Peran Rehabilitasi Medik dalam

Penanganan Komprehensif
Kelainan Spinal

Siti Annisa Nuhonni

Department of Physical Medicine and Rehabilitation
Dr. Cipto Mangunkusumo Hospital,
Faculty of Medicine,
University of Indonesia

FALSAFAH & TUJUAN

REHABILITASI MEDIK
Falsafah rehabilitasi medik ialah
meningkatkan kemampuan fungsional
seseorang sesuai dengan potensi yang
dimiliki untuk mempertahankan dan atau
meningkatkan Kualitas hidup dengan
cara mencegah atau mengurangi
Impairment, Disability dan handicap
semaksimal mungkin

General goals in rehabilitation of

patients with spinal disorders
Decrease spinal related pain
Improve strength, flexibility, lifting
capacity, and cardiovascular endurance
Minimize spine-related disability
Normalize activities of daily living
Return to work and vocational activities

Components in a non operative

spine treatment program
Education
Local modalities
Medication
Injections
Exercise
Orthoses and assistive devices
Complementary and alternative therapies
Home environment modification
Ergonomic modifications
Lifestyle modification

Common causes of cervical pain

seen in a rehabilitation medicine
Myofascial pain
Cervical spondylosis
Cervical sprain/strain
Cervical disc herniation
Cervical stenosis
Cervical fractures
Inflammatory conditions of the spine such as
rheumatoid arthritis

Common causes of lumbar pain

seen in a rehabilitation medicine
Lumbar sprain/strain
Myofascial pain
Fibromyalgia
Lumbar spondylosis
Lumbar radiculopathy
Lumbar spinal
stenosis

Lumbar spondylolysis
and spondylolisthesis
DISH
Spondyloarthropathy
( ex. Ankylosing
spondylitis)
Fracture
Tumor
Infection

Hierarchy of physical function

Integration level III

Role function

Integration level II

Task or
goal-oriented
function
(e.g., ADL, IADL)

Integration level I

Specific physical
Movements
(e.g., 8-foot walk)

Basic component
Coordination
Line motor

Balance

Strength

Flexibility

Endurance

Ruas Vertebra

The Neck In Action

POSTURE and Emotional Stress

Posture has more
to do with the
neck than most
people realize.
The head and
spine must
balance in
relation to the
line of gravity.

Low Back Pain

is a symptom that can be caused by
various disease entities and can affected
by various psychosocial factors

Objective

The objective of any

preventive or therapeutic
rehabilitation program is to
teach patients how to help
themselves.
They are taught how to be
Kind to ones back

RISK FACTORS
OCCUPATIONAL FACTORS
Hard labor and heavy exertions
Lifting, pulling and pushing, twisting,
slipping
Sitting for an extended period
Exposure to prolonged vibration
Persons who view their occupations as
boring, repetitious or dissatisfying may
also report a higher rate of low back
pain

RISK FACTORS
PATIENT - RELATED FACTORS

Age
Sex
Anthropometric Factors
Postural Factors
Spine Mobility

Muscle Strength
Physical Fitness
Smoking
Psychosocial
Factors

Mechanical units of the spine

Anterior segment (two adjacent vertebral bodies and
the intervertebral discs between them)
Posterior segment (neural arches)
The anterior segment is primarily the weight bearing
and shock absorbing component
The posterior segment protects the neural structures
and direct movements of the units in flexion and
extensions
The amount of force exerted on the spine can very
depending on the type of activity and posture.

Muscle Supporting The Spine and

Their Function
Muscle Groups
Four groups of muscles : the extensor, the flexors, the lateral
flexors, and the rotators of the spine
The extensors and rotators are the main supportive muscles of
spine
The main role of the back muscles in erect posture is to resist
gravity
Once vertebral column is bent far enough in any direction, the
muscles of the back that resist this movement must actively
contract to provide smooth and controlled movements and also to
prevent falling
The abdominal muscles are significant flexors and lateral flexors
of the trunk and also participate in rotation

Rehabilitation of Back Pain

General Consideration
Rest Relax
Avoidance of stressful activities
Use of back supports
Exercise

TYPES OF EXERCISE
TYPE
Aerobic / Anaerobic
Resistance / Weights
Antigravity
Balance
Stretching

PURPOSE / EXPECTED BENEFIT

Cardiovascular conditioning
Strength, tone, muscle mass
Prevent osteoporosis
Prevent falls
Flexibility

Therapeutic response

Therapeutic window

Toxic response

Age

Narrowing of the therapeutic window. This diagram portrays

in a conceptual manner how the space between a therapeutic
dose and a toxic dose narrows with age

Low back pain mechanical

strain
Goal : - pain free
- decrease soft tissue edema
- maintained ROM & muscle strength
Th/ : - cold pack during the first 48 hrs
- heating modalities 20-35 minutes
- stroking massage
- Bed rest 2-3 days, not more than 2 weeks
- use a firm mattress and soft top layer
covering
- Supine / side lying position, flexed hips & knees
- Gentle ROM and isometric exercise

ORTHOTICS
The Reduction of motion in the lumbar
spine can be achieved only if the
support is extended from the lower
thoracis spine to the greater
trochanteric areas
This immobilitation significantly
decreases the pain and reduces the
duration of bed rest

ORTHOTICS
Restriction on back motion results in weaknes
of the low back supportive muscles
Prolonged use of a back support is
discouraged

Rigid orthoses side effect:

Muscles atrophy, accelerated, osteopenia,
osteoarthritis

EXERCISE
Isometric strengthening exercises (paraspinal
& abdominal muscles)
Back extension or flexion or combination
exercise program ; depends on indications
Pain free +, start daily activities, usually after
2-4 weeks
William flexion exercise
Mc Kenzie hyperextension exercise

Thank you