Back Pain is a Major Health Problem
Transcript of Back Pain is a Major Health Problem
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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
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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 $uickly.
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$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
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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
/
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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
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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
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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
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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
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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.
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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
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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# $uadratus lumbar pain#
myofascitis# spinal stenosis# degenerati!e disc disease#
latissimus dorsi syndrome# abnormal transforaminal
ligaments# and a great many more enjoy current!ogue&mode# sedang digemari(
An enigma&tekateki( remains in that there is no
uni!ersality or standardi:ation of low back pain
disorders. 1he term syndrome must remain in todayCs
terminology without clarification or uni!ersalunderstanding.&Gailliet .# -,8-(
ow back pain considered to ha!e excited less than '
months can be termed acute. Ghronic back pain# like
any chronic pain# may persist in the absence of any
clinical findings or confirmatory test. '*ailliet 1,
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1isk factors associated with manual material
handling inuries
4ersonal factors
Age
4ender
Anthropometry&body weight and height(
?hysical fitness and training umbar mobility
3trength
"edical history
ears of employment
3moking
?sychosocial factors
Anatomical abnormality "arital status
'. )nvironmental factors
umidity
ighting Hoise
ibration
Air temperature
;. @ob-related factors
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ocation of load relati!e to the worker
>istance object is mo!ed
2re$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$uently
injured&''% of -#E million injuries( and the most
costly to workersC compensation system.
orkrelated &"3Is( musculoskelethal injuries are
typically attributed to a direct trauma# a single
exertion'Aoverexertion(,or multiple
exertion'Arepeated trauma(. It is not always
possible# howe!er# to determine the specific cause ofthe injury# and the pathophysiology of many types of
"3Is is poorly understood.
!ixty-seven percent'#7%( of overexertion inuries
claims involve lifting, while 80% involve pulling or
pushing3ixty percent&50%( of people with low back
pain report that o!erexertion was the cause. 1he
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likelihood of identifying a specific cause for a
patientCs low back pain is approximately /-0%K a
defined structural diagnosis can be reached in
no more than /0% of all cases. Another major causebelie!ed rele!ant to low back pain includes the
degenerative disease of the spine.
echanical low back pain
1he spine is a mechanical structure that supports the
indi!idual from the day of birth throughout his or her
life. 1he spine defies&menentang9melawan( gra!ity# or
at least is in balance with gra!ity. It supports mankind
in standing and sitting and allows an indi!idual to
bend# stoop# s$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#
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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
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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$uently# especially a!oiding prolonged
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sitting or fixed flexion. ?atients should be ad!ised that
good lumbar support and seating is often helpful.
*hronic pain
Ghronic pain re$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.
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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
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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.
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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
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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
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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
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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
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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
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+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
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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. $uadratus lumborum#grup otot ekstensor batang tubuh diantaranya terdiri
dari m. erector spinae# m. longisimus thorasis#
m.rotatores# m.multifidus# dan grup fleksor panggul
yang meliputi m. iliopsoas# m.tensor fasia latae#
m.rektus femoris# serta grup eksorotasi panggul
meliputi m.piriformis# adductor panggul# grup
hamstring# m. gastroknemius dan soleus.
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2ipe .. 6 adalah otototot yang berfungsi untuk gerak
cepat dan kuat. *elemahan otot tipe ini adalah
cenderung melemah dan menjadi lembek. 1ermasukotot tipe ini diantaranya adalah otot perut#$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%
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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.
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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
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-. 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
;;
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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.
;+
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'. 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
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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
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9 &steoarthritis
O/0 year&age(
Back9unilateral&pain pattern location(Insidious&onset(
>ecreased&standing(
Increased&sitting(
Increased&bending(
Hegati!e&straight leg(
?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(
Hegati!e&straight leg(
?ositi!e&pain xray(
;8
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# !coliosis
;0 year&age(
Back&pain pattern location(Insidious&onset(
>ecreased&standing(
Increased&sitting(
>ecreased&bending(
Hegati!e&straight leg(
?ositi!e&pain xray(
;,