Download - MEKANICAL CERVICAL & LUMBAR TRACTION
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MEKANICAL CERVICAL & MEKANICAL CERVICAL & LUMBAR TRACTIONLUMBAR TRACTION
Oleh: Sugijanto
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PengertianTraksi: proses menarik utkmeregangkan jarak antar suatubagian. Traksi spinal: tarikan utkmeregangkan jarak antar vertebra. Traksi Non sceletal; Scr manual (traksi manual) ataumekanis (traksi mekanis).Traksi mekanis pd vertebra cervical (cervical traction) danvertebra lumbal (lumbar traction).
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Pengaruh Penguluranscr mekanik pd spine
• Koreksi kurva spine
• Peregangan otot spinal
• Regangan ligamenta dankapsul facet joint
• Translasi facet joint
• Melebarkan for. intervertebra
• Meratakan tonjolan discus
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Faktor2 Faktor2 ygyg mempengaruhimempengaruhidistraksidistraksi antarantar vertebravertebra
PosisiPosisi spinespineSudutSudut tarikantarikanBebanBeban tarikantarikanKenyamananKenyamanan dandan relaksasirelaksasipasienpasien
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MobilisasiMobilisasidiscusdiscus
• Mengurangi bebanintra discal
• Meningkatkan kadarair dlm discus
• Dorongan nucleus ketengah
• Dapat terjadi jebakannucleus yg protrusi
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Posisi pasien:TerlentangPosisi spinal: ekstensiSudut traksi: 00 / ekstensiJenis: IntermittentDurasi aplikasi: 15 - 30 menitBeban Cerv ± 30% Lumb ± 66%Terapi latihan ssd traksi: mobilEkstensi ; Mc.Kenzie
Faktor2 yg mempengaruhi disc mobilization:
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MobilisasiMobilisasi facet jointfacet joint
• Efek mobilisasi dr variasiposisi & beban tarikan:– Translasi permukaan facet
• Thoracal & upper lumbale
– Distraksi permukaan facet• Cervical & lower lumbale
– Kompresi permukaan facet• Lower cervical & mid thoracal
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RelaksasiRelaksasi otototot
a.a. Faktor2 Faktor2 ygyg mempengaruhimempengaruhiPosisiPosisi pasienpasienPosisiPosisi spinalspinalDurasiDurasi aplikasiaplikasiBebanBeban
b. b. EfekEfek ygyg timbultimbulPenguranganPengurangan nyerinyeriDistraksiDistraksi vertebra vertebra ygyg lebihlebih besarbesar
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PenguranganPengurangan nyerinyeri: : EfekEfek--efekefekinhibisiinhibisi dandan penguranganpengurangan nyerinyeri
MekanikalMekanikalGerakanGerakan →→ sirkulasisirkulasi & & mengurangimengurangipenekananpenekanan duradura, , pembuluhpembuluh darahdarah dandan radix radix for. for. intervertebralintervertebral. . SirkulasiSirkulasi →→ menurunkanmenurunkankonsentrasikonsentrasi iritasiiritasi chemical chemical penyebabpenyebab nyerinyeri..DistraksiDistraksi intervertebraintervertebra →→ jarakjarak for. for. intervertebralintervertebral →→ menurunkanmenurunkan tekanantekananradix.radix.DistraksiDistraksi facet joint facet joint →→ mengurangimengurangipenekananpenekanan dandan penjebakanpenjebakan..PereganganPeregangan mekanikmekanik jar. tightness jar. tightness →→meningkatkanmeningkatkan mobilitasmobilitas dandan mengurangimenguranginyerinyeri penghambatpenghambat gerakangerakan
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PenguranganPengurangan nyerinyeri: : NeurofisiologiNeurofisiologi
StimulasiStimulasi pd pd mekanoreseptormekanoreseptorblokblok transmisitransmisi stimulasistimulasinosisensoriknosisensorik level spinal cord level spinal cord dandan brain stem.brain stem.
InhibisiInhibisi hipertoniahipertonia otototot →→menurunkanmenurunkan rasarasa tidaktidaknyamannyaman..
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Jenis dan Dosis Traksi
Non sceletal traction & non bracingTraksi statis atau konstan (lumbar tract)
Kontinyu : beban kecil (± 5% BB), waktu traksimenetap.Sustained : Beban (± 5% BB), waktu 30-60’
Traksi intermiten (lumbar - cerv tract)Beban besar waktu pendek
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YgYg harusharus dipantaudipantau
Cervical tractionCervical traction–– TMJ painTMJ pain–– PusingPusing, , mualmual--muntahmuntah, , –– Vital signVital sign–– JebakanJebakan discdisc
Lumbar tractionLumbar traction–– BunyiBunyi–– IschialIschial painpain–– JebakanJebakan discdisc–– SesakSesak nafasnafas
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IndikasiIndikasi–– GangguanGangguan akarakar sarafsaraf spinalspinal–– HipomobilitasHipomobilitas sendisendi akibatakibat disfungsidisfungsi / /
degeneratifdegeneratif–– NyeriNyeri facet facet simptomatiksimptomatik–– SpasmeSpasme ototototKontraindikasiKontraindikasi–– KasusKasus spinal/spinal/prosesproses penyakitpenyakit ygyg kontrakontra--
indikasiindikasi gerakangerakan–– Strain Strain dandan sprain sprain akutakut & & inflamasiinflamasi–– Spasm pd Spasm pd bagianbagian spinal spinal hipermobilitashipermobilitas–– RA cervical RA cervical berpotensiberpotensi necrosis necrosis ligamenligamen shgshg
instabilitasinstabilitas, , subluksasisubluksasi atauatau dislokasidislokasi vertebra vertebra dandan gangguangangguan spinal cordspinal cord
–– KasusKasus spinal spinal sptspt osteoporosis, tumor osteoporosis, tumor dandaninfeksiinfeksi
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KeterbatasanKeterbatasan
DistraksiDistraksi vertebra vertebra temporertemporer–– DiikutiDiikuti mobilisasimobilisasi dandan stabilisasistabilisasiTidakTidak adaada protokolprotokol ygygkonsistenkonsisten–– PosisiPosisi, , sudutsudut tarikantarikan dandan bebanbebanKekuatanKekuatan traksitraksi longitudinal longitudinal tidaktidak spesifikspesifik pd level vertebra.pd level vertebra.–– PosisiPosisi, , fiksasifiksasi dandan sudutsudut tarikantarikan
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PenerapanPenerapan traksitraksi posisiposisidudukduduk•• SudutSudut tarikantarikan 0000 / / ekstensiekstensi
•• Upper Upper cervcerv
TidurTidur terlentangterlentang•• VariasiVariasi SudutSudut tarikantarikan 0000 / /
ekstensiekstensi hinggahingga 454500
•• Segment Segment tertentutertentu
PerhatianPerhatian nyerinyeri TMJ TMJ dandangang. gang. respirasirespirasi
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PengukuranPengukuranhasilhasil
PainPainVAS/ VRS/VDSVAS/ VRS/VDS
PosturePosturePlumb linePlumb line
Active stabilizationActive stabilization
Joint ROMJoint ROMCm/ Cm/ GoniometerGoniometer
FunctionFunction
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KasuistikKasuistik•• Disc bulging, HNPDisc bulging, HNP
–– PosisiPosisi: : terlentangterlentang ganjalganjal bawahbawah lumbalelumbale, , tungkaitungkai luruslurus–– JenisJenis & & ArahArah traksitraksi: intermittent : intermittent araharah longitudinal longitudinal
•• Cervical/lumbar Cervical/lumbar arthrosisarthrosis–– PosisiPosisi: : terlentangterlentang ganjalganjal bawahbawah lututlutut, , tungkaitungkai menekukmenekuk–– JenisJenis & & ArahArah traksitraksi: : statikstatik araharah fleksifleksi
•• Joint blockade, Joint blockade, hypomobilityhypomobility–– PosisiPosisi: : terlentangterlentang, hip & knee flexion, hip & knee flexion–– JenisJenis & & ArahArah traksitraksi: : sudutsudut 30 30 –– 454500
•• ForamentForament intervertebralintervertebral iritationiritation–– PosisiPosisi: : tidurtidur miring, hip & knee flexionmiring, hip & knee flexion–– JenisJenis & & ArahArah traksitraksi: : suspencesuspence / intermittent / intermittent araharah longitudinallongitudinal
•• Muscle tightness, contracted?Muscle tightness, contracted?
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ResearchResearch
• Membedakan pengaruh traksi mekanikdan traksi manual
• Membedakan pengaruh traksi mekanikdengan contract relax and stretching
• Membedakan pengaruh traksi mekanikdengan muscle energy teshnique
• Mengetahi dosis beban dan durasi yang efektif
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