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Iliocostalis Longissimus
cervicis cervicis
Intertransversarii Spinalis
cervicis
Multifidus
Iliocostalis
thoracis
Spinalis
Iliocostalis thoracis
lumborum
Longissimus
Ligamen - ligamen pada Pandangan Lateral
tulang belakang struktur tulang belakang
Ligamentum Flavum
Diskus Intervertebra
Ligamen
Intertransversa Korpus
Vertebra
Ligamen
Facet
Capsulary Ligamen
Longitudinal
Posterior Sendi
Ligamen Facet
Interspinous
Pedikel
Ligamen Ligamen
Supraspinous
Longitudinal
Anterior
Lumbopelvic Stability
Conventional rehabilitation?
Active care ??
The Current Management of LBP:
(The Agency for Health Care Policy and Research/ AH CPR, 1994)
1. Biomechanical principles :
Stress/muscle tension & pain are related
When & how to stabilize the back
2. Neurophysiological principles :
Poor endurance & coordination of trunk flexors &
extensors caused spinal instability.
Training motor control pattern
that are protective of the spine
Active Care Adheres To :
3.Biochemical principles
Pain & tissue healing are related to metabolic &
nutritional status
Macrophages are in high concentration with disc
herniation
4.Psychological principles
• Patients who worry & fear of their pain will have
chronic problem
• Fear/ stress increase muscle tension
exacerbate pain
Benar Salah
Memasukkan/mengeluarkan
Benar Salah barang dalam mobil
Duduk
Mengangkat barang
Benar Salah
Membawa barang
didepan tubuh
Benar Salah
Membawa barang
di punggung
Benar Salah
Sit-up parsial untuk memperkuat Latihan untuk mengurangi
otot-otot abdomen peregangan otot punggung
Beberapa variasi latihan ekstensi, mulai dari yang paling ringan ditingkatkan
disesuaikan dengan kekuatan otot-otot ekstensor lumbal
DBC
(Documentation Based Care)
Is a functional rehabilitation progam
→ To restore lumbar function & movement
→ To influence the behavioral pattern
Based on :
→ The severity of pain & deconditioning
→ Psychological profile
→ Social needs
Stabilization Training
Coordination
Mobility
Muscle endurance exercise
Stretching
Relaxation
Individualized Treatment Program
Exercise :
→ The DBC device guide patients movement:
• Plane
• Targeted
• Controlled & physiologically correct patterns
Cognitive & behavioral support
Supporting elements : - relaxation & functional exercise
- psychological & work place
intervention
DBC Program
One course: 12 sessions
1st session: baseline evaluation
- progress check
- treatment in group
12th session: outcome evaluation
Follow up / maintenance
Indications
Back
Inflammatory
Post-traumatic
Post-operative
Spondylolisthesis/ -lysis
Non-specific pain
Indications
Neck
Inflammatory
Post-traumatic
Whiplash-Associated-Disorder
Post-operative
Shoulder arthritis
Frozen shoulder
QA 2007, Back
Pattern % N
I=Inflammatory 1,4 % 805
II=Post-traumatic 5,2 % 2 990
III=Postoperative 7,3 % 4 198
IV=Nerve root compression 12,4 % 7 130
V= Stenosis 2,5 % 1 438
VI=Pelvic and LBP 7,8 % 4 485
VII= Spondylolisthesis and –lysis 4,3 % 2 473
VIII=Non-specific pain 59,0 % 33 926
DBC Internasional
QA 2007, Back
DBC Internasional
QA 2007, Back
DBC Internasional
DBC Clinic RS Internasional Bintaro
Distribusi Kasus
4,34%
20,65%
Back
Neck
Shoulder
82,50%
50,00
45,00 42,88
40,00
34,26
35,00
30,00
Sebelum Treatment
VAS
25,00 22,33
Sesudah Treatment
20,00 18,06
15,00
10,00
5,00
0,00
2007 2008
TAHUN
Pain decreased
No change or
pain increased
81,5%
Trouble decreased
No change or
trouble increased
78,1 %
DBC RSIB 2007-2008
Treatment Results
ROTATION MOBILITY
4,1 %
Mobility increase
No change or mobility
decreased
95,9 %
6,0 %
Mobility increase
No change or
mobility decreased
94,0 %
DBC RSIB 2007-2008
Treatment Results
LATERAL FLEXION MOBILITY
3,6 %
Mobility increase
No change or
mobility decreased
96,4 %
DBC RSIB 2007-2008
PAIN AND TROUBLE