EFFECTIVENESS OF HOLISTIC SELF CARE TO OVERCOME WORK-

RELATED SKELETAL MUSCLE DISORDER IN PALM WORKERS USING

HARVASTING TOOL DODOS: A SYSTEMATIC REVIEW

Raihanatu Binqalbi Ruzain, Siti Umairah, Rosyida, Vanessa Adela Putri

Psychology Study Program, Faculty of Psychology, University of Islamic Riau

ABSTRACT

Background: Oil palm Dodos workers manually harvest the palm fresh fruit which can cause work
related musculoskeletal disorders (WMSDS). Holistic self-care by combining stretching exercises and
breathing techniques is believed to be able to overcome work related skeletal muscle disorders. The
study aimed to conduct a systematic review of research articles identifying the effectiveness of holistic
self-care in overcoming work-related skeletal muscle disorders in Riau palm Dodos workers, and
identifying the frequency of implementing holistic self-care.
Subject and Method: A systematic review was conducted through electronic database, including
Google scholar, Science Open, and ScienceDirect. The keywords used were "musculoskeletal disorders"
AND "stretching exercise" AND "breathing technique". The articles were collected between 2009 to
2020.
Results: The article analysis used in this study were 4 articles. The effectiveness of holistic self-care
(stretching exercise and breathing technique) showed 30 minutes of exercise per day for 5 days per
week for a period of 6 weeks can overcome the skeletal muscle disorders caused by work related neck,
shoulder, upper, and low back pain in workers.
Conclusion: Holistic self-care (stretching exercise and breathing technique) overcomes work related
musculoskeletal disorders in workers.

Keywords: work related musculoskeletal disorders, holistic self-care.

Correspondence:
Siti Umairah. Psychology Study Program, Faculty of Psychology, University of Islamic Riau,
Pekanbaru, Riau, Indonesia. Email: pujaumayrah@gmail.com. Mobile: +628 2250453378.
Workers who harvest palm fresh fruit
BACKGROUND bunches are known as dodos oil palm work-
Riau Province, cannot be separated from the ers. The dodos oil palm worker cannot work
existence of oil palm plantations. Although directly to the fresh fruit bunches because
this oil-rich area has many commodities in large palm fronds block it and irregular
coconut, sago, rubber, and cocoa, oil palm arrangement, and the height of this tree can
itself is still the prima donna among all the reach 5 meters or more from the ground.
commodity rows. No wonder oil palm in Riau Harvested fresh fruit bunches can weigh up
has now reached 40% of production at the to 50 kg. (Tansala et al., 2017). The work of
national level, which has a total area of harvesting fresh fruit bunches causes skeletal
around 2.3 million hectares. In 2010, based muscle disorders, known as work-related
on data from the Riau Plantation Office, the work-related musculoskeletal disorders
number of workers on oil palm plantations (WMSDS). Skeletal muscle disorders due to
was nearly 1.19 million. Each plantation work arise due to the worker's non-ergo-
industry had 688 thousand workers (Bumn, nomic body position (such as the position of
2012). the head looking up, hands and arms above

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the shoulders, body bending and the waist
twisting along the waist axis), repetitive
harvesting movements, and working 10 hours
per day for 6 hours a day every week. (Pri-
yambada, 2018).
The results showed that 98 of the
harvesters and 19 of the oil palm plantation
loaders at PT. X South Sumatra. Having a
calculation of the level of risk caused by
harvesting work (harvesting and loading) has
a high categorization (score 8-10), where the
REBA score for the work of cutting fronds
and FFB: 9, putting FFB into the rickshaw: 9,
pushing the rickshaw containing FFB to the
TPH: 8, and loading FFB onto the truck: 10.
Complaints of MSDs were felt by work-
ers on the neck and lower back as many as 98
workers. Meanwhile, the body position that
became the next complaint was on the right
shoulder, right and left wrist felt by 95 work-
ers, and at least on the buttocks (67 workers).
The impact of MSDs itself is that most work
activities are slightly disrupted (97.4%), and
a small proportion cannot work (2.6%). The
research data analysis showed that the
variables associated with MSDs complaints
were the type of work (harvesting and load-
ing) (OR= 3.44; 95% CI= 1.25 to 9.44), age
(OR= 2.56; 95% CI= 1.00 to 6.55), and length
of work (OR= 2.75; 95% CI= 1.18 to 6.41)
(Hendra, 2009).
WMSDs is a disorder that occurs in the
system musculoskeletal caused by work and
work performance, such as posture that is not
ergonomic, workload, work duration, fre-
quency, and factors from the individual, such
as age, years of work, and smoking habits
(Annisa et al., 2013). According to WHO,
other factors can interfere with health, occu-
pational or biomechanical factors, and psy-
chosocial factors (Cho, 2016).
Injuries to bones are in the form of bru-
ises, microfractures, or bent bones (Setyanto,
2015). MSDs can also occur due to two causes
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constant injury and fatigue caused by the fre-
quency and long duration of muscle lifting
and injuries that occur suddenly due to stre-
nuous activity or unpredictable movements.
The process of preventing and correcting
MSDs complaints is fundamental in reducing
fatigue in workers to guarantee workers'
health and safety and increase productivity in
a company, especially at PT. Oil Palm Plan-
tation (Setyanto, 2015).
In the European Union (27 European
countries), 35.4% - 59% of workers experien-
ce skeletal muscle disorders due to work
(ILO, 2013). Data from the Indonesian Mi-
nistry of Health in 2005, 40.5% of work-
related diseases experienced by workers in
Indonesia, 16% of which are skeletal muscle
disorders work (Tana, 2009).
Treatment for those who experience
complaints of skeletal muscle disorders due
to work in general, use massage and taking
pain relievers without paying more attention
to aspects of repair and maintenance of the
worker's anatomy. One of the main strategies
in carrying out treatment and overcoming
skeletal muscle disorders is exercising, good
posture or ergonomics, and diet (Wulandari,
2012).
In this case, the treatment of workers
who experience skeletal muscle disorders due
to work can use holistic self-care techniques
by combining stretching and breathing
techniques.
The formulation of the problem in this
study was to determine whether holistic self-
care can overcome skeletal muscle disorders
due to work. How many times activities holis-
tic self-care can be carried out to overcome
skeletal muscle disorders due to work. This
study aimed to determine the effect of holis-
tic self-care to overcome skeletal muscle
disorders due to work.
Knowing the frequency of activities re-
quired for holistic self-care can overcome
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skeletal muscle disorders due to work. The
benefits of this research are to overcome and
treat skeletal muscle disorders due to work
field of Occupational Health and Safety Sci-
ences.
SUBJECTS AND METHOD
1. Study Design
A systematic review was conducted through
an electronic database, including Google
scholar, Science Open, and ScienceDirect.
The keywords used were "musculoskeletal
disorders" AND "stretching exercise" AND
"breathing technique".
1. Inclusion Criteria
The inclusion criteria were the articles
published between 2009 to 2020, full-text
articles in English and Indonesian.
2. Data Analysis
The findings were reviewed systematically.
RESULTS
The results of searches for research journals
used database a related, by entering key-
words predefined. A total of 4 journals re-
levant and connected to the topic was con-
tinued as material for the systematic review.
The summary sources of the articles was
showed in Table 1.
DISCUSSION
The reviews' findings were as many as 4 na-
tional articles regarding 2 articles of stretch-
ing exercise, and 2 articles on breathing tech-
nique. The results obtained after analyzing
the articles as a whole showed the same con-
clusion.
The study results stated that the post-
test scores after being given stretching
exercises indicated an effect or difference in
skeletal muscle disorders' level of complaints
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for the entire community. The research re-
sults can be used as a development in the
due to work that could be carried out for 4
weeks, which focused on reducing musculo-
skeletal complaints.
This study result was in line with those
conducted by Astuti (2016), for 60 workers of
PTPN IX (Persero) Kebun Merbuh Kendal
rubber tapping showed an effect of stretching
on low back pain (p= 0.066). However,
stretching did not affect the range of motion
(p= 0.066).
Analysis of the article on breathing
technique showed the results of research
conducted by L Skoglund (2011) on 37 office
workers or employees using Qigong tech-
niques or sports with slow-motion rhythm
patterns and the breathing technique which
affects the work of the autonomic nervous
system. It showed that this Qigong training
could reduce disability or neck pain and
disability in office workers for 6 weeks in 2
groups.
This systematic review showed the
Holistic Self Care technique by combining
stretching and breathing techniques to re-
duce musculoskeletal complaints or skeletal
muscle disorders. Work in workers can be
done for 4 weeks even 6 weeks. This study's
results can be used as a reference source for
further research on how to deal with skeletal
muscle disorders due to work.
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Table 1. Databases and Keywords used for searching the articles
Databases Search strategy
-Musculoskeletal disorders among oil palm fruit harvesters
-Work-related musculoskeletal disorders
Google Scholar
-Stretching exercise and work-related musculoskeletal disorders
-Breathing technique and work-related musculoskeletal disorders
-Musculoskeletal disorders among oil palm fruit harvesters
-Work-related musculoskeletal disorders
Science Open
-Stretching exercise and work-related musculoskeletal disorders
-Breathing technique and work-related musculoskeletal disorders
-Musculoskeletal disorders among oil palm fruit harvesters
-Work-related musculoskeletal disorders
Science Direct
-Stretching exercise and work-related musculoskeletal disorders
-Breathing technique and work-related musculoskeletal disorders

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Table 2. Summary Sources
Author
No. Title Study Design Samples Results
(Year)
1 Effect of Workplace Syafrianto E et al., Quasi Experiment Design 52 nurses using the random Data analysis used the
Stretching Exercise (2019) research with Two-Group sampling technique, which statistical Wilcoxon test 95%
(WSE) and Heat PrePost design measured using were divided into 2 groups. test (p= 0.000). This showed
Therapy (Hot Pack) the Nordic Body Map (NBM) Group 1: WSE intervention that there was an effect of
on Complaints and Hot Pack WSE and hot packs on mus-
Musculoskeletal in Group 2: Hot Pack culoskeletal complaints in
Nurses. intervention only nurses.
2 The effectiveness of a Tunwattanapong P A randomized controlled trial. as many as 96 subjects with pain, function neck, and
neck and shoulder et al., And interventions using neck pain of moderate to quality of life were evaluated
stretching exercise (2015) informative brochures about severe (visual analog score at baseline and week 4 using a
program among office ergonomic work positions ⩾5/10) during ⩾3 months of visual analog scale of pain,
workers with neck Questionnaire Neck Pain
pain: a randomized Northwick Park, and Short
controlled trial. Form-36. The two groups
have baseline data that can be
compared. All results
improved significantly from
the start. When compared
between groups, the magni-
tude of the increase was
substantially greater in the
treatment group than in the
control group. For visual
analog scale (OR= 1.4; 95%
CI= -2.2 to 0.7), the North-
wick Park Neck Pain Ques
tionnaire (OR= 4.8; 95% CI=
-9.3 to - 0.4), and physical
dimensions of the Short
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 Form-36 (OR= 14.0; 95% CI=
7.1 to 20.9) Compared with
patients who exercised <3
times/week, those who ex-
ercised 3 times/week produc-
ed significantly greater im-
provements in neck function
and physical dimensions of
quality-of-life scores (p=
0.005 and p= 0.018, respec-
tively).
3 Qigong training and Skoglund L, Using a crossover intervention 37 employees who were Based on qigong training that
effects on stress, Josephson M, study with participants func- randomized into 2 groups. was carried out for 6 weeks
neck-shoulder pain Wahlstedt K, tioning as controllers them- The first group started first, with a slow-motion rhythm
and life quality in a Lampa E, Norbäck selves and measuring using a after 6 weeks. The first pattern and breathing
computerized office D questionnaire. group stopped, and the technique. There were
environment (2011) second group started significant small improve-
training. ments in neck pain and
disability after therapy.
4 Qigong and Musculo- Marks R Literature reviews that speci- Regardless of the tool used. Qigong practice can help
skeletal Pain (2019) fically focused on qigong and its No age limit was imposed reduce pain to varying de-
impact on various forms of on samples examined in the grees among adults with
musculoskeletal pain between study concerned, and heal- various forms of chronic pain
2015 and 2019 were searched thy samples and patients with few side effects
and analyzed, along with were deemed acceptable
associated data. To obtain the and articles that do not
desired data, an electronic data work focus on adult
source search was performed samples. Focus on cell
on Academic Search Complete, biology, or do not only focus
PUBMED, EMBASE, and the on Qigong practice alone
joint Web of Science website. with or without an
instructor, nor do they focus
on adult samples exception.
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