Background: Interventions for acute low back pain include exercise therapy such as stretching, aerobic exercise, and sling exercise. Another treatment method for back pain is soft tissue release. Soft tissue release is a relaxation method that improves balance while allowing tension tissues to relax as much as possible. Objectives: To investigated the effect of acute low back pain on the massage ball exercise. Design: Randomized controlled trial. Methods: The twenty-eight subjects were randomly allocated to the Massage ball exercise with TENS group (MBETG, n=14) and the transcutaneous electrical nerve stimulation group (TG, n=14). For MBETG, massage ball exercise (BALLance Dr. Tanja Kühne method) was applied for 25 minutes followed by TENS for 15 minutes. The TG group applied TENS for 40 minutes. Each group conducted the intervention three sessions. The results were analyzed by measuring the numeric pain rating scale (NPRS), surface electromyography (%MVIC), and Oswestry disability index (ODI) before and after the intervention in each group. Results: Significant reduction was observed for NPRS and ODI in the MBETG (P<.05). And Significant higher was observed for %MVIC of the Erector spinae in the MBETG (P<.05). The NPRS and ODI in the MBETG were decreaed than the TG (P<.05). Conclusion: Massage ball exercise to patients with acute back pain will be effective in reducing pain, increasing muscle activity, and improving functional disability.