Back Pain is a Major Health Problem

8/10/2019 Back Pain is a Major Health Problem

1/39

Back pain is a major health problem. An estimated

80% of the population will experience low back pain

at some time during their lifetime. Impairment of the

back and spine are the third leading cause of disabilityof people in their employment years.

ow back pain may be caused by a large !ariety of

conditions. "ost low back pain is caused by

musculoskeletal problems# for example# acute

lumbosacral strain# unstable lumbosacral ligamentsand week muscles# osteoarthritis of spine# spinal

stenosis# inter!ertebral disc problems# and ine$uality

of leg length.

ther causes include kidney disorders# pel!ic

problems# retroperitoneal tumors# abdominal

aneurysms# and psychosomatic problems.

"ost back pain due to musculoskeletal disturbances is

aggra!ated by acti!ity# whereas pain due to other

considerations is not influenced by acti!ity.

According to a sur!ey published this year&'000(almost half of the adult population of the )nited

*ingdom&+,%( report low back pain lasting for at

least '+ hours at some time during the year. In a

similar sur!ey carried out -0 years earlier just o!er

one third of the population complained of such back

pain. In l,,8 almost one in fi!e adults &-8%(

experienced low back pain for the first time It is

-


2/39

estimated that up to four out of fi!e people &80%( will

experienced back pain lasting more than a day at

some time during their life.

In -,,8 in o!er half of those people who reported

back pain the episode lasted for o!er + weeks

affecting 8 million people and in the case of '#/

million of these the back pain lasted throughout the

year.

oung people are more likely to ha!e brief acute

episodes of back pain while chronic pain is more

characteristic of older people. 1here is little difference

in the occurrence in men and women.

&ow back pain# kumpulan referensi dari sumber

internet(

ow back pain is extremely common. By middle life,

50-70% of adults will report having experienced

low back pain at some time As many as '/% of

adults report experiencing low back pain in a gi!en

year. ike headache# it is the norm to experience low

back pain.

!ome "0% of reported cases of acute low back pain

settle within # weeks 2or most people# a simple

back strain is an interruption to life which gradually

settles and return to normal function occurs $uickly.

'


3/39

$or a small number of low back pain starts with a

physical problem which may lead to psychological

disturbances 3imple distress is a common

accompaniment to low back pain. Anxiety anddepression and other psychosomatic symptoms may

de!elop later.

&4uidelines for the management of employees with

compensable low back pain# l,,5(

anual handling describes 6any acti!ity re$uiring

the use of forced exerted by a person to lift# push# pull#

carry or otherwise more or restraint any animate or

inanimate object7.

here manual handling tasks in!ol!e repetiti!e

actions# forceful mo!ement# and9or sustained awkwardpostures# they may result in type of injury called &&!

'&ccupational overuse syndrome( 1hese injuries

may be characteri:ed by discomfort or persistent pain

in muscles# tendons# and other soft tissues.

)*+.*/ .!&1)1! &$ 2+)/3B&!*1/ !4.)

"echanical disorders of the lumbosacral spine are the

most common cause of low back pain. echanical

low back pain may be defined as pain secondary to

overuse of a normal anatomic structure 'muscle

strain( or pain secondary to inury of deformity of

;


4/39


5/39

strain may account for #0% to 70% of

abnormalities

1he etiology of back strain is not always clear but maybe related to ligamentous or muscular strain

secondary to either a specific traumatic episode or

continuous mechanical stress

.n summary, muscle pain in low back pain patients

may be caused by four different mechanisms6

4ain is associated with muscle strain that is

related to muscle disruption from indirect

trauma such as excessive stretch or tension

8 nother possible source of muscle pain is

muscle fatigue associated with overuse

9uscle spasm is associated with persistentcontraction of muscle

:4araspinous muscles become deconditioned

after inury

'avid ; Borenstein, /ow Back , pp ari hasil

penelitiannya# didapatkan bahwa 80% populasi

/


6/39

mengalami masalah punggung sesuati dengan

tingkatan usia. 3edangkan /0% populasi mengalami

masalah punggung yang terjadi minimal setahun

sekali dan '/% populasi menderita sakit punggungkronis. anya -/% dari kasus keluhan nyeri punggung

disebabkan oleh penyakit tertentu# sisanya disebabkan

karena kurang gerak badan yang posisi duduk yang

salah dan berlangsung dalam waktu yang lama..

ge

3pondyloarthropathies# including ankylosing

spondylitis# eiterCs syndrome spondylitis associatedD

with inflammatory bowel disease# and benign tumors

of the spine&osteoid osteoma# aneurismal bone cyst#

osteoblastoma(# occurs between the third and fourthdecades# iseases of middle age include diffuse

idiopathic skeletal hyperostosis '.!+(, gout,

paget=s disease, and ostomyelitis A different set of

diseases occurs more commonly during and following

the sixth decade# which includes malignant metastasis#

colon cancer# prostatic cancer# metabolic&osteoporosis(# and degenerati!e diseases&expanding

abdominal aortic aneurysm(. Approximately 80 % of

patients with malignant disease affecting the lumbal

spine are o!er /0 years of age.

!ex

5


7/39

Back pain occurs predominantly in men

ccupational exposure to hea!yduty labor explains

some of the increased pre!alence of this symptom."any illnesses including the spondyloarthropathies#

infections# and malignant and benign tumors also

occur more commonly in men. )ndocrinologic

disorders, including osteoporosis and parathyroid

disorders, and muscle disease 'polymyalgia

rheumatica and fibromyalgia( are more likely toappear in women ?soriatic spondylitis# spondylitis

associated with inflammatory bowel disease#

hemangioma# ;aucher=s disease, pituitary disease,

and subacute bacterial endocarditis occur with

e>ual fre>uency in both sexes

$amily history

2amilial predisposition does occur in certain medial

illnesses that are associated with back pain. A prime

example is the spondyloarthropathies. In the presence

of a particular +istocompatibility /ocus ntigen'+/-B87(# members of a family are at risk of

de!eloping ankylosing spondylitis# eiterCs syndrome#

psoriatic spondylitis and spondylitis associated with

inflammatory bowel disease. ther

spondyloarthropathies# such those occurring in

familial "editerranean people and hippleCs disease#

occur more commonly in family members without any

E


8/39

specifically associated genetic factor. 1he etnic

backgroundof the family may predispose members

to specific illnesses. *aucasian women of orthern

)uropean extraction are at greatest risk ofdeveloping osteoporosis

&ccupational?social history

1he occupational history is essential for e!aluating thepatientC risk of de!eloping mechanical low back pain.

orkers doing hea!y lifting at their job are at risk of

de!eloping mechanical low back pain. owe!er# this

symptom also occurs in sedentary workers. ifting a

light object from a rotated position or stretching far

o!erhead to reach an object on a shelf may be

associated with the onset of low back pain. 1herelationship of work and onset of pain is important in

e!aluating the patient in regard to compensation.

hether the symptoms of back pain are workrelated

of not# it is important to discuss their association from

the patient !iewpoint.

!ocial history also includes $uantification of

consumption of alcohol, coffee, and recreational

drugs and cigarette smoking are associated with

osteoporosis, while illicit drugs results in

immunosuppression and predisposition to

infection 3moking may also be associated with

increased risk for herniated inter!etebral disc and low

8


9/39

back pain.&Borenstein >.4.# iesel 3..# and Bodeb

3.> -,,/( hal F 5+5E

Back and neck pain is one of the leading causes oflost work time# second only the common cold. It

affects 5/8/% of the population of the )nited 3tates

at some point on their li!es. 1he most common cause

is sprain, strain or spasm usually brought on by

poor lifting techni>ues, improper posture, or an

unhealthy ergonomic environment Anothercommon cause is disc problems brought on by injury#

wear and tear# or age. ther causes include spinal

stenosis# osteoarthritis# osteoporosis# and other

conditions.&kumpulan referensi dari sumber internet#

halF - dari +(

2ypes of back and neck pain

cute pain

Acute pain can be defined as se!ere shortterm pain.

?ostoperati!e pain is an example. Acute pain is self-

limiting, which means the pain acts to warn you tocease or limit activity that could cause additional

tissue damage1he more intense and prolonged an

acute pain episode is# the more likely it will lead to

chronic pain. 1his makes sense gi!en the information

that we are beginning to learn about how the central

ner!ous system changes in response to instant pain. As

a result of intense pain# neurons in the spinal cord that

,


10/39

help to pre!ent pain transmissions actually die. At the

same time# paintransmitting neurons grow more

connections to other ner!es# become more sensiti!e#

and react more strongly to painful stimulus.

*hronic pain

ather than being the symptoms of a disease process.

chronic pain is itself a disease process Ghronic pain

is unrelenting&tidak menjadi lunak( and not selflimiting. It can persists for years and e!en decades

after the initial injury. 1here many factors that affect

the de!elopment of chronic pain such as age# le!el of

disability# depression or the presence of ner!e damage.

?ersons with chronic low back pain are fre$uently

obese. 3ome studies suggest that they may ha!eproblems dealing with stress and exhibit depressed#

dependent personalities. 3ome patients with chronic

low back pain de!elop a dependence on alcohol or

analgesics.

?atients with muscle strain ha!e back pain as theirmain complaint. 1he pain can be limited to a small

local area or can co!er a diffuse area of the

lumbosacral spine but does not radiate to the lower

extremities. At times# there may be a referral of pain to

the buttocks or posterior thigh# since the mesenchymal

structures in the lower back# buttocks# and posterior

thigh all originate from the same embryonic tissues.

-0


11/39

3uch referral of pain does not necessarily

connote&mengandung arti( any mechanical

compression of the neural elements and should not be

called sciatica.

1he patients may experience pain simultaneously

with an injury. 1he pain increases in intensity and

grows larger in its distribution after a few hours. e

change in pain is associated with increasing edema in

the injured structure along with the reflex contractionof surrounding muscles that limit motion. 1he patient

may be able to continue to be acti!e for a few hours.

owe!er# marked pain and stiffness occur the next day

after sleeping. 2lexion or extension of the spine may

cause pain. ?ain occurs with the motion that contract

the injured muscle. Gertain motions may be painless#

while others cause incapacitating pain. In general#muscle strain will be increased with acti!ity and

relie!ed with rest.

4athophysiology

1he spinal column can be considered as an elastic rodconstructed of rigid units 'vertebra( and flexible

units 'intervertebral discs(that are held together by

complex facet joints# multiple ligaments and

para!ertebral muscles. 1he uni$ue constraction of the

back allows for flexibility while pro!iding maximum

protection for the spinal cord. 1he spinal cur!es

absorb !ertical shocks from running and jumping. 1he

--


12/39

trunk helps to stabili:e the spine. 1he abdominal and

thoracic muscles are important in lifting acti!ities.

ack of use weakens these supporting structures.

besity# postural problems# structural problems# oro!erstretching of the spinal supports may result in

back pain.

/ow back pain remains a symptom of vague

etiology umerous terms prevails in the literaturealong with nonspecific mechanisms and, therefore

nonspecific treatment regimes 1erms such as

lumbosacral strain# unstable back# facet syndrome#

iliolumbar ligamentous strain# $uadratus lumbar pain#

myofascitis# spinal stenosis# degenerati!e disc disease#

latissimus dorsi syndrome# abnormal transforaminal

ligaments# and a great many more enjoy current!ogue&mode# sedang digemari(

An enigma&tekateki( remains in that there is no

uni!ersality or standardi:ation of low back pain

disorders. 1he term syndrome must remain in todayCs

terminology without clarification or uni!ersalunderstanding.&Gailliet .# -,8-(

ow back pain considered to ha!e excited less than '

months can be termed acute. Ghronic back pain# like

any chronic pain# may persist in the absence of any

clinical findings or confirmatory test. '*ailliet 1,

"


13/39

1isk factors associated with manual material

handling inuries

4ersonal factors

Age

4ender

Anthropometry&body weight and height(

?hysical fitness and training umbar mobility

3trength

"edical history

ears of employment

3moking

?sychosocial factors

Anatomical abnormality "arital status

'. )nvironmental factors

umidity

ighting Hoise

ibration

Air temperature

;. @ob-related factors

-;


14/39

ocation of load relati!e to the worker

>istance object is mo!ed

2re$uency and duration of handling acti!ity

eight of object or force re$uired to mo!e object Bending and twisting

3tability of the load

?ostural re$uirements

&Amit B.# @ames >. and "cglothlin -,,5(

&ccupational Jrgonomics# hal. ;;-(

A more recent report by Hational 3afety Gouncil

indicated that o!erexertion&kerja keras9akti!itas fisik

yang berat( is the most common cause of occupational

injury# accounting for ;-% of all injuries. 1he back#

moreo!er# is the body part most fre$uently

injured&''% of -#E million injuries( and the most

costly to workersC compensation system.

orkrelated &"3Is( musculoskelethal injuries are

typically attributed to a direct trauma# a single

exertion'Aoverexertion(,or multiple

exertion'Arepeated trauma(. It is not always

possible# howe!er# to determine the specific cause ofthe injury# and the pathophysiology of many types of

"3Is is poorly understood.

!ixty-seven percent'#7%( of overexertion inuries

claims involve lifting, while 80% involve pulling or

pushing3ixty percent&50%( of people with low back

pain report that o!erexertion was the cause. 1he

-+


15/39

likelihood of identifying a specific cause for a

patientCs low back pain is approximately /-0%K a

defined structural diagnosis can be reached in

no more than /0% of all cases. Another major causebelie!ed rele!ant to low back pain includes the

degenerative disease of the spine.

echanical low back pain

1he spine is a mechanical structure that supports the

indi!idual from the day of birth throughout his or her

life. 1he spine defies&menentang9melawan( gra!ity# or

at least is in balance with gra!ity. It supports mankind

in standing and sitting and allows an indi!idual to

bend# stoop# s$uat# twist# turn# and in other manners#

function throughout the acti!ities of daily li!ing.

1he lumbar spine contains fi!e !ertebrae and forms a

normal cur!e in the erect posture called lordosis. 2his

lordosis is also fre>uently called the

sway'lenggang?goyangan( of the low backBetween

!ertebrae are the discs and behind the discs emerge thener!es that descend into the legs. 1he fi!e lumbar

!ertebrae balanced upon the sacrum. 1he sacrum is

contained between two broad bones of the pel!is#

called ilia. ne of the ilia is called an ileum and

connects to the sacrum by the sacroiliac joint. Both

ilia contain sockets into which the hip joins fit. 1hese

ballandsocket joints permit mo!ement of the ilia#

-/


16/39

and hence the pel!is and the lumbar spine. 1he sacrum

continues down to form the tailbone&the coccyx(. 1he

sacrum is a flat bone between the two pel!ic

bones&ilia(. 1he coccyx is formed by se!eral smallbones that resemble a tail.

isc inuries

2or reasons that are still unknown# inter!ertebral discs

may degenerate and lose their strength F they becomeflattened and in ad!anced cases the !iscous fluid may

e!en be s$uee:ed out. 1he degenerati!e processes

impair the mechanics of the !ertebral column and

allows tissues and ner!es to be strained and

pinched&terjepit(# leading to !arious back trouble#

most commonly lumbago&painful muscle cramps(#

and sciatic troubles# and e!en in se!ereinstances to paralysis of the legs.&4randjean J. l,88(

1he most se!ere problem in!ol!es the spine and the

muscles of the back# which in many sitting positions

are not merely not relaxed# but are positi!ely stressed

in !arious ways.

ost back pain comes from the muscles, ligaments

and oints in your back

-5


17/39


18/39

nerve )ven then a slipped disc usually gets better

by itself

2or most people# a simple back pain is an interruption

to life which gradually settles and return to normal

function occurs $uickly. 2or a small number# low back

starts with a physical problem which may lead to

psychological disturbances. 3imple distress is a

common accompaniment to low back pain. Anxietyand depression and other psychosomatic symptoms

may de!elop later.

3ome ,0% of reported cases of acute low back pain

settle within

six weeks. 1he challenge for treating practitioners is

the cases which do not settle $uickly. "any studiesha!e suggested factors other the se!erity of the injury

or problem are associated with delayed reco!ery..

ow back pain will ha!e substantial financial#

domestic and social conse$uences. 2hose the person

needs to be assessed in the context of what theirphysical problem means to their life

Jrgonomic ad!ice should include care with liftingK for

example holding and object as close to the body as

possible# and standing as close as possible to the

workstation. ?atients should be ad!ised to change

positions fre$uently# especially a!oiding prolonged

-8


19/39

sitting or fixed flexion. ?atients should be ad!ised that

good lumbar support and seating is often helpful.

*hronic pain

Ghronic pain re$uires a different approach to

management than acute pain. ?hysical problems may

contribute a part of the disability while psychological

distress and social interactions reinforce beha!ior. 1he

combination of these problems can result in a fixeddisabled state# often pre!enting usual acti!ities.

2eatures suggesting this condition will be F

istory of protracted low back pain and disability

ack of response to any treatment

Increasing symptoms )se of words such as 6excruciating7&menyiksa( or

6agoni:ing7&mengerikan( in situations where it is

inappropriate

here most acti!ities are being a!oided because

of the pain

here most acti!ities are being a!oided becauseof the problem

1he loading on the !ertebral column increases from

abo!e downwards# and is at its greatest in the lowest

fi!e lumbar !ertebrae.

-,


20/39


21/39

but much more the wear and tear on the inter!ertebral

discs# which the increased risk of back troubles.

Back troubles are painful and reduce one=smobility and vitality 2hey lead to long absences

from work, and in modern times are among the

main causes of early disability 1hey are

comparati!ely common in the age group '0+0# with

certain occupations&laborer# farmer# nursing staff# etc.(

being particularly !ulnerable to disc troubles.&4randjean J. l,88(

?atients with muscle strain ha!e back pain as their

main complaint. 1he pain can be limited to a small

local area or can co!er a diffuse area of the

lumbosacral spine but does not radiate to the lower

extremities. At times# there may be a referral of pain tothe buttocks or posterior thigh# since the mesenchymal

structures in the lower back# buttocks# and posterior

thigh are all originate from the same embryonic tissue.

3uch referral of pain does not necessarily connote any

mechanical compression of the neural elements and

should not be called sciatica.&connoteLmengandungarti(

uscle strain results from overuse or

overstretching of a musclen physical examination#

any acti!e motion of the in!ol!ed muscle against

resistance will cause pain. "uscle pain in low back

'-


22/39

pain patients may be caused by four different

mechanisms F

-. ?ain is associated with muscle strain that isrelated to muscle disruptions from indirect

trauma such as excessi!e stretch of tension.

'. Another possible source of muscle pain is muscle

fatigue associated with o!eruse. 2atigue has a

metabolic component manifested by increased

concentrations of lactic acid# a byproduct ofanaerobic metabolism.

;. uscle spasm is associated with persistent

contraction of muscle. 1he absence of blood flow

with accumulation of metabolic byproducts may

stimulate pain receptors within blood !essels.

+. 4araspinous muscles become deconditioned

after inury adiographic e!aluation of crosssectional !iews of patients with back pain

demonstrate decreased muscle mass in

paraspinous and psoas muscles. >ecreased

muscle mass results in decreased muscle power

that puts indi!iduals at risk for persistent muscle

injury.&Borenstein >.# iesel 3..# Boden 3.>.#-,,/(

1he usual physical findings are limited to local

tenderness o!er the in!ol!ed area with limited

motionsK owe!er# the attacks will !ary in intensity

and can con!eniently be di!ided into three

categories F mild# moderate and se!ere.

''


23/39

a 2he mildis associated with subjecti!e pain

without objecti!e findings# and patients

usually are able to return to customaryacti!ity in less than a week

b 2he moderate is characteri:ed by a limited

range of spinal motion and para!ertebral

muscle spasm as well as pain# and patients

fre$uently resume full acti!ity in under two

weeksc 2he severe may cause patients to tilt forward

or list&miring( to one side. 1hese patients

ha!e trouble ambulating&dapat berjalan( and

can take up to three weeks to reco!er full

function.

ow back pain is !ery common in de!elopedcountries# especially in adults of working age. ow

back pain is characteri:ed by a range of symptoms

which include pain# muscle tension or stiffness# and

is locali:ed between the shoulder blades and the

folds of the buttocks# with or without spreading to

the legs&sciatica(.

ow back pain is commonly categori:ed into acute#

subacute and chronic. cute low back pain is

usually defined by a period of complaint of six

weeks or shorter, sub-acute low back pain as a

period between six and twelve weeks, and chronic

low back pain as a period of complaint longer

';


24/39

than twelve weeksow back pain is often self

limiting so may resol!e with or without treatment.

"enurut >ieter Breithecker# ketua tim peneliti darisuatu riset yang dilakukan oleh 2ederal ork

Association for ?osture and "o!ement di @erman#

proses kemerosotan fungsi tulang dan system

pergerakan&locomoti!e system( pada saat ini telah

menjadi masalah kesehatan yang serius untuk semua

kelompok usia. asil penelitiannya menunjukanbahwa 80% populasi mengalami masalah pinggang

sesuai dengan tingkatan usia. 3edangkan /0 % dari

populasi mengalami masalah pinggang yang dialami

minimal satu tahun sekali# dan '/% populasi

menderita sakit pinggang kronis. anya -/% dari

kasus keluhan nyeri pinggang disebabkan oleh

penyakit tertentu# sisanya disebabkan oleh kuranggerak badan dan posisi duduk yang salah dan

berlangsung dalam waktu yang lama.&kumpulan

internet#MM..(.

1isk factors for low back pain

ow back pain typically begins in young adulthood#

affecting the most producti!e years of life in an

industrial workers. 1here is a rising pre!alence with

age until the fourth and fifth decades# after which

'+


25/39

there is a le!eling off or decrease. Attacks of low back

pain seem to be more common among those who ha!e

had pre!ious back pain episodes.

Buckle and colleagues found that of 58 patients# o!erE0% reported at least one pre!ious episode. owe

similarly noted that 8/% of low back pain patients had

a history of intermittent episodes.&Borenstein >. 4. et

al# hal. 55/(

3e!eral studies ha!e examined differences in relation

to the risk of low back pain injury. Comen represent

about :0% of the working population but develop

only 80% of the industrial low back problems 2his

may be because women typically are employed in

less physically demanding obs

In a re!iew of ;-.000 employees from onemanufacturer# Bigos and associates found that women

had statistically fewer injuries than men

But had an increased risk of making a highcost injury

claims. "agora reported that in occupations

demanding strenuous physical efforts# women had a

higher incidence of low back pain than men. therin!estigators report e$ual pre!alence of back pain in

men and women.&Borensstein >.4. et. al.# hal 55/(.

t leasttwo studies have found ow back pain to be

more prevalent in cigarette smokers than in

nonsmokers It is not clear whether this association

is a result of increased intradiscal pressure from

chronic coughing and straining or whether nicotine

'/


26/39

itself has a direct biochemical role in the

pathophysiology of back injury.

4oor physical fitnessmay be a predisposing factor

for back pain. Gady and associates# in a prospecti!e

study of firefighters found that the least fit group of

employees was -0 times more susceptible to de!elop

back pain than the most fit group.

ne of the betterstudied risk factors for industrial low

back pain is ob typeK howe!er the data are

inconsistent. 1he Bureau of /abor !tatistics has

identified construction and mining as the industries

with highest incidence of back injuries# followed

closely by the trucking industry and the nursing

profession.

In a retrospecti!e study of '000 workers# owe found

that 95% of sedentary workers and :5% of heavy

handlers had made visits to physicians for low back

pain within a 0-year period Jastrand reported a

sur!ey of 3wedish workers that suggested that thenumber of years spent doing hea!y labor ha!e a

cumulati!e effect on predisposition to low back

problems.&Borenstein >.4.# hal 55(

>espite contradictory data# it does seem likely that

certain tasks in the workplace are important in the

'5


27/39

de!elopment of low back pain. !nook and associates

found that handling tasks were responsible for

70% of low back inuries, and *lein and associates

later reported similar findings 1he weight of the

object lifted has been implicated in lifting injuries. In

one study# more than half the injured workers had

lifted objects weighing at least #0 pounds1he risk of

low back pain is thought to be increased by prolongedsitting and exposure to !ibration. /ess physically

stressful, but boring and repetitive obs'assembly

line work( also have been linked to increased

incidence of back pain

It is imperati!e to understand the distinction between

physical impairment and physical disability. 4hysicalimpairment is an objecti!e anatomic or pathologic

dysfunction leading to loss of normal body ability.

4ermanent impairment isan objecti!e assessment of

functional abnormality or loss after the acute injury

phase and after maximal medical rehabilitation.

4hysical disability is a measure of reduced capacityto engage in gainful e!eryday acti!ity as a result of

some impairment.

Eery heavy work is that which in!ol!es lifting

objects weighing more than 00 pounds at a time,

with fre>uent lifting or carrying of obects

weighing 50 pounds or more

'E


28/39

+eavy work in!ol!es lifting no more than 00

pounds at a time, with fre>uent lifting or carryingof obects weighing up to 50 pounds

edium workis defined as lifting of no more than

50 pounds at a time, with fre>uent lifting or

carrying of obects weighing up to 85 pounds

orkers with /% or less backrelated permanent

partial physical impairment can $ualify in this

category# but those with higher ratings cannot.

/ight work is described as lifting of no more than 80

pounds at a time, with fre>uent lifting or carrying

of obects weighing up to 0 pounds Applicantswith between -0 % and -/% permanent partial

physical impairment because of a low back problem

should be able to do this type of work.&Borenstein et.

al.# hal 5E+(.

natomi and patofisiologi pinggang

3ecara anatomic# yang disebut pinggang adalah

keseluruhan daerah !ertebra lumbal dan sakrum# yang

diperkuat oleh beberapa ligamen dan otot yang

terdapat disekitar daerah tersebut. igamen yang

'8


29/39

dimaksud adalah ligament longitudinal

anterior&melekat pada tiap lorpus !ertebra bagian

depan9!entral# dan berfungsi untuk mengontrol gerakn

ekstensi batang tubuh9trunk(# ligament longitudinalposterior&melekat pada korpus !ertebra bagian dorsal#

dan berfungsi untuk mengendalikan gerakan fleksi

batang tubuh(# ligamentum plavum&terletak pada

bagian dorsal kolumna !ertebralis dan merupakan

bagian dari kanalis !ertebralis# berfungsi untuk

melindungi medulla spinalis(# dan ligamentuminterspinosum&melekat pada prosesus yang

memanjang dari proksimal ke distal(.

4ambar letak ligamentum&gambar MM.(

3edangkan otot yang berpengaruh baik secara

langsung maupun tidak langsung pada nyeri pinggangsecara umum dapat dibedakan menjadi dua tipe yaitu F

2ipe . F adalah otot yang berfungsi mempertahankan

sikap tubuh. *elainan pada otot tipe ini adalah

cenderung untuk menjadi tegang dan memendek.

1ergolong otot tipe ini adalah m. $uadratus lumborum#grup otot ekstensor batang tubuh diantaranya terdiri

dari m. erector spinae# m. longisimus thorasis#

m.rotatores# m.multifidus# dan grup fleksor panggul

yang meliputi m. iliopsoas# m.tensor fasia latae#

m.rektus femoris# serta grup eksorotasi panggul

meliputi m.piriformis# adductor panggul# grup

hamstring# m. gastroknemius dan soleus.

',


30/39

2ipe .. 6 adalah otototot yang berfungsi untuk gerak

cepat dan kuat. *elemahan otot tipe ini adalah

cenderung melemah dan menjadi lembek. 1ermasukotot tipe ini diantaranya adalah otot perut#$uadrisep#

gluteus maksimus dan minimus# peroneal dan tibialis

anterior.

;erakan yang teradi pada pinggang

$leksi 6 gerakan yang terbesar terjadi pada

!ertebra lumbal /3-&50E/%(# pada +/&-/

'0%(# dan pada -+&/-0%(

8 )kstensi F gerakannya hanya sedikit karena

dibatasi oleh ketegangan lig. ongitudinal

anterior# posisi prosesus spinosus yang saling

berbenturan.9 1otasi F paling besar terjadi pada ;+ dan

paling kecil pada l/3-# dan untuk setiap

segmen sebesar ;E derajat.

: /aterofleksi&fleksi ke lateral(. Bagian9sisi

cekung dari korpora saling mendeka

4enekanan?kompresi intradiskal pada berbagai

aktivitas

Berdiri F 0 %

>uduk F N;0%

Berjalan F N-/%

Batuk F N/0%

;0


31/39

oncat F N/0%

"embungkuk '0 derajat kedepan F N8%

"engangkat benda seberat '0 *g F N;00%

>engan lutut sedikit menekuk"engangkat benda '0 *g dengan F N/00%

utut lurus

>uduk bersandar O ,0 derajat F -0'0%

&Ismiati 3..# '00-(

&?elatihan fisioterapi tiga sindroma nyeri pinggang(

4enyebab nyeri pinggang

3ecara umum penyebab nyeri pinggang dapat dibagi

menjadi F

-. *elainan congenital misalnya kelainan facet dan

kelainan pada !ertebra yang meliputi sakralisasi#lumbalisasi dan scoliosis.

'. 1rauma misalnya fraktur kompresi# spondilosis#

spondilolitesis# dan subluksasi pada sendi facet.

;. ?eradangan misalnya rematoid arthritis#

spondilitis ankilopoitika# tuberculosis# jamur# dan

salmonella.+. 1umor9neoplasma misalnya metastase karsinoma

payu dara# kelenjat gondok9tiroid# ginjal# paru

dan prostat.

/. 4angguan metabolic misalnya osteoporosis

dengan akibat fraktur kompresi.

;-


32/39

5. ?roses degenerasi misalnya spondilosis# hernia

nucleus pulposus&H?(# osteoartritis# stenosis

spinalis dan penyempitan foramen inter!ertebra.

E. *elainan biomekanik&merupakan factorpenyebab utama(.

>itinjau dari aspek biomekanik# penyebab nyeri

pinggang dapat dibagi menjadi F

-. Hyeri pinggang static&static9postural back pain('. Hyeri pinggang kinetic&kinetic back pain(

yeri pinggang static'static low back pain(

Hyeri pinggang ini terjadi akibat de!iasi dari

postur9sikap tubuh yang salah dan berlangsung dalam

waktu yang relatif lama sehingga menimbulkanketegangan pada ligament# dan kelelahan pada otot.

?ada posisi tegak # tubuh dipertahankan oleh ligament

iliofemoral tensor fasia latae# ligament longitudinal

anterior# ligament poplitea# dsan kontraksi minimal

dari otot gastrok dan soleus.

Finetic low back pain

?ada nyeri pinggang kinetic# timbulnya rasa nyeri

dipengaruhi oleh gerakan9akti!itas dengan tiga

kemungkinan yaitu F

;'


33/39

-. 3tres abnormal pada pinggang yang normal yang

disebabkan oleh F

a. *etidakmampuan otot karena beban terlaluberat.

b. "engangkat benda dengan jarak yang cukup

jauh dari tubuh.

c. "engangkat beban9benda yang berat dalam

waktu yang lama

'. 3tres normal pada pinggang yang abnormal Fa. 3koliosis struktural# dimana letak facet tidak

sejajar pada bidang simetris.

b. >egenerasi diskus yang menyebabkan fungsi

!ertebra menjadi tidak normal.

c. ?emendekan otot hamstring.

d. ?emendekan otot pinggang bawah dan

ligament.;. 3tres normal pada pinggang yang normal# tetapi

tubuh tidak siap menghadapi stress tersebut.

"isalnya# seseorang mengangkat beban yang

berat tetapi yang bersangkutan menduga beban

tersebut ringan sehingga tubuh tidak siap.

/oading of the disc between the third and fourth

lumbar vertebrae in 'ewton(, during various

postures and tasks

PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP

?osture9acti!ity H

;;


34/39

3tanding upright 850

alking slowly ,'0

Bending trunk sideways '0 degree --+0

otating trunk about +/ degree --+0Bending trunk forwards ;0 degree -+E0

Bending trunk forwards ;0 degree# '+00

3upporting weight of '0 *g

3tanding upright holding '0 *g -''0

&-0 *g in each hand(

ifting '0 *g with back straight# and '-00*nees bent

ifting '0 *g with bent back and knees ;'E0

3traight

PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP

&4ranjean J.# -,88( hal. -0E

/ifting techni>ue and disc pressure

If a person bends o!er until the upper part of his body

is hori:ontal# then the le!erage effect imposes !ery

hea!y pressure on the discs between the lumbar

!ertebrae. An a!erage weight of the upper part of thebody would be about +/ *g and the length of le!erage

about ;/0 mm# with a resulting moment of between

-000 and '000 Hm. If a weight is lifted at the same

time# the force on the discs could rise to ;000+000

Hm.

;+


35/39


36/39

'. Inflammation of the tendon sheaths &tendinitis or

peritendinitis(.

;. Inflammation of the attachementpoint of tendons.

+. 3ymtoms of arthrosis &chronic degeneration of thejoints(.

/. ?ainful muscle spasms.

5. Inter!ertebral disc trouble.

4ersistent musculoskeletal troubles

1hese symptoms of o!erstress can be di!ided into two

groups F reversible and persistent musculoskeletal

troubles

1he re!ersible symptoms are shortli!ed. 1he pains

are mostly locali:ed to the muscles and tendons# and

disappear as soon as the static load is relie!ed. 1hesetroubles are the pains of weariness.

?ersistent troubles are also locali:ed to strained

muscles and tendons# but they affect the joints and

adjacent tissues as well. 1he pains do not disappear

when the work stops# but continue. 1hese persistentpains are attributable to inflammatory and

degenerati!e processes in the o!erloaded tissues.

)lderly employees are more prone to such

persistent troubles According to an ely#

persistent musculoskeletal troubles are commonly

obser!ed among operators who work all the year

;5


37/39

round at the same machine at which the manual

controls are either too high or too low.

?ersistent musculoskeletal troubles# if supported o!eryears# may get worse and lead to chronic inflammation

of muscular work.

echanical low back pain

uscle strain

'0+0 years&age(

Back9unilateral&pain pattern location(

Acute&onset(

>ecreased&standing(

Increased&sitting(>ecreased&bending(

Hegati!e&straight leg(

Hegati!e&plain xray(

8 +erniated nucleus pulposus

;0/0 year&age(Back9unilateral&pain pattern location(

Acute9prior episodes&onset(

Increased&standing(

>ecreased&sitting(

>ecreased&bending(

?ositi!e&straight leg(

Hegati!e&plain xray(

;E


38/39

9 &steoarthritis

O/0 year&age(

Back9unilateral&pain pattern location(Insidious&onset(

>ecreased&standing(

Increased&sitting(

Increased&bending(


?ositi!e&plain xray(

: !pinal stenosis

O50 year&age(

eg9bilateral&pain pattern location(

Insidious&onset(

>ecreased&standing(

Increased&sitting(Increased&bending(

?ositi!e9stress&straight leg(

?ositi!e&pain xray(

5 !pondylolisthesis

'0 year&age(Back&pain pattern location(

Insidious&onset(

>ecreased&standing(

Increased&sitting(

>ecreased&bending(


?ositi!e&pain xray(

;8


39/39

# !coliosis

;0 year&age(

Back&pain pattern location(Insidious&onset(

>ecreased&standing(

Increased&sitting(

>ecreased&bending(


?ositi!e&pain xray(

;,

Back Pain is a Major Health Problem

Documents

Transcript of Back Pain is a Major Health Problem