the traditional approach to low back pain ( lbp ) has failed as an effective treatment for 
 lbp patients1 .
accordingly , some 
 researchers have recently suggested the necessity of a patient - centered approach to lbp1 .
the decreased lumbar spine 
 lordosis induces changes in spinal discs , creating abnormal pressures when absorbing shock 
 between vertebrae , and creating stresses in spinal muscles , tendons and ligaments2 , 3 . 

flat - back syndrome is characterized by forward inclination of the trunk , inability to stand 
 upright , and lbp pain4 .
therefore , the 
 exercises for flat back syndrome include trunk backward extension and pelvic anterior tilt 
 exercises3 , 5 .
clinicians recommend various anterior pelvic tilt exercises for lbp 
 with flat back in the lying , sitting , quadriped or standing positions3 , 5 .
however , the 
 anterior pelvic tilt motion in these positions does n't apply powerful resistance for 
 anterior pelvic tilt muscle strengthening .
the purpose of this paper was to report showed 
 the effect of individual strengthening exercises for anterior pelvic tilt muscles on back 
 pain , pelvic tilt angle , and lumbar rom of a lbp patient with flat back .
a 37  year - old male , who complained of lbp pain in l3 - 5 levels with flat back , was 
 participated .
ethical approval was obtained from yonsei university faculty of health science 
 human ethics committee , and the subject provided written informed consent to participation 
 prior to the commencement of the study .
he complained of continuous lbp for 10 months , and 
 an examination revealed that his pelvis was tilted posteriorly .
he had not undergone any 
 specific treatment for his condition , which included mechanical lbp without radiating pain , 
 and in forward flexion in the standing position with his knees fully extended , he 
 experienced pain and stiffness in his lower back .
the visual analogue scale ( vas ) score of 
 this back pain was 6 .
pelvic inclination was measured with a palpation meter ( palm ; 
 performance attainment associates , st .
the intra - test and inter - test reliabilities of the palm 
 are greater than 0.86 .
the subject removed 
 his shoes and spread his feet during the measurement , stood upright with the anterior aspect 
 of the thighs against a stabilizing table .
the sagittal plane rotation was measured with the 
 caliper tips of the palm in contact with the ipsilateral anterior superior iliac spine 
 ( asis ) and posterior superior iliac spine ( psis ) . at the initial assessment ,
the anterior 
 pelvic tilt angles were 2 and 2 on the right and left sides ( normal range , 11  4 ) , 
 respectively .
the dual inclinometer ( acumar , lafayette instrument co. , lafayette , usa ) was 
 used to measure the trunk flexion and extension angles .
the intra - test and inter - test 
 reliabilities of the dual inclinometer are greater than 0.8 .
initially , the lumbar flexion 
 angle was 55 and the extension angle was 34. the subject performed individual 
 strengthening exercises for the anterior pelvic tilt muscles ( erector spinae , iliopsoas , 
 rectus femoris)5 .
the strengthening 
 exercise for erector spinae was as follows : stand with the feet shoulder width apart with 
 both hands holding 5  kg weights ; then flex the trunk slowly ( 5 seconds ) until parallel with 
 the floor while keeping the natural arch of the back with the shoulder blades back ; then 
 slowly return ( 5 seconds ) to the starting postition .
the strengthening exercise for the 
 iliopsoas was an above 90 hip flexion ( so - called psoas isolation ) exercise for both legs 
 with 10  kg weights .
the initial position was sitting with the hips and knees flexed at 90 
 on a table .
reciprocal flexion to above 120 hip flexion on both sides was performed with 
 knee flexion of 90. the strengthening exercise for the rectus femoris was an 80 knee 
 extension exercise for both legs with 10  kg weights on a nk table .
the subject performed the 
 three individual strengthening exercises for two weeks in three sets of 30 repetitions per 
 day .
after the exercise intervention , the anterior pelvic tilt angle increased , the angles were 
 7 and 8 on the right and left sides , compared to the initial angles of 2 and 2 on the 
 right and left sides .
the lumbar roms were increased : the flexion angle was 62 and 
 extension angle was 45 , compared to the initial flexion angle of 55 and extension angle of 
 34. when in backward trunk extension , the vas score of back pain decreased to a score of 3 , 
 compared to the initial score of 6 .
pelvic anterior tilt motion is produced by couple - force of the erector spinae , iliopsoas 
 and rectus femoris muscles5 . during 
 anterior pelvic tilt motion
, clinicians ca n't directly apply a powerful resistance to 
 patients for strengthening of pelvic anterior tilt muscles .
so , in this study , we tried 
 prescribing individual resistance exercises for pelvic anterior tilt for a lbp patient with 
 flat back .
after the intervention , pelvic tilt angles of the right and left sides had 
 recovered to normal ranges .
the patient 's lumbar roms had increased , and the vas score of 
 low back pain had decreased .
we think that these individual strengthening exercises for the 
 strengthening of pelvic anterior tilt muscles are an effective approach for the treatment of 
 lbp with flat back .
therefore , we suggest that individual resistance exercises are necessary 
 for effective and fast strengthening of pelvic anterior tilt muscles in lbp with flat 
 back .
   [ purpose ] the purpose of this paper is to report the effect of individual strengthening 
 exercises for the anterior pelvic tilt muscles on back pain , pelvic tilt angle , and lumbar 
 rom of a low back pain ( lbp ) patient with flat back . 
 [ subject ] a 37  year - old male , who 
 complained of lbp pain at l3 - 5 levels with flat back , participated . 
 [ methods ] he performed 
 the individual strengthening exercises for anterior pelvic tilt muscles ( erector 
 spinae , iliopsoas , rectus femoris ) . [ results ] pelvic tilt angles of the right and left 
 sides were recovered to normal ranges . 
 his lumbar roms increased , and low back pain 
 decreased . 
 [ conclusion ] we suggest that individual resistance exercises are a necessary 
 approach for effective and fast strengthening of pelvic anterior tilt muscles in lbp with 
 flat back . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION