PENANGANAN GANGGUAN

MUSKULOSKELETAL
Sudut Pandang Kedokteran Fisik dan Rehabilitasi

Oleh :
Dr. Asmaun Nadjamuddin, Sp.RM

Rehabilitasi Medik, R.S. Wahidin Sudiro Husodo

Jl. Perintis Kemerdekaan No. 11
 PENANGANAN GANGGUAN
MUSKULOSKELETAL

BAGIAN II

BAGIAN I BAGIAN III

BAGIAN IV BAGIAN V
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Berbicara mengenai penanganan
gangguan muskuloskeletal dalam
Kedokteran Fisik dan Rehabilitasi (KFR)
akan disederhanakan sebagai
penanganan gangguan rematik dalam
KFR.
Program in termasuk:
Resep yang benar dalam beristirahat;
Latihan; dan
Modalitas Fisik.
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Modalitas Fisik:
Penggunaan braces dan splints;
Panduan dalam menyederhanakan /
memodifikasi pekerjaan;
Konservasi energi.

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 Istilah “Kedokteran Fisik” mengacu kepada
semua program terapi yang menggunakan
modalitas fisik.

Tujuan Utamanya, antara lain:

1. Untuk mengobati nyeri, peradangan, dan kejang otot.
2. Untuk mencegah komplikasi sekunder seperti kontraktur
sendi/otot, atrofi otot, dan kelainan bentuk sendi lainnya.
3. Untuk mempertahankan fisiologis senormal mungkin
4. Untuk mengembalikan fungsi, minimal untuk perawatan
diri

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Item Kedokteran Fisik Terapi Obat Bedah
& Rehabilitasi (KFR)
Kekakuan otot/
kontraktur (reversible)
Ketegangan otot
Kontraktur Otot/Sendi
Parah-Lama Berdiri
Meningkatkan Sirkulasi
Penanganan Nyeri

Penanganan Inflamasi

Keterangan: Sangat Mungkin Tidak Mungkin

Mungkin Menu
Item Kedokteran Fisik Terapi Obat Bedah
& Rehabilitasi (KFR)
Atrofi otot dan kelemahan
secara menyeluruh

Penanganan pmbengkakan
Kelemahan fungsi
(bukan operasi)
Penunjang untuk tindakan
pencegahan
Penunjang rehabilitasi
Kontrol faktor penyebab

Keterangan: Sangat Mungkin Tidak Mungkin

Mungkin Menu
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‫ ٭‬Istirahat ‫ ٭‬Superficial Heat
‫ ٭‬Terapi manual: ‫ ٭‬Deep Heat
 Latihan ‫ ٭‬Short Wave Diathermy
 Pemijatan ‫ ٭‬Microwave Diathermy
 Manipulasi ‫ ٭‬Ultrasound Diathermy
 Relaksasi ‫ ٭‬Cold
‫ ٭‬Terapi Mekanik ‫ ٭‬Vapocoolant Spray
‫ א‬Traksi : Cervical/Lumbal ‫ ٭‬Ice Packs
‫ ٭‬Ice Massage
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‫ ٭‬Ultrasound-Phonophoresis
‫ ٭‬Iontophorosis
‫ ٭‬Transcutaneous Electrical
Nerve Stimulation (TENS)
‫ ٭‬Laser (Low) Therapy
‫ ٭‬Hydrotherapy
‫ ٭‬Joint Protection

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‫ ٭‬Recreational Exercises
‫ ٭‬Supports-Braches, Splints, Strapping, and
Assisitive Devices
‫ ٭‬Occupational Therapy

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♥ Istirahat
♥ Istirahat Lokal
♥ Istirahat Sistemik
♥ Istirahat Jangka Pendek
♥ Latihan
♥ Tujuan :
1. Meningkatkan dan Mempertahankan LGS
2. Pengurangan dan penguatan otot
3. Meningkatkan daya tahan statik dan dinamik
4. Mengurangi pembengkaan persendian
5. Membuat fungsi sendi menjadi lebih baik secara
biomekanik

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 6. Meningkatkan densitas tulang
7. Meningkatkan fungsi-fungsi pada pasien secara
keseluruhan
♥ Metode :
1. Passive Exercise
2. Active Exercise
3. Strengthening Exercise
4. Endurance Exercise
5. Stretching Exercise
♥ Specific Exercise
♥ Massage

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♥ Manipulation
♥ Kontraindiksai Terapi, antara lain:
1. Tidak memiliki kemampuan manipulasi
2. Kekerasan pada tulang belakang
3. Infeksi atau inflamasi
4. Cauda equina syndrome
5. Myelopathy
♥ Traction
♥ Kontraindikasi:
1. Spinal infection eg tbc, osteomyelitis

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 2. Myelum compression
3. Malignancy
4. Severe osteoporosis
5. Pregnancy (pelvic traction)
6. Malignant hypertension
7. Unstable coronary heart disease
8. Very weak alderly
9. RA (cervical joint)
♥ Phonophoresis
♥ Iontophoresis

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♥ Heat Therapy
♥ Indikasi :
1. Tendon/muscle syndromes, regardless of etiology
2. Osteoarthritis of large and small joints
3. Chronic forms of arthritis
4. Chronic periarthropathies
5. Degrenerative disease of the spine
6. Ankylosing spondylitis (other than during flares)
♥ Kontraindikasi:
1. Umum : edema, heat disorders, tumors, etc
2. Spesifik : acute arthritis, vasculitis, active osteoarthritis

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♥ Infrared Lamp
♥ Hydrocollator Hot Packs
♥ Melted Paraffin/Paraffin Bath
♥ Moist Air
♥ Shortwave Diathermy (SWD)
♥ Microwave Diathermy (MWD)
♥ Ultrasound Diathermy (UWD)

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♥ Terapi Dingin
♥ Indikasi :
1. Indikasi absolut pada Terapi Dingin:
1. All acute forms of arthritis (termasuk infeksi arthritis)
2. Acute gout
3. Active OA
4. Acute periarthropathy of the shoulder
5. Acute bursitis and epicondylitis
6. Acute post-trauma on muscles, joints and ligaments
7. Myalgia, especially myofascial trigger point syndrome

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2. Terapi Dingin direkomendasikan untuk:
1. Sub acute arthritis, bursitis, epicondylitis
2. Sub acute and chronic periarthropathy of the shoulder, less
often in osteoarthritis in major joints
3. Chronic tendinitis
4. Shoulder-hand syndrome, stage I
5. Postoperative cases after joint and tendon surgery and
discoperations
6. Sub acute post-trauma
7. Joint and spinal stiffness
3. Terapi Dingin secara umum tidak direkomendasikan:
1. Scleroderma
2. Ankylosing spondylitis

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 4. Kontraindikasi Terapi Dingin :
1. Raynaud’s disease
2. Vasculitis
3. Urticaria from exposure to cold
4. Sensitivity to cold
5. Severe “cold pressure” reaction
6. Paroxysmal cold hemoglobulinemia
7. Cold agglutinin disease
8. Pronounced cryoglobulinemia
9. Kidney and bladder disease
10. Severe cardiovascular disease

♥ Aquatic Therapy / Hydrotherapy

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♥ Laser Therapy
♥ TENS
♥ Indikasi :
1. Respon yg Paling Baik : ~ Neurogenic pain of peripheral
nature
~ Post-operative pain
2. Respon Sedang : ~ Musculoskeletal pain
3. Respon yg Buruk : ~ Central pain
~ Psychogenic pain
Kontraindikasi absolut : Cardiac Pacemaker

♥ Terapi Rekreasi

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♥ Alat bantu seperti Brace, Splints, and Penunjang
♥ Crutches
♥ Canes
♥ Walkers
♥ Wheelchairs
♥ Braces
♥ Splints
♥ Special Shoes
♥ Strapping and Bandaging

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♥ Joint Protection
♥ Guiding principles of joint protection :
1. Avoid positions that cause deformity
2. Avoid sustained positions
3. Use the strongest joint for heavy work
4. Sufficiently frequent rest periods
5. Use joints to the greatest mechanical advantage
6. The patient must be taught to respect pain
7. The therapist teaches the patient the use of assistive
devices for self-care and homemaking activities

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8. The arthritic patient’s home can be made safe by the addition
railings at stairways, removal of heavy managed latches on
doors and cabinets, and arrangement of furniture and work areas
for ease of movement and function
9. To maintain muscle power and prevent deformity, the patient
learns methods of using the muscle that maintain joint ROM,
strength, coordination, and body aligment.
As a rule, the following sports are contra indicated in
rheumatic disease :
Boxing, wrestling, and martial arts
Weight lifting
Sport with a high risk on injury
Sports requiring extreme stamina
Playing sports under unfavorable climatic conditions

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Tujuan utama penunjang pada kasus rematik:
Maintenance of function
Joint mobilization without exercise load-bearing
Reduction of muscle strength
Prevention of muscular athropy and postural defects
Prevention of osteoporosis and osteoarthritis
Maintenance of general fitness
Enjoyment of physical exercise and restoration of self-
confidence

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Occupational Therapy
The goal of occupational therapy
1. To alleviate functional impairment
2. To increase the patient’s independence (through self-help
training and the use of aids)
3. To improve the patient’s fitness for work (including training
for house work and adaptation of work place)
4. Instruct patient in joint protection techniques
5. Vocational counseling
Untuk meningkatkan prospek kerja pasien, terapi
kerja memfokuskan pada :
1. Latihan pada Tempat Kerja
2. Adaptasi Tempat Kerja
3. Penyediaan Bantuan

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A. Main goals of Physical Therapy :
A. Relief of pain
B. Suppression of inflammation
C. Prevention and correction of contracture/increasing
range of motion (ROM)
D. Maintaining or increasing muscle strength
E. Maintaining or increasing muscle endurance or
cardiopulmonary endurance
F. Improving coordination
G. Relaxation of circulation
H. Proper gait training

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B. Modes of action
A. Triggering of short-term reactions (Immediate
effects)
B. Triggering of long-term regulatory processes
(adaptation)

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