• 대한방사선기술학회지:방사선기술과학
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• 제40권2호
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• pp.311-316
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• 2017

골다공증 검사의 표준검사법은 이중 에너지 X선 흡수율(DEXA) 차이를 이용한 방식이고, 임상에서는 유사한 방식의 이중 에너지 X선 전산화단층영상장치(DECT)가 사용되고 있다. 본 논문의 목적은 기존 방식의 DEXA와 DECT 장비를 활용하였을 때 골밀도 차이를 확인하고 DECT 활용의 유용성을 알아보고자 한다. 기존 방식의 DEXA (QDR 4500W, Hologic)와 DECT (750 HD, GE Healthcare system) 장비를 이용하여 동일한 부위의 허리척추 팬텀 대상으로 검사 시행과 측정을 하였고, 1개월 내 기존 DEXA와 DECT 검사를 동일하게 허리 척추 검사를 시행한 환자 50명을 대상으로 골밀도를 측정 분석하였다. 허리척추 팬텀 대상 골밀도 측정 결과 두 영상장비 간에 통계적으로 높은 상관성(r=0.93, p<0.05)을 나타냈고, 사람을 대상으로 하였을 때도 비교적 높은 상관성(r=0.635, p<0.05; ${\tau}=0.46$, p<0.05)을 나타냈다. DECT를 이용한 골다공증 검사는 일반적으로 시행한 CT 영상 정보를 추가로 분석하여 골밀도 값을 얻는 것으로 추가적인 방사선 노출 없이 유용한 골밀도 정보를 제공해줄 수 있다는 유용성이 있다.

• 한국방사선학회논문지
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• 제11권1호
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• pp.43-48
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• 2017

최근 동위원소를 이용한 뼈 스캔 (Bone Scan)검사 후 골밀도 (BMD; Bone Mineral Density)검사를 당일검사로 병행한 경우 이로 인한 골밀도 측정값에 오차 발생 가능성이 제기되고 있으나 방사성의약품 표지화합물 투여 후 이중에너지 X선을 이용한 골밀도 측정값 변화에 대한 임상적 자료가 미비하여 핵의학 체내검사 후 당일 골다공증 검사의 측정값에 대한 논란의 소지가 있다. 따라서 동위원소 표지화합물인 $^{99m}Tc-MDP$가 골밀도 측정값에 영향을 미치는지 임상적 측면에서 실험하였다. 실험에 참가한 대상자의 평균 나이는 $35.17{\pm}9.45$세로 실험 대상자 17명 중 대사성 질환과 골밀도 측정에 영향을 줄 수 있는 허리뼈 압박골절 및 몸쪽 넓적다리뼈 골절이 있는 자를 제외한 12명 중 정상 골밀도 T-scores>-1.0의 환자 6명을 대상으로 $^{99m}Tc-MDP$ 투여 전 후 측정값을 분석한 결과 허리뼈에서 전 후 각각 평균 $0.975{\pm}0.084g/cm^2$, $0.966{\pm}0.078g/cm^2$으로 $0.009g/cm^2$ 증가, 우측 몸쪽 넓적다리뼈에서는 전 후 각각 평균 $0.909{\pm}0.078g/cm^2$, $0.913{\pm}0.086g/cm^2$으로 $0.004g/cm^2$ 감소, 좌측 몸쪽 넓적다리뼈에서는 각각 평균 $0.887{\pm}0.099g/cm^2$, $0.881{\pm}0.103g/cm^2$으로 $0.007g/cm^2$의 증가를 보여 몸쪽 넓적다리뼈 보다 허리뼈에서 더 큰 골밀도 변화를 보여주었다. 그러나 허리뼈와 몸쪽 넓적다리뼈 전체에서 전 후 변화 평균은 $0.0038{\pm}0.014g/cm^2$으로 골밀도 측정값에 유의한 영향이 없음을 알 수 있으며, 또한 두 실험간 전체 상관계수는 0.987으로 방사성동위원소 표지화합물인 $^{99m}Tc-MDP$ 투여가 골밀도 측정값에 영향을 주지 않았다. 따라서 140 keV의 감마선 에너지를 방출하는 테크네슘 표지화합물을 이용한 뼈 스캔검사 후 골밀도 측정값에 유의한 영향을 미치지 않음을 확인하였다. 그러나 핵의학적 체내검사와 골다공증 검사를 당일로 검사함으로 인한 환자의 피폭을 고려한다면 시간 간격을 두고 검사를 시행하는 것이 좋을 것으로 사료된다.

• 동의생리병리학회지
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• 제18권6호
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• pp.1918-1926
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• 2004

Osteoporosis is defined as a progressive systemic skeletal disorder characterized by low bone mineral density, microarchitectual deteriorations of bone and susceptibility to fracture. numerous methods have been used for quantitative assessment of the skeleton in osteoporosis. QCT has been shown to measure changes in trabecular mineral content in the spine with great sensitivity and precision. To provide the normal reference values and changes of lumbar spinal bone mineral density in korean adult spinal bone mineral density was evaluated in 451 women (229 premenopausal and 222 postmenopausal women) and 206 men, aged 20 to 74 years old in Wonkwang hospital from 2000 to 2004, which was carried out by using QCT. women with oophorectomy, vertebral compression fracture, any history of endocrine disease and use of drugs that alter bone metabolism were excluded. According to the WHO definition, a patient is osteoporotic based on a bone mineral density(BMD) measurement that is 2.5 standard deviations (SDs) below typical peak bone mass of young healthy white women. This measurement of standard deviation from peak mass is called the T score. BMD values of normal women in their 20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years, 45-49 years, 50-54 years, 55-59 years, 60-64 years, 65-69 years, over 70 years were 168.95㎎/㏄ K₂PHO₄, 155.41㎎/㏄ K₂PHO₄, 166.87㎎/㏄ K₂PHO₄, 160.67㎎/㏄ K₂PHO₄, 154.06㎎/㏄ K₂PHO₄, 132.04㎎/㏄ K₂PHO₄, 114.05㎎/㏄ K₂PHO₄, 91.78㎎/㏄ K₂PHO₄, 78.61 ㎎/㏄ K₂PHO₄, 61.35㎎/㏄ K₂PHO₄, 50.53㎎/㏄ K₂PHO₄ Mean bone density of normal women was 115.77K₂PHO₄ K₂PHO₄. BMD values of normal men in their 20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years, 45-49 years, 50-54 years, 55-59 years, 60-64 years, 65-69 years, over 70 years were 171.46㎎/㏄ K₂PHO₄, 162.19㎎/㏄ K₂PHO₄, 155.62㎎/㏄ K₂PHO₄, 147.28㎎/㏄ K₂PHO₄, 137.56㎎/㏄ K₂PHO₄, 137.56㎎/㏄ K₂PHO₄, 101.25㎎/㏄ K₂PHO₄, 109.00㎎/㏄ K₂PHO₄, 103.32㎎/㏄ K₂PHO₄, 91.53㎎/㏄ K₂PHO₄, 88.35㎎/㏄ K₂PHO₄ Mean density of normal men was 115.77㎎/㏄ K₂PHO₄. Peak bone density of women and men was in the age group of 20-24 years and 168.95㎎/㏄ K₂PHO₄, 171.46㎎/㏄ K₂PHO₄, respectively. Bone loss was increased with aging and was accelerated in postmenopausal women than that of premenopausal women. The total loss of BMD for women and men was 70.09% and 48.47%, respectively. Postmenopausal women(mean BMD : 85.83㎎/㏄ K₂PHO₄) had significantly lower BMD than premenopausal women(meand BMD : 144.80㎎/㏄ K₂PHO₄)(p<0.001). The annual loss of BMD of women and men was 2.702㎎/㏄ K₂PHO₄ and 1.795㎎/㏄ K₂PHO₄, respectively. This study provided the BMD reference data for normal korean adult. further studies on BMD in healthy adult and comparison with published data are needed.

• 여성건강간호학회지
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• 제7권2호
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• pp.169-187
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• 2001

This study was performed to probe the effect of exercise program on muscle strength, endurance, flexibility, pain, disability level and life satisfaction in female teachers of elementary school who complain of low back pain. For this study, 44 female teachers aged 30-50 years with mechanical low back pain of 6 months' duration, who had the structural normalities in the lumbar spine, were recruited from April 1 to July 10 1999. Twenty three out of them were assigned to the experimental group and twenty one to the control group. The exercise program consisted of education on right postures, the etiology and diagnosis of low back pain, and exercise intervention such as muscle relaxation, elongation and strengthening. With 8 weeks program, the subjects received two sessions of education and six sessions of group exercise in the 1st week, while three sessions of group exercise and four sessions of individual exercise weekly and two sessions of education during the later 7 weeks. The muscle strength and endurance were measured by Cybex 770, the flexibility by flexibility measurement machine, the intensity of pain by Visual Analogue Scale (VAS), the level of disability by Oswestry low back pain disability scale, depression by Beck depression inventory (BDI), and life satisfaction by Life satisfaction index-Z. Study measurements were taken before and after 8 weeks exercise program. Data were analyzed using paired t-test, t-test, and ANCOVA. The results were as follows ; 1. The flexors and extensors peak torque and flexors peak torque per body weight of experimental group were significantly increased at test velocities $30^{\circ}$/sec, $60^{\circ}$/sec compared with those of control group. There was no significant difference in extensors peak torque per flexors peak torque at $30^{\circ}/sec$, $60^{\circ}/sec$ between experimental and control group. 2. The flexors and extensors total work and flexors total work per body weight of experimental group were significantly increased at $120^{\circ}/sec$, compared with those of control group. 3.The flexibility of lumbar spine in experimental group was significantly increased compared with that of control group. The pains in anterior, posterior, left lateral and right lateral bending and in rotation of experimental group were significantly increased compared with those of control group. 4. The Oswestry disability scores of experimental and control group were significantly decreased, and there was no difference in the Oswestry disability score change between experimental and control group. 5. The scores of BDI of experimental group were significantly decreased compared with those of control group. Life satisfaction index-Z scores of experimental group were not changed, but those of control group were significantly decreased. There was no difference in the score change of Life satisfaction index-Z between experimental and control group. 6. ANCOVA analysis for the data variables of inhomogeneous baseline represented that there was no significant difference in extensors peak torque and extensors total work at $120^{\circ}/sec$ and extensor total work per body weight at $120^{\circ}/sec$ change between experimental group and control group. These findings indicate that the exercise program could be effective in increasing the muscle strength, endurance, flexibility and decreasing pain, improving depression in female teachers of elementary school with chronic low back pain. It is suggested that the exercise program could be an essential factor for the effective nursing intervention to the patients suffered from chronic low back pain.

• 대한영상의학회지
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• 제84권2호
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• pp.427-440
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• 2023

목적 MRI Dixon method (이하 DIXON) 기법을 이용하여 슬관절 지방우세 골조직의 지방신호분율(fat signal fraction; 이하 FF)을 구하고 골밀도(bone mineral density; 이하 BMD)와 상관관계 분석을 시행하였다. 대상과 방법 본원 슬관절 DIXON 영상을 촬영한 환자들 중 일 년 이내의 dual energy X-ray absorptiometry가 있는 환자 93명을 후향적으로 분석하였다. DIXON 영상에서 원위부 대퇴골 골간단(femur metaphyseal; 이하 Fm)과 근위부 경골 골간단(tibia metaphyseal; 이하 Tm)의 FF를 계산하였다. FF와 BMD 간 상관관계를 분석하였다. 또, 요추(lumbar spine; 이하 L), 대퇴경부(femoral neck; 이하 FN), 총대퇴골(femur total; 이하 FT)의 BMD 별로 나누고 FF에 대하여 Kruskal-Wallis H test를 시행하였다. 결과 전체 환자군에서 TmFF와 FN-BMD 사이에 유의미한 음의 상관관계를 보였다(r = -0.26, p < 0.05). 여성 환자에서는 TmFF가 FN-BMD, FT-BMD 및 L-BMD와 음의 상관관계를 보였다(r = -0.38, -0.28과 -0.27, p < 0.05). 남성 환자에서는 FmFF가 FN-BMD 및 FT-BMD와 음의 상관관계를 보였다(r = -0.58과 r = -0.42, p < 0.05). 여성 환자들을 세 군으로 나누었을 때 TmFF에 유의한 차이를 보였다(p < 0.05). 남성 환자들을 두 군으로 나누었을 때, FmFF이 군간에 유의미한 차이를 보였다(p < 0.05). 결론 슬관절 주변의 FF와 BMD는 음의 상관관계를 보였으며, DIXON을 이용한 FF 측정이 BMD 스크리닝에 사용될 수 있는 가능성을 보였다.

• 한국방사선학회논문지
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• 제7권2호
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• pp.121-129
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• 2013

최근 다중검출기 CT의 보편화 된 사용으로 환자의 피폭선량이 증가하고 있다. 따라서 광자극발광선량계를 이용해 촬영 목적 부위와 주변 결정장기에 대한 환자의 피폭선량을 측정하고 그에 따른 생물학적 효과를 예측하여 저감화 방안을 제시하고자 하였다. ICRP에서 권고한 표준안을 대상으로 만들어진 인체 모형 표준 팬텀에 교정상수를 부여받은 OSD 선량계를 측정하고자 하는 좌 우 수정체, 갑상선, 촬영의 중심점, 생식선에 부착하여 각 검사 부위별 노출 조건과 동일한 상태에서 환자의 피폭 선량을 모사하였다. OSL 선량계의 평균 교정상수는 $1.0058{\pm}0.0074$이었으며 검사 부위별 주변 결정장기의 등가선량은 좌 우측 수정체의 경우 직접 피폭이 약 50mGy로 최대였으며 간접 피폭되는 경우 0.24mGy, 원거리에서는 0.005mGy미만의 기준 준위 이하로 측정되었다. 갑상선의 경우 두부 검사에서 10.89mGy로 최대였으며 흉부에서 7.75mGy, 복부 및 요추부, 골반부에서는 기준 미만이었다. 생식선의 경우 골반검사에서 21.98mGy로 최대였으며 간접 피폭되는 검사에서 기준 준위 미만에서 6.92mGy까지 피폭되었다. CT 검사에서 DRL에 대한 저감화 방법은 국제기구에서 권고하고 있는 방사선 방어 원칙에 대한 정당한 해석과 제도적 뒷받침이 필요하다. 따라서 환자의 피폭을 최소화하기 위해서는 정당성을 충족하여야 하며 환자의 피폭선량에 미치는 영향들을 체계화하고 조직의 불필요한 피폭을 최소화 하여야 한다.

• 핵의학기술
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• 제15권1호
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• pp.3-9
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• 2011

이중에너지 방사선 흡수계측법(Dual-energy X-ray Apsorptiometry, DXA)은 일반적으로 골밀도를 통한 골다공증 평가 및 치료목적으로 이용되어 왔으며 최근 비만에 대한 관심이 높아지면서 체지방검사 처방이 증가하고 있는 추세이다. 기존의 체지방 측정은 전신을 검사해야만 평가가 가능했지만 근래 DXA장비의 소프트웨어가 향상 되면서 요추와 대퇴부의 측정만으로도 전신체지방률을 추측 할 수 있게 되었다. 전신측정이 아닌 부분측정 값이 다른 검사방법으로 산출된 값과 비교하여 타당성을 갖는지 생체전기저항측정법(Bioelectrical Impedence Analysis, BIA)과 체질량 지수(Body Mass Index, BMI)와의 상관도 분석을 통해 알아보고자 한다. 2010년 3월부터 8월까지 본원 건강검진센터에 내원한 수검자 중 40세 이상의 여성 90명을 대상으로 DXA와 BIA를 통해 체지방률을 측정하였다. BMI는 신체 계측기를 통해 측정된 신장과 체중을 수검자 정보에 기입하여 자동으로 산출되는 값을 활용하였다. 또한 체중에 따른 차이가 있는지 알아보기 위해 BMI를 기준으로 저체중, 정상, 비만의 세 그룹으로 분류하여 각 그룹에서 BMI와 BIA, DXA 간의 상관도를 분석하였다. 저체중과 정상, 비만으로 나눈 세 그룹에서의 DXA와 BIA의 비교는 모든 그룹에서 통계적으로 유의한 차이를 보이지 않았다. 그룹으로 나누지 않은 상태에서의 상관분석결과 DXA로 측정된 체지방률은 BMI와 비교해 통계적으로 유의한 높은 상관관계를 나타냈으며(r=0.908, p<0.01) BIA와의 비교에서도 통계적으로 유의한 높은 상관관계를 보였다(r=0.927, p<0.01). 부분 골밀도 측정으로부터 추정된 전신체지방률이 BIA 그리고 BMI와 비교해 뛰어난 상관관계를 보여 정보의 신뢰도가 높다는 것을 확인하였다. 아직 추정된 전신체지방률에 관한 명확한 기준이 없어 골밀도측정만으로 체지방평가를 하기는 어렵다. 그러나 골밀도검사를 통해 골다공증의 진단은 물론 체지방에 관한 정보까지 얻을 수 있다는 점에서 매우 효율적이며 추후 전신골밀도검사로 측정된 체지방률과의 비교연구를 통해 더 객관적이고 임상적으로 유용한 정보 제공이 가능할 것으로 판단된다.

• Tuberculosis and Respiratory Diseases
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• 제72권3호
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• pp.310-317
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• 2012

Background: Airway obstruction and the extent of emphysema are reported to be responsible for reduced bone mineral density (BMD). Corresponding to different phenotypes of a pulmonary disease, different severity in extra pulmonary features may exist. We compared BMDs of subjects with or without airway obstruction and/or emphysema and investigated the relationships among BMD, the severity of airway obstruction, and the extent of emphysema. Methods: Using a university hospital database, we reviewed patients over 40 years old who performed spirometry, computed tomography of chest, and measurement of BMD of the lumbar (L) spine. According to the presence or absence of airway obstruction and/or emphysema, four groups were classified. Results: Among a total of 59 subjects, 33 (56%) had osteoporosis. The prevalence of osteoporosis in subjects with no airway obstruction and no emphysema, those with only emphysema, those with only airway obstruction, and those with both airway obstruction and emphysema were 42%, 57%, 64%, and 73%, respectively (p=0.047 by linear-by-linear association). The mean T-scores of BMD of L1 (p=0.032) and L1-4 spines were different among the four groups (p=0.034). Although the T-score of L1 BMD negatively correlated with the extent of emphysema (r=-0.275, p=0.035) and positively with each of body mass index (BMI) (r=0.520, p<0.001), forced expiratory volume in one second ($FEV_1$) (r=0.330, p=0.011), $FEV_1$/forced vital capacity (r=0.409, p=0.001), and forced expiratory flow at 25~75% of FVC ($FEF_{25-75%}$) (r=0.438, p=0.0001), respectively, multiple linear regression analysis indicated that BMI (p<0.001) and $FEF_{25-75%}$ were predictive of BMD (p=0.012). Conclusion: Low BMI and airway obstruction were strongly associated with reduced bone density rather than the extent of emphysema.

• 대한물리의학회지
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• 제1권1호
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• pp.23-36
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• 2006

Purpose : The purpose of this study was to evaluate the effects of back muscle stretching on the flexibility of spinal column. Methods : The subjects were consisted of healthy adults (18 of females, 22 males ; mean aged 21.83) from 18 to 29. All subjects randomly assigned to the control group, back muscle stretching group. back muscle stretching group received back muscles stretching for 20 minutes per day and 3 times a week during 3 week period. Spine motion analyzer (Spinal Mouse) was used to measure the flexibility of spinal column. All measurement of each subjects were measured at pre-experiment, after 10 days, and after 21 days. Results : The results of this study were summarized below 1. The sacral tilt angle of the hip joint of control group, back muscle stretching group was no significantly differences at pre-experiment and after 10 days(p>0.5), but differency of each group occurred at after 21 days(p<0.5). the sacral tilt angle significantly increased at the back muscle stretching group rather than the control group. 2. The thoracic vertebral tilt angle of the control group, back muscle stretching group was no significantly differences at pre-experiment, after 10 days, after 21 days(p>0.5). 3. The lumbar vertebral tilt angle of the control group, back muscle stretching group was no significantly differences at pre-experiment, after 10 days, after 21 days(p>0.5). 4. The spinal tilt angle of control group, back muscle stretching group was no significantly differences at pre-experiment and after 10 days(p>0.5), but differency of each group occurred at after 21 days(p<0.5). the spinal tilt angle significantly increased at the back muscle stretching group rather than the control group(p>0.5). 5. The length of the spinal column of control group, back muscle stretching group was no significantly differences at pre-experiment and after 10 days (p>0.5), but differency of each group occurred at after 21 days(p<0.5). the length of the spinal column significantly increased at the back muscle stretching group rather than the control group(p<0.5). Conclusion : These data suggests that 3-week back muscle stretching improved the flexibility of sacrum, spinal column, and also improved spinal column lengthening. Additional randomized controlled trials to more fully investigate treatment effects and factors that may mediate these effects are needed.

• 대한정형도수물리치료학회지
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• 제12권1호
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• pp.1-15
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• 2006

Purpose: The purpose of this study was to evaluate the effects of abdominal muscle strengthening exercises and back muscle stretching on the flexibility of spinal column. Methods: The subjects were consisted of healthy adults ( 28 of females, 32 males; mean aged 21.6) from 18 to 29. All subjects randomly assigned to the control group, back muscle stretching group, abdominal muscle strengthening exercises group. back muscle stretching group received back muscles stretching for 20 minutes, abdominal muscle strengthening exercises group received abdominal muscle strengthening exercises for 30 minutes per day and 3 times a week during 3 week period. Spine motion analyzer (Spinal Mouse) was used to measure the flexibility of spinal column. All measurement of each subjects were measured at pre-experiment, after 10 days, and after 21 days. Results: The results of this study were summarized below 1. The sacral tilt angle of the hip joint of control group, back muscle stretching group, abdominal strengthening exercises group was no significantly differences at pre-experiment and after 10 days(p>0.5), but differency of each group occurred at after 21 days(p<0.5). the sacral tilt angle significantly increased at the back muscle stretching group, abdominal muscle strengthening exercises group, rather than the control group. 2. The thoracic vertebral tilt angle of the control group, back muscle stretching group, abdominal muscle strengthening exercises group was no significantly differences at pre-experiment, after 10 days, after 21 days(p>0.5). 3. The lumbar vertebral tilt angle of the control group, back muscle stretching group, abdominal muscle strengthening exercises group was no significantly differences at pre-experiment, after 10 days, after 21 days(p>0.5). 4. The spinal tilt angle of control group, back muscle stretching group, abdominal muscle strengthening exercises group was no significantly differences at pre-experiment and after 10 days(p>0.5), but differency of each group occurred at after 21 days(p<0.5). the spinal tilt angle significantly increased at the back muscle stretching group, abdominal muscle strengthening exercises group, rather than the control group(p<0.5). 5. The length of the spinal column of control group, back muscle stretching group, abdominal muscle strengthening exercises group was no significantly differences at pre-experiment and after 10 days (p>0.5), but differency of each group occurred at after 21 days(p<0.5). the length of the spinal column significantly increased at the back muscle stretching group, abdominal muscle strengthening exercises group, rather than the control group(p<0.5). Conclusion: these data suggests that 3-week abdominal muscle strengthening exercises and back muscle stretching improved the flexibility of sacrum, spinal column, and also improved spinal column lengthening. Additional randomized controlled trials to more fully investigate treatment effects and factors that may mediate these effects are needed.