Stability Ball Push Up (Progressions and Regressions)

Stability Ball Push-ups:

1. Have the client or patient place their hands on either side of a stability ball, gripping into the ball with fingers pointed down. Note, sagittal plane push-ups are more comfortable when performing hands-on stability ball push-ups.
2. Cue your client into a position in which their nearly fully extended arms are perpendicular to the ball. This is achieved by asking them to adjust their foot position, body angle, and shoulder and arm position appropriately.
3. Ask the client or patient to assume optimal form/posture:
   • Feet perpendicular to the floor and 2nd toe aligned with ASIS
   • Ankles, knees, and hips in alignment
   • Pelvis neutral (absence of anterior or posterior pelvic tilt)
   • Torso, scapula, and head in neutral alignment
4. To enhance core muscle recruitment and trunk stability, ask your client or patient to maximally dorsiflex their ankles and attempt to get as much of the ball of their foot on the floor as possible. Have them “squeeze (contract)” their glutes and quads as if they are pushing the balls of their feet back into the floor. Last, have them perform the abdominal drawing-in maneuver before initiating the eccentric phase.
5. Cue the client or patient to maintain trunk stability as they bend the elbows and slowly lower themselves into the bottom position. Note, the forearms should maintain near perpendicular alignment with the ball; the lower chest/upper abdominal area should approach the ball.
   • The foot position may need to be repositioned during the first few repetitions to ensure that forearms maintain near perpendicular alignment throughout the motion.
6. Ensure that your client is maintaining the drawing-in maneuver, glutes contracted, and quads contracted before they push themselves up (or push the ground away) to full elbow extension and scapula protraction; achieving a plank position with fully extended arms.
   • Note, it may feel counter-intuitive to the client, but they should start with a slower tempo. Faster tempos will result in larger perturbations, more “wobble” from the ball, and a significant increase in the challenge to stability.
7. Repeat for the desired number of repetitions.

Regressions and Progressions:

• Regressions: Replace the stability ball with a medicine ball (increases inertia and decreases perturbation speed), press the ball into a wall imparting friction (reducing perturbation speed), and/or elevate the ball to reduce load.
  • Initial Progression: Position a bench against a wall, and then place the stability ball on the bench and press it into the wall. This elevates the hands and torso which reduces load and pushing the ball against the wall reduces instability.
  • Increase Load: Elevate the feet or add a weighted vest.

Common Mistakes:

• The scapula should not be cued into a fixed position. The concentric phase of a push-up should include protraction, and the eccentric phase should include retraction.
• Placing the hands on top of the ball (fingers pointing cranially) as if doing a horizontal plane push-up is not advised. Generally, stability balls and medicine balls are too narrow to perform a horizontal plane push-up with good form/posture.