever you call.”

“We use stability trainers and balls with our spine, low back, and cervical patients to facilitate core stability in patients with poor mobility and issues of balance,” says Andre Labbe, PT, MOMT, founder and co-owner of A&K Physical Therapy in New Orleans. His clinic uses Thera-Band products (www.thera-band.com). “We can use these techniques to stimulate this system without overchallenging them. That’s probably the key to getting everyone from a chronic pain patient to an older adult to someone with acute back pain moving safely without crossing that line where they feel unstable or that they’re doing too much.”

Labbe also says he utilizes belt-type exercises across all diagnoses from neurorehab all the way to wellness and sports performance. “You’re limited only by the imagination you have.”

EXERCISE BANDS, RESISTANCE TUBES, AND FOAM ROLLERS

Exercise bands are typically used for both general strength and conditioning, and for rehab or injury prevention. Especially good are the heavier bands with more tension for strengthening specific muscle groups. A bonus is that they’re compact and lightweight.

Resistance tubes are extremely adaptable and can be enhanced with very little additional equipment. Smaller muscle groups that are hard to train can be targeted, and movement patterns in a particular sport can be emulated with the bands. Tubing is used routinely by many health and fitness practitioners to prevent and rehabilitate overuse injuries and possibly improve performance by strengthening the smaller muscle groups.

Foam rollers stretch muscles and tendons but also break down soft-tissue adhesions and scar tissue. They can be used to do a self-massage or myofascial release, break up trigger points, and soothe tight fascia while increasing blood flow and circulation to the soft tissues. In these cases they are ideal for pain, soreness, and reduced flexibility or range of motion.

Fite says her practice uses a lot of products from Stretchwell (www.stretchwell.com) and Thera-Band depending on the diagnoses, in addition to Swiss balls, medicine balls, and foam rollers. “We use the Thera-Band with a lot of our shoulder patients as a way of providing graduated resistance. The Swiss balls we use in our back and shoulder patients for core stability exercises; the medicine balls we use with pretty much all patients’ legs, backs, and shoulders,” she explains. Fite also says that her practice treats everything from bunionectomies, ankle sprains or fractures, to ACL/MCL injuries, total knees and hips, lower back pain and other back injuries, to all types of shoulder injuries and impairments. “At times we also treat other things like [injuries from] car accidents and generalized pain or fibromyalgia.”

BALANCE BOARDS/PADS, SLIDE BOARDS, PLYOMETRIC BOXES/JUMP TRAINERS

Users can stand on a balance board just to learn how to stay balanced enough to keep the board’s edge from touching the ground. For the individual who needs more of a challenge or for a professional athlete, however, some have a more dramatic incline.

Slide boards are good for developing lateral strength, power, and endurance while improving balance, agility, speed, and flexibility through lower-, middle-, and upper-body exercises. They allow patients to work in the sagittal, frontal, and transverse plane while utilizing movement. They are very popular for upper-body stabilization and strength as well as for lower-body balance and power.

Jump boxes, also known as plyo platforms, are used as a training tool for explosive jump and speed training such as plyometrics. These kinds of exercises use body weight and gravity to build muscle and explosive strength and power.

PURCHASING TRENDS

There’s a lot of cross core training, according to Jagger, taking the bands and creating sling-type forces and focusing attention outside of the normal anterior/posterior. “Bands should be long enough that patients can anchor it with their foot and then use their hand working with attached adapters,” she says.

“For about $100, you can do a lot for patients,” Labbe says. These types of products don’t take up a lot of room, Labbe points out, and are great for a small clinic focused on health care costs. “They’re less cumbersome, less expensive, and limitless,” he says. Labbe says that you can walk into a patient’s room with a band that fits in your pocket, a stability trainer, and a ball you can carry in and carry out.

“We can do a number of different things with the client—work through things that are a little above and beyond full sets of 10 or a quad set. With a piece of band you can do pushes, pulls, squats—everything that may be based on a functional outcome earlier,” he says. A&K is more specific about single point-type movements because it’s generally hard to train multipoint, multifunction patterns with a piece of equipment based on a cam or pulley system, or something along those lines. “We’ve seen that these [accessories] have stayed the course,” he concludes.

Nina Silberstein is a contributing writer for Physical Therapy Products. For more information, contact .