OBJECTIVE: To assess the effects of neuromuscular electrical stimulation combined with lumbar stabilization exercises on lumbar multifidus muscle thickness, disability, pain, depression, anxiety, and fear-avoidance beliefs in patients with chronic low back pain; and to examine the correlation between ultrasound and magnetic resoce imaging of the lumbar multifidus. DESIGN: Forty patients aged 18 to 65 years were randomized into two groups: Group 1: exercise and Group 2: exercise plus neuromuscular electrical stimulation. The participants underwent 15-session electrical stimulation and/or exercise (3 days/week). All outcome measures assessed at baseline, post-treatment, and 3 months after. Multifidus cross-sectional area on magnetic resoce imaging was measured only at baseline. RESULTS: Multifidus thickness increased, and pain decreased significantly in both groups, more prominent in Group 2. Disability, depression, and fear-avoidance beliefs scores significantly decreased in both groups, while anxiety decreased only in Group 1. Both magnetic resoce and ultrasound measurements demonstrated excellent inter-rater reliability and statistically significant correlations. CONCLUSION: Both groups improved in terms of pain, disability, psychological status and muscle thickness. Neuromuscular electrical stimulation adjunct to lumbar stabilization exercises demonstrated enhanced effectiveness in increasing lumbar multifidus thickness.

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