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    Lumbar Pain Opi

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    Afifah Dienillah Khusnun
    ❖ meningkatkan stabilitas lumbal ❖ mengurangi nyeri ❖ meningkatkan ROM Teknik: ❖ https://id.physitrack.com/exercises?query=taping Efek: ❖ Autogenik inhibisi pada otot yang ditape ❖ Memperbaiki alignment lumbal ❖ Mengurangi nyeri ❖ Meningkatkan stabilitas lumbal fl Aerobic Exercise ❖ Low-to-moderate intensity aerobic exercise like walking is generally safe for

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    © All Rights Reserved
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    Lumbar Pain Opi

    Uploaded by

    Afifah Dienillah Khusnun
    7 views34 pages
    ❖ meningkatkan stabilitas lumbal ❖ mengurangi nyeri ❖ meningkatkan ROM Teknik: ❖ https://id.physitrack.com/exercises?query=taping Efek: ❖ Autogenik inhibisi pada otot yang ditape ❖ Memperbaiki alignment lumbal ❖ Mengurangi nyeri ❖ Meningkatkan stabilitas lumbal fl Aerobic Exercise ❖ Low-to-moderate intensity aerobic exercise like walking is generally safe for

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    11. Lumbar Pain Opi

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    ❖ meningkatkan stabilitas lumbal ❖ mengurangi nyeri ❖ meningkatkan ROM Teknik: ❖ https://id.physitrack.com/exercises?query=taping Efek: ❖ Autogenik inhibisi pada otot yang ditape ❖ Memperbaiki alignment lumbal ❖ Mengurangi nyeri ❖ Meningkatkan stabilitas lumbal fl Aerobic Exercise ❖ Low-to-moderate intensity aerobic exercise like walking is generally safe for

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views34 pages

    Lumbar Pain Opi

    Uploaded by

    Afifah Dienillah Khusnun
    ❖ meningkatkan stabilitas lumbal ❖ mengurangi nyeri ❖ meningkatkan ROM Teknik: ❖ https://id.physitrack.com/exercises?query=taping Efek: ❖ Autogenik inhibisi pada otot yang ditape ❖ Memperbaiki alignment lumbal ❖ Mengurangi nyeri ❖ Meningkatkan stabilitas lumbal fl Aerobic Exercise ❖ Low-to-moderate intensity aerobic exercise like walking is generally safe for

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 34

    Physiotherapy for Lumbar Pain

    Assessment, Diagnose, Treatment for Lumbal condition

    Opi a Dian Wahyono, SST.FTr


    Senior Physiotherapist Brawijaya Clinic
    Country Manager Physitrack Indonesia
    fi
    Problematik LBP
    LBP

    Nyeri dan spasme


    Fibrosis dan kontraktur
    Kekuatan otot menurun

    Fleksibilitas lumbal turun Akti tas Fungsi Turun


    fi
    Low Back Pain

    1. Mechanical low back pain (97%)


    • Lumbar strain or sprain (≥ 70%) Diffuse pain in lumbar muscles; some radiation
    to buttocks
    • Degenerative disk or facet process (10%) Localized lumbar pain; similar ndings
    to lumbar strain
    • Herniated disk (4%) Leg pain often worse than back pain; pain radiating below
    knee
    • Osteoporotic compression fracture (4%) Spine tenderness; often history of
    trauma
    • Spinal stenosis (3%) Pain better when spine is exed or when seated, aggravated
    by walking downhill more than uphill; symptoms often bilateral
    • Spondylolisthesis (2%) Pain with activity, usually better with rest
    fl
    fi
    2. Nonmechanical spinal conditions (1%)

    • Neoplasia (0.7%) Spine tenderness; weight loss


    • In ammatory arthritis (0.3%) Morning stiffness, improves with
    exercise
    • Infection (0.01%) Spine tenderness; constitutional symptoms
    fl
    3. Nonspinal/visceral disease (2%)

    ▪ Pelvic organs—prostatitis, pelvic in ammatory disease,


    ▪ Endometriosis saat menstruasi
    ▪ Lower abdominal symptoms common
    ▪ Renal organs, Usually involves abdominal symptoms; abnormal urinalysis
    ▪ Aortic aneurysm - Epigastric pain; pulsatile abdominal mass
    ▪ Gastrointestinal system—pancreatitis, cholecystitis, peptic ulcer Epigastric
    pain; nausea, vomiting
    fl
    Red Flags

    Age > 50
    Bowel or bladder loss
    IV drug use
    Fever
    Hx/o cancer
    Trauma
    Prolonged steroid use
    Unexplained wt loss
    Osteoporosis
    Pain at rest/night
    Distal numbness
    Weakness
    Saddle anestesia
    ASSESSMENT

    ■ Inspection
    ■ Palpation
    ■ ROM
    ■ Strength
    ■ Neurovascular
    ■ Special Tests
    Inspection
    ❖ Ensure
    ❖ No obvious deformities
    ❖ No erythema

    ❖ Skin lesions (Zoster)

    ❖ Posture

    ❖ Allignment

    ❖ Pattern overload
    Palpation
    ❖ Soft Tissue
    ❖ 4 clinical zones
    ❖ Paraspinal muscles
    ❖ Gluteal muscles
    ❖ Sciatic area
    ❖ Anterior abdomen /abdominal wall
    ❖ Soft, tight, weak ???
    ■ Bones
    ■ Primarily palpating spinous processes and facets
    Range of Motion

    Flexion - 80º

    Extension - 35º

    Side bending - 40º each side

    Twisting - 3-18º
    Neurologic Testing
    ❖ Sensation
    ❖ Strength
    ❖ Re exes
    fl
    Neurologic Examination
    (L4 level)

    ❖ Motor
    ❖ Tibialis Anterior
    ❖ Resisted inversion of ankle
    ❖ Re exes
    ❖ Patellar Re ex (L2, L3, L4)
    ❖ Sensory
    ❖ Medial side of leg
    fl
    fl
    Neurologic Examination
    (L5 level)

    ❖ Motor
    ❖ Extensor Hallicus Longus
    ❖ Resisted dorsi exion of great toe
    ❖ Re exes - none
    ❖ Sensory
    ❖ Dorsum of foot in midline
    fl
    fl
    Neurologic Examination
    (S1 level)

    ❖ Motor
    ❖ Peroneus Longus and Brevis
    ❖ Resisted eversion of foot
    ❖ Re exes
    ❖ Achilles
    ❖ Sensory
    ❖ Lateral side of foot
    fl
    Special Tests
    ❖ Tests to stretch spinal cord or sciatic nerve
    ❖ Tests to stress the sacroiliac joint
    SLR BRAGARD
    Sacroiliac Sress Test

    FABER test:

    Flexion

    ABduction

    External

    Rotation
    Tes Piriformis

    FADIR test:
    Flexion
    ADduction
    Internal
    Rotation
    Pemeriksaan Neurologis yg lain :
    Slump test

    ❖ Posisi awal : Duduk tegak


    ❖ Gerakan: (1). Terapis mempertahankan kepala pasien pada posisi netral, pasien diminta
    mengendorkan punggungnya ( eksi lumbal), (2) kemudian beri tekanan (kompresi) pada
    bahu kanan kiri untuk mempertahankan posisi eksi lumbal, (3) selanjutnya pasien diminta
    menggerakkan eksi leher dan kepala sejauh mungkin, (4) kemudian terapis mempertahankan
    posisi maksimal eksi vertebrae tersebut dengan memberi tekanan pada kepala bagian
    belakang, (5) terapis menahan kaki pasien pada maksimal dorsi eksi, pasien diminta
    meluruskan lututnya dan pasien diminta meluruskan (ekstensi) lututnya, (6) jika pasien tidak
    mampu meluruskan lututnya (karena nyeri), tekanan pada kepala dipindah ke bahu kanan
    kiri.
    ❖ Intepretasi: Bila saat tekanan pada kepala dipindah ke bahu pasien, mampu menambah
    gerakan ekstensi lutut atau nyeri berkurang, berarti tes positif.
    fl
    fl
    fl
    fl
    fl
    SACROILIAC JOINT TEST
    ❖ Compression tests
    Test : mengetahui sprain dari posterior sacroiliac joint atau ligament.
    Prosedur : posisi pasien terlentang ataau tidur miring. Tekan R dan L ASIS (Anterior Superior Iliac Spine) arah satu sama
    lain
    Positive sign : symptom nyeri meningkat
    ❖ Sacral fixation test (Gillet’s test)
    Tes ini digunakan untuk mengetahui apakah ada bloking pada sendi sacroiliaca
    Posisi pasien: Berdiri tegak, terapis mempalpasi SIPS kanan kiri dengan ibu jari.
    Gerakan: Fleksikan hip secara penuh, terapis merasakan apakah SIPS sisi yang sama drops (berarti normal) atau elevasi
    (yang berarti sendi sacroiliaca terkunci. Ulangi prosedur tersebut untuk SIPS sisi satunya.
    ❖ Piedallu’s Sign
    Test : mengetahui pergerakan sacrum terhadap ilium.
    Prosedur : pasien duduk. Terapis mempalpasi SIPS kanan kiri dengan ibu jari sambil pasien membungkuk (forward
    exes).
    Positive sign : satu sisi bergerak lebih tinggi disbanding sisi satunya. Mengindikasi adanya hypomobility di sisi tersebut.
    fl
    ❖ Standing Flexion
    Test : mengetahui pergerakan ilium terhadap sacrum

    Prosedur : pasien berdiri. Terapis mempalpasi SIPS kanan kiri dengan ibu jari
    sambil pasien membungkuk (forward exes).

    Positive sign : satu sisi bergerak lebih tinggi disbanding sisi satunya.
    Mengindikasi adanya hypomobility di sisi tersebut.

    fl
    PALPATION
    Maitland Lumbar PAIVM

    Adalah active accessory movement dengan arah central PA (Posterior Anterior) pada prosesus spinosus
    dan lateral PA pada prosesus spinosus untuk mengetahui symptom lain seperti :
    ❖ nyeri local,
    ❖ stiffness pada vertebra joint
    ❖ nyeri menjalar

    Grade yg digunakan :
    ❖ Grade I – small amplitude movement at the beginning of the available range of movement
    Grade II – large amplitude movement at within the available range of movement
    ❖ Grade III – large amplitude movement that reaches the end range of movement
    Grade IV – small amplitude movement at the very end range of movement
    Maitland Lumbar PAIVM
    INTERFENSI PHYSIOTHERAPY
    ❖ Berdasarkan temuan dari objective assessment
    ❖ Edukasi ke Pasien tentang treatment plan
    ❖ Lacak progress pasien
    ❖ Follow up
    ❖ Put everything in 1 documentation
    Terapi Manual
    ❖ Evans (2002), Terapi Manual dg teknik high-velocity, low-amplitude thrust
    manipulation ! Mobilitas sendi meningkat
    ❖ Descarreaux et al (2003), intensive spinal manipulation efektif menurunkan
    nyeri LBP
    ❖ Ferreira et al (2002) menyimpulkan bahwa terapi manual menurunkan nyeri
    LBP
    ❖ Senna et al (2003), terapi manual effektif pd non spesi k kronik
    ❖ Juni et al 2008, terapi manual effektif pd LBP akut yang spesi k.

    fi
    fi
    Myofascial Release Technique
    ❖ Barnes (2009): mekanisme autogenik inhibisi pada muscle spindle
    dan organ golgi tendon
    ❖ Marshal (2009): MRT menurunkan nyeri
    ❖ Schleip (2003), Slow Deep Pressure ! Tonus otot turun
    ❖ Westmoreland et al (1994), Laundy (1998), SDP ! Acetylcholine +
    ! aktif ! Depolarisasi ! pelepasan gamma-aminobutyric acid
    (GABA) ! Inhibisi
    ❖ https://id.physitrack.com/exercises?query=myofascial
    Massage

    ❖ for Subacute and Chronic Low Back Pain


    ❖ 1 or 2 times a week for 4 to 10 weeks for a total of between 6 and 10
    sessions. Each session lasted 30 to 35 minutes
    Core Stability Exercises

    ❖ LBP ! Nyeri ! Stabilitas lumbal jelek ! nyeri bertambah


    ❖ Jenis Latihan: https://id.physitrack.com/exercises?
    refinementList%5Bsource_name%5D%5B0%5D=Physitrack&r
    efinementList%5Bsource_name%5D%5B1%5D=physiotools&r
    efinementList%5Bsource_name%5D%5B2%5D=mobilus&refin
    ementList%5Bthemes_en%5D%5B0%5D=Musculoskeletal%20
    %28MSK%29&refinementList%5Bthemes_en%5D%5B1%5D=S
    trength%20%26%20conditioning&refinementList%5Bregions_
    en%5D%5B0%5D=Pelvic%20floor&query=core
    ❖
    Fisiotaping
    Tujuan:
    ❖ menginhibisi aktivasi otot yang mengalami gangguan/kelainan
    ❖ memfasilitasi fungsi otot yang mengalami kelemahan.
    Metode Aplikasi (Kase, 2006) :
    ❖ LBP myogenik aktualitas tinggi, dg metode “I”
    bilateral dari arah insersio ke origo dengan
    tarikan 15-20%
    ❖ aktualitas sedang dg spasme, dg metode “I”
    bilateral dari arah insersio ke origo dengan
    tarikan tarikan 35%
    ❖ LBP dg kelemahan otot, menggunakan metode
    “I” bilateral dari arah insersio ke origo dengan
    tarikan 40-50%

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