INTRODUCTION: Low back pain (LBP) is a very common disorder and also costly for a society. Some evidence has demonstrated that unstable training is an effective intervention in the field of LBP treatment. The aim of this systematic review was to investigate the effect of exercise therapy in an unstable surface on pain, disability and muscle activity pattern in patients with low back pain. MATERIALS AND METHODS: A data base search within the period of 2000 to 2014 was performed, using PubMed, Google Scholar, ScienceDirect, Ovid, PEDro, Cochrane Library and CINAHL systems. Studies investigating the effect of exercise therapy in an unstable surface compared to a stable surface on pain and disability, trunk muscles activity pattern in patients with LBP were included. PEDro quality scale was used for the assessment of included studies. RESULTS: Seven out of 110 relevant articles had our search entrance criterions, which were chosen for this review. There was a large difference between various studies base on their methodology, outcome measures, sample size, procedure, etc. However, results from studies have verified that unstable training has been more effective than stable training in reducing pain and disability, improving the spinal stabilization muscles activity pattern and flexion- relaxation responses, although it did not show any significant improvement in muscle endurance and fatigue. CONCLUSION: It is likely that exercise therapy in an unstable surface compared to stable surface is acting more effectively in rehabilitating programs of patients with low back pain. Exercises in an unstable surface, by facilitating the neuromuscular junctions, have considerable effects on improving the spinal stabilization muscles activity pattern, flexion- relaxation responses and reducing pain and disability.

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