Comparing the Effects of Core Stability and Williams Training on Dynamic Balance and Back Pain in Women With Chronic Back Pai

Document Type : Research Paper


1 Sport Medicine Research Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran.

2 Department of Physical Education and Sport Sciences, Najafabad Branch, Islamic Azad University, Najafabad, Iran.


Introduction: This research aimed to compare the effects of the Williams and core stability training on dynamic balance and back pain in women with chronic back pain. 
Materials and Methods: In total, 45 women with chronic back pain were selected as the available sample and were randomly divided into 3 groups of 15 participants, including core stability, Williams, and control. Before the beginning and the end of the training period, the dynamic balance with the Star Excursion Balance Test (SEBT) and low back pain with Québec Questionnaire was measured. To analyze the obtained data, Analysis of Covariance (ANCOVA) was used in SPSS at P<0.05.
Results: The present study findings revealed a significant difference in core stability and Williams training on dynamic balance and improvement in the extent of low back pain in the study participants. There was a significant difference between the training groups in dynamic balance; however, there was no significant difference in the improvement of low back pain between the experimental groups.
Conclusion: To improve dynamic balance, a core stability training program is recommended, and Williams’ flexor movements are more appropriate for reducing low back pain.


  1. van Tulder M, Koes B. Evidence-based medicine for low back pain. In: van Goethem JWM, van den Hauwe L, Parize PM. Spinal Imaging. London: Springer; 2007. pp. 111-125. [DOI:10.1007/978-3-540-68483-1_5]
  2. Refshauge KM, Maher CG. Low back pain investigations and prognosis: A review. British Journal of Sports Medicine. 2006; 40(6):494-8. [DOI:10.1136/bjsm.2004.016659] [PMID] [PMCID]
  3. Kahle NL, Gribble PA. Core stability training in dynamic balance testing among young, healthy adults. Athletic Training and Sports Health Care. 2009; 1(2):65-73. [DOI:10.3928/19425864-20090301-03]
  4. Costa LOP, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, et al. Motor control exercise for chronic low back pain: A randomized placebo-controlled trial. Physical Therapy. 2009; 89(12):1275-86. [DOI:10.2522/ptj.20090218] [PMID]
  5. Ebrahimi I, Shah Hosseini GR, Farahini H, Arab A. Clinical trunk muscle endurance tests in subjects with and without low back pain. Medical Journal of The Islamic Republic of Iran. 2005; 19(2):95-101.
  6. van Tulder MW, Malmivaara A, Esmail R, Koes BW. Exercise therapy for low back pain. Cochrane Database of Systematic Review. 2000;(2):CD000335. [DOI:10.1002/14651858.CD000335] [PMID]
  7. Blackburn SE, Portney LG. Electromyographic activity of back musculature during Williams’ flexion exercises. Physical Therapy. 1981; 61(6):878-85. [DOI:10.1093/ptj/61.6.878] [PMID]
  8. Yarahmadi Y, Hadadnezhad M, Shojaodin SS. [The effect of core stabilization on pain control, Dynamic balance and lumbopelvic proprioception of subjects with non-specific chronic low back pain (Persian)]. Journal of Anesthesiology and Pain. 2017; 8(1):54-66.
  9. Farzinmehr A, Moezz A, Koohpayezadeh J. [A combination training of pelvic floor muscles and core muscles in improvement of stress urinary incontinence (Persian)]. Razi Journal of Medical Sciences. 2013; 20(109):30-40.
  10. McGill SM. Low back stability: From formal description to issues for performance and rehabilitation. Exercise and Sport Sciences Reviews. 2001; 29(1):26-31. [DOI:10.1097/00003677-200101000-00006] [PMID]
  11. Clark M, Fater D, Reuteman P. Core (trunk) stabilization and its importance for closed kinetic chain rehabilitation. Orthopaedic Physical Therapy Clinics of North America. 2000; 9(2):119-36.
  12. King MB, Judge JO, Whipple R, Wolfson L. Reliability and responsiveness of two physical performance measures examined in the context of a functional training intervention. Physical Therapy. 2000; 80(1):8-16. [DOI:10.1093/ptj/80.1.8]
  13. Lotfi HR, Ebrahimi Atri A, Hashemi Javaheri SAA, Norozi K. [The effect of six weeks supine movement in water on the pain and disability in men with chronic low back pain due to lumbar disc herniation (Persian)]. Journal of Paramedical Sciences & Rehabilitation. 2016; 5(1):14-9. [DOI:10.22038/JPSR.2016.6381]
  14. Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: What works? Pain. 2004; 107(1-2):176-90. [DOI:10.1016/j.pain.2003.10.017] [PMID]
  15. Shojaedin SS, Sadeghi H, Bayat Tork M. [Relationship between the trunk muscles endurance and anthropometric characters with low back pain among athletes with lumbar lordosis (Persian)]. Journal of Movement Science & Sports. 2009; 6(12):23-33.
  16. Shojaedin SS, Yousefpour K. [The effect of Pilates exercises and Kinesio taping on pain in subjects with non-specific chronic low back pain (Persian)]. Journal of Research Rehabiltation Scinces. 2013; 9(1):28-38.
  17. Sanadgol R, Ebrahimi Atri A, Hashemi Javaheri SAA. The evaluating of efficacy of McKenzie exercises, Massage and foot Reflexology on pain and disability of men with mechanical chronic low back pain. Ciência e Natura. 2015; 37(2):69-75. [DOI:10.5902/2179460X20755]
  18. Sadeghi H, Norouzi H, Karimi Asl A, Montazer M. [Functional training program effect on static and dynamic balance in male able-bodied elderly (Persian)]. Salmand: Iranian Journal of Ageing. 2008; 3(2):565-71.
  19. Kinzey SJ, Armstrong CW. The reliability of the star - excursion test in assessing dynamic balance. The Journal of Orthopaedic and Sports Physical Therapy. 1998; 27(5):356-60. [DOI:10.2519/jospt.1998.27.5.356] [PMID]
  20. Calmels P, Béthoux F, Condemine A, Fayolle-Minon I. [Low back pain disability assessment tools (French)]. Annales de Réadaptation et de Médecine Physique. 2005; 48(6):288-97. [DOI:10.1016/j.annrmp.2005.04.008] [PMID]
  21. Ostelo RWJG, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting change scores for pain and functional status in low back pain: Towards international consensus regarding minimal important change. Spine. 2008; 33(1):90-4. [DOI:10.1097/BRS.0b013e31815e3a10] [PMID]
  22. Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood-Dauphinee S, Lamping DL, et al. The quebec back pain disability scale. Measurement properties. Spine. 1995; 20(3):341-52. [DOI:10.1097/00007632-199502000-00016] [PMID]
  23. Borg G. Borg’s perceived exertion and pain scales. Champaign, IL: Human Kinetics; 1998.
  24. Parfitt G, Evans H, Eston R. Perceptually regulated training at RPE13 is pleasant and improves physical health. Medicine and Science in Sports and Exercise. 2012; 44(8):1613-8. [DOI:10.1249/MSS.0b013e31824d266e] [PMID]
  25. Jeffreys I. Developing a progressive core stability program. Strength & Conditioning Journal. 2002; 24(5):65-6. [DOI:10.1519/00126548-200210000-00017]
  26. Souza GM, Baker LL, Powers CM. Electromyographic activity of selected trunk muscles during dynamic spine stabilization exercises. Archives of Physical Medicine and Rehabilitation. 2001; 82(11):1551-7. [DOI:10.1053/apmr.2001.26082] [PMID]
  27. Haddad Mehrjerdi S, Moazzami M, Tara F. [Effect of physioball selected exercise on low back pain, lumbar lordosis, strength and flexibility in pregnant women (Persian)]. Iran Journal of Obstetrics, Gynecology and infertility. 2016; 18(183):20-31. [DOI:10.22038/IJOGI.2016.6723]
  28. Farzaneh hessari A, Daneshmandi H, Mahdavi S. The effect of 8 weeks of core stabilization training program on balance in hearing impaired students. Journal of Exercise Science and Medicine. 2011; 3(2):67-83.
  29. Farajzadeh Ahari F, Ghaderi F, Asghari Jafarabadi M, Azghani MR, Eterafoskouei A, Rezaei M, et al. [Effects of McGill Stabilization Exercise on pain and disability, range of motion and dynamic balance indices in patients with chronic nonspecific low back pain (Persian)]. Journal of Babol University of Medical Sciences. 2017; 19(10):69-75. [DOI:10.22088/jbums.19.10.3]
  30. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992; 268(6):760-5. [DOI:10.1001/jama.1992.03490060092030] [PMID]
  31. Shields RK, Heiss DG. An electromyographic comparison of abdominal muscle synergies during curl and double straight leg lowering exercises with control of the pelvic position. Spine. 1997; 22(16):1873-9. [DOI:10.1097/00007632-199708150-00012] [PMID]
  32. Hooper P. Whatever happened to Williams’ flexion exercises. Dynamic chiropractic. 1999; 17(1):26-30.
  33. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: Randomized controlled trial of patients with recurrent low back pain. Physical Therapy. 2005; 85(3):209-25. [DOI:10.1093/ptj/85.3.209] [PMID]
  34. Elnaggar IM, Nordin M, Sheikhzadeh A, Parnianpour M, Kahanovitz N. Effects of spinal flexion and extension exercises on low-back pain and spinal mobility in chronic mechanical low-back pain patients. Spine. 1991; 16(8):967-72. [DOI:10.1097/00007632-199108000-00018] [PMID]
  35. Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain: A predictor of symptomatic discs and anular competence. Spine. 1997; 22(10):1115-22. [DOI:10.1097/00007632-199705150-00011] [PMID]
  36. Snook SH, Webster BS, McGorry RW, Fogleman MT, McCann KB. The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion: A randomized controlled trial. Spine. 1998; 23(23):2601-7. [DOI:10.1097/00007632-199812010-00015] [PMID]
  37. Williams MM, Hawley JA, McKenzie RA, van Wijmen PM. A comparison of the effects of two sitting postures on back and referred pain. Spine. 1991; 16(10):1185-91. [DOI:10.1097/00007632-199110000-00010] [PMID]
  38. George SZ, Childs JD, Teyhen DS, Wu SS, Wright AC, Dugan JL, et al. Rationale, design, and protocol for the prevention of low back pain in the military (POLM) trial (NCT00373009). BMC Musculoskeletal Disorders. 2007; 8:92. [DOI:10.1186/1471-2474-8-92] [PMID] [PMCID]
  39. Effgen SK. Effect of an exercise program on the static balance of deaf children. Physical Therapy. 1981; 61(6):873-7. [DOI:10.1093/ptj/61.6.873] [PMID]
  40. Sung PS. Multifidi muscles median frequency before and after spinal stabilization exercises. Archives of Physical Medicine and Rehabilitation. 2003; 84(9):1313-8. [DOI:10.1016/S0003-9993(03)00139-4] [PMID]
  41. Hodges PW. Core stability exercise in chronic low back pain. The Orthopedic Clinics of North America. 2003; 34(2):245-54. [DOI:10.1016/S0030-5898(03)00003-8] [PMID]
  42. Franke A, Franke K, Gebauer S, Brockow T. [Acupuncture massage vs. Swedish massage and individual exercises vs. group exercises in low back pain sufferers: A randomised clinical trial in a 2×2-factorial design. Focus on Alternative and Complementary Therapies. 2000; 5(1):88-9. [DOI:10.1111/j.2042-7166.2000.tb02346.x]
  43. Hesari A, Mahdavi S, Hosein Abadi MR, Sangdevini M, Golpaigani M. Comparisons of berg balance scale following core stabilization training in women elderly. Annals of Biological Research. 2012; 3(1):1499-504.
  44. Piegaro AB. The comparative effects of four-week core stabilization & balance-training programs on semidynamic & dynamic balance. Morgantown: West Virginia University Libraries; 2003.
  45. Sato K, Mokha M. Does core strength training influence running kinetics, lower-extremity stability, and 5000-M performance in runners? The Journal of Strength & Conditioning Research. 2009; 23(1):133-40. [DOI:10.1519/JSC.0b013e31818eb0c5] [PMID]