Work Related Poor and LBP

Rehabilitasi Medis
Dr. Wikha Aprian
 Pathofisiology
• Disabilitas pada para pekerja , produktifitas
menurun
– Nonciceptive Pain
– Neuropatic Pain
– Nociplastic Pain > faktor Psikososial >perubahan
psikologis , post menoupase
 Klasifikasi LBP
• Acute dan Chronic
• Specific dan Non Specific
 Etiology
• Spondilogenic
– Myofascial Pain
– Facet Joint Pain
– Sacroiliac joint Pain
– Discogenic Pain :
– Spinal Stenosis : usia diatas 50 tahun ,
– And failed back surgery
• Neurogenic
• Myogenic
• Vasculogenic
• Viscerogenic : pankreatitis
• Physcogenic
 Patofisiologi Kronis
• Structural Abnomalities or Injury
– Scoliosis
– Spondylolysthesis
– Acute “Back Sprain”
– Disc herniation
• Genetic Presdiposition to connective tissue injury
–
• Direct tissue Mechanical Stimulus
– Akupuntur
– Yoga
– Massage
– Chiropractic
• Genetic Differences in Sensory Processing
• Pschosocial factors
– Pain Behavior
– Job dissatisfaction
• Placebo Interventions
• Cognitve Theraphy , behavioral Theraphy , Relaxation techniques
• Movement and Posture reeducation
• Pathoanatomic >Biomedical
• Psychological and social > Psychosocial
• Mixed
 Diagnosis LBP
• Axial Lumbosacral
• Radicular
• Reffered Pain
 Diagnostic Approach
• Sign extravertebral > spesialis
• Red Flag > surgery
– Trauma
• Accident, osteoporosis (minor) , sistemis steroid
– Tumour
– Infection
– Radicular
• Specific back pain
–
• Non Specific pain ,
• Acute <6 week
• Assesment physilogis
Klasifikasi Terapi Metode
Spesific Pathology Conservative
Intervensi
Surgery
Acute non Specific LBP Wait and See , 6 minggu Education
Medication
Chronic Non-Specific LBP Multimodal Approach Multimodal therapy ,
biopsikosocial
 Pharmacotherpy
• 1. Nsaid
• 2. Lidocaine Patch
• 3. Skletal Muscle Relaxants
• 4. Acetaminophen
• 5. Glucocorticoid
• 6. Opiates
Interventional Pain Management
 Physiotherapy ,Occupational Therapis
• Non Mechanical disease
• Heavy Lifting
• Trauma
• Poor Sitting Posture
• Frequent Bending Forward
• Degenerative Conditions
 Psycosocial Theraphy
• 1. Your issues are interfering with daily life
• 2. Your Friend and family are worried
 LBP tatalaksana Rehab Medik
• Postural LBP
 Causes Of Back Pain
Mechanical 97% Non-Mechanical 1% Visceral
Strain, sprain 70% Neoplasma Pelvic Inflamatory disesas
Degenerative Process dicc Osteomylietis
and Facet 10%
Osteoporotic compresi 4%
 Diagnosis
• Pemeriksaan Manuver Spesifik
– Slump Tes
– Straigh Leg Raise Tes
– Faber Tes
– Comppresion Tes
 Management
• Pasien education
• Medication
• Physical modalitis : cold packs (48 hours)
• SWD, MWD
• Orthototic (lumbosacral orthosis
• Exercise
• Hydroteraphy
• Trigger Point Injection
• Kinesiotapping
• Central of gravity depan S2
– Ear
– Shoulder
– Pelvis
– Knee
– Ankle
• Edukasi mengenai Proper Body mechanic
– Standing
– Sitting
– Lying
– Driving
– Loading
– Working
 Exercise LBP
• Penderita LBP Kronis mengalami
– Atrofi otot togok
– Perubahan Recruitment dan neuromuscular
control dari otot2 togok
– Gangguan Vaskularisasi > oksigenasi ke otot
menurun
• Latihan mengembalikan sistem neuromuskular+
vaskularisasi untuk mengontrol + melindungi tulang
belakang dari cedera /cedera berulang
 Pengaruh Mobilisasi
• Pain
• Fear movement
• Decreased movement
• Increased Muscle Tightness
• Decrease in local circulation
• Build
 Exercise for LBP
• To strengthen the weak muscle :
– Abdominal ,
– Glutei,
– Back extensors
• To Strech the shorthened muscles :
– Hamstring
– Hip Flexors
– Back Extensor
 Jenis Latihan Pada LBP
• Koreksi Postur > kesergarisan
• Latihan Fleksibilitas > latian ROM
• Muscle Strengtening Exercise
– Flexion Based Exercise (Wiliam Flexion) , duduk .
– Extension Base Exercise (Mc Kenzie )
• Core Stability
• Aerobic/Cardiopulmonary endurance
• Proper Body mechanic and kinestetic Awarness
Yellow flag