title: Swiss ball enhances lumbar multifidus activity in chronic low back pain.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Cross-Sectional Case Controlled Study.
  
  
  METHODS
  Isle of Man Institute of Sport.
  
  
  METHODS
  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).
  
  
  METHODS
  Cross-sectional area of LM was measured using rehabilitative ultrasound imaging.
  
  
  RESULTS
  Swiss Ball (SB) was more effective at stimulating LM than a Stable Surface (SS) in both groups: CLBP:SB:12.3 (cm(2)) (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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School for Health, University of Bath, Bath, UK; Isle of Man Institute of Sport, Douglas, Isle of Man. Electronic address: isla@scottphysio.com.
authors.forename: I R
authors.initials: IR
authors.lastname: Scott
authors.affiliation: Isle of Man Institute of Sport, Douglas, Isle of Man. Electronic address: frank@vaughan-iom.com.
authors.forename: A R S
authors.initials: AR
authors.lastname: Vaughan
authors.affiliation: School for Health, University of Bath, Bath, UK; Royal National Hospital for Rheumatic Diseases, Bath, UK. Electronic address: jane.hall@rnhrd.nhs.uk.
authors.forename: J
authors.initials: J
authors.lastname: Hall
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008161:Lumbosacral Region / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000295:instrumentation*
keywords: Chronic low back pain (CLBP); Lumbar multifidus; Rehabilitative ultrasound imaging; Swiss ball