The Swiss Ball: Theory, Basic Exercises and Clinical Application

406 Pages·1998·17.891 MB·English

by  Beate Carrière (auth.)

Beate Carriere The Swiss Ball
Springer-Verlag Berlin Heidelberg GmbH
Beate Carriere
The Swiss Ball
Theory, Basic Exercises and Clinical Application
Foreword by V. Janda
With a Contribution by Renate Tanzberger
With 355 Figures in 532 Separate Illustrations
i
Springer
Beate Carriere PT, CIFK
512 S. Euclid No. 4
Pasadena CA 91101, USA
ISBN 978-3-540-61144-8
Library of Congress Cataloging-in-Publication Data
Carriere, Beate, 1943 - The Swiss bali: theory, basic exercises and clinical application /
Beate Carriere, with a foreword by V. Jauden, with a contribution by Renate Tanzberger.
p. cm. Includes bibliographical references and index.
ISBN 978-3-540-61144-8 ISBN 978-3-642-58864-8 (eBook)
DOI 10.1007/978-3-642-58864-8
1. Exercise therapy. 2. Physical therapy. 3. Balls (Sporting goods) 1. Tanzberger, Renate.
II. Title. [DNLM: 1. Exercise therapy - methods. WB 541 C316s 1997] RM 725.C37 1998
615.8' 2-dc21 DNLM/DLC for Library of Congress
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To my father from whom I inherited the gift of the pen
To my mother who gave me the gift of adventure
To Susanne Klein-Vogelbach, who taught me to observe
and analyze movement
To all my friends who supported me faithfully with en
couragement and understanding
Foreword
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. Her knowledge
of the various techniques commands respect, and her familiarity
with both the American and European (mainly German) tradi
tions makes this book attractive to readers from all parts of the
world.
It was a real pleasure for me to read Beate's book and I am
confident that others will feel the same.
Prague, September 1997 Professor Vladimir Janda
Director, Dept. of Rehabilitation Medicine
Charles University Hospital, Prague, Czech Republic
Preface
For many years I have been asked by students and physical ther
apy friends to write a book about the Swiss ball, my daily com
panion in treating patients. The Swiss ball has become a tool
that I use to motivate patients, to make exercising easier for
them and for the physical therapists, and to relieve the strain on
my own back when I have a hard day at work.
The more that I taught and lectured about the Swiss ball, the
more I wanted to understand why and how this tool can be used
not only by the very ill and recovering patient but also by
healthy individuals. I began to read up on the matter and rea
lized increasingly how the ball helps to motivate and challenge
patients, probably activating the limbic system as well as other
systems in the brain.
During the course of my career I have encountered many
treatment protocols which are utterly boring, and which provide
little or no feedback or motivation to the patient. Proper use of
the Swiss ball can help to solve these problems. Many patients
are able to use the Swiss ball at home, enjoy the exercises, feel
challenged, and receive instant feedback. This is very important
at a time when efficiency of treatment and self-motivation as
well as cooperation of the patient and family is required in order
to achieve progress. Long hospital stays are rare, and paid physi
cal therapy treatments are often limited to a few sessions. When
a patient exercises at home, the therapist gains valuable time to
perform other treatments which may help the patient to recover
more quickly.
Although the Swiss ball is rarely used exclusively, and some
times only for certain aspects of the treatment with very ill and
recovering patients, it is also a great tool for healthy individuals
who wish to stretch, mobilize, and move the body after sitting all
day at work, and for persons who must stand or move in a pos
ture which is less than ideal.
The book is organized in two parts. The first part provides
the background - the "why" and "how" of using the Swiss ball;
the second part provides clinical applications and patient exam-
X Preface
pIes. A glossary is provided at the end, defining most of the
principal terms used through the text.
It is my hope that this volume will not only provide thera
pists, teachers, and students with ideas and inspire them to in
vent exercises which are safe and challenging for their patients,
but also help patients and family to have fun, and the therapists
to work more efficiently with them.
I am particularly grateful to Dr. Susanne Klein-Vogelbach, who
was my mentor and teacher for many years. This book is based
on her teaching of functional kinetics as it is taught in Europe.
I also thank Renate Tanzberger, a physical therapist from Mu
nich, who contributed the chapter on pelvic floor exercises. I
know no other person who has such a sensitive and profound
understanding of this subject. Her concept of pelvic floor exer
cises is widely taught in Germany. Mrs. Tanzberger contributes
exercises which are not known in the United States but have
helped many patients with urinary incontinence.
My thanks are also extended to the many persons who have
encouraged and supported me to write this book in English,
which is not my mother tongue (an additional challenge). It
would be impossible to name all my friends and colleagues who
have lent me support.
My specific thanks go to the following: Mary Sheh, who 12
years ago composed the first manuscript from lectures that I pre
sented; she also contributed most of the drawings here. Susanne
Greengard, who served as a model and as a friend. All the pa
tients and families who allowed me to take "real" patient pic
tures. Prof. Darcy Umphred, with whom I have had many
personal discussions, and who was always ready to answer my
many questions. Thanks for helping me to make this a better
book! prof. Dee Lilly Masuda, who reviewed a chapter and pro
vided me with advice. Jennifer Ault and Margret Goetz who
faithfully proofread and corrected what I put on paper. Naomi
Shwarzer, the director of the Physical Therapy Department at
Kaiser Permanente Hospital, who encouraged me and allowed me
to adjust my schedule so that I could write, work, and teach. The
staff of the Kaiser Permanente library, who helped me in the search
for articles. Marga Botsch and Dr. T. Barton from Springer
Verlag in Heidelberg, for making the trans-Atlantic communica
tion an easy task. Karin Hofheinz a dear friend and colleague
who is now translating the text into German. (Note: In the text I
refer to the therapist as "she" and the patient as "he" unless
otherwise noted.)
Pasadena, October 1997 Beate Carriere
Contents
1 History of the Swiss Ball ...................... 1
1.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 History of Literature on the Swiss Ball .......... 2
References ..................................... 3
2 Neuroanatomical, Neurophysiological,
and Physiological Bases: A Hypothesis ............ . 4
2.1 Brain Stem and Reticular Formation ........... . 4
2.2 Cerebellum .............................. . 8
2.3 Vestibular System ......................... . 11
2.3.1 Vestibular Nuclei ......................... . 11
2.3.2 Visual and Auditory Tracts .................. . 12
2.4 Hypothalamus ........................... . 13
2.5 Thalamus ............................... . 14
2.6 Basal Ganglia ..... . . . . . . . . . . . . . . . . . . . . . . . . 14
2.7 Autonomic Nervous System ................. . 16
2.8 Limbic System ........................... . 17
2.9 Sensorimotor System ...................... . 22
2.10 Physiological Responses .................... . 29
2.10.1 Valsalva Maneuver ........................ . 32
References ..................................... 33
3 Motor Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 36
3.1 Stages of Learning ......................... 37
3.2 Knowledge of Result, Knowledge of Performance .. 37
3.3 Feedback. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 38
3.4 Clinical Applications: Examples ............... 38
3.5 Plasticity of the Brain . . . . . . . . . . . . . . . . . . . . . .. 40
References ..................................... 41
4 Practical Considerations . . . . . . . . . . . . . . . . . . . . . .. 43
4.1 Ball Conditions ........................... 43
4.1.1 Exercise Surface ........................... 43
4.1.2 Cleaning the Ball .......................... 43
4.1.3 Pressure in the Ball ........................ 44
XII Contents
4.1.4 Size of the Ball . . . . . . . . . . . . . . . . . . . . . . . . . . .. 45
4.2 Safety Conditions. . . . . . . . . . . . . . . . . . . . . . . . .. 47
4.3 Precautions, Contraindications ................ 49
References ..................................... 51
5 Points of Observation ........................ 52
5.1 Ball-Floor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 52
5.2 Ball-Body. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
5.3 Body-Floor. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 55
5.4 Base of Support ........................... 55
5.5 Bisecting Plane ........................... 56
5.6 Body Distances ........................... 58
5.7 Hinged Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
5.8 Continuing Movement and Buttressing . . . . . . . . .. 63
References ..................................... 64
6 Exercise Terminology and Muscle Activity . . . . . . . . . .. 65
6.1 Exercise Terminology. . . . . . . . . . . . . . . . . . . . . . . 65
6.1.1 Body Segments ........................... 65
6.1.2 Potential Mobility. . . . . . . . . . . . . . . . . . . . . . . . .. 66
6.1.3 Dynamic Stabilization ...................... 66
6.2 Variations of Muscle Activity ................. 66
6.2.1 Parking Function . . . . . . . . . . . . . . . . . . . . . . . . .. 66
6.2.2 Supporting Function ....................... 67
6.2.3 Free-Play Function . . . . . . . . . . . . . . . . . . . . . . . . . 69
6.2.4 Bridging Activity .......................... 70
6.2.5 Hanging Activity .......................... 70
6.3 Primary Movement, Actio-Reactio ............. 72
6.4 Conditio-Limitatio . . . . . . . . . . . . . . . . . . . . . . . .. 72
References ..................................... 73
7 Planning of Exercises, Screening, Evaluation,
and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
...............................
7.1 Evaluation 75
7.2 Muscle Strength and Range of Motion .......... 78
7.2.1 Hip Extensor and Flexor Muscles:
Testing Strength in Side-Lying Position ......... 82
7.2.2 Hip Extensor Muscles:
Testing Strength in Supine Position ............ 84
7.2.3 Hip Extensor Muscles:
Testing Strength in Prone Position .............. 85
7.2.4 Hip Abductor and Adductor Muscles:
Testing Strength in Supine Position ............ 87
7.2.5 Hip Abductor and Adductor Muscles:
Testing Strength in Side-Lying Position .......... 88
7.2.6 Combination of Movements in Several Planes ..... 89