STABILITY TRAINING

COURSE STUDY GUIDE

This course discusses stability training, including core stability
training, upper body stability training, lower body stability
training, balance training, injury prevention, and the use of
stability training in physical rehabilitation. A comprehensive
systematic research review is included that implies evidence-
based progressions and regressions for all of the large
movement patterns (muscle groups), including the use of
unstable loads and unstable environments. Additionally, stability
training outcomes and adaptations are discussed in detail: EMG
activity, motor pattern recruitment, fatigue, rate of force
development, balance, muscle endurance, muscle strength,
muscle hypertrophy (muscle growth), sports performance, injury
prevention, and injury recovery.

For an in-depth breakdown, webinar,

and annotated bibliography,
Go to the course: Stability Training
RESEARCH SUMMARY
STABILITY TRAINING

Key Points about Stability Training

Increasing the stability demand of an exercise has a larger effect
on the EMG activity of novice exercisers when compared to
experienced exercisers.
A significant stability demand is necessary to increase muscle
EMG activity.
Unstable loads result in larger changes in EMG activity than
unstable surfaces.
Additional adaptation to unstable load and surface training,
beyond EMG activity, must be considered (i.e. balance and
coordination). Studies have demonstrated that experienced
exercisers may benefit from several weeks of stability training,
despite being unlikely to exhibit immediate increases in EMG
activity during stability training.
Stability training in a rehabilitation setting may be beneficial for
increasing balance, improving function, reducing pain for certain
conditions, and increasing EMG activity without increasing force.
Research suggests that EMG activity can only increase to a "peak
level", at which point no additional changes in environment or
load will result in further increases in EMG activity.
RESEARCH SUMMARY
STABILITY TRAINING

Rehabilitation
Unstable training may be beneficial for progressing exercise for
individuals who may benefit from an increase in muscle activity
without an increase in force output (e.g. strain, tendon repair, etc.)
Unstable surface training may improve balance and performance
on functional tests for those with assessed balance deficits.
The addition of balance training to a rehabilitation program for
chronic ankle instability improves self-reported and objective
functional outcomes but does not effect strength or self-reported
pain.
Research demonstrates that rehabilitation programs for low back
pain (LBP) using unstable surfaces improves function and reduces
pain better than programs using stable exercise alone.
Stability training is unlikely to have a significant effect on altered
kinematics.
Individuals must continue balance training exercises, even after the
resolution of symptoms, to maintain benefits beyond 6 weeks.
RESEARCH SUMMARY
STABILITY TRAINING

Note on Corrective Exercise

There are a few studies that suggest unstable environments may
exaggerate altered recruitment patterns in those exhibiting
dysfunction. This may imply that specific interventions (e.g. serratus
anterior activation) should precede multi-joint exercises using
unstable surfaces or loads.

Performance
Balance training may be as effective as traditional strength training
for improving performance in novice exercisers. for improving
performance in novice exercisers.
Experienced exercises may require longer balance training
programs (6+ weeks) to see performance gains.
RESEARCH SUMMARY:
LOWER BODY EXERCISE
STABILITY TRAINING

Squats
Adding unstable surfaces to a squat may increase prime mover
activity for inexperienced lifters.
Adding unstable surfaces to a squat may not alter EMG activity for
stabilizers or prime movers in experienced lifters.
Adding unstable loads to a squat significantly increases stabilizer
and core muscle activity for experienced and inexperienced lifters.
More research is needed to determine how unstable surfaces
contribute to the increases in performance noted above; for
example, increased coordination, balance, and reaction time.
RESEARCH SUMMARY:
LOWER BODY EXERCISE
STABILITY TRAINING
Comparing squats, step-ups, lunges, Bulgarian split squats,
single-leg squats, and single-leg deadlifts.
The reduction in biceps femoris activity and increase in core and
hip muscle activity may imply lunges are a better progression from
squats than Bulgarian split squats.
Gluteal complex and core muscle activity increases as you progress
from squats to step-ups to lunges to single-leg squats/deadlifts;
however, differences in EMG activity decrease when external loads
are added.
Single-leg deadlifts increase recruitment of the hamstrings and
glutes but reduce quadriceps activity when compared to squats to
step-ups to lunges.
Adding an unstable environment to body-weight exercise is likely
to increase EMG activity; whereas, adding unstable environments to
loaded exercise may reduce the capacity to produce force.
Band-resisted abduction around the knees only increases gluteal
complex activity during squats.
Note: Bulgarian split squats are not recommended due to an
increase in biceps femoris activity, compensation around
commonly restricted hip flexors, and potential strain on the
knee of the back leg.
RESEARCH SUMMARY:
UPPER BODY EXERCISE
STABILITY TRAINING

Push-ups
Instability and changing body position (elevating feet) during a
push-up increases upper-body muscle activity.
Some research suggests that unstable surfaces/loads may
exaggerate compensation patterns correlated with dysfunction;
implying corrective interventions should precede stability training.

Chest Press
Prime mover activity is greater for stable exercises when loads are
attempted that could not be performed with unstable loads or
surfaces; however, unstable loads may be appropriate when loads
are low to moderate.
Core muscle activity is similar for unstable and stable surfaces when
loads are high, but greater core muscle activity is noted when
unstable surfaces are compared to stable surfaces and loads are
low to moderate.
Unstable loading during a chest press may increase the activity of
ancillary muscles including the biceps brachii, middle trapezius,
and middle deltoid.
RESEARCH SUMMARY:
UPPER BODY EXERCISE
STABILITY TRAINING

Overhead Press
Unstable loads have a larger impact on prime mover muscle
activity than unstable surfaces.
Unstable loads may increase muscle activity of antagonists,
scapular stabilizers, and trunk muscles.
Heavier loads only possible on stable surfaces elicit the greatest
prime mover muscle activity.
Rotator cuff muscle activity is similar in all conditions, due to high
levels of recruitment throughout (88).

Inverted Row:
Unstable loads will increase the activity of stabilizing muscles.
Prime mover muscle activity may be highest when high loads can
be performed from an unstable apparatus.
Placing the feet on unstable surfaces does not have an effect on
muscle activity.
Inverted rows are helpful for those recovering from low back pain,
as these progressions result in smaller amounts of posterior to
anterior force on the lumbar spine and lower erector spinae activity
than many other back exercises (102).
RESEARCH SUMMARY:
CORE EXERCISE
STABILITY TRAINING

Planks
Lower Extremity Support: Modified (knees), to bilateral (both feet),
to unilateral (one foot)
Unstable Environment: Floor plank, to inflatable disks or balance
pads, to stability ball or suspension trainer
Placement of Unstable Environment: Under the feet, to under the
forearms, to under the feet and forearms.
Posterior Chain Muscles: Although studies demonstrate that some
progressions increase erector spinae activity, the addition of
unstable environments to planks is likely not ideal for improving
posterior chain muscle strength/endurance.

Quadrupeds
Stability Progressions: Quadrupeds may be progressed from arm
raise, to opposite arm/leg raise, to leg raise, to increasing abduction
angle; and further, increasing hip flexion angle and/or decreasing
weight shift may increase trunk muscle activity.
Addition of External Load: The addition of unstable loads has the
potential to further increase trunk muscle activity during the
quadruped exercise.
RESEARCH SUMMARY:
CORE EXERCISE
STABILITY TRAINING

Glute Bridge
Bilateral to Unilateral: Progressing from a bilateral bridge to a
single-leg bridge nearly doubles gluteus maximus and gluteus
medius activity, and increases trunk muscle activity. Further,
adding an unstable surface may further increase gluteus medius
and gluteus maximus activity (unless force output decreases), and
will significantly increase trunk muscle activity.
Trunk Muscle Activity: An increase in internal oblique activity (and
perhaps transverse abdominis activity) may match initial demand
when progressing from stable to unstable environments; however,
as demand increases, activity of the external obliques and rectus
abdominis may aid in compensating for further increases. Similarly,
multifidus activity increases initially, followed by erector spinae
activity when demand increases.
Adding Un-resisted Abduction: The addition of un-resisted
abduction of the contralateral leg during a unilateral bridge is likely
to increase core muscle activity and may improve recruitment by
increasing transverse abdominis, internal oblique, and multifidus
activity relative to rectus abdominis, and erector spinae activity.
Not Enough: Two studies reported no significant difference when
comparing a floor bridge to a bridge on an unstable surface. Based
on the effects demonstrated in previous studies, these studies may
be demonstrating that the BOSU® ball is an insufficient stimulus to
result in significant changes in recruitment, or that allowing clients
to keep their arms on the floor may provide an alternative method
for maintaining stability.
DEFINITIONS
STABILITY TRAINING

Human movement professionals have a variety of ways to progress

exercise. One method of progressing exercise is challenging stability by
introducing unstable loads and/or surfaces. The objective of this course
is to review all research pertaining to stability training, transparently
present research findings, and develop reasonably objective
conclusions about those findings for application in practice.
Definitions

Center of mass (CoM) - an object's mean position of mass; that is, a

point that is perfectly surrounded by an equal amount of mass in all
directions.

Base of support (BoS) - refers to the area beneath an object or

person and the area within the perimeter created by every point of
contact that the object or person makes with the supporting
surface. This may include the glutes of someone sitting on a chair or
the back of someone leaning against a wall.

Equilibrium - A state in which opposing forces or influences are

balanced.

Balance - The ability to maintain a body’s center of mass over its

base of support. Balance can be static or dynamic.
DEFINITIONS
STABILITY TRAINING

Stability - The ability of a body to produce forces that will restore

equilibrium when disturbed.

Stability Training - An exercise or rehabilitation program designed

to enhance the body's ability to stabilize; the ability to
maintain/restore balance.

Exercise Progression - Modification of an exercise that increases

demand with the intent of promoting adaptation. This can be
accomplished by increasing reps, load, tempo, range of motion,
complexity, and/or challenge to an individual's stability.
Because load, reps, tempo, and complexity are often explicitly
noted, the term "exercise progression" is most often used
throughout Brookbush Institute (BI) content to refer to an
exercise or series of exercises that make it harder to maintain
stability with good form.

Experienced Exercisers - Participants in a study who have at least

six months of exercise experience.

Inexperienced Exercisers - Participants in a study who have less

than six months of exercise experience.
 MODELS
STABILITY TRAINING

Punjabi's Model: Three Subsystems - passive (connective tissue), active

(muscles), and neural (nervous system)
Comerford and Mottram's Model: Two Subsystems - local muscles
and global muscles
Comerford and Mottram's model could be viewed as a division of
Punjabi's "active system".

Summary: Both models describe the interdependent relationship of

the body's systems, are predictive of how stability training may engage
specific systems, and how dysfunction of one or more systems could
result in tissue stress and pain.
For an in-depth breakdown,
videos, and annotated
bibliography,

Go to the course: Stability

Training