Instability trainers such as the Bosu Balance trainer and Swiss Ball are often used to strengthen the abdominal muscles (m. rectus abdominis, m. obliquus externus and internus and the m. abdominis transversis) and the muscles of the lower back (m.erector spinae). This is often done with the same sort of exercises most people use to strengthen their core without the aid of an instability trainer such as the crunch or back extension. According to a study by Vera-Garcia et al. (2000) which measured EMG activity of the abdominal muscles during crunches on a Swiss Ball and compared these with a regular crunch on the floor. During the crunch on the Swiss Ball, the m. rectus abdominis was two times more active compared with the regular crunch. The m. obliquus externus even was four times more active to aid in stabilizing the movement. These results are in correspondence with studies performed by Petrofsky et al. (2007) and Behm et al. (2005), who conclude that exercises performed on an instability trainer are more effective in strengthening the core muscles than exercises on a stable surface. In light of the results in the studies above, it can be concluded that training the core muscles on an instable surface such as a Swiss Ball or Bosu Ball activates the muscles more strongly than on a stable surface and is therefore more effective.
One of the most common causes for low back pain lies in the coordination of the muscles that stabilize the spine. It would therefore seem logical that exercises that aim to improve this muscle coordination would be effective in reducing low back pain. According to a pilot study performed by Marshall & Murphy (2006), exercises performed on a Swiss Ball an effective method to treat low back pain. Carpes et al. (2008) found that it was effective to reduce low back pain and, in addition, it also improves walking pattern and balance. Although both of these studies were performed without a control group, the patients in both studies had been suffering from lower back pain for at least one year and on average 4-8 years. Therefore it is unlikely that the reduction in pain would be a result of a healing process instead of the exercises on an instability trainer. Another study performed by Marshall & Murphy (2008) did include a control group and it found that exercises on a Swiss Ball under supervision of a physio therapist were more effective in treating low back pain than exercises performed on a stable surface. Put together, these studies support the use of training the core muscles on an instable surface to positively affect the cause of lower back pain.
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