8

CHAPTER II
LITERATURE REVIEW
2.1 Anatomy of Cervical Physiology
2.1.1 Cervical I-VII The cervical vertebral I is also called the atlas, essentially
different from the others because it does not have a vertebral corpus because the
atlas depicts the anterior archus of the joints, fovea, vertebralis, travels through
the posterior arches for the arcus passes
posterior to the passage of the vertebral artery. The cervical vertebra II is also called
the axis, in contrast to the 3rd to 6th cervical vertebrae due to dens or processus
odontoid . On the cranial surface of the corpus the axis has a tooth-like bulge ,
dens rounded edges, dentical aspects. Cervical vertebrae III-V branched spinous
processus .
The transverse foramen divides the transverse process into
anterior and posterior tuberculum . There transversarium
foramen Lateral sulcus nervi spinalis, preceded by nervi spinalis. The cervical
vertebra VI difference with the cervical vertebra I to the cervical V is the caroticum
tuberculum , as it is close to the carotico artery. 9 Cervical Vertebra VII is a
large spinous processus , which can usually be palpated as a processus spinosus
columna
the highest vertebral , therefore called vertebrae
prominens (Syaifuddin, 2003). Figure 2.1.1 Vertebra Servikal I-VII (Source:
Syaifuddin, 2003)
2.1.2 Ligament . The ligament is a strong fibrous band of tissue and serves to bind
and unite bones or other parts or to support an organ (Snell, 2006). a. An anterior
longitudinal ligament An anterior longitudinal ligament is a fibers that form broad
bands and thick and strong, attached to the vertebral body part , starting from the
anterior side of the corpus 10
vertebrae cervicalis II (which extends to the head on os occipitale
basilary pars and anterior atlantic tuberculum ) and extends downward until the
upper front of the pelvina os sacrum fascies . This anterior longitudinal ligament is
thicker on the front of the corpus because it fills the corpus corpus . This anterior
longitudinal ligament serves to limit the movement of the vertebral
columns extension . Where the lumbar area due to body weight will experience the
addition of the arch in the vertebra columna lumbar area. Figure a. The Longitudinal
Ligament Anterior (Source: Syaifuddin, 2003) b. Posterior longitudinal ligament The
posterior longitudinal ligament lies on the posterior surface of the corpus
vertebrae so that it is at the front 11
the vertebral canal . This ligament is attached to the cervical vertebral corpus II and
extends down os sacrum . This ligament above the intervertebral disc between the
bordering vertebrae will widen, whereas behind thevertebral corpus will narrow so
that it will form the rigi. This ligament functions like other ligaments on the posterior
side
the vertebral column , which limits movement to flexion and helps fix and hold in
the correct position of a reduction position toward hyperextension, especially in the
thoracic region. Figure b. Ligament Longitudinal Posterior (Source: Syaifuddin, 2003)
12 c. Intertransversary ligament Intertransverse ligament attached
between processus
transversus two adjacent vertebrae . This ligament serves to lock the joints to form a
stable make persendiaan. Figure c. Intertransversary Ligament (Source: Syaifuddin,
2003) d. Flavum ligament The flavum ligament is an elastic, yellow, ribbon-shaped
tissue attached from the anterior surface of the lower edge of a lamina, then
extending downward attached to the top of the posterior posterior surface of the
lamina. This flavum ligament in the cervical region in the area of thin but rather
thicker thorakal this ligament. This ligament will close the intervertebral foramen for
passage of the arteries, veins and the intervertebral nerve . The function of this
ligament is to strengthen the relationship between adjacent vertebrae . Figure
d. Ligamentum Flavum (Source: Syaifuddin, 2003) e. Interspinale ligament The
interspinale ligament is a thin membrane attached to the underside of theprocessus
of a vertebra leading to the upper edge of the subsequent vertebral process . This
ligament 14 corresponds to the supra spinosus ligament and this ligament in the
lumbar region becomes narrower. Figure e.Interspinale Ligament (Source:
Syaifuddin, 2003)
2.1.3 Neck Muscles The muscles in the neck are composed of muscles
sternocleidomastoideus origonya lies in the processus mastoideus and linea nuchae
superior , insersio In jugular incisura sterni and
articulation of the sternoclavicularis , rotational function, lateral flexi, bilateral
contractions lift the head and assist breathing when the head is inactivated in the
accessory nerve and cervical plexus (C 1 and C 2 ) (Daniel, S. Wibowo, 2005). 15
Figure 2.1.3 Muscle Sternocleidomastoideus (Source: Daniel, 2005) Scaleni muscle
is divided into 3 fibers, the first muscle scalenus
anterior , origo on tuberculum anterius transverse processus
vertebra cervicalis III to VI, insersio on scaleni tuberculum
anterior, inervation of the brachial plexus (C 5 -C 7 ) and functioning to attract costa I,
bending the neck to the anterior latero and bending the neck to anterior. The
second muscle of the scalenus medius origo is located on theposterior tuberculum
transverse process of cervical vertebrae II to VII, insertion of costa I behind the
a.subclavicular sulcus and into the membrane
intercostalis externa from spatium intercostalis I, inervasi plexus
cervicalis and brachialis (C 4 -C 8 ) and serves to lift the costa I and 16 bend the neck
to the lateral costa I. The latter of the posterior scalenus muscle lies in
the transverse process of the vertebral vertebrae cervicalis V to VII, the insersio on
the lateral surface of costa II, the inervation of the brachial plexus (C 7 -C 8 ) and
functioning neck flexion, assisting the rotation of the neck and head and
raising costa I (Daniel, S. Wibowo, 2005). Figure 2.1.3Scaleni muscle (Source: Daniel,
2005) Trapezius muscle is divided into 3 fibers that is the first pars
descendens origo derived from the superior linea nuchae , protuberantia
occipitalis externa and ligamentum nuchea , insersio in the lateral third of
the clavicula , serves to perform adduction and retraction movements and to
conserve accessorius nerve and trapezius flax (C 2 - C 4 ). Tranversa origomuscle
muscles originate from the cervical, insersio at 17 third lateral clavicula , serves to
perform adduction movement and retraction. and conserves accessorius
nerve and trapezius rami (C 2 -C 4 ). The third pars ascendens origo comes from
the vertebra
thoracalis III to XII, of the spinous processus and ligament
supraspinasum , insersio on trigonum spinale and spina parts
adjacent scapulae , serves to pull down (depression) and conserve accessorius
nerve and trapezius rami (C 2 -C 4 ) (Daniel, S. Wibowo, 2005) . Figure
2.1.3 Trapezius muscle (Source: Daniel, 2005) 18 levator muscle scapulaorigo lies on
the posterior tuberculum
transversus process of cervical vertebra I to IV, insersio on
superior angular scapula , serves to lift the scapula while rotating the inferior
angle to the medial and to conserve the dorsal nerve
scapulae (C 4 -C 8 ). This muscle is enabled to lift the medial edge
scapula . When working with middle trapezius muscle fibers and
rhomboideus , this muscle attracts the scapula to the medial and upper, that is in
the movement pinning back to back (Daniel, S. Wibowo, 2005). Figure 2.1.3 Levator
Scapula Muscles (Source: Daniel, 2005) 19 The longus collimuscles roughly form a
triangle because it consists of three groups of fibers. Its function: to bend the
cervical forward and
sideways. Inervasinya cervicalis and brachialis plexus (C 2 - C 8 ). The muscle longus
colli consists of 3 fibers, the first fibers
oblique superior origonya derived from tuberculum anterius processus
transversus vertebra cervicalis II to V and insersio on
anterior tuberculum atlas . The second oblique inferior fibers , origo runs from
the corpus vertebra thoracalis I to III and insersio on
tuberculum anterius vertebra cervicalis VI. And last of the fibers
medial , origo extends from the corpus of the upper thoracic vertebra and
the lower cervical spine of insersio in the vertebral corpus
upper cervicalis (Daniel, S. Wibowo, 2005). Figure 2.1.3 Colli longus muscle (Source:
Daniel, 2005) Origo capitis longus muscle 20 lies in the anterior tuberculum
transversus process of the cervical vertebrae III to VI, the insertion of the basal os
occipital portion serves to form flexi motion, Lateral flexi and the cervical
plexus (C 1 -C 4 ) (Daniel, S. Wibowo, 2005) . Figure 2.1.3 Muscles of Longus
Capitis (Source: Daniel, 2005)
2.2 Biomechanics
2.2.1. Cervical Region Composed by 3 joints of atlanto-occipital joint ( C 0 - C 1 ) ,
atlanto-axial joint (C 1 -C 2 ) and vertebra joints (C 2 -C 7 ). This region is the most
commonly moving region of the entire vertebral bone. It can be seen from its role is
to manage 21 joints and facilitate the position of the head, including vision ,
hearing, smell and balance the body. The movements generated in this region are
flexibility, rotation and lateral flexion
cervical (Neuman, 2002). a. Atlanto-occipital Joint (C 0 -C 1 )
Atlanto-occipital Joint plays a role in the flexibility and lateral movement
of cervical flexion . Arthrokinematics on the condylus flexion movement that
the convx will slide toward the back against
facet articularis that concaf of 10 degrees. While on
the condylus extension the conventional movement will slide toward the facet
articularis front of the concaf of 17 degrees. In the lateral movement
of cervical flexion there will be a roll of sisisisi on a small amount in
the occipital condylis that is convex to the facet articularis ( atlas) which is a concaf of
5 degrees. b. Atlanto-axial Joint (C 1 -C 2 ) The main movement in atlanto-axial joint is
rotational motion
cervical coupled with flexion and extension movements. In the movement of
flexion will occur pivot movement forward and slightly rotate on
the atlas of the axis (C 2 ) is 15 degrees while the pivot movement extension moves
backward and slightly spins on the atlas to the axis (C 2 ). 22 The rotational motion of
the joint is 45 degrees where the ring-shaped atlas willrevolve around the procesus
odonthoid the procesus articularis inferior atlas of slightly concaf will slide in a
circular direction (circular) to the procesus articularis
superior axis . c. Vertebra joints (C 2 -C 7 ) In the joint vertebrae there is flexion-flexion
movement, rotation and lateral cervical flexion . On the flexion motion of
the procesus surface
articularis inferior shaped concaf superior vertebra will slide toward the top and front
of the procesus articularis superior vertebra
inferior at 40 degrees, whereas in the extension of the surface of the inferior
articular probe the superior vertebra of the concaf will slide downward and backward
against
procesus articularis superior inferior vertebra of 70 degrees. In the rotation
movement will occur slide on the articularis processus
inferior vertebra superior to the back and bottom on the ipsilateral rotational
direction and there will be a frontward upward slide on the contralateral side of
the superior articular process of the inferior vertebra of 45 degrees.Cervical flexion
lateral movement , inferior articular procesus
the superior vertebrae on the ipsilateral side slide downward and slightly backward
and on the contralateral side will slide upwards and 23 slightly forward by 35
degrees. Inlination on facet joints will produce a unidirectionalcoupling motion which
during the rotation motion will be accompanied by lateral flexion which is also
direction. The mechanism of lateral flexion movement is shown as shown in Figure
2.2.1 below. Figure 2.2.1 Lateral Movement of Neck Flexions (Source: Neumann,
2002)
2.3 Scope of Neck Joint Motion The scope of motion of the joints or Range of
Motion (ROM) is the extent of joint movement that occurs when the joint moves
from one position to another, either passively or actively. The range of motion of the
joint may also be defined as the motion space / limits of movement of a muscle
contraction in motion, whether the muscle can be shortened or elongated fully or
not (Deuster et al ., 2007).
muscle stretch
muscle contraction 24 The scope of motion of the joints is related to flexibility. Flexibility is the ability of
a tissue or muscle to extend as much as possible so that the body can move with full scope of motion
joints, without pain. The main neck movement is the flexion of carrying the chin towards the chest, the
extension is turning the backward head to see the ceiling, and lateral flexion is bringing the ear towards
the shoulder. The cervical spine stability is provided by a combination of zygapophyseal joints, many
ligaments and muscles. Extension, flexion, lateral movement, and rotation are induced
by zygapophyseal orientation (Weerapong et al. , 2005).Measurements of the scope of
the neck joint motion can be measured using a goniometer tool. By way
of laying axis (fulcrum) position measurement or at a later point proximal
arm (stationary arm) is still and the distal arm(moving arm) moves following the
movement of the joint. The angle shown in the goniometer is interpreted as the
sphere of joint motion of the joint (Reese , 2002 ). Here is a picture of the
goniometer gauge. 25 Figure 2.3 Goniometer (Source: Reese , 2002 )
2.4 Pathophysiology Decreased Scope of Neck Joint Motion The problem of
decreasing the scope of motion of the joints in the human body one of them often
occurs in upper trapezius muscle because these muscles are often found to be
impaired (Lestari, 2010). The upper trapezius muscle is a type I or tonic and is also a
postural muscle that performs shoulder elevation, extension and lateral movements
of cervical flexion. Abnormalities that occur in this type of muscle tend to tense and
shorten. That is why if the upper trapezius muscles contract for a long time, then the
muscle tissue becomes tense, pain arises and in a long time resulted in decreased
scope of motion of the joints. Work of upper trapezius muscle will increase weight
with bad posture, micro and macro trauma (Makmuriyah & Sugijanto, 2013). The
condition of muscle contraction that lasts for a long time resulted in a condition
known as muscle fatigue. This is due to the decrease in the number of ATP, so there
is no availability of energy to displace actin and myosin. The longer
contractions will get weaker, although the nerves still work well and the action
potential is still spreading on the muscle fibers (Guyton & Hall, 2008). In this
study will be used lateral movement of cervical flexion as an interpretation of the
scope of joint motion where upper trapezius muscle acts as
main muscle or muscle is the most dominant work on the movement. The normal
lateral cervical flexion motion scope is over 45º. Muscle
The upper trapezius consists of two parts: the right and the left where the muscle
training can be optimized by providing intervention with specific movements such
as lateral flexion (Neuman, 2002).
2.5 Infrared
2.5.1 Definitions
Infrared is a wave of electromagnetic waves with a wavelength of 7700-4 Million
A o . Infrared rays can produce superficial local heat and are recommended for
subacute conditions to reduce pain and inflammation. Supefisial warming will affect
the temperature of the underlying tissue injury, and penignkatan temperature in
superficial tissues will produce analgesia. The resulting heat effect causes
vasodilation of the blood vessels, and increases circulation in the tissues (Prentice,
2002). 27 Based on its wavelength, the infrared is divided into two:
(1) Non- penetrating waves which are infrared with a wavelength of 12,000
A o - 150,000 A o . Penetration power of these waves only to the superficial layers
of the epidermis is about 0, 5 mm. (2) Short waves ( penetrating ) which has a
wavelength of 7,700 A o - 150,000 A o . This wave has a deeper penetration power
than long waves. The penetration power of these waves reaches subcutaneous
tissue and can directly affect capillary blood vessels, lymph vessels, nerve endings,
and other tissues under the skin. In addition to having physiological and therapeutic
effects, infrared poses hazards such as: (1) burns that occur in the area
superficial epidermis , (2) Electric shock resulting from the presence of wires open
and touched by the patient, (3) Improving the state
gangrene, (4) Headaches occurring at the time of administration,
(5) Kaitness occurring at the time of therapy where the patient becomes
unconscious or suddenly unconscious, (6) Damage to the eye, infrared beam may
causing cataracts when it comes to the eyes (Prasetyo, 2013). In infrared there are
indications and contraindications to the intervention. Indications
of infrared modalities are conditions of inflammation after the acute phase, such
as kuntusio , muscle strain, muscle
sprain , trauma synovitis , arthritis such as rhematoid arthritis, osteoarthritis,
myalgia, neuralgia, neuritis, blood circulation disorders, skin diseases, preparation
of exercise and massage. Meanwhile, the contraindications of the modalities
infrared is an area with blood insufficiency, skin sensibilities disorder and a tendency
for bleeding (Prentice, 2002).
2.5.2 Infrared Application Techniques Position patients 20 inches
from infrared lights . Remove the metal material or clothing on the part to be in
therapy. Position the infrared lights perpendicular to the treated area. The duration of
time during therapy therapy is 10-15 minutes. During the treatment process, it is
necessary to control the skin's warmth (Prentice, 2002).
2.5.3 Securities Granting Granting modalities infrared Infrared, physiological effects
and may provide a therapeutic effect on the body, namely (Prentice, 2002): 1. a
physiological effect. Improve the metabolism process A chemical reaction will be
accelerated by the heat or temperature increase on the network. The metabolic
processes occurring in the superficial layers of the skin will increase so that the
circulation of oxygen and nutrients to tissues get better, and the release of
metabolic waste substances also smoothly. b. Vasodilation of blood vessels The heat
effects generated by infrared rays will cause dilation of capillary blood vessels
and artiole . The skin willreact and the so-called reddish color
erythema . For this the vasomotor mechanism reacts by widening the blood vessels
so that the amount of heat passes through the tissues through the blood
circulation. With a high blood circulation, the provision of nutrients and oxygen to
the tissues will be increased, so the maintenance of tissue for the better and
resistance to inflammation is also
good. c . Repeated infrared pigmentation with infrared light can cause pigmentation
in the irradiated area.This is caused by a change in red blood cells in the
place. d. Influence on muscle tissue Increase in temperature in tissues affect the
occurrence of muscle relaxation, heating will also help the process of disposal of
metabolic substances. 30 e. Network Distruction Excessive irradiation can cause a
high rise in network temperature and last for a long time causing damage to the
network. f. Increase body temperature Increase in superficial tissue temperature will
be transmitted throughout the body, then in addition to heat distribution will also
occur a decrease in systemic blood pressure. This is because of the heat
that will stimulate the body heat regulator to flatten the heat that occurs with a
general dilatation path. g. Activate the work of sweat glands Effect of heat
stimulation brought the sensory nerve endings can activate the working of sweat
glands. 2. Therapeutic effects a. Reduces mild pain Heat gives a sedative effect
on superficial sensory
nerve ending , While strong heat can generate counter
irritation that will lead to pain reduction. Deangan
smooth blood circulation then the substance " P" which is one cause of pain will be wasted. 31 b. Muscle
relaxation Muscle relaxation is achieved when pain is reduced and muscle tissue is warm. c. Increase
blood circulation Increase in temperature that occurs, will cause vasodilation of blood
vessels. This will lead to an increase in blood circulation in the treated tissue. d. Removing waste products
from metabolism Radiation in large areas will activate the gland
gudoifera throughout the body, thereby thereby increasing the disposal of metabolic
remnants through sweat. According to the results of a study from Usuba, et al .
(2006) that the effects of heat generated by infrared can increase the scope of joint
motion in areas of limited range of motion of the joints . Another study conducted by
Anjas Wichaksono (2014) the effect of infrared intervention on the neck can provide
vasodilation and relaxation of the muscles to reduce spasm and increase the scope
of neck joint motion. This is reinforced by Prentice (2002) in his book Therapeutic
Modalities for Physical
Therapists , that infrared can have a relaxing effect on muscle spasm 32 that will
have an impact on increased flexibility in muscle.
2.6 Slow Reversal
2.6.1 Definition Slow reversal is one of the methods in PNF to add flexibility to
muscles involving muscle contraction of agonists and antagonists to increase the
scope of motion of the joints. In practice, the therapist provides resistance while the
patient contracts the agonist muscle as a stronger muscle until the desired ROM
and afterwards without any reduction in muscle contraction or relaxation is
continued by giving contraction resistance to the antagonist muscle. Continuous
contraction without interruption by the pause will provide maximum relaxation that
can help in stretching and increasing the scope of joint motion. Maximal contraction
in extended muscles willprovoke the structural changes of actin-miosin. Slow
movement that will ensure any desired muscle to contract maximally (Alder et
al., 2007). In the slow reversal there are indications and contraindications to the
intervention.The indication of slow reversal is the limited range of joint motion due
to adhesion, 33 scar tissue formation, which contributes to muscle tension,
connective tissue and skin, restricted movement due to structural deformity, muscle
weakness and shortening of antagonistic tissue. Contraindications to slow
reversal are novel fractures, prominent bones restricting joint motion, acute
infection, bleeding, there is incomplete bone union and acute sharp pain in joint
motion or muscle elongation (Kisner & Colby, 2007).
2.6.2 Slow Reversal Application Technique The technique of slow reversal application
is as follows (Alder et al., 2007 ): a. The therapist provides resistance to the subject
to move in one direction (usually a stronger direction) of 5 reps. b. At the end of the
desired ROM is reached, change the manual contact while providing the preparation
of verbal commands. c. Verbal commands start the movement to move in reverse
direction without relaxation and provide containment in the direction of a new
movement from the distal. d. Application of this technique is done with 3x frequency
in one week as much as 6x treatment. 34
2.6.3 Mechanism of Increasing the Scope of Neck Joint Motion Through Slow
Reversal The concept of the slow reversal technique basically occurs in the elastic
component (actin and myosin) which causes the tension in the muscle to rise
sharply, the sarcoma will be elongated and when this is done continuously the
muscles will adapt. When the application of dynamic reversals intervention
techniques will occur a mechanism called reciprocal innervations / inhibition .
Reciprocal inhibition refers to the inhibition of antagonist muscle when isotonic
contractions occur within the agonist muscle. This occurs because
the strecth receptors in muscle muscle spindle muscle fibers . Muscle spindleswork to
maintain a constant muscle length by providing feedback on contraction changes, in
this direction
muscle spindle plays a part in proprioceptive. In response to stretching, muscle
spindles stop the nerve impulses that increase contraction, preventing over
stretching (Alder et al., 2007). In slow reversal also elongation of elastic components
in the muscle. thereby affecting the elastic component of the sarcomomer in the
muscle where it releases adhesion or actin and moisine band linkage so that it
affects the elongation of the muscles (Alder et al.,2007). 35 According to research
conducted in Sherrington 2004 slow reversal technique can increase the scope of
motion of the joints in the neck region as much as 10% -20% performed for six
treatments in 2 weeks. This is reinforced by Candra Prayoga's research (2014) that
slow reversal of upper trapezius muscles can increase the scope of joint motion in
the neck.
2.7 Contract Relax Stretching
2.7.1 Definitions
Contract relax stretching is a technique that uses isometric contraction in muscle
that is shortening followed by relaxation then re-stretch. Contract relax
stretching is a technique that combines between types
isometric stretching with passive stretching type . The technique aims to lengthen
the soft tissue structures such as ligaments, muscles, fascia and tendons that are
pathologically shortened. This elongation may increase joint motion (LGS) and
reduce pain caused by spasm, muscle shortening or fibrosis (Azizah & Hardjono,
2006). The contract relax stretching technique begins with the therapist providing
isometric contraction in the muscle that is shortened 36 then followed by
relaxation. After relaxation the therapist gives stretching to the muscle. Contract
relax stretching is said to be a combination of the type
of isometric stretching and passive stretching for the implementation of this
technique done by contracting the muscle that retracts then relaxing, then do
stretching (Azizah & Hardjono, 2006). The benefits of contract relax
stretching techniques are to reduce muscle tension and pain, make the body more
relaxed, increase flexibility, prevent muscle strains , prepare for activities that are
easier to run, swim, and signal to muscles muscles knowing that they will be used
for activities (Nelson 2007). Incontract relax stretching there are indications and
contraindications to the intervention. Indication done
contract relax stretching ie Range Of Motion (ROM) is limited due
to adhesive contracture and the formation of scar tissue ( scar tissue ) that triggers
the shortening of the muscles and skin, the limitations of motion resulting from
structural deformity, muscle contractures and muscle weakness, prevent
musculoskeletal injuries (Kisner & Colby, 2007). 37 Contraindications for contract
relax stretching are novel fractures, dislocations or subluxations, there are
symptoms of trauma or acute infection in the area around the joint, acute trauma to
the muscles and tendon and muscle rupture (Kisner & Colby, 2007).
2.7.2 Application Engineering Contract Relax Stretching
Contract relax stretching is a stretching technique that aims to increase the scope of
joint motion, eliminate muscle spasm and increase the soft tissue
length. The implementation is as follows (Kisner & Colby, 2007): a. Position the
patient in a comfortable position and explain the procedures, goals and effects
of contract relax stretching perceived. b. The physiotherapist is behind the patient
with the right hand fixating the lateral part of the patient's neck while the left hand
is above the patient's shoulder. c. The patient moves against the left thrust of the
physiotherapist and is held for 7 seconds followed by maximal inspiration ,
then relaxation followed by expiration and the physiotherapist
performs stretching for 9 seconds.
2.7.3 Improvement Mechanisms of Neck Joints Movement Through
Contract Relax Stretching
Contract relax stretching is done to get relaxation effect and long return of muscle
and connective tissue. The existing 38 motor units in all muscle fibers will
be activated as a result of the isometric contraction followed by maximum
inspiration. It will also stimulate the Golgi tendon organ which can help the
relaxation of muscles after contraction (reverse innervation) so that the emission of
adhesions in the muscles (Azizah & Hardjono, 2006).Strong muscle
contraction will facilitate the pumping mechanism
action so that local metabolic and circulatory processes can proceed well as a result
of vasodilation and relaxation after the maximum contraction of the muscle. Thus
the transport of metabolic ( substance ) and acetabolic remnants produced through
the inflammatory process can proceed smoothly so that the pain can be reduced
(Azizah & Hardjono, 2006). Relaxation performed after maximum isometric
contraction for 9 seconds where in this process obtained maximum relaxation
facilitated Reverse Innervation . The relaxation process followed by maximal
expiration will facilitate the acquisition of muscle relaxation. When stretching
simultaneously during maximal relaxation and expiration, the achievement of
muscle length is achieved
tightness / contracture is maximal because contract
relax through stretch relaxation mechanism , autogenic inhibition so that it can be
said that stretching at maximum range of motion (ROM) will stimulate golgi tendon
organs that arise relaxation on muscle antagonist (Risal, 2010). With
the stretching component then the muscle length can be kicked by activating
the tendon golgi organ so that relaxation can be achieved because the pain due to
muscle tension can be lowered and the viscous circle chain can be
decided. If contract relax stretching is applied to these conditions it can reduce
irritation of
the Aδ and C nerves that cause pain resulting from abnormal cross-link . This may occur
because at the time of intervention the contract relax
stretching muscle fibers is pulled out until the full length of the sarcoma. When this
happens it will help straighten out some fibers or abnormalcross links on tension.
(Azizah & Hardjono, 2006). Research that has been done 3 times a week for 2 weeks
with a sample of 20 people resulted in increased scope of neck joint motion 63 , 3 %
(Zuriatum Faizah, 2011). This is reinforced by the study of Somprasong, et al .,
(2011) that the provision of contract relax stretching on the upper trapezius can
increase the scope of motion of the joints in the neck.