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Phys Ther Sport. 2014 Mar 12. pii: S1466-853X(14)00011-X. doi: 10.1016/j.ptsp.2014.02.007. [Epub ahead of print]

Swiss ball enhances lumbar multifidus activity in chronic low back pain.

Author information

  • 1School for Health, University of Bath, Bath, UK; Isle of Man Institute of Sport, Douglas, Isle of Man. Electronic address: isla@scottphysio.com.
  • 2Isle of Man Institute of Sport, Douglas, Isle of Man. Electronic address: frank@vaughan-iom.com.
  • 3School for Health, University of Bath, Bath, UK; Royal National Hospital for Rheumatic Diseases, Bath, UK. Electronic address: jane.hall@rnhrd.nhs.uk.



This study examined the effects of sitting surfaces on the cross-sectional area of lumbar multifidus (LM) in patients with Chronic Low Back Pain (CLBP) and healthy controls (HC).


Cross-Sectional Case Controlled Study.


Isle of Man Institute of Sport.


40 age and sex matched, sporting participants aged 18-45 years, recruited from private physiotherapy practice patients (n = 20 CLBP, 16 male, 4 female, and n = 20 healthy controls, 16 males and 4 females).


Cross-sectional area of LM was measured using rehabilitative ultrasound imaging.


Swiss Ball (SB) was more effective at stimulating LM than a Stable Surface (SS) in both groups: CLBP:SB:12.3 (cm2) (SD:3.6), SS:10.15 (SD:2.6), p < 0.0001; HC:SB:12.5 (SD:2.7), SS:11.3 (SD:2.9), p < 0.0001). No significant differences between groups were noted. No differences between left and right side cross-sectional areas between or within groups were noted.


Cross-sectional area of LM increased as the lability of the surface increased, demonstrating that SB was more effective at stimulating LM activity than a non-labile surface. This confirms current clinical practice and supports the use of a labile surface in spinal rehabilitation. The lack of LM asymmetry within and between groups is discussed.

Copyright © 2014 Elsevier Ltd. All rights reserved.


Chronic low back pain (CLBP); Lumbar multifidus; Rehabilitative ultrasound imaging; Swiss ball

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