Background: The purpose of this study was to investigate the effect of Plank exercise on unstable support surfaces on flexibility, abdominal muscle thickness and pain in patients with chronic back pain. Design: Randomized controlled trial. Methods: This study was performed on 16 patients with chronic back pain of ◯◯ military unit. Sixteen subjects were randomly assigned into two groups, an upper extremity trainer group (group I, n=8) and a lower extremity trainer group (group II, n=8). The subjects in group I carried out Flank exercise applying the stability trainer to their upper extremities and ones in group II carried out the same exercise applying the stability trainer to their lower extremities for 4 weeks. In order to ascertain the difference between two groups, flexibility, abdominal muscle thickness and pain were measured before and after the exercise. The flexibility was measured by sit and reach test, the thickness of the abdominal muscle was measured by using ultrasonic imaging equipment, and the pain was measured by the visual analogue scale. A paired t-test was utilized to compare changes in pain, abdominal muscle thickness and flexibility before and after flank exercise on unstable support surfaces. Analysis of Covariance (ANCOVA) was performed for ascertaining the significant differences between groups. The significance level was set by α=.05. Results: 1) The flexibilities of two groups were increased after the exercise (p<0.05). 2) In both groups, the thicknesses of rectus abdominis, external oblique abdominis, internal oblique abdominis, and transverse abdominis were all increased after the exercise (p<0.05). 3) The pains in both groups were decreased after the exercise (p<0.05). 4) In the comparisons of two groups, there were no differences in the flexibility, thickness of external oblique abdominis, internal oblique abdominis and transverse abdominis and pain (p>0.05). Whereas only thickness of Rectus abdominis was larger in the group I than in the group II (p<0.05). Conclusion: Plank exercise on the unstable support surface for 4 weeks resulted in increased flexibility, abdominal muscle thickness and pain reduction in patients with chronic back pain. Therefore, it is considered that performing flank exercise on the unstable supporting surface is suitable for the reduction of the pain in patients with chronic back pain. However, in this study, it is considered that continuous and diverse studies are needed because there was not a large difference between the groups when the upper or lower limbs are provided unstable support surfaces.