Should You Strength Train On Unstable Surfaces?

On the BOSU ball

A patient come to our clinic this week injured after lifting weights on an unstable surface. The studio he went to had them do chest presses and flys with a glute bridge on a BOSU ball (knees bent, buttocks up and feet resting on BOSU ball). 

Indo board

I often use the BOSU ball, wobble board and/or  Indoboard (much later on - see end of article) when my patients require proprioceptive training to prep them before they return to sport. Also for those if they have lots of metalwork (pictured below) in the ankle after a fracture. I find that challenging my patients on unstable surfaces may enable them to rehab faster compared to stable surfaces when it is safe to do so.

Check out all the metal work in the leg

Other than working on their balance and proprioception (joint position sense), I get them to step on and off, lunge sideways, forward, backwards and sideways so they will be ready when the terrain that they are on are cambered or cobblestones (especially overseas).

However, I never use them while doing strength training. Turns out there is some research supporting that. I came across the following article to investigate if there are benefits or cross over effects of strength training on an unstable surface.

The following study evaluated subjects undergoing stable and unstable resistance training for muscle power. The subjects were randomly assigned into 2 groups. Each group performed resistance exercises under stable or unstable conditions 3 times a week for 8 weeks. 

Before and after 4 and 8 weeks of the training program, the subjects underwent squats and chest presses on either a stable surface or BOSU/ Swiss ball with increasing weights of up to 85 percent 1RM (rep max). 

There were significant improvements of mean power during chest presses on a Swiss ball at weights up to 60.7 percent 1RM after 4 and 8 weeks of raining on an unstable surface. Mean power also increased significantly during squats on a BOSU ball at weights up to 48.1 percent for 1RM after 4 weeks but not after 8 weeks of training on an unstable surface.

There were no significant changes in mean power during bench presses and squats on a stable surface after the same training. We do know from previous studies (Zemkova et al, 2014) that lower pre training values of power during resistance exercises on unstable surfaces are expected when compared to stable surfaces, especially at higher weights.

The researchers concluded that there is no cross over effect while weight training on unstable surfaces. Training has to be specific, if you want to get really strong and increase your 1RM max, you do not train on unstable surfaces since you cannot lift as heavy compared to on a stable surface.

Now you know, so you do not get hurt while trying something different that your gym suggests you do.

References

Zemkova E, Jelen M, Cepkova A et al (2021).There Is No Cross Effect Of Unstable Resistance Training On Power Produced During Stable Conditions. Appl Sci. 11(8): 3401. DOI: 10.3390/app11083401

Zemkova E, Jelen M, Kovacikva Z et al (2014). Weight Lifted And Countermovement Potentiation Of Power In The Concentric Phase Of Unstable And Traditional Resistance Exercises. J Appl Biomech 30: 213-220. DOI:10.1123/jab.2012-0229.

How's that for balance?

Thera/ Massage And Vibration Guns. Do They Work?

Picture taken by iPhone 11 Pro from Shopee

Earlier in the week, I read an article on the same topic written by CNA Lifestyle. Actually, I already wrote half of the article on that exact same topic last week but decided to publish the article on bicycle lanes in Sigapore since bicycles are much closer to my heart.

The author did a good introduction on what massage or thera guns are and what they do in that article. She also interviewed other health professionals for their thoughts. So my article will be different. It will explain the science behind why thera or massage guns feel so good when you use them. And of course the evidence available.

Thera or massage guns are being advertised with all kinds of benefits like helping with aches, pain and stimulating "muscle recovery". They can certainly vibrate your muscles/ tissues but almost all the medical claims are not totally true.

Vibration therapy definitely is relaxing for most people especially if it's not too strong or sudden or in an uncomfortable location. Sitting in a warm pool with bubble jets (like a jacuzzi) come to mind and I'm sure all of you who tried will agree that it's a pleasant sensation.

And vibration, waves and frequencies are what some physiotherapists already use for treatment. These include ultrasound, electrical (TENs) and magnetic stimulation, infrared radiation and even lasers. The above are mainly microscopic vibrations aimed at cells at the cellular level and a wider range of frequencies and smaller amplitudes.

Even ESWT (or shock wave) uses high intensity waves to smash kidney stones, (used by doctors) and/ or stimulate bone healing. Many other physiotherapists also uses ESWT to treat plantar fasciitis.

An article published in the British Journal of Sports Medicine showed that runners who receive daily sessions of vibration therapy on the legs were less sore  and had fewer blood markers associated with soreness compared to runners who did not (Broadbent et al, 2010).

Coarse vibrations have interesting neurological effects too. Vibrations added to really flexible gymnasts appears to increase their flexibility further (Kinser et al, 2008).

One reason why vibrations help is a change in our proprioceptive state. Proprioception is how we sense or judge our position. When the body is being vibrated or shaken, plenty of input goes to our cerebellum in the brain. When there is no danger perceived by the cerebellum, the nervous system send signals for the body to relax. That's why the body calms down and you feel good.

Another reason is the strong and distinctive vibratory sensations are quite the opposite of feeling stiff and tight. Just like splashing cold water on your face when you're hot, vibration feels like a natural remedy to your stiffness.

So patients with conditions like muscle strains, neck pain and especially low back pain with fear being a big part of it may feel better after using massage guns or other vibration therapy.

However, if you have shin splints (will hurt more actually), plantar fasciitis and nerve entrapment issues then they probably will not help.

So, still thinking about splashing your your earned cash on this? Save your money. Or better still come see us in our clinic to treat the cause of your problem.



References

Broadbent S, Rousseau JJ et al (2010). Vibration Therapy reduces Plasma IL6 And Muscle Soreness After Downhill Running. BJSM. 44(12): 888-894. DOI: 10.1136/bjsm.2008.052100

Kinser AM, Ramsey MW et al (2008). Vibration And Stretching Effects On Flexibility And Explosive Strength In Young Gmynasts. Med Sci Sp Exer. 40(1): 133-140. DOI: 10.1249/mss.0b013e3181586b13.

Don't Ignore That Ankle Sprain

Now that's a nasty ankle sprain

We've seen quite a few cases of ankle sprains in our clinics recently. Most of these patients are young school athletes representing their school or participating in sports.

We've always managed to get our patients playing/ competing again quite quickly. Even ankle cases that were deemed serious, we've managed to get them up and running so quickly that their parents/ coaches were pleasantly surprised.

Hence I was surprised to read that ankle even if sprained only once but not treated properly can have lifelong consequences. Especially if the sprains keep recurring.

In the study referenced below, the researchers had students who had chronic ankle instability (caused by ankle sprains) wear a pedometer for a week. Their steps taken were compared with a control group of students who had normal ankles. Gender, BMI and general health were the variables controlled in both groups.

Turns out that the students with chronic ankle instability moved significantly less than the other group. They took about 2000 steps fewer on average.

The researchers were concerned with the obvious decrease in step count as this decrease may be secondary to other functional limitations. If this decrease in physical activity continues for an extended period,it may lead to other more substantial health risks.

Next time you sprain your ankle, make sure you get it checked and treated properly, even if it seems to be mostly healed as it can lead to lifelong consequences.

Reference

Hubbard-Turner T and Turner MJ (2015). Physical Activity Levels In College Students With Chronic Ankle Instability. J Athl Trg. 50(7): 742-747. DOI: 10.4085/1062-6050-50.3.05.


Note to self and my colleagues: be wary even of a simple ankle sprain