Ischialgia dan paresthesia L5-S1

HNP lumbal L5-S1

 Hipotesis: NYERI
RADICULAR – LUMBAR
DISC BULGING/HNP

Degeneratif + injury 
annulus fibrosus robek penonjolan
menekan lig. longit
posterior/ dural
Pergeseran nucleus  disc sleeve 
menonjol ke inflamasi
posterolateral/posterior Neuropathic pain

Iritasi jar lunak radix 

inflamasi  radicular pain

Sugijanto, 2015
 Process of Manualtherapy for Disc
impairment
Aktif:
Fleksi nyeri-
ekstensi hilang

Valsava
maneouvre
Nyeri
bungkuk/ Compression in Bila
Bila negatif
tunduk flexion pain positif
 ganti
(Spurling) hipotesis
lain
Traction in
extension no
pain

PACVP pain
Sugijanto, 2015
 Process of Physiotherapy for nerve
impairment
Aktif:
brudzinsky nyeri

Membebaskan
Palpasi-Tinnel
Nyeri entrapment
test
regang saraf
Neural
mobilization
ULTT nyeri
Nerve gliding

Slump test

Sugijanto, 2015
 Lumbar disc herniated

Functioning and disability Constextual factors

Anatomic impairment
Internal External
factors factors
Disc Nerves Muscle Capsels Facet

Annulus Autonom
Chronic
rupture system
inflamation
Nocisensoric Guarding Weak-
atrphy Inter fiber
spasm
Nucleus
Sympathic
adhesion Functional
herniation
hyperactivity
Vascular impairment
Neuropathic Capsel contracture Activity
pain limitation
Micro circular Capsular Participation
constriction pattern restriction
Sitting
Sitting
Radicular pain Stretched
pain Muscle Lifting
Lifting Work
imbalance
Driving
Driving Sport
Postural
Pain deformity Recreation

Sugijanto, 2015
PEMERIKSAAN FISIOTERAPI YG
DIBUTUHKAN

Diutamakan pemilihan evidence untuk:

 Tes cepat utk menentukan hipotesis Discogenic LBP
 Pemeriksaan Discus:
◦ Springing test
◦ Spurling’s test
◦ Distraction test
◦ Extension test
 Pemeriksaan Integritas radix:
◦ Dermatome test
◦ Kenn muscle test
◦ Lower Limb Tension Test (LLTT)
 Pemeriksaan stability:
◦ Core stability test
Sugijanto, 2015
Low Back Maneouvre III
POSISI TENGKURAP
 Hip extension knee extension 
fiksasi pada tuber ischiadicum
(Hip Joint)
 Hip extension knee extension 
fiksasi pada sacrum (+Sacroiliac
joint)
 Hip extension knee extension 
fiksasi pada Lower thoracal
(Lumbar spain)
Sugijanto, 2015
Low Back Manouvre II
SLR / Lasegue dan Contra Lasegue
(Nerve root, Ischiadicus)

 Bragard (nerve root-n.

ischiadicus)

 Neri/Brudzinsky (Dural)
berurutan

Sugijanto, 2015
Neurodynamic test
N. Ischiadicus (SLR)
N. Femoralis.
N. Suralis.
N. Peroneus dan n. tibialis.

Sugijanto, 2015
INTERVENSI FISIOTERAPI YG
DIBUTUHKAN
MODALITAS DAN METODA
 Anatomic Impairment target:
◦ Disc bulging  traksi posisi lordosis;
Oscillated resonance Pold method; Mc. Kenzie
extension exercise
◦ Nerve root  Neural tension Mobilization,
Nerve gliding technique
 Functional Impairment target:
◦ Postural correction
◦ Core stability exercise
◦ Lifting technique and proper body mechanic
 Disability target

Sugijanto, 2015
 Intervensi
• Intermittent lumbar traction
posisi lumbar lordosis
• Mobilisasi discus gerak ekstensi:
Ekstensi lumbale dengan PACVP
• Extension program (Mc. Kenzie);
Muscle strengthening untuk
stabilisasi
• Proper body mechanics:
• Posisi tidur, duduk, berdiri, kerja
dan lifting technique

Sugijanto, 2015
 Kombinasi metoda Mc. Kenzie
ekstensi dgn PACVP.
Posisi telungkup gerak ekstensi penuh.
PACVP pd segment disc bulging.
Neural mobilization.

Sugijanto, 2015
ALAT UKUR/EVALUASI
FISIOTERAPI YG DIBUTUHKAN
 Pengukuran nyeri
 Pengukuran fleksibilitas/ekstensibilitas
otot
 Pengukuran ROM,
 Pengukuran movement disfunction
 Pengukuran disabilitas

Sugijanto, 2015