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OBJECTIVES The purpose of this study was to compare transversus abdominis muscle thickness and exercise performance before and after foam roller exercise (FRex). METHODS This was a randomized controlled trial (RCT). Twenty-four adult female subjects were randomly divided into two groups: (1) an intervention group that underwent FRex, and (2) a control group that remained in the supine position for the same period. Transversus abdominis muscle thickness, modified Star Excursion Balance Test (mSEBT) score, and degree of back pain experienced during daily work were measured before and after the intervention in each group using a visual analog scale (VAS), and a within-group comparison was conducted for each value. The amount of change before and after the intervention was calculated, and the correlation between each measurement item was examined. RESULTS Pre-intervention and post-intervention comparisons in the intervention group revealed significantly greater values for transversus abdominis lower fiber thickness and mSEBT scores, and significantly lower values for low back pain after the intervention. A moderate negative correlation was found between changes in lower back pain VAS scores and changes in transversus abdominis lower fiber thickness and mSEBT scores. Moreover, a moderate positive correlation was noted between changes in the transversus abdominis lower fiber thickness and mSEBT scores. CONCLUSIONS These results suggest that FRex may be beneficial for preventing low back pain and improving balance.