as the development of civilization has led to decreasing levels of physical activity , 
 chronic illnesses accompanying various symptoms and activity disorders are increasing . a person with low back pain avoids activity to reduce the pain , and 
 this causes an increase in pain or psychological stimulus due to atrophy of the lumbar 
 extensor and attenuation of muscle strength2 . o'sullivan et al.3 pointed out that the occurrence of problems in spinal stability 
 causes the relapse of low back pain , as the core muscles of patients with low back pain are 
 weakened compared with a normal person and the patients lack relocating ability due to the 
 decrease in the capacity of the proprioceptive sense . this has also been proven in the study 
 of cooper et al.4 , in which they reported 
 that the atrophy of muscles located in the core of patients with chronic low back pain is 
 greatly advanced compared with patients without chronic low back pain . lumbar stabilization exercise is related to the capacity to control the strength of 
 movement when the posture is unstable and consciously and unconsciously control movement to 
 maintain a neutral spine position , a position of the spine that can best adapt to the load 
 of the spine5 . the purpose of the lumbar 
 stabilization exercise is to recover the capacity to control muscles and their movement , and 
 it was recently proposed to be an approach indispensable in the treatment of patients with 
 low back pain6 . in particular , exercise 
 using the swiss ball has been proven to be not only effective for development of the upper 
 body but also for patients suffering from low back pain and sciatica , to provide stability 
 for the spine , to be helpful for patients with sciatica and referred pain7 , and to be even more helpful for patients 
 who have experienced failure of discectomy than any other exercises and physical 
 therapies8 . osteoporosis is a representative illness of adults and elderly women characterized by the 
 low bone mineral density , damage in the ultrastructure of the bone , and sensitivity towards 
 fracture9 and causes frequent occurrence 
 of fractures that lower quality of life due to limits on activity , decrease in self - esteem , 
 depression , and other factors10 . although 
 osteoporosis often occurs in the elderly and women after menopause , it is a serious illness 
 in that the importance of bone health should be recognized from adolescence , and the gravity 
 of the negative consequences brought about by osteoporosis should not be overlooked from 
 early stages of adulthood11 . although the 
 method of maintaining maximum bone mass is uncertain , it is reported that genetic 
 factors12 and regular exercise have 
 great influence13 . generally , adequate 
 physical activities , namely ones that exert minimum effective strain ( mes ) , over a long 
 period of time increase the muscle mass and change the bone mass with an impulse that 
 accelerates during physical activities14 . in particular , it is reported that the resistance exercise not only prevents bone loss and 
 increases the strength of bone but also increases the muscle mass , strengthens muscles , and 
 enhances the balance of the body weakened due to aging15 . therefore , the purpose of this study was to carry out a 16-week treatment of lumbar 
 stabilization exercise with a ball targeting patients with chronic low back pain who do not 
 need surgery and to look into its effects on alleviation of low back pain and bone mineral 
 density . the subjects of this study were 36 patients composed of 12 patients in the conservative 
 treatment group ( gtg ) , 12 patients in the floor exercise group ( feg ) , and 12 patients in the 
 ball exercise group ( beg ) who were diagnosed with chronic low back pain and not severe 
 spinal disease by a physiatrist at y hospital in yeongju - si , korea , between dec . patients who were suffering from back pain accompanying compression fracture , 
 diseases such as spondylarthritis , rheumatoid arthritis , systematic disease ( cancer 
 patients ) , cerebral disease , and heart disease and those in which electrotherapy was 
 contraindicated , as well as others for various reasons , were excluded as subjects . the 
 purpose and method of this study were explained , and voluntary consent was received from all 
 subjects . subject characteristics are summarized in table 2 . in ctg , hot pack , interference current ( modulation depth , 100% ; frequency , 80100  hz ) , and 
 deep - heat ( microwave , intensity : 100  w / kg ) treatment were carried out for 20 , 15 , and 5 
 minutes respectively 3 times per week for 16 weeks . in feg , the patients performed lumbar 
 stabilization exercise on a fixed floor , maintaining 10 seconds of equilibrium , with 
 3-second breaks between repetitions for 40 minutes a day , 3 times per week for 16 weeks 
 ( table 1 ) . in beg , the patients received the 
 conservative treatment and performed lumbar stabilization exercise on a ball , maintaining 
 equilibrium for 10 seconds , with a 3-second break between repetitions for 40 minutes a day , 
 3 times per week for 16 weeks as ( table 1 ) . for 
 the ball exercise treatment , a gymnastikball ( togu , germany ) was used , and the ball size was 
 determined based on the guidelines of togu ( height : ball size ) ( under 155  cm , 45  cm ; 
 156165  cm , 55  cm ; 165178  cm , 65  cm ; over 178  cm , 75  cm ) . for the measurement of pain , a visual analogue scale ( vas ) was used . for the measurement of 
 bone mineral density , this tool is able to 
 measure lumbar vertebrae and three parts of the femur in a nonstop scan , and precise 
 measurement data can be collected for the same part during remeasurement as it is equipped 
 with a laser pointer . measurement errors were minimized with standard data for koreans and a 
 cruciform laser pointer . a quantitative evaluation of pain and bone mineral density of 
 lumbar vertebrae 1 to 4 was performed before the experiment , 8 weeks after the experiment , 
 and after completion of the 16 weeks of the experoment , and 30 minutes of rest was given to 
 the patients after exercise to minimize fatigue . for data analysis , a one - way anova was applied to analyze the characteristics of the 
 subject using spss 12.0 for windows . in order to compare the vas and bone mineral density of 
 each group before the experiment , 8 weeks after the experiment and after completion of the 
 experiment , a two - way repeated anova was applied , and the level of statistical significance 
 was set as 0.05 for all analyses . the vas scores based on the intervention period are shown in table 3 . in regards to the vas score based on the intervention 
 period , there was a statistically significant difference ( f=145.09 , p<0.05 ) , and there 
 was also a statistically significant difference in the interaction based on the intervention 
 period and intervention method ( f=30.42 , p<0.05 ) . validation of the scale of effect for 
 each intervention period revealed that there was a statistically significant difference 
 between before the intervention and after 16 weeks and between after 8 weeks and after 16 
 weeks ( p<0.05 ) . comparison of the effect between each subject in regard to the 3 groups 
 showed that there were statistically significant differences ( f=11.06 , p<0.05 ) ( table 3 ) . the bone mineral density based on the intervention period there were statistically significant differences in 
 regard to the bone mineral density based on the intervention period for each lumbar vertebra 
 ( l1 ( f=36.91 , p<0.05 ) , l2 ( f=20.96 , p<0.05 ) , l3 ( f=8.83 , p<0.05 ) , l4 ( f=5.28 , 
 p<0.05 ) ) . also , there was a statistically significant difference in regard to the 
 interaction based on the intervention period and method ( l1 ( f=20.57 , p<0.05 ) , l2 
 ( f=13.61 , p<0.05 ) , l3 ( f=12.51 , p<0.05 ) , l4 ( f=12.17 , p<0.05 ) ) . validation of the 
 scale of effect for each intervention period showed that there were statistically 
 significant differences between before the intervention and 16 weeks after the intervention 
 and between 8 weeks and 16 weeks after the intervention in regard to lumbar vertebrae 1 to 4 
 ( p<0.05 ) . comparison of the effect between each subject in regard to the 3 groups showed 
 that there was no statistically significant difference for each lumbar vertebra ( l1 ( f=1.03 , 
 p>0.05 ) , l2 ( f=0.64 , p>0.05 ) , l3 ( f=0.26 , p>0.05 ) , l4 ( f=0.29 , p>0.05 ) ) ( table 4 ) . the purpose of this study was to look into the effects of lumbar stabilization exercise 
 with a ball on the pain and bone mineral density of patients with chronic low back pain . as 
 a result , the floor exercise group ( feg ) and ball exercise group ( beg ) displayed significant 
 decreases in vas scores compared with the conservative treatment group ( ctg ) . although there 
 was no significant difference among groups for the bone mineral density , it was increased in 
 feg and beg and decreased in ctg . lumbar stabilization refers to internal stabilization achieved by isometric contraction of 
 the abdominal and lumbar muscles to maintain stability16 . it has also been referred to in the literature as core 
 strengthening , motor control training , and dynamic stabilization17 . o'sullivan et al.18 reported that among the effects of lumbar stabilization exercise on 
 the alleviation of pain and improvement in function of patients with low back pain , special 
 exercises concerning the stability of the trunk are more effective in alleviating pain and 
 improving function of patients with chronic spondylolisthesis , spondylolysis , and 
 degenerative disc compared with conservative treatment . in particular , the swiss ball 
 exercise is one of the dynamic lumbar stabilization exercises , and its main principle is to 
 reduce low back pain by comprehensively improving muscle strength , endurance , balance , and 
 flexibility of the trunk and the reflexes , cognitive sense , balance , and proprioceptive 
 sense while the individual leans their body on the ball19 . in the study of saal20 , a treatment success rate of 87% was displayed when 52 patients 
 with herniated discs were treated with dynamic lumbar stabilization exercise , and 92% of 
 patients returned to work . the vas was used to measure the degree of pain in this study as 
 well . the results of this study were in agreement with the preceding studies in that the vas 
 scores of feg and beg were significantly decreased compared with ctg . it can be considered 
 that the lumbar stabilization exercise reduces pain by reducing the stimulus delivered to 
 pain - sensitive tissues such as ligaments and joint capsules through reduction of the load on 
 the lumbar vertebra as a result of enhancing the muscle function of the stabilizer muscles 
 and core abdominal muscles that contribute to positional control of the trunk . according to the report of malina21 , 
 physical composition continually changes from infanthood to adulthood , constant physical 
 activities have a positive influence on physical composition , and an effective exercise 
 program can prevent bone loss in the lumbar vertebra and femur neck of women before and 
 after menopause or increase the bone mass by 1% per year22 . rhodes et al.23 
 reported that the bone mineral density of the femur and lumbar vertebra increased after 
 resistance training for 52 weeks and that of the control group decreased , and lohman et 
 al.24 also reported an increase in bone 
 mineral density after execution of 18 months of muscle strength exercise . furthermore , the 
 study of krolner et al.25 reported that 
 the bone mineral density of the lumbar vertebra increased about 3.5% in 50- to 72  year - old 
 women who carried out regular training for 8 months and that that of women who did not 
 receive training decreased about 2.7% . in addition , several studies have reported positive 
 correlations between general physical activity , structured exercise , and back strength or 
 bone mineral density26,27,28,29 . in this study , examination of the effects of lumbar 
 stabilization exercise on bone mineral density revealed significant results with regar to 
 measurements in feg and beg based on the intervention period . although there were no 
 significant differences in the comparison among groups , bone mineral density was reduced by 
 1.4% in ctg and increased by 0.96% and 2.81% in feg and beg respectively . it can be 
 considered that there was no significant difference because this study was conducted for 
 only 16 weeks , which is a relatively a short period of time compared with previous studies . however , the fact that the average age of the subjects for this study was in the mid 30 's 
 and that it included men contributed to enhancing the rate of increase of bone mineral 
 density in beg regardless of the study being carried out for a short period of time . considering the above results , it can be said that the lumbar stabilization exercise on a 
 ball is effective for alleviating low back pain and produces a higher rate of increase of 
 bone mineral density compared with lumbar stabilization exercise on the floor . as it 
 suggests that the lumbar stabilization exercise on a ball has a positive influence on the 
 increase in bone mineral density , regular and long - term lumbar stabilization exercise would 
 be very helpful for patients who are suffering from osteopenia and osteoporosis . limitations of this study include a small sample size and the fact that it did not control 
 for lifestyle influences on bone mineral density .
[ purpose ] the purpose of this study was to carry out a 16-week treatment of lumbar 
 stabilization exercise with a ball targeting patients with chronic low back pain and 
 investigate its effect on alleviation of low back pain and bone mineral density . 
 [ subjects 
 and methods ] the subjects of this study were 36 patients who were diagnosed with chronic 
 low back pain . 
 they were divided into a conservative treatment group ( ctg , n=12 ) , floor 
 exercise group ( feg , n=12 ) , and ball exercise group ( beg , n=12 ) . 
 the degree of recovery 
 from pain was looked into using a visual analogue scale ( vas ) and dexxum t ( osteosys , 
 seoul , korea ) which was used to observe the changes in bone mineral density . 
 [ result ] 
 although the vas score was reduced in feg and beg with treatment , it was not reduced in 
 ctg . also , the bone mineral density was increased in feg and beg , while it was reduced in 
 ctg . 
 [ conclusion ] lumbar stabilization exercises using a ball are thought to be an 
 effective interventional therapy for the alleviation of chronic low back pain and to 
 increase bone mineral density of patients .