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 “Low back pain” (LBP) atau nyeri punggung bawah
adalah sindroma klinik dengan gejala utama nyeri atau
ketidaknyamanan lainnya pada area punggung bawah
 LBP akut : sampai 4 minggu

 LBP kronik : lebih dari 6 bulan

 LBP subakut : 2 sampai 6 bulan (Negrini, 2010)

 Mekanikal Non Mekanikal Penyakit organ viseral

- Strain, sprain lumbal (70%) - Neoplasia (0,7%) - Penyakit organ pelvis

- Proses degenerative diskus dan - Infeksi (0,01%) (prostatitis, endometriosis)

facet (10%) - Osteomyelitis - Penyakit ginjal

- Herniasi diskus (4%) - Abses epidural - Aneurisma aorta (Wahyuni &

- Stenosis spinal (3%) - Abses paraspinal Tulaar, 2012)

- Fraktur kompresi osteoporosis (4%) - Penyakit pott

- Spondylolistesis (2%) - Artritis inflamatorik

- Ankylosing spondylosis
- Fraktur traumatic (<1%)

- Kongenital (<1%)
ANATOMI
THE SPINAL CURVATURES
MAKE THE SPINE 16 x
STRONGER
ANATOMI
Curvatura Spine
ANATOMI
 THE LONG AND
SHORT LIGAMENTS
OF THE SPINE

11
THE BACK MUSCLES 12
CORE MUSCLES
13
PEMERIKSAAN
Anamnesis
• S=site,Lokasi nyeri
• O=onset nyeri
• C=characteristic yang menyertai nyeri
• R=Radiating, penjalaran nyeri
• A=aggravating, hal2 yang meningkatkan nyeri
• T=time, waktu munculnya nyeri
• E=eliminating, haal2 yang mengurangi nyeri
• S=severity, derajat nyeri,biasanya menggunakan VAS
Observasi
• Postur
• Gerakan
• Sikap
• Bahasa tubuh
Pemeriksaan Spesifik
• Postur
• Saat berdiri, dari depan, samping dan belakang
• Fleksibilitas
• Re-Ekstensi ke postur tegak
• Spine
• Tenderness
• Inflamasi
• Pemeriksaan Neurologis
 Posture Ideal
 There is no “normal” posture
 Ideal posture serves as a reference point
 Postur Ideal…
• Mendistribusikan stres gravitasi untuk fungsi otot yang seimbang
• Memungkinkan sendi untuk bergerak di rentang pertengahan
mereka untuk
• Meminimalkan stres pada ligamen dan permukaan artikular ace
• Menurunkan stres abnormal
• Efektif untuk aktivitas kehidupan sehari-hari individu
• Meningkatkan kinerja
• Mengurangi perkembangan kondisi patologis
• Memungkinkan individu untuk menghindari cedera

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Posture Types

22
Lateral View
In the standing position and viewed from the lateral
position, the plumb line should be aligned so that it
passes slightly in front of the lateral malleolus (Fig. 21-6).
For ideal posture, the body segments should be aligned
so that the plumb line passes through the landmarks in
the order listed below:
Head
Through the earlobe.
Shoulder
Through the tip of the acromion process.
Thoracic Spine
Anterior to the vertebral bodies.
Lumbar Spine
Through the vertebral bodies.
Pelvis
Level.
Hip
Through the greater trochanter (slightly posterior to
the hip joint axis).
Knee
Slightly posterior to the patella (slightly anterior to
the knee joint axis) with the knees in extension.
Ankle
Slightly anterior to the lateral malleolus, with the
ankle joint in a neutral position between dorsiflexion
and plantar flexion. Lynn’s
Schober Test

• Tujuan: Mengukur fleksibilitas Lumbal.

• Prosedur: Pasien berdiri. Pemeriksa memberi tanda
pada proc spinosus S1 dan 10 cm di atasnya.
• Intepretasi: N: bergerak 15 cm pada fleksi dan 8-9 cm
pada ekstensi maks
Patrick Test (Fabere Sign)
• Tujuan: membedakan hip
disorders - disorders of the
sacroiliac joints
• Prosedur: pasien telentang,
satu kaki ekstensi dan yg lain
fleksi . Maleolus lateral kaki yg
fleksi berada pada superior
patella kaki ekstensi. Kaki yg
fleksi ditekan. Pemeriksa perlu
meng imbobilisasi pelvis pada
sisi kontralateral.
• Inttepretasi: Normal: lutut kaki
yg fleksi abduksi dapat
menyentuh bed. Perbedaan
mobilitas dan keterbatasan LGS
krn nyeri  sacroiliac
 Lasègue
Sign
(Straight Leg
Raising Test)

• Tujuan: indikasi iritasi akar syaraf

• Prosedur: pasien posisi telentang, pemeriksa mengangkat
ekstremitas bawah (dgn ekstensi lutut) pasien secara pasif,
perlahan hingga ada keluhan nyeri
• Intepretasi: +nyeri hebat pada sacrum dan tungkai  iritasi
akar syaraf (genuine Lasègue Sign is at 60° or less)
Hoover Test

• Evaluasi malingering.
• Prosedur: pasien supine, pemeriksa menempatkan satu tangan pada tiap
calcaneus, pasien diminta melakukan SLR aktif dgn lutut tetap lurus.
• Intepretasi: jika pasien tidak mengangkat kaki atau pemeriksa tidak
merasakan penekanan pada tumit kontralateral  +
• Pada tungkai yang lemah  usaha untuk mengangkat dengan dibantu
tungkai kontra lateral  menekan tangan pemeriksa
DD/
Degenerative Disease
• Occurs at all levels of
the spine
• Asymptomatic
degeneration in majority
of the population

Normal Degenerative
Degenerative Disease
• The spinal structures most
affected by degenerative
disease are
• Intervertebral discs
• Articular facet joints
• These conditions are
similar to osteoarthritis
and degenerative disease
of the spine, which is
often referred to as
“osteoarthritis of the
spine,” or spondylosis
 Degenerative Disc Disease
• Symptoms
• Low back pain and/or
buttocks pain
• If leg pain also exists, there
is likely an additional
cause, eg, HNP, stenosis,
etc
• DDD is not usually the sole
diagnosis
Herniated Nucleus Pulposus
• Diagnosis
• Magnetic resonance
imaging (MRI)/patient
exam
• Nonoperative Care
• Initial bed rest
• Nonsteroidal anti-
inflammatory (NSAID)
medication
• Physical therapy
• Exercise/walking
• Steroid injections
Herniated Nucleus Pulposus
• The progressive degeneration of a
disc, or traumatic event, can lead to a
failure of the annulus to adequately
contain the nucleus pulposus
• This is known as herniated nucleus
pulposus (HNP) or a herniated disc
 Stages of Spinal Disc Herniation

A. Bulging disc No annulus defect. Disc convexity is

beyond vertebral margins

B. Prolapsed disc Nucleus material protrudes into an

annulus defect

C. Extruded disc Nuclear material extends to the

posterior longitudinal ligament

D. Sequestered disc Nuclear fragment free in the canal

Penyebab HNP SERING DI LUMBAL

• ANATOMIS  LIGAMEN POSTERIOR, letak nucleus pulposus

• BIOMEKANIK  FLEKSI L5-S1 , L4-L5

Spondylolisthesis
• Gradation of
spondylolisthesis
• Meyerding’s Scale
• Grade 1 = up to 25%
• Grade 2 = up to 50%
• Grade 3 = up to 75%
• Grade 4 = up to 100%
• Grade 5 >100%
(complete dislocation,
spondyloloptosis)
Spondylolisthesis Grading
• Meyerding’s
Classification
• Grade 1 = up to 25%
• Grade 2 = up to 50%
• Grade 3 = up to 75%
• Grade 4 = up to 100%
• Grade 5 >100%
(complete dislocation,
spondyloptosis)
Spondylolisthesis
• Symptoms
• Low back pain
• With or without buttock or thigh
pain
• Pain aggravated by
standing or walking
• Pain relieved by lying down
• Concomitant spinal
stenosis, with or without
leg pain, may be present
• Other possible symptoms
• Tired legs, dysthesias,
anesthesias
• Partial pain relief by leaning
forward or sitting
Spondylolisthesis
• Diagnosis
• Plain radiographs
• CT, in some cases with
leg symptoms
• Nonoperative Care
• Rest
• NSAID medication
• Physical therapy
• Steroid injections
Spondylolysis
• Spondylolysis
• Also known as pars defect
• Also known as pars
fracture
• With or without
spondylolisthesis
• A fracture or defect in the
vertebra, usually in the
posterior elements—most
frequently in the pars
interarticularis
Spondylolysis
• Symptoms
• Low back pain/stiffness
• Forward bending
increases pain
• Symptoms get worse
with activity
• May include a stenotic
component resulting in
leg symptoms
• Seen most often in athletes
• Gymnasts at risk
• Caused by repeated
strain
Spondylolysis
• Diagnosis
• Plain oblique radiographs
• CT, in some cases
• Nonoperative care
• Limit athletic activities
• Physical therapy
• Most fractures heal
without other medical
intervention
57
WF EXC

59
Lumbosacral Corset
• Decrease the need for
muscle spasm to splint the
back for comfort during
healing
• Unload the lumbar spine by
increasing the abdominal
pressure when abdominal
muscle tension is not
possible
• Improve the posture
• Minimize movement of the
lumbar spine, forcing any
flexion to occur at the pelvis

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