Med. J. Cairo Univ., Vol. 84, No.
3, December: 73-83, 2016
www.medicaljournalofcairouniversity.net
Effect of Ball Stability Exercises on Low Back Pain during Pregnancy
MOHAMED A. AWAD, Ph.D.*; MARWA A. MOHAMED, Ph.D.*;
ABD EL-HAMID A. ATTA ALLAH, M.D.** and CHRISTINE B. HENNEN, M.Sc.*
The Departments of Physical Therapy for Gynecology & Obstetrics, Faculty of Physical Therapy, Cairo University*,
Orthopedic Surgery, Faculty of Medicine (Girls), Al-Azhar University**, Egypt
Abstract
Aim of Work: This study was conducted to investigate the
effect of stability ball exercises on low back pain during
pregnancy. Forty primigrvida and multigravida women com-
plaining from low back pain selected randomly from outpatient
clinic of Port Said General Hospital in Port Said.
Material and Methods: The study was conducted from
December 2014 to March 2016. Their ages ranged from 25
to 35 years old and their body mass index was not exceeding
32kg/m 2 . All women were on second trimester of pregnancy.
They were divided into two groups equal in number, Group
(A) treated by receiving antenatal routine; vitamin supplemen-
tations, instructions about back care during pregnancy, as well
as using pelvic belt to support pelvic joints and Group (B)
treated by the same treatment in group A in addition to ball
stability exercises day after day for six weeks.
Visual Analogue Scale (VAS) was used to measure pain
intensity and pregnancy mobility index was used to assess
functional disability for both Groups (A & B) before and after
treatment.
Results: The results of this study indicated that there was
highly statistically significant decrease in low back pain
intensity, daily mobility in the house and mobility outdoor in
Group B than Group A after six weeks of treatment.
Conclusion: Accordingly, it could be concluded that the
performance of the ball stability exercises with receiving
instructions about back care and wearing pelvic belt were
more effective in reducing low back pain intensity and func-
tional disability than receiving instructions about back care
with wearing pelvic belt support only on pregnant women.
Key Words: Ball stability exercises – Low back pain – Preg-
nancy.
Correspondence to: Dr. Mohamed A. Aw ad, The Department
of Physical Therapy for Gynecology & Obstetrics, Faculty of
Physical Therapy, Cairo University, Egypt
73
Introduction
PREGNANCY-related low back pain is a common
problem during pregnancy. More than half of all
pregnant women experience low back pain at some
time during pregnancy. The pain can vary from a
mild discomfort to being severe and disabling. In
one-third of these women, pain is a severe problem
compromising activities of daily living, work and
sleep. Pain usually develops between the fifth and
seventh month of pregnancy but may appear as
early as the first trimester [1] .
The main cause of back pain during pregnancy
is strain on the back muscles. As thepregnancy
progresses, your uterus become heavier. Because
this increased weight is carried in front of the body,
female naturally bend forward. To keep the balance,
the posture change. Female may find leaning back-
ward, which can make the back muscles work
harder. This extra strain can lead to pain, soreness,
and stiffness. And abdominal muscles become
stretched and may weaken [2] .
Examination should include observation of the
posture and gait, neurologic screen to rule out
underlying pathology, range of motion, muscle
tests, palpation, muscle length tests, and assessment
of joint mobility. Even though the Active Straight
Leg Raise test seems accurate, the sensitivity would
be elevated when combined with the Posterior
Pelvic Pain Provocation (PPPP) test. The following
findings were commonly revealed: Para vertebral
muscles were tender to palpation, back muscles
weakness, decreased ROM in flexion [3] .
There are a number of things female could be
done to treat back pain during pregnancy. Some
of the steps you took to avoid back pain may also
74 Effect of Ball Stability Exercises on Low Back Pain during Pregnancy
be used to treat current back pain. Here were some
other common interventions: Ice or heat, brace or
support devices, sleep on the left side and used a
support pillow under the knees, medications used
to treat inflammation and used a licensed health
care professional such as a chiropractor or massage
therapist [4] .
Another trial showed that acupuncture and
stabilizing exercises were important treatments for
pelvic pain management during pregnancy [5] .
Back pain may not be prevented completely,
but there are things that pregnant female can do
to reduce the severity or frequency. Here are few
steps you can take to help reduce the back pain
you are experiencing: Up use exercises approved
by the health care provider that support and help
strengthen the back and abdomen, squat to pick
something versus bending over, avoid high heels
and other shoes that do not provide adequate sup-
port, avoid sleeping on your back, wear a support
belt under the lower abdomen, make sure your
back is aligned using chiropractor, get plenty of
rest and elevating your feet is also good for your
back [4] .
Abdominal bracing uses your deep tummy mus-
cles to help protect your back and pelvis from pain
and injury [6] .
The exercise ball is an exercise treatment option
for back pain sufferers and is designed to help
prevent or minimize further episodes of low back
pain as part of a rehabilitation program. Also it’s
effective in rehabilitation because it strengthens
and develops the core body muscles that help to
stabilize the spine [7] .
A stability or exercise ball was a lightweight,
strong plastic ball used to perform exercises with.
Use of an exercise ball was well-suited for pregnant
women because the ball could provide support in
the back and buttocks, where pregnant women
experience pregnancy-related strain [8] .
Stability ball exercises that require a neutral
spine position might be appropriate for targeting
the specific muscles that stabilize the spine during
the early phase of training; they also might improve
trunk endurance because of the high percentage of
slow-twitch fibers recruited to maintain a neutral
position [9] .
Other potential benefits. Stability ball training
might offer a number of additional potential bene-
fits: Improved balance, joint stability, propriocep-
tion, and neuromuscular control decreased the
incidence of injury. Heart rate response and oxygen
consumption rate increased. Strength, stability,
balance, posture, proprioception, and flexibility
in pregnant women increased. These adaptations
result in stronger abdominal muscles, which helped
to support the baby, decreased the incidence of
back pain, and reduced the chances of accidental
falls [10] .
Performing exercises on a stability or balance
ball could improve your strength, balance and
coordination. Your core, the muscles of the stomach
and lower back, work extra hard with ball exer-
cises to keep your body stabilized. This could
be especially beneficial during pregnancy. As your
belly grows, you might experience postural chan-
ges that cause stress to your lower back and other
areas [11] .
Aim of this study was to investigate the effect
of stability ball exercises on low back pain during
pregnancy.
Subjects and Methods
This study was conducted on forty pregnant
women were selected randomly from outpatient
clinic of Port Said General Hospital in Port Said.
The study was conducted from December 2014 to
March 2016. All women were in their second
trimester of pregnancy (after 12 weeks gestation)
at the time of enrollment in the study. Their ages
ranged from 25 to 35 years old and their body mass
index was less than 32kg/m 2 . All women were
primigravida or multigravida. They were divided
into 2 groups equal in number as the following:
Group (A) control group, was consisted of 20
women received antenatal routine vitamin supple-
mentations, instructions about back care during
pregnancy, as well as using pelvic belt to support
pelvic joints. Group (B) study group, was consisted
of 20 women treated by the same treatment in
Group A in addition to ball stability exercises day
after day for six weeks.
Procedures:
All pregnant women were given a full explana-
tion of the protocol of the study and consent form
was signed for each woman before participating
in the study.
A- Evaluation procedures:
BMI was calculated by dividing the weight in
kilograms on the square of height in meters by
Mohamed A. Awad, et al.
using weight and height scale, to ensure that female
BMI was less than 32kg/m 2 to be enrolled in the
study. Pain was assessed through VAS for each
woman in both Groups (A & B) before starting
and after the end of the study. Pregnancy Mobility
Index (PMI) was specifically designed to be used
in a pregnant population and concerns exclusively
mobility in relation to back and pelvic pain.
B- Treatment procedures:
Group A received routine antenatal vitamins
supplementation as well as antenatal instructions
about back care and Group B received the same
instructions and advices as in Group A in addition
to ball stability exercises (45min) every other day
for sex weeks (18 sessions).
Ball stability exercises (pilates ball exercise):
Preparation step:They began gentle exercise
such as rock the hips gently from side to side,
rotate the hip in circles for ten sits clockwise and
ten sits anti-clockwise and rotate the pelvis in slow
figure of eight.
Then made pilates ball exercise by the following
steps:
Step (1) spine twist exercise:
Woman was asked to sit on the exercise ball
and keep the nose, sternum and naval in one line
then rotate her trunk to the right side with inhala-
tion, then exhale while returning to the starting
position then repeat this exercise to the left side.
This exercise was done for 5 times, Fig. (1).
Step (2) side stretch:
It helps with the mild back pain and helps to
open the ribs and strengthen the oblique muscles
on the sides of the torso. Woman was asked to sit
on the ball and stretched the spine to the right side
with inhalation and exhales while return to the
starting position then repeat this exercise to the left
side. This exercise was done for 5 times, Fig. (2).
Step (3) pilate cat/caw stretch:
This is most helpful at stretch low back and to
relieve the pain in mild and lower back after work-
ing all day. Use the ball to flex or round the back
with an exhalation, then inhale as the woman
pushes the ball away extending the spine and
poking the sacrum upward. This exercise was done
for 5 times, Fig. (3).
Step (4) pilate bridge and pelvic tilt:
It helps to stretch the spine while strengthening
the abdominal and deep pelvic floor muscles,
75
exhale as the woman tilt or bridge up and then
inhale to stay at the top with the hips lifted. Then
exhale to roll the spine and hips back down to start.
This exercise was done for 5 times with rest in
between to avoid hyperventilation, Fig. (4).
Step (5) pilate wall squat:
Woman was asked to stand with the back against
the wall, heels about 20 inches from the wall, feet
shoulder width apart, the woman was asked to
engage her abdominals, slowly slide down the wall
into a squat position with the knees bent to about
60º, hold for the count of 5 and repeat 10 times,
Fig. (5).
Step (6) abdominal crunch:
Woman was asked to sit on the exercise ball.
Slowly walk the feet out until the woman is seated
but slightly reclined, with the ball above the upper
buttocks to mid back. Place hands loosely behind
the head and neck for support, or cross arms in
front of the chest, exhale as the woman contract
abdomens in toward spine and lift head, arms and
shoulders up and forward then inhale to return to
incline position. Repeat 5 repetitions with rest in
between to avoid hyperventilation, Fig. (6).
Step (7) Seated arm and leg raise:
Woman was asked to sit on the exercise ball,
feet flat on the ground, hip-width apart. Place her
hands on the hips or down to the sides. Keep the
spine in a natural position and pull the abdominal
in for balance, carefully lift the left foot off the
ground, lifting the knee up as high as the female
can comfortably. At the same time, release the right
hand from the hip and extend the arm overhead.
Hold here for 1-3 counts, and then slowly return
to the starting position. Switch sides and repeat 10-
15 times (each side) to complete one sit, Fig. (7).
Statistical analysis:
Results are expressed as mean, Standard Devi-
ation (SD), median, minimum and maximum. Com-
parison between values of different variables in
the two studied groups was performed using either
unpaired t-test or Mann-Whitney test whenever it
was appropriate. Pairwise comparison (pre vs post)
within the same group was performed using either
paired t-test or Wilcoxon Signed Ranks test when-
ever it was appropriate. SPSS computer program
(Version 16 windows) was used for data analysis.
p-value less than or equal to 0.05 was considered
significant and <0.01 was considered highly sig-
nificant.
76 Effect of Ball Stability Exercises on Low Back Pain during Pregnancy

Fig. (4): Pilate bridge and pelvic tilt.

Fig. (1): Pilates spine twist exercise.

Fig. (5): Pilate wall squat.

Fig. (2): Pilate side stretch.

Fig. (6): Abdominal crunch.

Fig. (3): Pilate cat/caw stretch. Fig. (7): Seated arm and leg raise.
Mohamed A. Aw ad, et al. 77

Results between the mean value of body weight and BMI

I- General characteristics of the patients:
There was no statistical significant difference
between mean value of age and height of Group
A and Group B with t-value = 0.908 and –1.340
respectively and p-value = 0.370 and 0.188 respec-
tively. [(Table 1) and Figs. (8,9)].
of Group (A) (71.32 ± 12.08), (28.09±3.29) and
Group (B) (76.75 ± 12.63), (29.46 ± 5.13) with the
t-value was 1.388, 0.999 and p-value was 0.173,
0.324 [(Table 2); Figs. (10,11).
Table (2): Mean values of body weight and BMI between
both groups (A & B) pre-and post treatment.

Group (A) Group (B) t-value p-value

Table (1): General characteristics of both groups (A & B).
Body weight:
Group (A) Group (B) Pre-treatment 68.60 ± 11.63 73.68 ± 12.39 –1.336 0.190 (NS)
(n=20) (n=20) t-value p-value Post-treatment 71.32 ± 12.08 76.75 ± 12.63 –1.388 0.173 (NS)
BMI:
Age (yrs.) 29.15 ± 3.08 28.40 ± 2.04 0.908 0.370 (NS)
Pre-treatment 27.02 ± 3.18 28.28 ± 5.01 –0.945 0.350 (NS)
Height (cm) 158.95±7.19 161.60 ± 5.16 –1.340 0.188 (NS) Post-treatment 28.09 ± 3.29 29.46 ± 5.13 –0.999 0.324 (NS)
NS = Non significant.
Data are expressed as mean ± SD.
NS = p>0.05 = Not significant.
90 76.75
35 80 68.6 73.68 71.32
29.15 28.4
30 70
Mean value (kg)

60
Mean value (yrs.)

25
50
20 40
15 30
20
10
10
5
0
Pre-treatment Post-treatment
0
Group A Group B
Group A Group B
Fig. (8): Mean values of age in both Groups (A & B).
Fig. (10): Mean values of body weight between both Groups
(A & B) pre- and post treatment.
200
180 158.95 161.6
160 35 29.46
140 27.02 28.28 28.09
Mean value (m)

30
120
Mean value (kg/m2)

100 25
80 20
60
15
40
20 10
0
5
Group A Group B
Fig. (9): Mean values of height in both Groups (A & B). 0
Pre-treatment Post-treatment

II- Body weight and BMI: Group A Group B

Between groups:
Fig. (11): Mean values of BMI measured pre- and post treat-
Pre-treatment, there was no statistically signif- ment in both Groups (A & B).
icant difference between the mean value of body
weight and BMI of Group (A) (68.60 ± 11.63),
III- Visual Analogue Scale (VAS):
(27.02±3.18) and Group (B) (73.68± 12.39), (28.28±
5.01) with the t-value was –1.336, –0.945 and p- A- Within groups:
value was 0.190, 0.350. Also at post-treatment, In Group (A), there was no statistical significant
there was a no statistically significant difference difference between the mean value of Visual Ana-
78 Effect of Ball Stability Exercises on Low Back Pain during Pregnancy

logue Scale (VAS) measured post-treatment (6.50 Table (4): Mean values of VAS between both Groups (A &
± 1.64) and its corresponding value in pre-treatment B) pre- and post treatment.
(6.60±0.68) with the t-value was 0.384 and p-value Group (A) Group (B) t-value p-value
was 0.705 (Table 3). Pre-treatment 6.60±0.68 7.20± 1.32 –1.805 0.082 (NS)
Post-treatment 6.50± 1.64 4.45± 1.57 4.03 8 0.001 (HS)
In Group (B), there was a statistical highly
significant decrease in the mean value of Visual NS = Non significant. HS = Highly significant.
Analogue Scale (VAS) measured post-treatment
(4.45± 1.57) when compared with its corresponding 8 7.2
6.6 6.5
value in pre-treatment (7.20± 1.32) with the t-value 7
was 11.495 and p-value was 0.001 [(Table 3); Fig. 6

Mean value (kg)

(12)]. 5 4.45

The percentage of change in Group B was 4

higher (38.2%) than in Group A (1.5%) (Table 3). 3
2
Table (3): Mean values of VAS measured pre- and post treat- 1
ment in both groups (A & B). 0
Pre-treatment Post-treatment
Group (A) Group (B)
Pre-treatment 6.60±0.68 7.20± 1.32 Group A Group B
Post-treatment 6.50± 1.64 4.45± 1.57
Fig. (13): Mean values of VAS between both Groups (A &
Difference 0.1 2.75 B) pre- and post treatment.
% of change 1.5% ↓↓ 38.2%↓↓
t-value 0.3 84 11.495 IV- Pregnancy Mobility Index (PMI):
p-value 0.705 (NS) 0.001 (HS) 1- Daily mobility index:
NS = Non significant. HS = Highly significant. A- Within groups:
In Group (A), there was a statistical highly
8 7.2
significant decrease in the median value of daily
7
6.6 6.5 mobility index measured post-treatment (5.5) when
compared with its corresponding value in pre-
6
Mean value (kg)

4.45 treatment (8.5) with the Z-value was –2.889 and

5
p-value was 0.004. Also in Group (B), there was
4 a statistical highly significant decrease in the
3 median value of daily mobility index measured
2 post-treatment (4.0) when compared with its cor-
1 responding value in pre-treatment (8.0) with the
0 Z-value was –3.860 and p-value was 0.001 [(Table
Group A Group B 5); Fig. (14)].
Pre-treatment Post-treatment The percentage of improvement was higher in
Group (B) (50%) than in Group (A) (35.3%)
Fig. (12): Mean values of VAS measured pre- and post treat- (Table 5).
ment in both Groups (A & B).

Table (5): Median values of daily mobility measured pre- and

B- Between groups: post treatment in both Groups (A & B).
Pre-treatment, there was no statistical significant Group (A) Group (B)
difference between the mean value of Visual Ana- Pre-treatment 8.5 8.0
logue Scale (VAS) of Group (A) (6.60 ±0.68) and Post-treatment 5.5 4.0
Group (B) (7.20± 1.32) with the t-value was –1.805
Median difference 3.0 4.0
and p-value was 0.082. At post-treatment, there a
% of improvement 35.3% ↓↓ 50%↓↓
statistical highly significant difference between
the mean value of Visual Analogue Scale (VAS) Z-value –2.889 –3.860
of Group (A) (6.50± 1.64) and Group (B) (4.45 ± p-value 0.004 (HS) 0.001 (HS)
1.57) with the t value was 4.038 and p-value was Data are presented as median (minimum-maximum).
0.001 [(Table 4); Fig. (13)]. HS = Highly significant.
Mohamed A. Awad, et al. 79

10
8.5
2- House hold activities:
8 A- Within groups:
8
In Group (A), there was no statistical significant
Median value

5.5 difference in the median value of house hold ac-

6
tivities measured post-treatment (12.0) when com-
4
4
pared with its corresponding value in pre-treatment
(13.5) with the Z-value was –0.508 and p-value
2
was 0.611. In Group (B), there was a statistical
highly significant decrease in the median value of
0
house hold activities measured post-treatment
Group A Group B (10.5) when compared with its corresponding value
in pre-treatment (16.0) with the Z-value was –3.632
Pre-treatment Post-treatment and p-value was 0.001 [(Table 7); Fig. (16)].
Fig. (14): Median values of daily mobility measured pre- and The percentage of improvement was higher
post treatment in both Groups (A & B). in Group (B) (34.4%) than in Group (A) (11.1%)
(Table 7).
B- Between groups:
Pre-treatment, there was no statistical significant Table (7): Median values of house hold measured pre- and
difference between the median value of daily mo- post treatment in both groups (A & B).
bility index of Group (A) (8.5) and Group (B) (8.0) Group (A) Group (B)
with the Z-value was –0.645 and p-value was 0.519.
On the other hand at post-treatment, there was a Pre-treatment 13.5 16.0
Post-treatment 12.0 10.5
highly statistical significant difference between
the median value of daily mobility index in Group Median difference 1.5 I 5.5
% of improvement 11.1% ↓4 34.4% 4
(A) (5.5) and Group B (4.0) with the Z-value was Z-value –0.508 –3.632
–2.730 and p-value was 0.006, in favor of Group p-value 0.611 (NS) 0.001 (HS)
(B) [(Table 6); Fig. (15)]. Data are presented as median (minimum-maximum).
NS = Non significant. HS = Highly significant.

Table (6): Median values of daily mobility between both

groups (A & B) pre- and post treatment. 20
Group (A) Group (B) Z-value p-value 18 16
16 13.5
Pre-treatment 8.5 8.0 –0.645 0.519 (NS)
14 12
Median value

12 10.5
Post-treatment 5.5 4.0 –2.730 0.006 (HS)
10
Data are presented as median (minimum-maximum).
HS = Highly significant.
8
HS = Highly significant. 6
4
2
10
8.5 0
8 Group A Group B
8
Pre-treatment Post-treatment
5.5
Median value

6
4 Fig. (16): Median values of house hold measured pre- and
post treatment in both Groups (A & B).
4

2 B- Between groups:
Pre-treatment, there was no statistical significant
0 difference between the median value of house hold
Pre-treatment Post-treatment activities of Group (A) (13.5) and Group (B) (16.0)
Group A Group B with the Z-value was –1.862 and p-value was 0.063.
On the other hand at post-treatment, there was a
Fig. (15): Median values of daily mobility between both statistical significant difference between the median
Groups (A & B) pre- and post treatment. value of house hold activities in Group (A) (12.0)
80 Effect of Ball Stability Exercises on Low Back Pain during Pregnancy

and Group B (10.5) with the Z-value was 2.080 20

and p-value was 0.038, in favor of Group (B) 18
15
[(Table 8); Fig. (17)]. 16 14 14
14

Median value
Table (8): Median values of house hold between both groups 12 10
(A & B) pre- and post treatment.
10
Group (A) Group (B) Z-value p-value 8
6
Pre-treatment 13.5 16.0 –1.862 0.063 (NS)
4
Post-treatment 12.0 10.5 –2.080 0.038 (S)
2
Data are presented as median (minimum-maximum). 0
NS = Non significant. S = Significant. Group A Group B
20 Pre-treatment Post-treatment
18 16
16 13.5 Fig. (18): Median values of mobility outdoor measured pre-
14 12 and post treatment in both Groups (A & B).
Median value

12 10.5
10
8 B- Between groups:
6 Pre-treatment, there was no statistical significant
4
2
difference between the median value of mobility
0 outdoor of Group (A) (14.0) and Group (B) (15.0)
Pre-treatment Post-treatment with the Z-value was –1.597 and p-value was 0.110.
On the other hand at post-treatment, there was a
Group A Group B highly statistical significant difference between
the median value of mobility outdoor in Group (A)
Fig. (17): Median values of house hold between both Groups (14.0) and Group B (10.0) with the Z-value was
(A & B) pre- and post treatment. –2.841 and p-value was 0.005, in favor of Group
3- Mobility outdoor: (B) [(Table 10); Fig. (19)].
A- Within groups:
Table (10): Median values of mobility outdoor between both
In Group (A), there was no statistical significant
groups (A & B) pre- and post treatment.
difference in the median value of mobility outdoor
measured post-treatment (14.0) when compared Group (A) Group (B) Z-value p-value
with its corresponding value in pre-treatment (14.0) Pre-treatment 14.0 15.0 –1.597 0.110 (NS)
with the Z-value was -0.636 and p-value was 0.525. Post-treatment 14.0 10.0 –2.841 0.005 (HS)
In Group (B), there was a statistical highly signif-
Data are presented as median (minimum-maximum).
icant decrease in the median value of mobility NS = Non significant. HS = Highly significant.
outdoor measured post-treatment (10.5) when com-
pared with its corresponding value in pre-treatment
(15.0) with the Z-value was 3.937 and p-value 20
was 0.001 [(Table 9); Fig. (18)]. 18
15
16 14 14
The percentage of improvement was higher
in Group (B) (33.3%) than in Group (A) (0.0%) 14
Median value

(Table 9). 12 10
10
Table (9): Median values of mobility outdoor measured pre-
8
and post treatment in both groups (A & B).
6
Group (A) Group (B)
4
Pre-treatment 14.0 15.0
2
Post-treatment 14.0 10.0
0
Median difference 0.0 5.0 Pre-treatment Post-treatment
% of improvement 0.0% 33.3% 4
Z-value –0.636 –3.937
Group A Group B
p-value 0.525 (NS) 0.001 (HS)

Data are presented as median (minimum-maximum). Fig. (19): Median values of mobility outdoor between both
HS = Highly significant. Groups (A & B) pre- and post treatment.
Mohamed A. Aw ad, et al.
Discussion
Low back pain is experienced by approximately
50 to 70% of women during pregnancy (compared
with 11% of the general population who have low
back pain severe enough to require sick leave).
Identified risk factors for low back pain during
pregnancy include history of low back pain, greater
body weight at the first trimester and the third
trimester, and lack of control over the pace of
activities at work. Women with a prior history of
back pain during pregnancy are more likely to
refrain from becoming pregnant, to experience low
back pain in subsequent pregnancies, and to have
low back pain at other times [12] .
Stability ball training may strength, stability,
balance, posture, proprioception, and flexibility
in pregnant women increase. These adaptations
result in stronger abdominal muscles, which help
to support the baby, decrease the incidence of
back pain, and reduce the chances of accidental
falls [13] .
This study was conducted to investigate the
effect of stability ball exercises on low back pain
during pregnancy. Forty primigrvida and multi-
gravida women complaining from low back pain
selected randomly from outpatient clinic of Port
Said General Hospital in Port Said. The study was
conducted from December 2014 to March 2016.
Their ages were ranged from 25 to 35 years old
and their body mass index was not exceeding
32kg/m2 . All women were on second trimester of
pregnancy. They were divided into two groups
equal in number, Group (A) treated by receiving
antenatal routine; vitamin supplementations, in-
structions about back care during pregnancy, as
well as using pelvic pelt to support pelvic joints
and Group (B) treated by the same treatment in
Group A in addition to ball stability exercises day
after day for six weeks.
Visual Analogue Scale (VAS) was used to meas-
ure pain intensity and Pregnancy mobility index
was used to assess functional disability for both
Groups (A & B) before and after treatment.
The results of this study found that there was
highly statistically significant decrease in low back
pain intensity, daily mobility in the house and
mobility outdoor were better in Group B than
Group A after six weeks of treatment.
The results of this study are supported by [14]
who found the benefits of stability ball exercise
facilitating fetal descent, helping with pelvic re-
laxation, mobility and widening. Also, relieving
81
back pain especially when make wall squat by
using it.
The results also supported by [15] who stated
that the pilates strengthens exercise for abdomen,
back and pelvic floor muscles are a great exercise
during pregnancy, some research suggests that
doing pilates regularly can be as effective as doing
pelvic floor exercises. Reduces back pain, by
exercising the deepest tummy muscles that stabilize
the back and pelvis. Due to weak muscles can lead
to back or pelvic pain.
The results are supported by [16] who found
most of pregnant women were suffering from back
pain. This study was non randomized and control-
led, examining a target population of low-risk
pregnancy women between 20 and 22 weeks of
gestation. All participants had at least minimal low
back pain, no prior history of chronic low back
pain before pregnancy, and no indications of pre-
term labour. In total, 89 individuals participated:
45 in the control group and 44 in the experimental
group (who attended an antenatal stability ball
exercise programme). This programme lasted 12
weeks, composed of at least three sessions per
week. Fitness workouts lasted from 25 to 30 min-
utes. And the result revealed that the inclusion of
stability ball exercises during pregnancy may re-
duce pregnancy low back pain and boost daily life
functions.
The results are agreed with that of [17] who
found exercise balls can be supporting the extra
weight and changing of center of gravity during
pregnancy. And during labor, the exercise ball can
also be used to provide support for certain positions,
rhythmic movement and gentle bouncing.
The results of this study agreed with that of
[18] who found exercising on a birthing ball in
pregnancy can help to reduce any back pain and
make it easier for the woman to move around. It
also helps ease labour pain, reduce the pain of
contractions, decrease anxiety and shorten the first
stage of labour.
The results of this study disagreed with that of
[19]who studied the effect of ball stability exercise
on low back pain during pregnancy. In their study
divided in two groups: Training group and a control
group, the training group received supervised
exercises in groups once a week and the control
group received standard care. The main outcome
measures were self-reported LBP and self-reported
PGP. Secondary outcome measures were pain in-
tensity and disability, found in their study that
group of ball stability exercises didn't reduce the
82 Effect of Ball Stability Exercises on Low Back Pain during Pregnancy
prevalence of low back pain or pelvic girdle pain
in pregnancy comparing with control group which
received standard care.
The results disagreed with that of [20] who
found who found no statistically significant differ-
ences between the exercisers and controls group,
Therefore a comparison of the women who had
attended at least 80% of the weekly exercise classes
with the control participants did not change the
results.
References
1- TURK J.R.: Pregnancy-related low back pain, Low back
pain pathogenesis and treatment, 24: 39-45, 2009.
2- KLEMAN P.G.: OMT relieves low back pain during
pregnancy. J. Am. Osteopath. Assoc., 110 (9): 555, 2010.
3- MENS J.M., HUIS Y.H. and POOL GA.: Technical and
measurement report: The Active Straight Leg Raise test
in lumbopelvic pain during pregnancy. Manual Therapy,
17: 364e368 (Evidence level: 2C), 2012.
4- GIBBS, JAMES R., SCOTT, RONALD S., BETH KAR-
LAN, ARTHUR HANEY and BETH Y.: Danforth obstet-
rics and gynecology, Textbook, 9 th ed., Ch. 1, 2007.
5- ELDEN H., LADFORS L., OLSEN M.F., OSTGAARD
H. and HAGBERG H.: Effect of acupuncture and stabi-
lizing ex as adjunct to standard treatment in pregnant
women with pelvic girdle pain randomized single blind
controlled trial. B.M.I., 330: 665-71, 2005.
6- YOUNG G. and JEWELL D.: Interventions for preventing
and treating pelvic and back pain in pregnancy. Cochrane
Database Syst. Rev., (1): CD001139, 2002.
7- ALICIA M.S.: Preventing and Managing Back Pain during
Pregnancy, Text book. 1 st ed., Expect Fitness, Ch. 6, pp:
31-9, 2010.
8- RACHEL N.: Core stability exercises on and off a Swiss
ball. Arch. Phys. Med. Rehabil, 86 (2): 242-9, 2014.
9- ZAZULAK B., CHOLEWICKI J. and REEVES N.B.:
Neuromuscular control of trunk stability: Clinical impli-
cations for sports injury prevention. Journal of the Amer-
ican academy of Orthopedic Surgeons, 16 (9): 497-505,
2008.
10- WARPEHA J.M.: Principles of speed training. NSCA
Performance Training Journal, 6 (3): 6-8, 2007.
11- ANDREA TALMADGE: Offer pregnant participant's
safe core exercises that will help get their bodies ready
for labor and delivery. IDEA Health and Fitness Journal,
Prenatal Progress, 2: 3-15, 2006.
12- JANET P.P. and ALAN D.H.: Approach to the patient
with low back pain. Women's Health: Principles and
Clinical Practice, Ch. 49, pp: 538-42, 2002.
13- JARED W. and MOH H.: NSCA's essentials of personal
training, Textbook, 2 nd ed., Ch. 1: pp 3-18, 2011.
14- PEREZ P.: Birth Balls: Use of Physical Therapy Balls in
Maternity Care. Cutting Edge Press, Johnson, 2001.
15- STUGE B., LAERUM E., KIRKESOLA G. and VOLL-
ESTAD N.: The efficacy of a treatment program focusing
on specific stabilizing exercises for pelvic girdle pain
after pregnancy: A randomized controlled trial, 29 (4):
351-9, 2004.
16- ALBERT H.B., GODSKESEN M., KORSHOLM L. and
WESTERGAARD J.G.: Risk factors in developing preg-
nancy-related pelvic girdle pain. Acta Obstetricia et
Gynecologica Scandinavica. 85: 539-44, 2006.
17- THOMAS E.: Preventing and Managing Back Pain during
Pregnancy. Expect Fitness, 10: 95-104, 2010.
18- YAN, HUNG Y.C., GAU M.L. and LIN K.C.: Effect of
a stability ball exercise programme on low back pain and
daily life interference during pregnancy. Midwfery, 30
(4): 412-9, 2014.
19- HAGEN K., EGGEN M., STUGE B., MOWINCKEL P.
and JENSEN K.: Can supervised group exercises including
ergonomic advice reduce the prevalence and severity of
low back pain and pelvic girdle pain in pregnancy? A
Randomized Controlled Trial, 92 (6): 781-90, 2012.
20- HAAKSTAD L.A.: Effect of a regular exercise programme
on pelvic girdle and low back pain in previously inactive
pregnant women. J. Rehab. Med., 47 (3): 229-34, 2015.
Mohamed A. Awad, et al. 83