Exercise As Medicine For MSK

EXERCISE AS A MEDICINE FOR
MUSCULOSKELETAL DISORDERS
ARI SUDARSONO
PHYSIOTHERAPIST & LECTURER
Gangguan MSK yang sering
terjadi:
 Nyeri pinggang
 Sakit kepala
 Nyeri dan kaku leher
 Nyeri dan kaku bahu ec. Frozen Shoulder
 Nyeri dan gangguan fungsi lutut ec. OA lutut
 Gangguan postur (Skoliosis, flat foot, dll)
Apa yang dapat Fisioterapis lakukan?
 Massage…?
 Mobilisasi dan Manipulasi sendi….?
 Setrum..?? Ultrasound/ Uleg2..??
 Dry Needling…?
 EXERCISE
Sejarah Fisioterapi
 460 B.C H ippocra tes
Hippocrates and Galenus were the first physiotherapy practitioners

who promote massage, manual therapy techniques and
hydrotherapy to treat people.
 1813
Per Henrik Ling is the “Father of Swedish Gymnastics” who founded
the Royal Central Institute of Gymnastic (RCIG) which helps in
manipulation and exercise for those who are ill.
 1894
4 nurses in Great Britain formed the Chartered Society of
Physiotherapy
 1913
The School of Physiotherapy of the University of
Otago, New Zealand.
 1914
The formation of Reed College, Portland, Oregon which graduates
“reconstruction aides” that plays a major role during the World War I.
.
 1916
The polio epidemic became widespread in the United States
and the urge to muscle testing and muscle re-education to
function grew dramatically
 1917
The United States entered World War I. The army
started to recognize the urge to recruit “reconstruction aide” to
rehabilitate the injured soldiers.
 1921
The first physical therapy journnal was published in United States in “
The PT review”
Mary McMillan organized the American Women’s Physical
Therapeutic Association ( now called American Physical Therapy
Association (APTA) )
 1924
Georgia Warm Springs Foundation promoted the field by suggesting to use
physical therapy as a treatment for polio.
 1946
Congress adopted the Hill Burton Act to build hospital across the country to
increase the public’s access to health care facilities.
 Early 1950
In England,Neurophysiologist (Herman Kabat) developed
neurological exercise (Proprioceptive Facilitation)
 1960
Physiotherapist practices in the neuromuscular area expanded
significantly with the development of techniques for adults who
experienced stroke, cerebral palsy, and disorder of the central nervous system.
 Physical therapists provide services that develop,
maintain and restore people’s maximum movement and
functional ability.
 They can help people at any stage of life, when
movement and function are threatened by ageing, injury,
diseases, disorders, conditions or environmental factors.
 Physical therapists help people maximise their quality of
life, looking at physical, psychological, emotional and
social wellbeing.
 Dilihat dari sejarahnya
 Dilihat dari dasar
ilmunya
 Dilihat dari manfaatnya  Fisioterapi adalah tindakan untuk
mengoptimalkan & memperbaiki
fungsi GERAK (movement)
dengan dasar ilmu gerak
(neurofisiologi, kinesiologi, dsb)
 Fisioterapis adalah
Movement Expert
TL pada MSK?
 Untuk meningkatkan fungsi otot (kekuatan, ketahanan
fleksibiltas)
 Untuk menambah ROM
 Untuk mengurangi nyeri, akibat patologi pada
 Otot
 Tendon
 Sendi (Kapsul-Ligamen)
 Pengaruh Untuk Kebugaran tubuh (ketahanan, imunitas)
Meningkatkan kekuatan otot
 3 plane strength exercise
 Overload principle
 SAID principle
 Reversibility principle
 FITT Principle
Latihan penguatan fungsional 3 bidang
gerak
 Latihan penguatan yang efektif menggabungkan gerakan
pada 3 (semua) bidang gerak: Sagittal, Coronal /frontal
dan Transverse. Jadi gerakannya “spiral and diagonal”
 Semua gerakan fungsional pada manusia selalu terjadi
lebih dari 1 bidang gerak maka latihan penguatan 3
bidang gerak ini akan lebih cocok digunakan untuk
pengembalian ke arah fungsional
 Contoh latihan : Menendang bola (fleksi-abduksi-ext.rot
hip), menyisir rambut (fleksi-abduksi-ext.rot bahu & fleksi-
supinasi siku), dll
Basic Training Principles
Overload Principle
 Physical conditioning is improved
when the body is placed under
greater than normal workload until it
adapts to a new level.
 Manipulate aspects of frequency,
intensity, time and type of activity
gradually until the body adapts to a
new load.
SAID (Specific Adaptation to Imposed Demands)
 A conditioning programme’s effects are specific to the type of
stress applied.
 As the body is placed under stress of varying intensities and
durations, it attempts to overcome the stress by adapting
specifically to the imposed demands.
 For example, muscles around a joint can be developed and
conditioned to provide optimal stabilisation of the joint.
 Likewise, when a muscle primarily produces motion of a joint,
proper conditioning can prevent the muscle from undergoing an
unwanted movement. The demands of a specific athletic event
must be a progressive stress applied in that athlete’s training.
Adaptation Principle
 Body adapts and responds over
time to exercise and the demands
placed on the body.
 Can be acute/short term or
chronic/long term.
 Demands must be placed on the
body on a regular and repeated
basis for chronic adaptations to
occur.
Specificity Principle
 SAID – Specific, Adaptation,
Imposed, Demands
 The type and degree of adaptation
to the body depends on the type and
amount of exercises performed.
 High reps builds endurance.
 Heavy weight builds size and
strength.
 Specificity applies to a
specific group of muscles.
Reversibility Principle
 If a body is not stressed,

training adaptations will
decline
1/3 the rate they were gained.
 E.g. a training effect after 1
month will be lost in 3 months.
 This of course varies from
individual to individual.
 The declines can be both
aerobic and strength.
F.I.T.T Principle
Muscular Strength
 F = 2-4 times a week (every other day) for a
basic full body or 2 day split routine
 I = 75% of 1RM (repetition maximum)
 T = Until muscle fatigue is achieved. Training
sessions vary between 30-90 minutes,
include 8-10 exercises, and include all major
groups
 T = Isotonic, Isometric
Meningkatkan ketahanan otot
 Combination of Isotonic principle
 FITT Principle
Combination of Isotonics
 Latihan ketahanan otot HARUS mengkombinasikan kontraksi
konsentrik dan eksentrik dari satu grup otot tanpa rileksasi/
jeda.
 DESKRIPSI: Lakukan gerakan tertentu dengan kontraksi
konsentrik kemudian dapat dilakukan kontraksi isometrik pada
posisi yang diinginkan dan kembali ke posisi awal dengan
kontraksi eksentrik dan dapat dilakukan kontraksi isometrik
dulu sebelum mengulang lagi dengan kontraksi konsentrik
F.I.T.T Principle
Muscular Endurance
 F = 2-4 times a week (every other
day)
 I = low to moderate resistance
12-20 repetitions – high volume
 T = Until muscular fatigue is
achieved
 T = Isotonic, Isokenetic
Meningkatkan fleksibilitas otot
 Contract-Relax theory
 FITT Principle
Contract – Relax
 Kontraksi isotonik yang ditahan, diikuti oleh rileksasi
(dan gerak tambahan sampai akhir ROM yang baru)
 DESKRIPSI: Dimulai dari posisi keterbatasan sendi.
Lakukan kontraksi isotonik dengan tahanan. Setelah
mempertahankan kontraksi ini beberapa detik maka
kita minta rileks dan kita bisa tambahkan ROM
secara pasif atau aktif setelah rileks.
F.I.T.T Principle
Flexibility
 F = 3-7x a week
 I = Until mild tension is felt,

perform stretches only after the
body is properly warmed up.
 T = 15-60 sec for each stretch,
usually stretch session lasts 10
minutes (depending on the
number of stretches performed)
 T= static, PNF.
Menambah ROM
 ROM ditentukan besarnya oleh otot yang
menggerakkan dan accesory motion (JPM) pada
sendi sehingga untuk menambah ROM dapat
diberikan dengan 2 cara
- stretching otot
- JPM (Traksi, roll & slide dengan gerak aktif dibantu
 MWM/ mobilisation with movement)
Untuk mengurangi nyeri ec. Muscle
spasm
 Stretching
 Hold Relax  Isometric (Jika nyeri sekali)
 Contract relax  Konsentrik
Untuk mengurangi nyeri ec. Tendon
pathologies
 Tendon adalah bagian otot yang melekatkan otot pada
tulang karena itu bekerja sangat keras terutama untuk
menjaga supaya tidak terjadi avulsi
 Latihan harus dimulai secara bertahap
 Repeated movement exercise (McKenzie)
 Combination of Isotonic atau Heavy Slow Resistance
 Isolated eccentric
 Plyometric (jika sudah mampu)
Untuk mengurangi nyeri ec. Capsule
pathology
 Traksi sendi dengan gerakan aktif
 MWM (mobilisation with movement)
 Repeated movement (McKenzie)
Untuk memperkuat stabilitas sendi
 Co-contraction Exercise (Dynamic Reversal)
 Repeated movement (McKenzie)
 CKC principle
Dynamic Reversals
 Gerakan aktif yang ditahan dan berubah dari satu arah
ke arah yang berlawanan tanpa jeda atau istirahat.
 DESKRIPSI: Tahan gerakan pasien pada satu arah
tertentu (biasanya yang kuat) begitu hampir mencapai
tujuan (mis: ROM fleksi bahu 600) maka kita ubah
manual contact kita dan pada saat tercapai 600 maka
segera lakukan verbal command untuk kontraksi ke arah
yang berlawanan tanpa jeda dan berikan tahanan.
Closed Kinetic Chain Exercise
• Long term adaptation
1. Heart rate decreases – decrease in
sympathetic tone.
2. An increase in capillarisation – more
capillaries for gaseous exchange at the
muscle.
3. An increase in muscle mitochondria – more
mitochondria = more ATP produced.
4. An increase in VO2max – increased O2
extraction ability.
Strength training:
• Long term adaptations – hypertrophy – increase in
muscle size by addition of myofilaments (actin and
myosin).
• Hypertrophy of type II muscle fibres are due to an
increase in protein formation, while type I fibres are
due to a decrease in protein breakdown.
• Hypertrophy of type II > hypertrophy of type I.
• Hyperplasia, splitting of muscle fibres, occur in
animals but are yet to be proven to occur in humans.
• Atrophy, decrease in muscle size, is due to lack of
strength training, decreased neural and mechanical
force on muscle fibres.
Pengaruh untuk imunitas
 Latihan yang menyebabkan kontraksi otot sangat
diperlukan oleh tubuh kita karena kontraksi otot
sebenarnya menghasilkan myokin. Myokin dapat
melakukan komunikasi pada sel lain secara autokrin,
parakrin dan endokrin. Artinya otot memiliki
kemampuan sbg organ endokrn.
THANK YOU

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EXERCISE AS A MEDICINE FOR

Hippocrates and Galenus were the ﬁrst physiotherapy practitioners

 If a body is not stressed,

 I = Until mild tension is felt,

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