Physiotherapy for HNP Lumbal

8/16/2019 Physiotherapy for HNP Lumbal

1/31

Physiotherapy for HNPLumbal

Oleh :Ana Ilmanian Na’ah

021211002

Siloam Semanggi SW Rehabilitasi Jum’at, 19 Februari 2016


2/31

Pengertian HNP

• Berpindahnya material diskus(nucleus pulposus dan anulusfbrosus) pada disk intervertebralis

( Jo Jordan, et all. 2010)

http://var/www/apps/conversion/tmp/scratch_2/clinical%20evidance.pdfhttp://var/www/apps/conversion/tmp/scratch_2/clinical%20evidance.pdfhttp://var/www/apps/conversion/tmp/scratch_2/clinical%20evidance.pdfhttp://var/www/apps/conversion/tmp/scratch_2/clinical%20evidance.pdfhttp://var/www/apps/conversion/tmp/scratch_2/clinical%20evidance.pdf


3/31


4/31

(American Acaem! o" #rtho$aeic Surgeons, 201%)

http://var/www/apps/conversion/tmp/scratch_2/herniated%20disc%20in%20lower%20back.pdfhttp://var/www/apps/conversion/tmp/scratch_2/herniated%20disc%20in%20lower%20back.pdfhttp://var/www/apps/conversion/tmp/scratch_2/herniated%20disc%20in%20lower%20back.pdfhttp://var/www/apps/conversion/tmp/scratch_2/herniated%20disc%20in%20lower%20back.pdfhttp://var/www/apps/conversion/tmp/scratch_2/herniated%20disc%20in%20lower%20back.pdf


5/31


6/31

Laporan asus


7/31

&entitas 'asien

ama *rs+ R

anggal lahir 2 Juli 19-.

/mur %1 ahun

Alamat aman Sentosa, iarang

iagnosis *ei 3' 4umbal

anggal 'emerisaan %0 Januari 2016


8/31

'engum$ulan ata Ri5a!at

'en!ait

/ !eri $aa $inggang belaang an men7alarsam$ai e betis sebelah anan+

R'S

#s merasaan sait $aa $inggang se7a 2 tahun!ang lalu, teta$i tia melauan tera$i arenahamil ana e82+ #S mengataan $ernahmelauan tera$i !ro$rasi selama 1 $aet+ #stia melan7utan tera$i tersebut an mengataan

masih merasaan n!eri $aa $inggang anmen7alar sam$ai betis sebelah anan+ !eribiasan!a hilang timbul $aa saat ber7alan atauuu lama, an saat uu e beriri+ 'ertama

ali melauan Fisiotera$i tanggal %0 Januari 2016


9/31

Pemeri!saan "mum

• ara atang *aniri

• oo$erati"tia oo$erati"

•

esaaran om$os *entis• Status gi:i

– ;; 61 g

–

; 16.cm


10/31


11/31

(Richar A+ 'o5ell, 2010)

Sala n!eri

• !eri tean 8

• !eri gera >8- (setelahmelauan geraan ce$attiba8tiba)

http://var/www/apps/conversion/tmp/scratch_2/guide%20to%20pain%20management.pdfhttp://var/www/apps/conversion/tmp/scratch_2/guide%20to%20pain%20management.pdf


12/31

#pe$ial %est

• he su$ine straight leg raise (aniel Scott reiner, et all, 201%), (?) 3' bila aa n!eri saat aiinaian e atas setinggi >0@

(Founation #" Athletic raining, 200-)

http://var/www/apps/conversion/tmp/scratch_2/An%20evidence-based%20clinical%20guideline%20for%20lumbar%20disc%20herniation.pdfhttp://var/www/apps/conversion/tmp/scratch_2/An%20evidence-based%20clinical%20guideline%20for%20lumbar%20disc%20herniation.pdfhttp://var/www/apps/conversion/tmp/scratch_2/lumbar%20spinal%20condition.pdfhttp://var/www/apps/conversion/tmp/scratch_2/lumbar%20spinal%20condition.pdfhttp://var/www/apps/conversion/tmp/scratch_2/lumbar%20spinal%20condition.pdfhttp://var/www/apps/conversion/tmp/scratch_2/lumbar%20spinal%20condition.pdfhttp://var/www/apps/conversion/tmp/scratch_2/An%20evidence-based%20clinical%20guideline%20for%20lumbar%20disc%20herniation.pdfhttp://var/www/apps/conversion/tmp/scratch_2/An%20evidence-based%20clinical%20guideline%20for%20lumbar%20disc%20herniation.pdfhttp://var/www/apps/conversion/tmp/scratch_2/An%20evidence-based%20clinical%20guideline%20for%20lumbar%20disc%20herniation.pdf


13/31

• &asalah 'isioterapi : – !eri $aa $inggang sam$ai betis sebelah anan

– S$asme otot $aralumbal an uaratus lumborum

• (iagnosa 'isioterapi :

!eri $aa $inggang sam$ai betis ans$asme otot $aralumbal serta uaratuslumborum et causa 3' 4umbal

• %u)uan 'isioterapi : – *engurangi n!eri

– *engurangi s$asme


14/31

• Inter*ensi '% : –

/S – BS

– raction 4umbal ? reamill

–

Flui !cle – Sling eCercise

– % e5ton


15/31

/raian inaan Fisiotera$i

• %+N# – u7uan *engurangi n!eri (

ar=alho 4;, 201%)

F %Cminggu

& 108%03:

electrothera$!

1D menit

http://var/www/apps/conversion/tmp/scratch_2/Lumbar%20disc%20herniation%20treatment.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Lumbar%20disc%20herniation%20treatment.pdf


16/31

• Bletroau$untur, $aa "reuensi . 3: selama %0menit tiga ali seminggu selama tiga minggu,

mengurangi rasa sait .2E oleh AS, 1 hari setelahsesi $engobatan terahir ($ G0,01)+ Selain itu, BS(ranscutaneous electrical ner=e stimulation)

mengurangi rasa sait 2%E ($ G0,0D), an$enera$an $lasebo -E, $aa "reuensi !ang sama+


17/31

• "ltrasoun, – u7uan mengurangi s$asme,

mengurangi n!eri, melancaran sirulasi

arah (&smail ;o!ra:, et all, 201D)F %Cminggu

& 2,. 5attscm2

electrothera$! Dmenit

http://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdfhttp://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdfhttp://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdfhttp://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdfhttp://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdf


18/31

• %ra$tion Lumbal - %rea,mill

– u7uan untu meregangan otot,stabilisasi lumbal, mengurangi n!eri (3ae Sun Hang, Won I!u Hoo, 201.)

F %Cminggu

eCercise

1D menit

http://var/www/apps/conversion/tmp/scratch_2/effect%20of%20lumbar%20traction.pdfhttp://var/www/apps/conversion/tmp/scratch_2/effect%20of%20lumbar%20traction.pdfhttp://var/www/apps/conversion/tmp/scratch_2/effect%20of%20lumbar%20traction.pdfhttp://var/www/apps/conversion/tmp/scratch_2/effect%20of%20lumbar%20traction.pdfhttp://var/www/apps/conversion/tmp/scratch_2/effect%20of%20lumbar%20traction.pdfhttp://var/www/apps/conversion/tmp/scratch_2/effect%20of%20lumbar%20traction.pdfhttp://var/www/apps/conversion/tmp/scratch_2/effect%20of%20lumbar%20traction.pdfhttp://var/www/apps/conversion/tmp/scratch_2/effect%20of%20lumbar%20traction.pdf


19/31

• 'lui, .y$le

– u7uan mengurangi s$asme otot,melatih euatan otot, mengurangin!eri (r:!s:to" Ra:is:e5si, 2012)

F %Cminggu

aerobic eCercise

10 menit

http://var/www/apps/conversion/tmp/scratch_2/Exercises%20in%20Low%20Back%20Pain.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Exercises%20in%20Low%20Back%20Pain.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Exercises%20in%20Low%20Back%20Pain.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Exercises%20in%20Low%20Back%20Pain.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Exercises%20in%20Low%20Back%20Pain.pdf


20/31

• #ling +/er$ise – u7uan *engurangi n!eri, mem$erbaiieseimbangan $ostural, anmenormalan "ungsi otot+ (

Ji 3ae im, et all, 201%)

F %Cminggu

stretching eCercise, relaCation,strengthening eCercise+

.08.D menit

http://var/www/apps/conversion/tmp/scratch_2/The%20Effect%20of%20the%20Neurac%20Sling%20Exercise%20on%20Postural%20Balance.pdfhttp://var/www/apps/conversion/tmp/scratch_2/The%20Effect%20of%20the%20Neurac%20Sling%20Exercise%20on%20Postural%20Balance.pdf


21/31

• ( Neton

– u7uan meningatan euatan ototF %Cminggu

eCercise

1D menit


22/31

3#*B 'R#IRA*

• Stretching an stabili:ation eCercise(Stuart *+ *cIill, 200%)

• 'illates (Ashle! Waler, 2012)

• *enggunaan meanisme tubuh!ang bai saat uu, beriri anmengangat beban (

/ni=ersit! 3ealth Ser=ice, 2012)

http://var/www/apps/conversion/tmp/scratch_2/Low%20Back%20Stabilization%20exercise.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Pilates%20Rehabilitation%20for%20Bulging%20Disc%20in%20Lumbar%20Spine.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Back%20Pain.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Back%20Pain.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Pilates%20Rehabilitation%20for%20Bulging%20Disc%20in%20Lumbar%20Spine.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Low%20Back%20Stabilization%20exercise.pdf


23/31

• Rabin et all re$orte a $ros$ecti=e case series o" D> consecuti=e$atients 5ith *R& conrme lumbar isc herniation, com$aring thesensiti=it! o" t5o methos o" $er"orming the straight leg raise (S4R)

test, one in the su$ine $osition an the other in the seate $osition,in $atients $resenting 5ith signs an s!m$toms consistent 5ithlumbar raiculo$ath!+ he sensiti=it! (9DE &) o" the su$ine S4Rtest in re$roucing the $atient’s raicular $ain in light o" an *R&scan inicating the $resence o" ner=e root com$ression 5as 0+6>(9DE &, 0+D%80+>9)+ he sensiti=it! (9DE &) o" the seate S4R test

5as at 0+.1 (9DE &, 0+2980+DD)+ (+ Scott reiner, *, et all, 2012)

http://var/www/apps/conversion/tmp/scratch_2/clinical%20guidelines%20north%20america.pdfhttp://var/www/apps/conversion/tmp/scratch_2/clinical%20guidelines%20north%20america.pdfhttp://var/www/apps/conversion/tmp/scratch_2/clinical%20guidelines%20north%20america.pdfhttp://var/www/apps/conversion/tmp/scratch_2/clinical%20guidelines%20north%20america.pdfhttp://var/www/apps/conversion/tmp/scratch_2/clinical%20guidelines%20north%20america.pdf


24/31

•

We "oun that 3&4, /S, an eCercise 5ere eKcientthera$ies "or lumbar isco$ath! but 3&4 an /S halonger eLect in terms o" some $arameters+ BCercisethera$! shoul ne=er be ignore to treat an $re=entlumbar bac $ain+ (&smail ;o!ra:, et all, 201D)

http://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdfhttp://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdfhttp://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdfhttp://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdfhttp://var/www/apps/conversion/tmp/scratch_2/comparison%20TENS%20and%20US%20therapy.pdf


25/31

• 'racticing acti=e eCercise in lo5 $ositions signicantl!im$ro=es the mo=ement range an bo! $osture an it

reuces $ain in the lo5er segments o" the s$ine+*oreo=er, the $atient’s "unctional abilities are im$ro=e5hile $er"orming e=er!a! acti=ities+ (*+ :ierMano5si et al+ 201)

http://var/www/apps/conversion/tmp/scratch_2/The%20Influence%20of%20Active%20Exercise%20in%20Low%20Positions.pdfhttp://var/www/apps/conversion/tmp/scratch_2/The%20Influence%20of%20Active%20Exercise%20in%20Low%20Positions.pdfhttp://var/www/apps/conversion/tmp/scratch_2/The%20Influence%20of%20Active%20Exercise%20in%20Low%20Positions.pdfhttp://var/www/apps/conversion/tmp/scratch_2/The%20Influence%20of%20Active%20Exercise%20in%20Low%20Positions.pdfhttp://var/www/apps/conversion/tmp/scratch_2/The%20Influence%20of%20Active%20Exercise%20in%20Low%20Positions.pdf


26/31

• As sling thera$! stuies are base on a small numbero" trials, 5e cannot ra5 conclusions about thethera$eutic eLects o" sling eCercise+ When segmental

stabili:ing eCercise an ini=iuall! esigne$rograms are ae to sling eCercise, it increases theeLecti=eness o" sling eCercise at im$ro=ing lo5 bac$ain+ ( Jin Su 4ee, et all+ 201.)

http://var/www/apps/conversion/tmp/scratch_2/Effectiveness%20of%20Sling%20Exercise.pdfhttp://var/www/apps/conversion/tmp/scratch_2/Effectiveness%20of%20Sling%20Exercise.pdf


27/31

eferensi

• Jordan, Jo. et all. 2010+ “Herniated lumbar disc. !linical"vidence 2011N06111-

• American Acaem! o" #rtho$aeic Surgeons+ 201% +3erniate isc in 4o5er ;ac+ #rthoin$o.or%

•

'o5ell, Richar A+ et all+ 2010+ Iuie to 'ain *anagementin 4o5 Resources Settings 3&ain History and &ain'ana%ement + &AS'

• reiner , aniel Scott+ et all+ 201%+ n evidencebasedclinical %uideline $or the dia%nosis and treatment o$ lumbardisc herniation *ith radiculopathy. 3B S'&B J#/RA4#FF&&A4 J#/RA4 #F 3B #R3 A*BR&A S'&BS#&BH+ #& 10+10167+s$inee+201%+0-+00%

• Founation #" Athletic raining+ 200-+ .HAP%+ 114umbar S$inal onitions+ 'age %068%.>

•

ar=alho, 4ilian ;raighi+ Bt all+ 201%+ +umbar discherniation treatment + he ;ra:ilian Association o" 'h!sical


28/31

•;o!ra:, &smail+ Bt all+ 201D+ !omparison o$ Hi%h-ntensity +aser herapy and /ltrasound reatment inthe &atients *ith +umbar iscopathy + 3ina5i'ublishing or$oration, ;io*e Research &nternational+htt$C+oi+org10+11DD201D%0.%2-

• Hang, 3ae Sun+ Won I!u Hoo+ 201.+ he "1ects o$tretchin% *ith +umbar raction on 3 and #s*estry

cales o$ &atients *ith +umbar 456 Herniated-ntervertebral isc. orea

•Ra:is:e5si, r:!s:to"+ 2012+ BCercises in 4o5 ;ac'ain+ 'olan+ 555+intecho$en+com

•im , Ji 3ae+ Bt all+ 201%+ he "1ect o$ the 7eurac lin%"8ercise on &ostural Balance d9ustment and 'uscular:esponse &atterns in !hronic +o* Back &ain &atients.

45 Phys5 %her5 #$i5 26: 1016710189 201

http://dx.doi.org/10.1155/2015/304328http://www.intechopen.com/http://www.intechopen.com/http://dx.doi.org/10.1155/2015/304328


29/31

• *cIill, Stuart *+ 200%+ "nhancin% +o*backHealth throu%h tabili;ation "8ercise5/ni=ersit! o" Waterloo

• Waler, Ashle!+ 2012+ &ilates :ehabilitation $orBul%in% isc in +umbar pine+ #alan, A+

•

/ni=ersit! 3ealth Ser=ice+ 2012+ A. PAIN5Http:;;stu,enta


30/31

• :ierMano5si, *acie75 Bt all+ 201%+ he-n


31/31

%han! =ou>

Documents

Physiotherapy for HNP Lumbal