It’s a question we can answer about almost every action in our life.
All of these questions are easily answered with a purpose and some reasoning behind them. Now, apply this same principle to rehabilitation, nutrition, or fitness and all of a sudden many either cannot answer or do not have any reasoning behind their action:
Those answers may be sufficient for some, but as professionals and individuals looking to better ourselves we need to be able to answer these questions with a greater purpose. The first individual should be able to support his protein use by his size, training frequency, and goals. Why is the second individual performing knee extensions rather than a squat? Is individual Number 3's training goal strength, endurance, or hypertrophy?
You may be saying to yourself that you are fine with your diet, you simply enjoy exercising, or that all of your clients seem to be happy and making progress. This is acceptable and this post may not be for you. This necessity to ask “why?” is for those looking to better themselves as an individual and a professional. Challenging yourself to be able to answer “why?” to each and every component of a program will ensure that you are treating (training, dieting, etc.) with a purpose.
Evidence based research, applying the best available research when making a decision, is a key component to being able to formulate your “why”. In addition, you should always consider the client’s values and your own clinical expertise when constructing your program. I am not here to tell you the best method, nor am I telling you that what you are already doing is insufficient. Instead I am challenging you to be able to answer “why?” and choose diets, exercises, and programs with a purpose.
Physical Therapy and UST
Balance training (also referred to as neuromuscular training or proprioceptive training) is prescribed by physical therapists to help patients recover from or prevent lower extremity injuries. Balance training is used to increase body awareness/control and increase the strength of muscles in the lower extremities.
A review by You-jou Hung (2) concluded that balance training might benefit individuals with an unstable ankle; however it is unlikely to prevent injuries caused by fast and large perturbations such as landing on an unstable surface with a single limb. In addition, the JOSPT Clinical Practice Guidelines for Ankle Ligament Sprain (3) give therapeutic exercise and activities, such as single leg balance and using unstable surfaces, a level C evidence (weak evidence).
Another population where the UST may be used in physical therapy is with the elderly and those at an increased risk of falls. A study by Martinez-Amat et al. (3) looked at the effect of a 12-week proprioceptive training program on postural stability, gait, balance, and fall prevention in adults older than 65 years. The results of the training program, which used the BOSU ball and Swiss ball, indicated that unstable surface training is effective in improving postural stability, static, and dynamic balance. It could also lead to an improvement in gait and balance capacity and may decrease the risk of falling in adults aged 65 years and older.
Weight Lifting and UST
Unstable surface training may serve a purpose in physical therapy, but what about in a healthy, athletic population?
There are several research articles comparing the use of an unstable surface (i.e. BOSU ball) versus stable ground when performing exercise. A study by Willardson et al. (4) investigated core muscle activation when using a BOSU ball versus stable ground and found that there was no advantage to using a BOSU ball for the squat, deadlift, overhead press, or curling exercises. With that being said, it was recommended that these exercises be performed on a stable surface without the fear of losing the potential core muscle training benefits. An article by Li et al (5) using electromyography comparing squatting on a reebok core board and stable ground found similar results to the Willardson study. No significant difference was found in the EMG readings of lower extremity muscles during stable and unstable exercises. An increase in muscle activation was found when weight load was increased, regardless of surface.
So far the evidence has stated that UST does not lead to an increase in muscle activation compared to a stable surface, but rather an increase in load correlates to an increase in muscle activation. A study by Drinkwater et al. (6) analyzed the effects of using a BOSU ball during the squat found adverse effects. What the researchers found was that as the weight increased while performing the squat on a BOSU ball, the participant’s kinematics and technique (or squat form) decreased. In other words, when trying to progressively overload a muscle on a BOSU ball by increasing the load, the form decreases leading to compensations and a higher risk of injury.
A study published in the Journal of Strength and Conditioning Research looked at the use of unstable surface training on athletic performance in elite athletes. After the 10-weeks of training, it was found that the control group (stable training group) showed improvements in jumping peak power, while the unstable surface training group did not show significant improvements. Both groups saw an improvement in 40-yard sprint, 10-yard sprint and agility test times, however the stable training group saw larger improvements. The study concluded that using an unstable surface reduces possible performance improvements in healthy, trained athletes. (7)
So maybe your purpose is to increase core strength and stability. This is not to say that every lower extremity exercise using UST does not increase core activation; however several studies using common functional exercises have shown no benefit to using an unstable surface for core activation. Another aspect to consider is that you are sacrificing strength and power while using an unstable surface. Here is an example:
In the second scenario the weightlifter sacrificed overloading their musculoskeletal system by adding in another factor, the unstable surface, thus causing them to focus more on their form and neuromuscular system. If the weightlifter performed the squats on the BOSU ball with the same weight as before, they would create an unsafe environment. They would compensate, correct form would be lost, and an increased risk of injury would result.
Overall unstable surface training may serve a purpose if implemented in the correct manor, however it is too often used with no real purpose. Remember to always have a purpose for all of your exercises and be able to answer “why” you chose that specific one!
1) Hung Y. “Neuromuscular control and rehabilitation of the unstable ankle.” World J Orthop. 2015 June 18;6(5):434-438.
2) Martin R, Davenport T, Paulseth S, Wukich D, Godges J. “Ankle stability and movement coordination impairments: ankle ligament sprains.” J Orthop Sports Phys Ther. 2013;43(9):A1-A40.
3) Martinex-Amat A, Hita-Contreras F, Lomas-Vega R, Caballero-Martinez I, Alvarez PJ, Martinez-Lopez E. “Effects of 12-week proprioception training program on postural stability, gait, and balance in older adults: a controlled clinical trial.” J Strength Cond Res. 2013 Aug;27(8):2180-8.
4) Willardson JM, Fontana FE, Bressel E. “Effect of surface stability on core muscle activity for dynamic resistance exercises” Int J Sports Physiol Perform. 2009 Mar;4(1):97-109.
5) Li Y, Cao C, Chen X. “Similar Electromyographic Activities of Lower Limbs Between Squatting on a Reebok Core Board and Ground.” J Strength Cond Res. 2013 May;27(5):1349-1353
6) Drinkwater EJ, Pritchett EJ, Behm DG. “Effect of instability and resistance on unintentional squat-lifting kinetics.” Int J Sports Physiol Perform. 2007 Dec;2(4):400-13.
7) Cressey E, West C, Tiberio D, Kramer W, Maresh C. “The effects of ten weeks of lower-body unstable surface training on markers of athletic performance.” JOSPT. 2007 May;21(2).
Now before everyone freaks outs, I only eat 2 eggs with the yolk while the other 4 are only egg whites, but that still puts my total cholesterol for breakfast at ~370mg (AHA previous recommendations were <300mg per day). You may be thinking a number of things including that my blood cholesterol levels must be crazy high and my heart and arteries must be unhealthy. Well, that is not exactly how the human body works --> an increase in dietary cholesterol does not mean an increase in blood cholesterol. I am going to explain, with the help of several resources, why you should not be afraid to eat a few eggs every morning.
Let me start out by saying I eat a well balanced diet with a conscious effort to consume the right amount of macronutrients, fiber, and vitamins, I exercise daily, and I am of a healthy body weight --> all important factors in determining someone’s risk for cardiovascular disease (CVD) and serum cholesterol levels. Now, I am not supporting that someone who suffers from high cholesterol (hyperlipidemia), is of an unhealthy body weight, or suffers from diabetes or other metabolic diseases go consume excess amounts of eggs (see medical physician). Instead, I am supporting that healthy individuals should consume eggs without the fear of raising their risk of CVD.
Here are some of the health benefits of eggs
What does the research say about egg consumption and dietary cholesterol?
I came across a very recent article by Robert Eckel titled “Eggs and beyond: is dietary cholesterol no longer important?” (4). In the article, Robert explains that the 2013 AHA Lifestyle Guidelines for Reduction of CVD and the 2015 USDA Dietary Guidelines have indicated that the evidence for dietary cholesterol restriction to lower total and LDL cholesterol is insufficient.
“Cholesterol is not considered a nutrient of concern in overconsumption”