Exercises on a balancе cushion to influence of lumbar vertebral syndrome

Introduction

Low back pain (LBP) is among the most prevalent musculoskeletal disorders worldwide and represents a leading cause of disability and reduced quality of life. It imposes a substantial socioeconomic burden through healthcare utilization, work absenteeism, and productivity loss (Shipton, 2018; Hartvigsen et al., 2018).

Lumbar vertebral syndrome is characterized by hypomobility, paraspinal muscle rigidity, and postural dysfunction. However, these symptoms may also result from conditions such as disc herniation, facet joint osteoarthritis, or spondylolisthesis, which highlights the need for accurate differential diagnosis (Todorova et al., 2015). Lumbar vertebral syndrome is a frequent cause of temporary disability and restricted motor activity in the working–age population (Shipton, 2018). It is associated not only with persistent pain, but also with impaired postural stability, muscle imbalance, and limited functional performance (Nikolovska et al., 2024). Contemporary kinesitherapeutic approaches integrate active exercises with manual techniques, aiming to alleviate pain while restoring mobility and movement control. It should be emphasized that not every case of low back pain is associated with lumbar vertebral syndrome; however, every vertebral syndrome is accompanied by low back pain. Moreover, lumbar vertebral syndrome may occur in the context of different conditions, such as radiculitis, disc herniation, facet joint osteoarthritis, or facet joint blockage. This distinction is essential both for clinical practice and for research standardization.

Recent findings indicate that the combination of exercise and manual therapy is more effective than exercise alone in patients with chronic low back pain (Sipaviciene & Pilelis, 2024). A systematic review and meta-analysis further confirmed exercise therapy as a cornerstone intervention, with consistent benefits in pain reduction and functional outcomes (Blanco-Gimenez et al., 2024).

Building upon these established approaches, researchers have increasingly explored the role of unstable environments in enhancing neuromuscular activation and proprioceptive control. Core stability exercises performed on unstable surfaces have been shown to improve proprioceptive control and trunk muscle activation in patients with nonspecific subacute low back pain (Hlaing et al., 2021). Similarly, dynamic seat cushions designed to encourage postural shifts have been shown to accelerate recovery and reduce recurrence rates of LBP (Channak et al., 2024a). Among innovative tools for improving stability and lumbopelvic control, balance cushions have gained increasing attention. Recent findings demonstrate that trunk stability exercises in unstable environments significantly enhance postural control following fatigue (Amiri & Zemková, 2025). Exercises on a balance cushion stimulate proprioception, improve coordination, and facilitate lumbopelvic stabilization (Behm & Anderson, 2006).

In parallel, manual techniques targeting myofascial trigger points reduce muscle tension, improve local circulation, and decrease pain (Simons, Travell & Simons, 1999; Cagnie et al., 2015). Although both proprioceptive training and manual therapy are well established, there is still limited evidence on their combined application in patients specifically diagnosed with lumbar vertebral syndrome.

Methods

Procedure

At baseline, all participants underwent assessment with the selected outcome measures (VAS, Schober test, lateral flexion measurement, and Straight leg raise test). After evaluation, they received an introductory supervised session including manual therapy for trigger points in the lumbar and gluteal regions, followed by instruction in balance cushion exercises.

The intervention period lasted four weeks. Participants were instructed to perform the exercise set at least three times per day, with each session lasting approximately 10 minutes. Exercises were demonstrated during the initial session and repeated until correct execution was ensured. Each subject then continued independently at home. Compliance was monitored through weekly check-ins and self – reported exercise diaries.

The balance cushion program consisted of:

Exercise 1. Pelvic tilts (anterior-posterior inclination) while seated on the cushion (8-10 repetitions) ( Figure 1).

Figure 1. Pelvic tilts (anterior-posterior inclination).

Exercise 2. Pelvic elevation to the left and right while seated (7-8 repetitions per side) ( Figure 2).

Figure 2. Pelvic elevation to the left and right.

Exercise 3. Circular pelvic movements while seated (7-8 repetitions per direction) ( Figure 3).

Figure 3. Circular pelvic movements.

In addition, all participants received manual trigger points therapy once per week (four sessions in total), targeting the lumbar and gluteal musculature. This ensured that the kinesitherapeutic program combined daily self – administered training with standardized manual intervention delivered by the therapist.

Participants with predominantly sedentary occupations were encouraged to use a balance cushion at their workplace to counteract hypomobility.

At the end of the 4-week intervention, all outcome measures were reassessed under identical conditions to baseline.

Results

The baseline characteristics of the participants are summarized in Table 1. The mean age of the cohort was 29.8 ± 3.89 years. Male participants (n=10) had a mean age of 29.4 ± 4.69 years, and female participants (n = 10) had a mean age of 30.2 ± 3.08 years.

Pain intensity, assessed by the visual analogue scale (VAS), decreased markedly from 6.7 ± 1.08 (range 5-9) before therapy to 0.4 ± 0.75 (range 0-2) after therapy. The Wilcoxon signed-rank test confirmed this reduction (W=210.0, p<0.0001, two-tailed). The correlation between paired values was weak (rs=0.314).

Lumbar mobility, assessed by the Schober test, improved significantly from 1.87 ± 0.23 cm (range 1.5-2.3) before therapy to 3.04 ± 0.15 cm (range 2.8-3.3) after therapy (W=210.0, p<0.0001). The consistency of paired values was moderate (rs=0.615).

Lateral flexion improved in both directions. To the left, mean values changed from 52.08 ± 1.07 cm (range 50-54) to 48.81 ± 1.61 cm (range 46-51) (W=210.0, p<0.0001; rs=0.719). To the right, values decreased from 51.79 ± 1.38 cm (range 49-54) to 48.91±1.28 cm (range 47-51) (W=210.0, p<0.0001; r=0.877).

The Straight Leg Raise (SLR) test also demonstrated a significant improvement, with mean values increasing from 48.45 ±5.94° (range 39-60) before therapy to 76.25 ± 3.34° (range 70-82) after therapy (W=210.0, p<0.0001). The correlation between paired values was weak (rs=0.336).

All outcomes are summarized in Table 2.

Discussion

The present study demonstrated that a one-month program of daily exercises on a balance cushion significantly reduced pain intensity and improved lumbar mobility and neurodynamic function in patients with lumbar vertebral syndrome. These findings emphasize the importance of proprioceptive and stabilization training as an effective conservative intervention for low back pain disorders.

Pain reduction, as measured by the VAS, was profound: most participants reported complete absence of symptoms at follow-up, while the remainder experienced only mild pain. This reduction surpasses improvements reported in conventional exercise interventions. For example, Islam et al. (2020) observed only moderate decreases in VAS pain scores in motorcyclists with chronic low back pain after six weeks of exercise, with many participants still reporting scores between 4 and 5. The greater improvements seen in the present study may reflect the enhanced neuromuscular activation and trunk stabilization achieved by the balance cushion, which continuously challenges proprioceptive mechanisms.

Lumbar mobility, assessed through the Schober test, also improved significantly, approaching values considered normal in healthy individuals (Pashkunova, 2015; Yen et al., 2015). Similarly, lateral flexion gains exceeded those reported by Krastev et al. (2011), who found more modest improvements after manual therapy, massage, and analytical exercises. These findings suggest that balance cushion training may offer superior stimulation of paraspinal and abdominal stabilizers, resulting in more effective functional recovery.

The Straight Leg Raise (SLR) test, widely used to detect neural involvement, showed marked improvement after the intervention, indicating beneficial effects on both muscular and neurodynamic components. Hall and McIntosh (2014) highlighted that correct application of the SLR is sufficient for clinical assessment of neural tension without additional tests. The improvements observed in our study therefore demonstrate the potential of balance cushion training not only to reduce pain and stiffness but also to mitigate neurodynamic limitations.

Our results are in agreement with previous studies exploring cushion-based rehabilitation strategies. Unlike Lee et al. (2018), who examined gel cushions primarily for postural unloading in occupational settings, the present study focused on patients with lumbar vertebral syndrome and combined proprioceptive training with manual trigger point therapy. Channak et al. (2024a) conducted a six-month cluster-randomized controlled trial showing that dynamic seat cushions significantly reduced the incidence of low back and neck pain in high-risk office workers (10% vs 59% in control group; HRadj = 0.16; p < 0.001). In a secondary analysis of the same trial, recovery was markedly faster in the intervention group, with full recovery achieved in one month compared to three months in controls (HRadj = 4.35; p < 0.01) (Channak et al., 2024b). Although these studies involve different types of cushions, their findings converge with ours, suggesting that stimuli through unstable or dynamic surfaces can enhance proprioceptive input, spinal unloading, and postural adaptation.

In addition, the present findings are consistent with our earlier research. In a cohort of 30 patients with chronic low back pain, we reported significant reductions in pain (VAS from 6.4 to 0.37), alongside improvements in the Schober test, lateral flexion, and neurodynamic parameters such as the Neri and SLR tests after one month of balance cushion therapy (Zlatkov & Zlatkova, 2021). Furthermore, in patients with lumbar radiculopathy, Chergov et al. (2019) observed similar improvements in both pain and mobility, underlining the applicability of this approach even in populations with pronounced neurological symptoms. By contrast, in a study focusing solely on myofascial manipulation and trigger point therapy, short-term improvements were documented, but symptoms tended to recur once treatment was discontinued (Nikolaev et al., 2018). Taken together, these findings suggest that while manual therapy may provide temporary relief, sustained daily balance cushion training promotes long-term functional stability and symptom reduction.

From a clinical perspective, balance cushion exercises are simple, safe, and cost-effective, making them suitable not only for rehabilitation but also as a preventive tool for individuals in sedentary occupations to counteract hypomobility and postural imbalance. Despite these promising results, several limitations should be acknowledged. The sample size was relatively small, the duration of the intervention was limited to one month, and no control group was included for comparison. Another limitation is that all participants also received manual trigger point therapy, which may have contributed to the improvements observed. However, our previous work has separately demonstrated the benefits of balance cushion training (Zlatkov & Zlatkova, 2021; Chergov et al., 2019) and of manual trigger point therapy (Nikolaev et al., 2018), although with more modest effects. This background supports the rationale for combining the two approaches in the present study, although it still limits the ability to isolate the specific contribution of each intervention. Future randomized controlled trials with larger samples and longer follow-up are warranted to confirm the effectiveness of balance cushion training and to clarify its long-term impact on pain and function in lumbar disorders.

Conclusions

Lumbar vertebral syndrome, resulting from diverse etiological factors, is increasingly prevalent among younger individuals. Conservative interventions remain central in its management, aiming to reduce pain, restore mobility, and improve quality of life. The present study demonstrated that exercises performed on a balance cushion, when systematically incorporated into daily routines, were associated with rapid and clinically meaningful improvements in pain reduction and lumbar mobility. These findings suggest that balance cushion training can be a valuable addition to kinesitherapeutic practice, supporting patients in maintaining functional independence and returning more effectively to occupational and professional activities. Future randomized controlled trials with larger samples and longer follow-up are needed to confirm these results and further clarify the role of balance cushion exercises in the comprehensive management of lumbar disorders.