PAPERS ON MUSCULOSKELETAL

DISORDER

Arranged By:
Name : Septia Eka Pertiwi
NIM : P07220118 1526
Class : 3B Nurse
Lecturer : Wahyu Eny Setyohari, M.Pd

MINISTRY OF HEALTH OF THE REPUBLIC OF INDONESIA

TANJUNGPINANG HEALTH POLYTECHNIC
NURSING DIII STUDY PROGRAM
2021
 FOREWORD

           With praise and gratitude for the presence of Allah SWT, whose blessings
and mercy the author can finish this paper entitled "Paper On Musculoskeletal
Disorder" can be completed properly.
We realize that this paper is not yet optimal and is far from perfect.
Therefore, we look forward to the input, criticism and suggestions of readers for
the perfection of this paper.
Finally, I hope that all parties' good deeds are accepted by Allah and get a
reply from him with the appropriate reward and I hope this paper is useful for us
and also for all readers, Ameen.

Tanjungpinang, 19 Maret 2021

Author

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 TABLE OF CONTENTS

FOREWORD..........................................................................................................i
TABLE OF CONTENTS.....................................................................................ii

CHAPTER 1 INTRODUCTION
1.1 Background.......................................................................................................1
1.2 Formulation of the problem..............................................................................2
1.3 Destination........................................................................................................3
1.4 Benefits.............................................................................................................3

CHAPTER II INTRODUCTION
2.1 Definition of Musculoskeletal Disorders (MSDs)............................................3
2.2 Causes ..............................................................................................................3
2.3 Symptoms.........................................................................................................4
2.4 Types of MSDs.................................................................................................5
2.5 Panthophysialogy of MSDs..............................................................................6
2.6 Measurement of Musculoskeletal Disorders.....................................................8
2.7 Stretching exercises..........................................................................................8

CHAPTER III CLOSING

3.1 Conclusion.......................................................................................................16
3.2 Suggestion.......................................................................................................17

DAFTAR PUSTAKA..........................................................................................18

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iii
 CHAPTER I
INTRODUCTION

1.1 Background
Musculoskeletal Disorders (MSDs) are disorders of the skeletal muscles
caused by muscles receiving static loads repeatedly and continuously for a
long time and will cause complaints in the form of damage to joints, ligaments
and tendons (Rizka 2012, quoted in Lestari 2014).
According to the Occupational Health and Safety Council of Ontario
(OHSCO) in 2007, musculoskeletal complaints are a series of pain in the
tendons, muscles, and nerves. Activities with a high repetition rate can cause
tissue damage, which can cause pain and discomfort in the muscles.
Musculoskeletal complaints can occur despite light force and satisfactory
work posture.
MSDs occur as a result of a combination of factors. The risk factors
usually appear to contribute to the emergence of MSDs (Kuntodi, 2008 in
Bukhori, 2010). According to Hernandez and Peterson 2013 (in Mayasari et
al, 2016) grouping the risk factors of MSDs into three major groups, namely
biomechanical factors including body position while working, force / load,
frequency, duration, and exposure to vibrations. Second, individual factors,
namely age, gender, Body Mass Index, smoking habits, exercise habits and
years of service. Finally, psychosocial factors.
1.2 Formulation of the problem
Based on the above background, the formulation of the problem in this study
is as follows:
1. How to determine the level of risk of injury to skeletal muscle disorders in
work postures that focus on the upper body?

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 2. How to determine the risk factors for muscle injury with differences in the
upper body area?
1.3 Destination
The objectives of this study are as follows:
1. Identify the level of risk of injury to skeletal muscle disorders in work
postures that focus on the upper body.
2. Identify risk factors for muscle injury with differences in upper body areas.
1.4 Benefits
The benefits that can be taken from this research are as follows:
1. For workers, later workers can take preventive measures in work postures
that are at risk of muscle injury, so as to provide comfort while working.
2. For business owners, this research is expected to help determine the risk of
injury at work and assist in minimizing the risk of work posture in order to
create comfort while working.
3. For researchers, as a means of applying the knowledge that has been gained
during lectures. Add insight, knowledge and understanding the real conditions
in the field related to ergonomics and good work posture.

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 CHAPTER II
LITERATURE REVIEW

2.1 Definition of Musculoskeletal Disorders (MSDs)

Musculoskeletal disorders are disorders of the skeletal muscles caused
by muscles receiving static loads repeatedly and continuously for a long
time and will cause complaints in the form of damage to joints, ligaments
and tendons (Rizka, 2012).
According to the Occupational Health and Safety Council of Ontario
(OHSCO) in 2007, musculoskeletal complaints are a series of pain in the
tendons, muscles and nerves. Activities with a high repetition rate can
cause tissue damage, which can cause pain and discomfort in the muscles.
Musculoskeletal complaints can occur despite light force and satisfactory
work posture.
Musculoskeletal complaints or skeletal muscle disorders are damage to
muscles, nerves, tendons, ligaments, joints, cartilages, and invertebral
discs. Damage to muscles can include muscle tension, inflammation and
degeneration. While damage to bones can be in the form of bruises, micro-
fractures, fractures, or twists (Merulalia, 2010).
2.2 Causes
The danger of musculoskeletal disorder can be caused by the work
done or the way it is done which can increase the risk of contracting MSDs
in a worker. The main causes of work-related MSDs are load, static or
awkward posture and repetitions (Sander et al, 2004).
a. Load / strength
Load refers to the amount of work put in by the muscles, and the
amount of stress on the body parts as a result of the different demands
of work. All job duties require workers to use muscles, but when the
job requires them to exert too high a level of force to any particular
muscle, it can damage the muscles or tendons, joints and other soft
tissues of the organs used.

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 This damage can occur from a single movement or action that requires
the muscles to lift very heavy weights. However, in general, the
damage is generated when the muscles exert moderate to high levels of
load repeatedly, for a long duration, and / or when the body is in an
awkward posture.
Some work tasks require high strength on different parts of the body.
For example, lifting heavy weights away from the body increases the
pressure (compressive force) on the spinal discs and the spine in the
lower back. This can potentially damage the disc and vertebrae.
b. Fixed (static) or awkward posture
Posture is the position of various parts of the body during activity.
For most joints, a neutral or good posture means that the joint is used
with a center of range of motion. The further you move towards both
ends of the series of motion, or farther from a neutral stance, the more
awkward the posture will be so that there will be tension in the
muscles, tendons and ligaments around the joints. In several batik
workers, many work positions move away from the center of motion or
do not work in a neutral position such as when doing canting on the
cloth and when doing stamping on printed batik because they have to
manually reach all parts of the fabric which forces the worker to be in
a too bent position and so on.
c. Repetition / repetition
The risk of MSDs increases when the same part of the body is used
repeatedly, with little pause or opportunity to rest. Very repetitive tasks
can cause fatigue, tissue damage, and ultimately pain and discomfort.
This can happen even if the pressure is low and the work posture is not
too awkward. With repetitive tasks, it's just not important.
2.3 Symptoms
Here are some common symptoms that mark the occurrence of MSDs
based on their stage according to Oliviera:

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 1. Stage I
Tired, uncomfortable, localized pain that worsens at work and
improves at rest.
2. Stage II
Pain is persistent and more intense, followed by paresthesia and a
burning feeling. Worsens at work and daily activities.
3. Stage III
Persistent and severe pain followed by decreased muscle strength
and control of movement, edema and paresthesia.
4. Stage IV
Pain is strong and persistent. (de Carvalho et al., 2009).
According to other literature sources, the symptoms of musculoskeletal
complaints have three stages, namely:
1. Stage I
Pain or aches and fatigue during working hours but these symptoms
usually disappear after work time (overnight). Has no effect on
performance. This effect can be recovered after resting.
2. Phase II
These symptoms persist after one night after work. There's no way
to be disturbed. Sometimes it causes reduced work performance.
3. Stage III
These symptoms persist even after rest, pain occurs when moving
repetitively. Sleep is disturbed and it is difficult to do work,
sometimes not according to work capacity.
2.4 Types of MSDs
The types of musculoskeletal complaints include:
1. Neck pain, is a general description of symptoms affecting the neck,
increased muscle tension or myalgia, sloping neck or neck stiffness.
2. Back pain, is a term used for specific back pain symptoms such as
lumbar herniation, arthiritis, or muscle spasm. Back pain can also be
caused by muscle tension and poor posture while working.

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 3. Carpal Tunnel Syndrome, is a collection of symptoms that affect the
hands and wrists caused by irritation and the median nerve. This
situation is caused by repeated activities that cause compression on the
median nerve.
4. Thoracic Outlet Syndrome, is a condition that affects the shoulders,
arms and hands which is characterized by pain, weakness and numbness
in the area. Occurs when the five main nerves and the two arteries
leaving the neck are compressed. Thoracic outlet syndrome is caused by
repetitive movements with the arm up or forward.
5. Tennis Elbow, is an inflammatory condition of the extensor tendon, the
tendon that originates from the elbow of the forearm and runs outward
to the wrist. Tennis elbow is caused by repetitive motion and pressure
on the extensor tendons.
6. Low Back Pain, occurs when there is emphasis on the lumbar area,
namely L4 and L5. If during work, the body position is bent
forwardthere will be an emphasis on the dis.
2.5 Pathophysiology of MSDs
1) Pathophysiology of the Lower Back
Finding the cause of low back pain is admittedly very difficult, because
damage usually does not only occur in intervertebral disc problems. Some say
that the pain in the lower back originates from the apophysical joint. Common
causes include damage or irritation to the posterior ligaments and other soft
tissues, caused by mechanical trauma or degeneration of the bone structure.
Pressure on the nervous system around the lower back is also one of the
causes of pain (Bridger, 2003).
Symptoms of back pain include injuries to the back, a burning or aching
sensation, severe back pain, weakness in the legs. Acute back pain for less
than a month and chronic back pain for longer than three months. In acute
cases, back pain is rare and arise only in certain conditions such as standing
and sitting, or lifting. Pain occurs when doing light movements.
Prevention of complaints in the back can be done by exercising in the form
of jogging, cycling and swimming for about 30-40 minutes, done 3 times /
week, doing fitness so as to improve blood circulation and nutrition to all body
tissues.

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2) Pathophysiology of the Neck
The anatomy of the cervical spine starts at the tip of the skull. There are
seven vertebrae with eight pairs of nerves that make up these parts and
function to control the neck, arms and other upper limbs. The combination of
the seven vertebrae can firmly support the weight of the head. The pressure
that occurs in this part of the neck depends on the movement.
Neck disorders can occur due to abnormalities in the soft tissues in the
neck such as muscles, ligaments and nerves and can also occur due to areas
near the neck such as shoulders, upper limb organs or jaw. The pain that
occurs may not be related to the structure of the neck, but pain can occur due
to pain in other parts of the body that give it influence on the nerves around
the neck. Neck disorders are divided into two, namely regenerative /
inflammatory diseases and injury (Karuniasih, 2009).
3) Pathophysiology of the Upper Body (Shoulders, Hands, Elbows and
Wrists)
The pathophysiology of the upper body based on the damaged tissue is
divided into 5, namely:
1. Muscle Pain, this type of pain is caused by prolonged use of muscles or
repetitive movements. This causes the buildup of waste substances in the
form of lactic acid in the muscles.
2. Tendon Pain, usually occurs in activities with a high level of repetition.
This is because the increased blood supply occurs in the muscles, so that
the blood supply is directed to the muscles, while the blood supply to the
tendons and ligaments in the associated joints is reduced.
3. Bursitis, is a condition in which the bursa (a bag filled with viscous
fluid in the tissue that functions to protect muscles and tendons from bone
friction when the body moves) experiences inflammation due to excessive
movement.
4. Neuritis, is a symptom in which the nerves that supply or pass through
the muscles are damaged. This matter caused by repetitive motion and
static movement. Symptoms include a feeling of numbness or tingling.
5. Osteoarthrosis is a non-inflammatory disease characterized by
degeneration of the articular cartilage, hypertrophy of the bones and
changes in the synovial membrane. One of the causes is mechanical
trauma to the bones and muscles. The symptoms you feel are stiffness and
pain in the joints (Karuniasih, 2009).

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2.6 Measurement of Musculoskeletal Disorders
(Nordic Body Map)
Nordic Body Map (NBM) is a measuring tool used to determine
musculoskeletal disorders. Measurement of musculoskeletal disorder
through NBM can determine which parts of the muscles are experiencing
complaints, ranging from discomfort (mild pain) to extreme pain.
This instrument is issued by the Occupational Safety and Health
Administration (OSHA, 2004) and under occupational safety law. The
NBM method is a very subjective assessment method, meaning that the
success of the application of this method depends on the conditions and
situations experienced by workers at the time of conducting the research
and also depends on the expertise and experience of the observer
concerned. NBM is also one type of ergonomics checklist questionnaire.
The purpose of filling in the Nordic Body Map is to find out which parts
of the body of the worker feel sick before and after doing work at the work
station. This survey uses many answer options which consist of two parts,
namely a general and a detailed section. The general part uses the body
parts that are seen from the front and back. Respondents were asked to
provide a sign of the presence or absence of disturbance in that part of the
body (Lestari, 2014).
Nordic Body Map has 28 questions about the level of musculoskeletal
complaints from neck to toe. Each left and right side of the body has
different questions, so the whole body pain will be assessed carefully. In
NBM, there are four ranges of scores, namely one for not being sick, a
score of two for mild pain, a score of three for being sick, and four for
being very sick. After the questionnaire is filled in, the scores from each
question will be accumulated to determine the level of musculoskeletal
complaints suffered (Dryastiti, 2013).
2.7 Stretching Exercises
1. Definition of stretching exercises
Stretching is a form of stretching or stretching the muscles in each limb so
that in every sport there is readiness and to reduce injuries that are very
prone to occur (Wiguna, 2012).
Stretching is a muscle stretch that is needed and used for both healthy and
sick people to stretch, flex or increase the flexibility of muscles that are
considered problematic (Dewi, 2011).

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So it can be concluded that stretching or stretching exercises is stretching or
stretching the muscles that are needed in healthy or sick people to provide
flexibility or flexibility to muscles that are considered problematic.
Stretching or stretching, muscle tension decreases, the body feels more
relaxed, expands the range of motion, increases comfort, and helps prevent
injury (Anderson, 2008; 14).
2. Types of Stretching Exercises
The types of stretching include:
a. Active stretch
Active stretching is done using your muscles without getting help
from external forces. Active stretching is important because it actively
builds muscle flexibility, which has been found to have a higher
correlation with exercise performance than passive stretching. Active
stretching has the disadvantage that it can initiate the stretch reflex, it
may also be ineffective due to certain disorders in your body and also
injuries such as acute sprains, inflammation or fractures.
b. Passive stretching
Passive stretching is a stretching technique in which you are relaxed
and without contributing to the area of movement. Instead, external
forces can be generated by tools either manually or mechanically. The
advantages of passive stretching are:
a) This technique is effective when the agonist muscle (the main
muscle that plays a role in the movement that occurs) is too weak to
accept the response to the movement.
b) This technique is effective when attempts are unsuccessful to block
the tight muscles (antagonist muscles).
c) The direction of the length of time to stretch and its intensity can be
measured.
d) Can promote team cohesiveness when stretching is done together
with other athletes.
The downside of passive stretching is the risk of greater pain or injury
and stretch reflexes.
c. Static stretch
Static stretching is a stretching movement of the muscles that is
carried out slowly until tension occurs and reaches pain or discomfort in
the muscle. Henceforth, the position of the discomfort is maintained for
a while. The length of time to hold this uncomfortable position is 20-25
seconds. The goal of static stretching is to increase and maintain
flexibility (the elasticity of the muscles being stretched).

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 d. Dynamic stretch
Dynamic stretching is a stretching movement that is done by
involving the muscles and joints, this stretching movement is carried out
slowly and in a controlled manner with the base of the movement being
the base of the joint. The goal of dynamic stretching is to maintain and
increase flexibility in joints, tendons, ligaments and muscles. The
difference between dynamic and static stretching lies in the timing of the
movement and the targets that are applied in the exercise. Movement in
static stretching after achieving pain is maintained for some time,
whereas in dynamic stretching it is the opposite. That is, actively
stretched the area of motion of the joint being trained. The goal of static
stretching is flexibility (muscle elasticity), while dynamic stretching is
flexibility of the joints.

3. Benefits of Stretching Exercises

The stretching exercises that have been done will help increase
muscle flexibility. Not only that, according to Anderson, 2010 by doing
stretching exercises the body will get the following benefits:
1. Reduces muscle tension
2. Improve blood circulation
3. Reducing anxiety, feeling depressed, and fatigue
4. Improve mental alertness
5. Reducing the risk of injury
6. Make work easier
7. Integrate the mind into the body
8. Make you feel better.

4. Prosuder (SOP) Stretching Exercises

To produce a piece of batik cloth, it must go through a process consisting
of affixing the wax using a written canting or canting cap, for printed batik,
which is then carried out by giving the color through a process of immersion
in a dye liquid (Pradito, 2010). When carrying out the batik-making process,
the batik worker will use his body to carry out a number of workloads on the
spot. This allows workers to always be in a static attitude whether they are
always standing or sitting for a long time, therefore stretching exercises are
needed so that muscle tension does not occur due to the workload being
carried out.
According to Dewi (2011), below are the steps in doing stretching or
stretching:
1. Stretching No. 1: Hand Stretching
Hold your fingers firmly for 6 seconds and release. Repeat for 5-10
times. Stretching is useful for

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 relaxation of the muscles of your fingers and forearms. The muscles
involved are the muscles of your fingers, wrist muscles and muscles
of your forearm.
2. Stretching No. 2: Facial Stretching
Stretching is done by saying the letters A, I, U, E, O with an emphasis
on pronunciation, hold for six seconds and release. Performed 5-10
times. This stretching is useful for relaxing the muscles around the
face, cheeks, chin, jaw, lips and forehead.
3. Stretching No. 3: Shoulder Shrugging
This stretching is done by lifting your shoulders or shoulders slowly
upwards, in an upright sitting posture, hold for six seconds and release
slowly, repeat 5-10 times. Stretching is useful for relaxing and
stretching the muscles around the neck, upper shoulders and upper
back (shoulder blades). It is very useful for workers who sit for long
periods of time, for batik workers such as workers in the canting
section.
4. Stretching No 4: Shoulder Reraction
This stretching is done with both hands holding the back of the head,
slowly moving the arms backwards so that the two shoulder blades
are close to each other and hold for six seconds and release slowly,
repeat 5-10 time. This movement is useful for stretching the muscles
of the shoulder blades.
5. Stretching No. 5: Neck Side Bending
This stretching is done with both arms at the side, then slowly moving
the neck to one side of the right or left until the movement is
maximum or there is no movement anymore. The movement is held
for six seconds, repeat for 5-10 times. This movement is useful for
stretching the outer side neck muscles and shoulder muscles.
6. Stretching No 6: Neck Rotation
This stretching is done with both arms at the side of the body, then
neck movements by turning the neck to the right or left slowly until
the movement is maximum or there is no more movement, hold the
movement for up to six seconds and repeat for 5-10 times. This
movement is useful for stretching the side neck muscles.
7. Stretching No. 7: Neck Flexion
This stretching is carried out in an upright body position, arms on the
right and left side, neck movement bending down to the maximum
until you feel the pull of the neck muscles, hold for 6 seconds and
repeat 5-10 times. This movement serves to stretch the neck muscles
in the middle or fit in the nape of the neck.

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8. Stretching No. 8: Shoulder Adduction
This stretching is done with the position of the upper arm in a 90
degree position, after that tighten the upper arm of the body slowly
then bend your elbows slowly also adjusting to the position of the
bent arm, until you feel a pull on the side shoulder muscles, hold for 6
seconds then slowly release, repeat 5-10 times.
9. Stretching No. 9: Bilateral Shoulder Half Flexion
This stretching is done with both hands grasping each other, then
move the two hands upward until they are parallel to the face, then
turn the hands from clenching both of them to open both of them by
turning the hands, hold for six seconds, repeat 5-10 times. This
stretching involves the muscles of the upper and lower arms to the
hands.
10. Stretching No. 10: Bilateral Full Shoulder Flexion
This stretching is almost the same as bilateral half stretching, only the
shoulder movement is added to the top of the head, hold it for six
seconds, repeat 5-10 times. This stretching serves to stretch the
muscles of the entire arm.
11. Stretching No. 11: Shoulder Lateral Bending
Stretching is done with both hands back, one hand holding the elbow
of the other arm, after that Pull slowly until there is a pull on the
bottom side of your shoulder, hold for six seconds and repeat 5-10
times. This stretching functions to stretch the tricep muscles.
12. Stretching No 12: Hip Stretching
Stretching is done in a sitting or standing position. For a sitting
position, try to sit up straight and keep your knees at 90 degrees.
Raise your lower leg by bending your knee, bring it to your chest,
hold for six seconds, repeat 5-10 times. This stretching functions to
stretch the muscles of the lower thigh and buttocks muscles.
13. Stretching No 13: Illio Tibial Stretch
This stretching is carried out in a sitting upright position, one leg
folded over to the other leg, with the hand holding the knee on the
opposite leg, pulling the knee and the neck turning to the opposite
side of the leg that is pulled hold for six seconds and repeat 5-10
times. This stretching functions for the muscles on the side of the
outside of your thigh.
14. Stretching No 14: Calf Stretching
This stretching is done in a standing position. With one side of the leg
at the knee bent and the other leg straight back, and the foot of the leg
that is straight back and tread straight forward, you will feel the pull
on the side of your calf muscles hold for up to six seconds and repeat
5-10 times. This stretching functions to stretch the muscles in your

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 calves. This stretching can be done in a sitting or standing position.
By sitting or standing upright body position, arms in a backward
position, grasping each other. After that, turn your palms back at once
and then push them down until the entire inside of your arm is pulled,
hold it for six seconds, repeat 5-10 times. This stretching works for
the muscles in your forearm and upper arm.
5. Matters that need attention
When doing or after doing stretching exercises, there are a number of
things you need to pay attention to, including:
1. Always stretch within the limits that make you comfortable, do not get
to the point of pain.
2. Breathe slowly and regularly (under control), don't hold your breath
3. Enjoy time stretching. Gentle, long-lasting stretches reduce unwanted
muscle tension and firmness
4. Don't compare yourself with others. We are all different. Comparisons
lead to over-stretching.
5. If you stretch correctly, the tension will feel less when you hold the
position
6.Any stretch that increases in intensity or produces pain indicates that
you are doing excessive stretching - drastic stretching (Lestari, 2014).

6. Stretching Exercises Affect Musculoskeletal Disorder

Stretching or stretching exercises have physiological principles that can
affect muscles, namely:
a. Mechanical response
The mechanical response of a muscle to stretch depends on the
myofibrils and sarcomere of the muscle. Each muscle fiber is
composed of several muscle fibers. One muscle fiber consists of
several myofibrils. Myofibrils are composed of several muscle
sarcomeres that lie parallel to muscle fibers. Sarcomere is the
contractile unit of myofibrils and consists of overlapping filaments of
actin and myosin. Sarcomeres give muscles the ability to contract and
relax and have the ability to elastic when they are stretched. When the
muscles are given stretching exercises, the initial lengthening occurs
in the sarcomere and the tension increases drastically, then when the
stretching force is released each sarcomere will return to its position.
lengtht. The tendency for the muscle to return to its resting length
after stretching is called elastic.
b. Neurophysiological Response
Depends on the muscle spindle and golgi tendon. The muscle
spindle is the main sensory organ and is composed of intrafusal
organs that are located parallel to the ectrafusal fibers. The muscle
spindle monitors the speed and duration of the stretch as well as the

13
feeling of changes in muscle length. In the muscle spindle there are
primary afferent nerves type Ia and secondary type II and synapses
with alpha and gamma motor neurons sequentially and facilitates the
contraction of extrafusal and intrafusal fibers. The golgi tendon and
musculotendineus junction enclosing both ends of the extrafusal and
intrafusal fibers are very sensitive to stretching both passively and
actively.
Stretching can cause an increase in range of motion (ROM) by
17% and a decrease in musculotendinous unit (MTU) stiffness by
47% in a study of eight male subjects who did passive stretching for
one minute. This is due to changes in the nature of the connective
tissue in muscles (Morse, 2008 in Lestari, 2014).
Skeletal muscle contracts when there is stimulation, the energy
of contraction is met by the breakdown of adrenosin tripospate (ATP)
and calcium activity, sufficiently oxygenated nerve fibers contract
vigorously compared to less oxygen. Movement occurs as a result of
the muscles pulling the bones that function as the legs and joints
working as hinges, the skeletal muscles contain many vascular
structures.
When there is tension in the muscles due to excessive and
continuous activity, the pulse will be depressed. Blood circulation to
the tissues will be hampered, including the transportation of oxygen
and nutrients, so there will be an anaerobic mechanism that produces
lactic acid. This accumulation of lactic acid will cause muscle fatigue
which is one of the musculoskeletal disorders. (wolf, et al, quoted in
Lestari, 2014)
Stretching exercises are a form of exercise that stimulates the
work of the skeletal muscles (striated or striated) contained in the
skeletal system which provides control of movement, maintains
posture and generates heat. So it is hoped that blood circulation will
be good and the transportation of oxygen and nutrients will be
adequate.
Muscles are protected by a mechanism called the stretch reflex.
Every time you stretch the muscle fibers it gets far, the nerve reflex
will respond by sending a signal to the muscle to contract, this will
protect the muscle from injury. (Anderson, 2008: p. 15).
Muscle contraction is influenced by several factors, one of
which is the length of the myofibrils (muscle fibers) before
contraction and stretching can reduce the tension of the tendons,
causing increased muscle compliance so that it is relatively shorter
than not stretching (Kubo, 2001 in Lestari, 2014).
Physical exercise can maintain joint flexibility, improve or
increase muscle strength, improve muscle endurance and improve

14
 “Cardio Pulmonary Endurance” and physical exercise in the form of
stretching can increase muscle flexibility, facilitate vascularization
and reduce spasm (MOH RI, quoted in Lestari, 2014).

20 vocabulary words :
1. Danger : Bahaya
2. Load : Beban
3. Fixed : Diperbaiki
4. occurrence : Kejadian
5. muscle spasm : Kejang otot
6. neck stiffness : : Leher kuku
7. Thoracic Outlet Syndrome : Sindrom outlet dada
8. Lower Back : Punggung bawah
9. Upper Body : Tubuh bagian atas
10. Elbows : Siku
11. Wrists : Pergelangan Tangan
12. Bursitis : Radang kandung lendir
13. Measurement : Pengukuran
14. stretching exercises : Latihan peregangan
15. increases comfort : Meningkatkan kenyamanan
16. Stretching : Peregangan
17. Calf : Betis
18. Breathe : Bernapas
19. Gentle : Lembut
20. contraction : Kontraksi

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 CHAPTER III
CLOSING

3.1 Conclusion
Based on the objectives and results of this study regarding the Attitude
Picture Work and Complaints of Musculoskeletal Disorders in Roof Tile
Making Workers at Klaci Hamlet, Margoluwih, Seyegan, Sleman, the
conclusion is as follows following:
1. Description of the risk of working attitudes to workers, namely 6
respondents or 9.8% of workers with high work attitude risk and as many
as 55 respondents or 90.2% of workers with a very high risk of work
attitude.
2. Description of the risk of musculoskeletal disorders as many as 5
respondents or 8.2% of workers with a high risk of musculoskeletal
disorders and complaints as many as 56 respondents or 91.8% of workers
with a risk of complaints musculoskeletal disorders.
3. There is a relationship between the risk of work attitude and the risk of
musculoskeletal complaints disorders in tile making workers in Klaci
Hamlet, Margoluwih, Seyegan, Sleman with a p value of 0,000.
4. There is a relationship between individual factors, namely age and years
of service with risk complaints of musculoskeletal disorders in tile making
workers in Dusun Klaci, Margoluwih, Seyegan, Sleman with each p value
0.001 and 0.043.
5. There is a relationship between work factors, namely work attitudes,
repetitive activities and length of work with the risk of musculoskeletal
disorders complaints in workers roof tile making in Klaci Hamlet,
Margoluwih, Seyegan, Sleman with each p value 0.000; 0.002 and 0.003.
6. There is no relationship between individual factors, namely gender,
smoking habits and physical fitness with a risk of musculoskeletal
disorders complaints roof tile workers in Klaci Hamlet, Margoluwih,
Seyegan, Sleman with each p value of 0.274; 0.08 and 0.763.

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3.2 Suggestion
Suggestions that can be given in relation to this research are as follows:
1. For Workers
We recommend that workers take the time to stretch the muscles
(muscle relaxation for example by extending legs, arms, back and others)
at rest when making tiles so that muscles are not tense and musculoskeletal
complaints disorders can be reduced.
2. For Business Owners
It is better to pay more attention to the workers by reminding them to
take a break or just to relax the muscles, so that workers do not experience
excessive muscle pain.
3. For Other Researchers
a. For future researchers, a musculoskeletal assessment can be
performed disorders with a more objective method of diagnosis or
testing lab.
b. It is hoped that future researchers can examine environmental factors.
c. For future researchers to add questions about since
what age did you start smoking so you may be biased for how long
smoking can be minimized.
d. For a history of musculoskeletal disorders it should be strengthened
with the employee's medical record.

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