KASUS THRACO-LUMBAR SPINE-

PELVIS2008

SugijantoDisampaikan pada: Kuliah reguler Manual terapi III

Joint blockade/ hypomobility

Lower thoracal facet & costovertebral-transversal joint blockade akibat kifosis ataulower thoracal akibat round back

ROM terbatas firm ef.Tes khusus: PACVP & LPAVP

terbatas firm efIntervensi:

– PACVP– LPAVP– Costovertebral gapping

manipulation, Facets Gapping manipulation tiga dimensi atauNelson traction

PROBLEMA NYERI PUNGGUNG BAWAH

Keterbatasangerak

Pain

immobilisasi

Soft tissue Contracted

Degeneration

InflamationCollagen adhesion

Muscle spasme

Joint mobilization / mobilization programs

PROV. TEST THORACAL SPINE

PACVP : bilateral segmental gapping

LPAVP : unilateral segmental gapping

PerhatikanPerhatikan: pain,

: pain,

mobilitasmobilitas, end feel.

, end feel.

GAPPING TEST THORACAL SPINE

3 DIMENSIONAL TRACTION TEST

rotasi homolateral – lateral fleksi kontra lateral danekstensi + longitudinal traction

Perhatik

an: pain

, klik

mobilitas,

end fee

l.

Joint mobilization

Thoraco lumbar facet (hypomobility-blockade)

PACVP oscilation diatasfirm capsular end feel apex kifosis

LPAVP oscilation diatasfirm capsular end feel

Joint mobilization

Thoraco lumbar facet (hypomobility)

Extension thoracalmobilization pd segmental hypomobility

Costovertebrale-Transversale(hypomobility-blockade)

Scoliosis idiopatikScoliosis idiopatik → kurva Vth8 (th7-8)

facet & costovertebral joint blockade

Asymmetry, Rib’s humpsTes: Gapping 3 dimensi. LPAVPIntervensi:

– Mobilisasi rotasi rib hump– Mobilisasi tiga dimensi facets apex

kurva, – Koreksi sikap metoda Bugnet / Klapp, – Orthosis (C)TLSO

Myofascial painIliolumbalis dan costolumbalis

myofascial pain akibat aktivitasstatic / injury

Nyeri dirujuk dlm pola somarik / vegetatif.

Tes: Palpasi nyeri, taut band & twisting dan stretch test.

Intervensi:– friction – manual muscle stretching– stretching exercise

Tendinitis/tendomyosisPenyebab spasme atau kontraksi

otot durasi lama Pd otot postural/antigravityNyeri dirujuk dlm pola somatik /

vegetatif.Intervensi:

– Transverse friction padatendonitis atau tendomyosis.

– Contract relax and stretching

PROBLEMA NYERI PUNGGUNG BAWAH

Nyerikontraksi

Tendinitis, myosis, myofasial

tendomyosis

Proses inflamasijar spesifik

sekitar

Refleksspasm & iskemik

Reganganjar saat

kontraksi

Intervensi: Friction, contract relax-stretching

Test panjang otot :Lumbar extensor: Bilateral hip flexion

Piriformis m,:Hip flex-add-int,rot

Iliopsoas m.: Posisi Hip flex contra lat, → hip ext ipsi latRectus femoris m.:Posisiidem → Hip ext.& knee flex.Iliotibial band.:Posisi hip contra lat flex-add → Hip ipsilat addAdductors ms.:Hip ipsi lat abd.Hamstrings ms: Hip flexion & Knee extension

Tx. MUSCLE MOBILIZATION

Paralumbal ms (myofascialpain or tightness)

Transverse friction and/or Contract relax & stretching: Max Bilat hip flex

Rotators ms (tightness)Contract relax and stretching:Lumbar rotation in side three dimentional position

Tx. MUSCLE MOBILIZATION

Rotators ms (tightness)

Contract relax stretching: Lumbar rotation in side three dimentionalposition

Tx. MUSCLE MOBILIZATION

Iliopsoas m (tight/contracted)stretching: Contra lat Hip flex dan

homo lat hip ext.

Rectus femoris m. stretching: Knee flexion danhip ext

Piriformis m. (spasm/tight)stretching: Hip flex-add-int.rot, isometric hip ext.

Tx. MUSCLE MOBILIZATION

Hip adductors ms (myofascialpain,tight/contracted)

Transverse frictionstretching: Hip abd, isometric hip add.

Hamstrings ms(tight/contracted)

stretching: SLR, isometric hip ext.

Tx. MUSCLE MOBILIZATION

Costolumbal-iliolumbal m(Spasm/myofascial pain)

transverse friction transversproc. L2, L3.

Contract relax-stretching:contra lat trunk side flex, isometric side flex

Tx. MUSCLE MOBILIZATION

Trunk rotator m. (spasm/tight)transverse friction: Iliac crest Contract relax & stretch: Contra lat trunk rot, isometric homo lat trunk rot

DISC BULGING/HNPDiscosis, disc bulging/hnp →

penonjolan menekan lig. longitposterior/dural sleeve →inflamasi

Tes: flexed compression test, Low back manouvre I-II

Intervensi:• Intermittent lumbar traction • Mobilisasi discus gerak ekstensi• Extension program;Muscle strengthening

Proper body mechanics

PROBLEMA NYERI PUNGGUNG BAWAH

Patologi diskus/ pilar anterior

Iritasisaat fleksi

Nyerifleksi

Patologi otot, lig. supra/interspinale

Regangansaat fleksi

Intervensi: Extension programs

Low Back Manouvre IISLR / Lasegue dan Contra

Lasegue (Nerve root, Ischiadicus)

→ Bragard (nerve root-n. ischiadicus),

→ Neri/Brudzinsky (Dural)

berurutan

Provocation testTraction & compression test: longitudinal, extension (facet bilat), flexion (disc) dan lat flexion (facet unilat)

PACVP (segmental Junghannstructure)

LPAVP (Facets thoracal spine)

MANIPULATION

Lumbal traction :Manual :

Posisi terlentang, miring, telungkup.

AlatPosisi terlentang, miring, telungkup.Sudut tarikan

Lumbosacrale dan Lumbale• Osteo arthrosis → iritasi tl

subchondral & osteophyte →iritasi jar sekitar

• Variasi bentuk facet L5-S1 →gerak traumatis

• Tes: kompresi pss ekstensi, gapping

• Intervensi:– contract relax and stretching– Joint mobilization atau gapping

technique– flexion program– Proper body mechanics

PROBLEMA NYERI PUNGGUNG BAWAH

Nyeriekstensi

Degenerasifaset

Iritasi subkondralsaat ekstensi

Osteofitkorpus/faset

Iritasi jar lunak, isiforamen intervert

Intervensi: Flexion programs

INSTABILITY/LYSTHESIS

• Hipermobilitas - instabilitas• Akibat ligament laxity,

kerusakan facet atauspondylolysis.

• Nyeri blk paha bilateral• Tes: stabilization test.• Intervensi:

– Terapi latihan stabilisasi aktif– Stabilisasi pasif dg lumbar

corset

PROBLEMA NYERI PUNGGUNG BAWAH

Sport

ADL

Kerja

Injury

Kongenital

Lain-lain

DeformititasMacro injuryMicro injury

ROM ↑JPM ↑

Hipermobil/instabilitas

Intervensi: Stabilization programs

Segmental test : 2 or 3 dimentional segment test

Lumbar segment gapping test: segmental/ regional intervertebral gapping

MANIPULATIONLumbar spine Gapping manipulation (minimal hypomobile/blockade)

2 dimentionalmanipulation3 dimentionalmanipulation

MANIPULATIONSacro iliac joint (hypomobility-blockade)

Nutation : Unilateral hip flex → pelvic foreward tilt.Contra nutation: Unilateral hip ext → pelvic backward tilt.SIJ NutationAnterior Gapping manipulationPosterior Gapping manipulation

See U