Specific Exercise

SPECIFIC EXERCISES
dr. Martina Sartika Fricilia S.

dr. Siti Nurul Badriyah
Pembimbing:
dr. Ibrahim Agung, Sp.K.F.R., M.S. (K)
TABLE OF
Contents
01 William Flexion Low back pain
02 McKenzie Extension Low back pain
03 Neck Calliet Neck pain
04 Buerger Allen Peripheral artery disease
LOW BACK PAIN
LOW BACK PAIN
Pain in between costal margin
and gluteal folds
Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 6ᵗʰ ed. Philadelphia (PA): F.A. Davis Company; 2012.
DISC, VERTEBRA, LIGAMENT, SPINAL ROOT
Brunnstorm’s,Clinical Kinesiology 6ᵗʰ edition, 2012. 4 : 321 – 322

Reyes TM, Reyes OL. Kinesiology The Phillipine Physical Therapy. 1978. 4 : 35 - 37
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2ⁿᵈ Edition. 3 : 318
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2ⁿᵈ Edition. 3 : 318
APPROACHING THE RIGHT EXERCISE
Flexion bias: Extension bias:
flexion approach extension approach
Extension causes worsening Extension reduces symptoms

symptoms or pain (centralization)
(peripheralization)
Diagnosis can be
Can be caused by spondylosis, intervertebralis disc lesion,
spinal stenosis, facet joint disc protrusion, abnormal
injury flexion posture
Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 6ᵗʰ ed. Philadelphia (PA): F.A. Davis Company; 2007.
Centralization
the symptoms
recede up the leg or Peripheralization
become localized to the symptoms are
the back experienced farther
down the leg
Houglum, Peggy A., and Peggy A. Houglum. Therapeutic Exercise for Musculoskeletal Injuries. Champaign, IL: Human Kinetics, 2005
Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 5ᵗʰ ed. Philadelphia (PA): F.A. Davis Company; 2007
WILLIAM FLEXION EXERCISE
Goals:
Invented by Dr. Paul Williams
(1937) 1. To open the intravertebral foramina
Indication: spondylosis, spinal 2. To stretch the back extensors, hip
stenosis, facet joint injury flexors, and facets
Emphasizes on lumbar flexion
3. To strengthen the abdominal and
=> to reduce the stress on
lordotic lumbar spine gluteal muscles
4. To mobilize the lumbosacral
junctions
WILLIAM FLEXION EXERCISE
Seven exercise to minimize the lordotic

lumbar spine:
1. Pelvic tilt exercise
2. Partial Sit Ups
3. Single & Double Knee to Chest
4. Hamstring Stretch
5. Standing Lunges
6. Seated Trunk Flexion
7. Full squat
Partial sit-ups Pelvic tilt
1. Lie on your back with knees bent, feet
flat on floor
Lie on your back with knees bent, feet flat on floor 2. Flatten the small of your back against the
Elevate the upper torso until the scapula clear the floor, without pushing down with the
resting surface and stress is placed on the rectus legs
abdominus, then relax 3. Hold for 5-10 seconds, then relax
Repeat 10 - 15X, twice a day 4. Repeat 10 - 15X, twice a day
To strengthen the abdominals To strengthen the gluteal muscles
Single knee to chest Double knee to chest
1. Lie on your back with knees bent and 1. Lie on your back with knees bent and
feet flat on the floor feet flat on the floor
2. Slowly pull your right knee toward you 2. Slowly pull your right knee toward you
shoulder shoulder, then pull left knee to chest
3. Hold for 5-10 seconds 3. Hold both knees for 5-10 seconds
4. Lower the knee and repeat with other 4. Slowly lower one leg at a time
knee
To stretch the erector spinae muscles
Seated toe reach with knees Hip flexor stretch / standing
extended lunges
1. Sit with extended knee and the toes 1. Begins with standing position with the feet
facing upward shoulder width apart.
2. With the knee extended, slowly flex the 2. Takes a big step forward with the right leg
trunk forward until both arms touch the and plants the foot out front, keeping the
toes. body relatively straight
3. Hold for 5 seconds, then relax 3. Flex the trunk forward and the knee should
4. Repetition 10 - 15X, twice a day stay in front of the ankle.
4. Hold for 6 seconds
5. Repeat with the opposite leg.
6. Repetition 10 - 15X, twice a day
To stretch erector spinae and hamstring To stretch the tensor fasciae latae and
muscles iliofemoral ligament
Seated trunk flexion Full squat
1. William’s squat position is with the feet

1. Sit on a chair in an upright position placed shoulder width apart,
2. Slowly flex the trunk forward until the 2. The hip and knees are flexed to the maximum
structure of the back is stretched available range of motion, and the lumbar
3. Hold for 5 seconds spine is rounded into flexion
4. Repetition 10 - 15X, twice a day 3. Hold for 5 seconds
4. Repetition 10 – 15 x, twice a day
To strengthen the quadriceps muscles
MCKENZIE EXTENSION EXERCISE
Centralizing approach
Moves the pain from its more distal region in the
extremities to a proximal and central location in the lumbar
region
Simple 6 sequential exercises:
1. Simple prone
2. Prone on elbow
3. Prone press-ups
4. Standing xtenssion
5. Seated “cat-cow” exercise
6. Double knee to chest
Simple prone Prone on elbow
Hold for 5 minutes 1. Lying prone on elbows (elbows under

Pelvis must be flat on the resting shoulders) for 5 mins
surface 2. Pelvis must be flat on the table
Prone press-ups Standing extension
1. Trunk extension in standing
Elbow extended into a full press up,
2. Both hands in the small of the back and
keeping ASISs flat on the table
extends the trunk backwards from the
At the end of push-up position, remain
waist (not the knees)
in that position a few seconds to relax
3. 6 to 8 repetitions
the spine and gluteal muscles
4. 6 to 8 times a day
10 repetitions
6 to 8 times a day
Seated “cat cow” exercise Double knee to chest
1. Begins in a slumped position with the lumbar 1. Bringing both knees to the chest
spine curved posteriorly 2. One leg is held in the start position while
2. Moves into an anterior pelvic tilt the other leg is brought down
3. 15-20 repetitions 3. 10 repetitions
4. Three times a day 4. 6 to 8 times a day
um, Peggy A., and Peggy A. Houglum. Therapeutic Exercise for Musculoskeletal Injuries. Champaign, IL: Human Kinetics, 2005
THE GOALS
1. To reduce discogenic pain by
decreasing the pressure on
the annulus fibrosus posterior
2. Return to normal functioning
in daily activities
3. Minimize the risk of recurring
pain
4. Minimize the number of
return visit to the spine
specialist
NECK PAIN
Anatomy of The Neck
Cervical Vertebrae
Smallest and most mobile
Unique feature: transverse foramen → vertebral artery ascends
→ blood supply
Typical: C3 – C6
Atypical: C1, C2, C7
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2nd edition. 3 : 358.; Reyes TM, Reyes OL. Kinesiology The Phillipine Physical Therapy. 1978. 4 : 23-24
Cervical Movement
0 – C1 (Occipital – Atlas)
“Yes” movement (flexion, extension)
C1 – C2 (Atlanto – Axial)
“No” movement (rotation) → due to axis of motion is vertical
C2 – C7 (Typical vertebral)
Articulating surfaces of facet joints: horizontal plane to 45°
→ permits motion in each plane
Neck Flexor Muscles
Lippert L S,Clinical Kinesiology and Anatomy, 5th Ed. F.A.Davis Company, 2011, p.223-6
Neck Extensor Muscles
Lippert L S,Clinical Kinesiology and Anatomy, 5th Ed. F.A.Davis Company, 2011, p.223-6
Neck Pain
Prevalence: 9 – 18% on general population
One out of three individuals suffered from neck pain in their lifetime
Cervical pain is more common during clinical practice than low back pain
Traumatic neck pain becomes chronic in up to of 40% patients with 8% to 10% experiencing
severe pain
PENYEBAB TERSERING •PENYEBAB LAINNYA

•Spinal stenosis → narrowing of spinal canal •Stress → physical pressure
•Disc injury→ disc protrusion into the spinal canal •Abnormal posture
•Disc degeneration →aging process •Minor trauma → sports injury and repetitive trauma
•Acute trauma →cervical fracture •Overuse → muscle spasm
Craniocervical Joint
Cervical Strain
Extension injuries:
Ketika kepala secara cepat ekstensi, tidak ada yang
menghentikan (seperti headrest di mobil), occiput distop oleh
thorax
Struktur posterior, terutama sendi menjadi terkompresi
Flexion injuries:
Ketika kepala secara cepat fleksi dan tidak ada yang
menghentikan (seperti kemudi atau airbag di mobil), dagu
dihentikan oleh sternum
Otot cervical posterior, ligament, fascia, dan kapsul sendi
menjadi teregang
Cervical Radiculopathy
The most frequently involved nerve roots : C6, C7, C8

Disebabkan oleh berbagai kondisi yang menyebaban penekanan pada saraf
yang keluar dari spinal column.
Penyebab utama : degenerasi, herniasi discus, dan spinal instability.
Mechanical Neck Pain
Tipe yang paling sering terjadi

Sering disebut 'simple' atau 'non-specific' neck pain.
Penyebab : cedera ringan atau tegangnya otot atau ligament pada leher
Postur yang salah juga merupakan penyebab tersering. Misalnya nyeri kepala
pada orang yang menghabiskan waktu kerjanya di belakang meja dengan posisi
kepala bent forward. Seringnya penyebab atau asal nyeri tidak diketahui
Calliet NecK
Awalnya: latihan isometric untuk otot

Perkembangan lebih lanjut → latihan postur untuk mengurangi lordosis leher dan forward head
posture, latihan peregangan otot leher dan bahu
Metode Calliet murni (isometric) = rhythmic stabilization exercise

Suatu kontraksi ritmis yang dilakukan pasien→ pasien dapat dengan tepat dan baik
merasakan dan membedakan regangan dan kontraksi otot
Dilakukan melalui kontraksi otot-otot yang mengelilingi sendi target, dengan menggunakan
resistensi terhadap kontraksi isometric bergantian dengan gerakan rotasi.
Calliet NecK
Tujuan Indikasi Kontraindikasi
Mengatasi spasme otot Cervical sprain & strain Cedera muskuloskeletal akut
Memelihara atau meningkatkan Trauma Unstable spine fracture
kekuatan otot leher Subacute mild injury Ketidakstabilan pada sendi,
Memperoleh ketahanan statis dan OA cervical ligamen
dinamis leher Tension Osteoporosis dan fraktur
Memelihara lingkup gerak sendi dan Bad posture Gangguan kardiovaskuler
kelenturan leher Fibromyalgia Nyeri hebat
Memperoleh postur yang benar Myofascial pain Infeksi, keganasan
dengan terkoreksinya muscle HNP cervical (bulge) Insufisiensi vertebrobasilar
imbalance
Meningkatkan sirkulasi daerah leher
Latihan I: Koreksi Postur
Posisi awal kepala tegak

Mata lurus ke depan
Gerakan kepala bergeser ke depan dengan tinggi dagu tetap
→ tahan 6 detik
→
Istirahat ke posisi awal 6 detik
Ulangi 10 kali
Caillet R. Neck and Arm Pain, 3rd ed., Philadelphia: F.A.Davis, 1991
Latihan II :
Penguatan dengan Latihan Isometrik
(Forward, Backward, Lateral)
Tundukkan kepala dengan pelan tetapi cukup kuat, kedua tangan menahan
gerakan menunduk dengan mendorong dahi ke arah berlawanan
Tahan 6 detik, istirahat 6 detik
Lakukan juga gerakan kepala ke arah backward, lateral bend, dengan tahanan
Ulangi 10 repetisi, latihan 2 kali sehari
Latihan III : Peregangan Otot Leher/
Lateral Flexion

Dorong/ tarik kepala ke arah bahu kanan, tahan 6 detik dengan menghitung 1001 s/d 1006
Istirahat 6 detik, ulangi 10 kali repetisi pada masing-masing sisi
Lakukan sehari 2 kali
Latihan III : Peregangan Otot Leher/
Rotation

Dorong/tarik kepala rotasi dengan sedikit ke bawah, ke arah kanan
Tahan 6 detik lalu istirahat 6 detik dan ulangi 10x ke kanan dan ke kiri
Lakukan 2 kali sehari
PERIPHERAL ARTERY
DISEASE
Peripheral Artery Disorder
Peripheral Arterial Disorder due to arterial occlusion

Arteriosclerosis Obliterans (ASO)
Thromboangitis Obliterans (Buerger’s Disease)
Raynaud’s Disease
Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 6th ed. Philadelphia (PA): F.A. Davis Company; 2012.
Management of PAD
Risk factor modification

Rehabilitation
Wear protective footwear at all times
Monitor extremities carefully for redness or skin
breakdown
Avoid extreme temperature
Wash the feet with mild soap and warm water
Drying is best performed by blotting or patting with a
soft clean towel (avoid rubbing because it may injure
the skin)
Use emollients to prevent skin cracking
Regular lower extremity exercises
Buerger Allen Exercise
Merangsang pembentukan pembuluh darah kolateral,

melalui perubahan posisi daerah yang terkena
Mekanisme:
Memanfaatkan efek perubahan gravitasi melalui
perubahan serial posisi tungkai terhadap otot polos
pembuluh darah
Gravitasiàmengosongkan dan mengisi kolom darah
secara bergantian → ↑
me transportasi darah
Meningkatkan sirkulasi kolateral
Dikombinasikan dengan active ankle pumping exercises
Chang CF, Chang CC, Chen MY. Effect of Buerger’s Exercises on Improving Peripheral Circulation: Asystematic Review. Open Journal of Nursing, 5, 120-128.c
Buerger Allen Exercise
Tungkai dielevasikan pada posisi sudut 45°sampai terlihat

pucat selama maksimal 2 menit
Kaki menggantung pada pinggir tempat tidur. Latihan:

dorsifleksi, plantarfleksi, inversi, eversi, fleksi-ekstensi jempol,
selama >2 menit atau sampai terlihat rubor/hangat
Berbaring supinasi dengan tungkai dilapisi selimut hangat

selama ± 5 menit
Gerakan diulangi 3-6x/sesi, sebanyak 2-4x/hari
Active Pumping Exercises
Tujuan: meningkatkan/mempertahankan aliran sirkulasi pada ekstremitas
Active ROM exercise yang berguna utk meningkatkan elastisitas

jaringan sekitar sendi
Isotonic exercise pada ankle, sehingga memompa aliran darah dan
juga menambah sirkulasi kolateral
Gerakan plantarfleksi, dorsofleksi, inversi, eversi dan sirkumduksi
Dilakukan 10 repetisi, 3x/hari
THANK
You

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SPECIFIC EXERCISES

dr. Martina Sartika Fricilia S.

Brunnstorm’s,Clinical Kinesiology 6ᵗʰ edition, 2012. 4 : 321 – 322

Extension causes worsening Extension reduces symptoms

Seven exercise to minimize the lordotic

To strengthen the abdominals To strengthen the gluteal muscles

To stretch the erector spinae muscles

1. William’s squat position is with the feet

To strengthen the quadriceps muscles

Hold for 5 minutes 1. Lying prone on elbows (elbows under

PENYEBAB TERSERING •PENYEBAB LAINNYA

The most frequently involved nerve roots : C6, C7, C8

Tipe yang paling sering terjadi

Awalnya: latihan isometric untuk otot

Metode Calliet murni (isometric) = rhythmic stabilization exercise

Posisi awal kepala tegak

Posisi awal kepala tegak

Posisi awal kepala tegak

Peripheral Arterial Disorder due to arterial occlusion

Risk factor modification

Merangsang pembentukan pembuluh darah kolateral,

Dikombinasikan dengan active ankle pumping exercises

Tungkai dielevasikan pada posisi sudut 45°sampai terlihat

Kaki menggantung pada pinggir tempat tidur. Latihan:

Berbaring supinasi dengan tungkai dilapisi selimut hangat

Gerakan diulangi 3-6x/sesi, sebanyak 2-4x/hari

Tujuan: meningkatkan/mempertahankan aliran sirkulasi pada ekstremitas

Active ROM exercise yang berguna utk meningkatkan elastisitas

Dilakukan 10 repetisi, 3x/hari

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