How To Find & Fix Musculoskeletal

Property of dr. Pagan Pambudi, M.Si, Sp.S.
HOW TO FIND & FIX

MUSCULOSKELETAL
ORIGIN OF BACKPAIN
Pagan Pambudi
SMF Neurologi FK UNLAM/RSUD Ulin Banjarmasin
Epidemiology of Backpain
Indian Journal of Occupational and Environmental Med

Vol. 15, No. 2, May-August, 2011, pp. 59-63
What Physician thinks

about Backpain
Patophysiology
Nerve Compresion
Vertebrae pathology
Kidney & Organs problems
SARAF KECEPIT !!
The Fact and What expert

says
56% of adults have disc bulging
MRI scans show that between 20% & 35% of
working age adults have asymptomatic disc
herniation
There is lifetime incidence of 2% for symptomatic
disc herniation
80% of general population will experience back
pain but only 2-3% will have sciatica
Most cases of back pain aren't caused by serious
damage or disease but by minor sprains, strains or
injuries, or a pinched or irritated nerve.
Our Traditional ApproachProperty

to of dr. Pagan Pambudi, M.Si, Sp.S.
Patient
with Chronic Backpain
Whats the results

The Backpain softenBut:
I cant works because Im to sleepy

I feel clumpsy in the morning can not work
The headache come when the drug goes
NSAIDs side effects:
Cardiovascular risks
GI effects
Drugs overuse
Transquilizer effect
Dependency or abuse
To expensive..I can not continue
There is no choice, You should

undergo spinal surgery
UppsIm afraid doc, My

neighbor did spinal surgery last
month and he is paralyzed now,
I dont have money doc, do
BPJS cover it thoroughly??
The Fact is spinal surgery rarely needed
What next we usually do

Ok..its up to youtake your pills at your own
risks..continue your life
Refers to
Pain Specialist Physician
Rehabilitation
Complimentary Alternative Medicine
What are Usually Forgot to

treat adequately in Backpain
Muscle stiffness & Trigger point
Patient posture
Sedentary lifestyle
Working behavior and environment
Diet
Muscle accounts for 50% of

human body mass, and so
most human pathological
conditions involve soft
tissue dysfunction, whether
in the case of physical
injuries such as muscles
damaged by overuse in daily
life or in sporting activity, or
in cases like Parkinsons
disease, drug addiction,
stroke, or cancer.
Muskuloskeletal influence in
Backpain
PAIN In the Muscle

Muscle bands are usually pain-free, but can
become tender and painful, possibly by
compressing intramuscu-lar nociceptors or
microneuromas Focal areas of tender-ness
and pain are often referred to as "trigger
points".
What is Trigger Point

A trigger point (TrP) is a focal area of
hyperirritability that is locally sensitive to pressure
and can refer symptoms (usually pain) to other
areas of the body
located within a taut band of skeletal muscle tissue
TrP Patophysiology
Stretch The Muscle usually

Resolve the Problems
Stretch Technique
Trp injection/Dry needling
Rehabilitation device
Muscle relaxan is not effective sometimes
harmfull
NSAID Helps but have limitation
Myofascial Dx
1-2
Take a carefull history

Find Biomechanical injury
3-4
Palpate a taut band

Identify a tender nodule
5-6
Identify patient pain recognition

Identify pain in ROM
Myofascial Dx
7-8
Identify LTR
Identify refered pain pattern
9-10
Identify muscle weakness

Corelate with Neurologic & orthopedic exam
11
Diagnosis made
How to Fix?
Find which muscle involve
Find the Trigger Point
Find the problems and correct it
Bad posture
Works environment
Habit
Sleep disorders
Obesity
Deactivate trigger
Stretch
Strengthen
Finding the Trigger

Palpation is important
Do not focus on area noted by patient, It could be
only a refered area not the muscle has trigger
Knowledge of refered pattern for each muscle
trigger is important
Trigger point confirmation

A nodul in taut band that:
Elicited pain when pressed, referred to another area
LTR observed when needling
Grityhard on needling
Palpation Technique
Pincer palpation
Flat palpation
Identify the Problems and

Fix
Culture effect on Posture
Common Trigger point in

Backpain
Quadratus Lumborum (QL)

Multifidus (Mfd) & erector Spinae
Pyriformis (Pr)
Gluteus Medius an external rotator complex (GM)
Tensor Fascia Latae (TFL)
First Correct
the Posture
Posture Correction
Lets check Our Posture

Stand tall with your feet a comfortable ten inches
apart
your toes pointing straight forward.
Put your hands on buttocks and tighten buttocks
Move hands to lower stomach muscles and suck in
stomach muscles.
Move hands up to lower rib cage, stretch up spine
and lift rib cage up.
Move hands to upper chest; lift chest up
Lets check Our Posture

Move hands to shoulders; lift them up and slightly back
Put right hand under chin and lift chin up
Now line body up straight, nose plumb-line to belly
button
drop hands heavy to sides, swinging them
easily back and forth
Look in the mirror to see if the shoulders are level. You
may have to lift one shoulder up a little to equalize and
level them.
The Simple Posture Principle

Stand Tall
Sit Tall
Walk Tall
Stretching
stretching is a method of physical bodywork
that lengthens and elongates soft tissues:
Muscle
Tendon
ligamen
Joint capsule
the client's body is moved into a position that
creates a line of tension that pulls on the target
tissues, placing a stretch upon them
Stretching
Stretching is done because soft tissues may increase in
tension
and become shortened and contracted.
Shortened and contracted soft tissues resist
lengthening and limit mobility of the joint that they
cross
If the stretch is effective, the tissues will be lengthened.
How to Stretch
(Learn from Trapezius)
Warmed up
recall the actions that were learned for the
target muscle,
the right upper trapezius, given that its actions are extension, right lateral
flexion, and left rotation of the neck at the spinal joints.
do the opposite of one or more of its actions.

flexion, left lateral flexion, and/or right
rotation of the head and neck at the spinal joints.
never be done too quickly; stretching should

always be done slowly and rhythmically.
How to Stretch
(Learn from Trapezius)
The principle awareness through movement should
be considered
always without pain
Hold for 10 30 second, can be adjusted wisely,
Repeat 3 times
Or Hold for 3 second..repeat 10 times
Imprudent stretching may not

only set back the progress of the client's
treatment program but may also cause
damage that is difficult to reverse.
Lets Fix The Back

Pain
Symptoms of QL Problems
Persisten deep aching in the rest
excruciating in the unsupported upright position and in sitting or
standing that increases
weight bearing or requires stabilization of the lumbar spine.
A minimal movement of the lower part of the torso may precipitate a
burst of sharp pain with a knifelike cutting quality,
Painfull when:
restrict forward bending;

turning or leaning to the opposite side and
climbing stairs
Rolling onto either side from the supine position is painful and difficult
How to Find QL
How to Stretch
See QL Stretch Video
Symptoms and Sign

restlessness and
discomfort
when sitting,
lateral rotation of the thigh at the hip joint resulting in turn-out of
the foot,
Restricted medial rotation of the thigh at the hip joint, and

sacroiliac joint dysfunction
are often incorrectly assessed as
sacroiliac joint dysfunction, herniated disc compression
upon spinal nerves L5 or SI ,
Piriformis Trp Refered Pattern
HOW TO FIND ?
Piriformis Stretch
See the Pr Stretch Video
Sleep postition
Erector Spinae, Multifidus
Symptom & Sign

Deep persisten low back pain
Reduced back ROM
Vertebral alignment problems
Paraspinal spasmcoccydynia
How to Stretch
Iliopsoas
Symptom & Sign

Back pain
Groin pain
Increased hyperlordosis of lumbar spine
Pain prominent in lying to sitting up
Pelvis asymetri
How to Find
How to Stretch
Get your back pain free
You will be
healthier.
younger,
stronger,
happier
and life
longer

How To Find & Fix Musculoskeletal

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

How To Find & Fix Musculoskeletal

Uploaded by

Copyright:

Available Formats

Property of dr. Pagan Pambudi, M.Si, Sp.S.

HOW TO FIND & FIX

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Indian Journal of Occupational and Environmental Med

What Physician thinks

Kidney & Organs problems

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

The Fact and What expert

Our Traditional ApproachProperty

Whats the results

I cant works because Im to sleepy

To expensive..I can not continue

Property of dr. Pagan Pambudi, M.Si, Sp.S.

There is no choice, You should

Property of dr. Pagan Pambudi, M.Si, Sp.S.

UppsIm afraid doc, My

The Fact is spinal surgery rarely needed

Property of dr. Pagan Pambudi, M.Si, Sp.S.

What next we usually do

Property of dr. Pagan Pambudi, M.Si, Sp.S.

What are Usually Forgot to

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Muscle accounts for 50% of

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

PAIN In the Muscle

Property of dr. Pagan Pambudi, M.Si, Sp.S.

What is Trigger Point

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Stretch The Muscle usually

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Take a carefull history

Palpate a taut band

Identify patient pain recognition

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Identify muscle weakness

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Finding the Trigger

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Trigger point confirmation

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Identify the Problems and

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Culture effect on Posture

Property of dr. Pagan Pambudi, M.Si, Sp.S.

Common Trigger point in

Quadratus Lumborum (QL)

Property of dr. Pagan Pambudi, M.Si, Sp.S.