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LBP DM Neuro
LBP DM Neuro
LBP DM Neuro
Penyebab
I. Kelainan Mekanik :
A. Deformitas :
Spondilolistesis
Sakralisasi / lumbalisasi
Spina bifida okulta
B. Trauma
Benturan / sprain / angkat berat
Fraktur kompresi
Osteoporosis
II.
Inflamasi :
Spondilitis
Arthritis
III. Sistemik
Osteoporosis
Gangguan metabolik
IV. Neoplasma
Hemangioma / meningioma
Tumor primer / sekunder
V.
VI.
Spondilosis deforman
Degenerasi diskus
Osteoartritis
HNP
Gejala :
Nyeri pinggang saat bergerak
Mobilitas berkurang dan sakit
nyeri pada tekanan, batuk, mengedan
PATIENT HISTORY
OPQRSTU
Onset
Palliative/Provocative factors
Quality
Radiation
Severity/Setting in which it occurs
Timing of pain during day
Understanding - how it affects the patient
Intervertebral Disc
Most common site of back pain
Normally comprises ~ 25% of length of spine
Consists of a central nucleus pulposus
Reticulated and collagenous substance
Composed of ~ 88% water
Annulus fibrosus
Consists of concentric lamellae of fibrocartilage
fibers arranged obliquely
With each layer, they are arranged in opposite
directions
Physical Examination
Inspection
Palpation
Bony
Soft Tissue
Range of Motion
Neurologic Examination
Special Tests
Neurologic Examinaion
Includes an exam of entire lower extremity, as
Neurologic Examination
(T12, L1, L2, L3 level)
Motor
Iliopsoas - main flexor of hip
With pt in sitting position, raise thigh against
resistance
Reflexes - none
Sensory
Anterior thigh
Neurologic Examination
(L2, L3, L4 level)
Motor
Quadriceps - L2, L3, L4, Femoral Nerve
Hip adductor group - L2, L3, L4, Obturator N.
Reflexes
Patellar - supplied by L2, L3, and L4,
although essentially an L4 reflex and is
tested as such
Neurologic Examination
(L4 level)
Motor
Tibialis Anterior
Reflexes
Patellar Reflex (L2, L3, L4)
Sensory
Medial side of leg
Neurologic Examination
(L5 level)
Motor
Extensor Hallicus Longus
Resisted dorsiflexion of great toe
Reflexes - none
Sensory
Dorsum of foot in midline
Neurologic Examination
(S1 level)
Motor
Peroneus Longus and Brevis
Resisted eversion of foot
Reflexes
Achilles
Sensory
Lateral side of foot
Special Tests
Tests to stretch spinal cord
or sciatic nerve
Tests to increase
intrathecal pressure
Tests to stress the
sacroiliac joint
Valsalva Maneuver
Reproduction of pain
Flexion
ABduction
External
Rotation
Herniated
Discs
Anatomy
Vertebral column (spin)
consists of 33 vertebrae
Spine is divided into
thoracic, lumber,
cervical
Each section of spine
containing 5-12
vertebrae
We will be focusing on
the lower back or
lumbar region
Lumbar Anatomy
The lumbar section
of the spine is
made up of the
lower 5 vertebrae
Commonly referred
to as L1 to L5
L5 connects to the
top of the sacrum
Anatomy of Lumbar
Verebra
The vertebral body
is a thin ring of
dense bone
Consisting of the
body, pedicles and
liminae
Vertebral foramen
is a whole in
vertebral body that
spinal cord runs
through
Intervertebral Discs
Gel like Tissue
Intervertebral Discs
The disc is made
up of 3 structures
the
(1) Nucleus
pulposus,
gelatinous center
(2) Annulus
Fibrosus. Its job is
to contain the
nucleus
(3) Vertebral end
plates that attach
the disc to the
Herniated disk
Can Occur when
there is enough
pressure from the
vertebrae above
and below
This can force
some or all of the
nucleus pulposus
through a
weakened or torn
part of the annulus
fibrosus.
Mechanism of injury
There are 3 main ways discs can become
herniated of ruptured
Many older people get herniated disks because the
disks have worn down over time
The extremely overweight are very susceptible
because they are carrying around excess weight which
puts extra pressure on the intervertebral disks
Improper lifting form, usually associated with bending
with back and not with knees. Which can cause a
sudden strain. This can be everyday lifting of objects or
actual weight training
Twisting violently can also cause a sudden strain that
could possible herniate a disk
Recognition
How can we recognize a herniated disk?
Sharp and shooting pain the runs down patientlow
back, buttocks and down the thigh
If the patient complains of numbness or tingling
anywhere in lower back, buttocks or leg
If patient complains pain gets worse after any kind
of strain to the body
Sometimes, the disk can pinch the nerve controlling
bladder functioning
Evaluation
The first thing that should be asked would
Doctors Evaluation
The patient must be sent to a doctor to
Treatment
The first thing that
should be done is
to rest and stay
away from activity
the agitate the
symptoms
Then the
application of ice
and heat
Treatment
Physical Therapy
Although performing
physical Therapy
does not directly
help the disks, it
does strengthen the
muscles around it,
so as to increase
stability, which can
help prevent
herniated disks in
the future
Treatment
Pain relievers are
often given to
patient to alleviate
pain
Anti-inflammatory
drugs are given to
reduce swelling
Although not all
patients report
having back pain
Physical Therapy
Exercises
Exercise #1 while
Physical Therapy
Exercises
Exercise #2 Start with
Surgery
Surgery is very rarely required for herniated
disks
The treatment previously described is almost
always done prior to surgery
Generally if symptoms, such as pain and
numbness grow worse over time surgery is
required
If herniated disk interferes with bladder and
bowl movements, surgery is also required
Rehabilitation
Herniated disks can vary in severity and the
Rehabilitation
Phase #2 After symptoms have subsided,
Rehabilitation
Hamstring stretch
Lay down face up
Rehabilitation
Cat and Camel
On your hand and
Rehabilitation
Arm/Leg Raise
On your hands and
knees
Tighten abs so
spinal column is stiff
Raise right arm and
left leg as shown to
the right
Do 10 reps and
switch arm/leg
Rehabilitation
After all pain has gone