APLIKASI PILATES EXERCISE DAN ULTRASOUND LEBIH BAIK DALAM MENURUNKAN NYERI FUNSIONAL DI BANDINGKAN MCKENZIE EXERCISE DAN ULTRASOUND PADA PASIEN NYERI PUNGGUNG BAWAH MIOGENIK DI KLINIK MITRA USADHA DENPASAR.
Skripsi
APLIKASI PILATES EXERCISE DAN ULTRA SOUND LEBIH
BAIK DALAM MENURUNKAN NYERI FUNGSIONAL
DIBANDINGKAN MC KENZIE EXERCISE DAN ULTRA SOUND
PADA PASIEN NYERI PUNGGUNG BAWAH MIOGENIK DI
KLINIK MITRA USADHA DENPASAR
TAHUN 2
011
FAJAR AKBAR PRAHMANA
1302315012
KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI
UNIVERSITAS UDAYANA
FAKULTAS KEDOKTERAN
PROGRAM STUDI FISIOTERAPI
2016
1
PERNYATAAN PERSETUJUAN
Nama
: Fajar Akbar Prahmana
NIM
: 1302315012
Judul Skripsi
: “Aplikasi Pilates Exercise Dan Ultra Sound Lebih Baik
Dalam Menurunkan Nyeri Fungsional Dibandingkan Mc
Kenzie Exercise Dan Ultra Sound Pada Pasien Nyeri
Punggung Bawah Miogenik Di Klinik Mitra Husadha
Denpasar”
Skripsi ini telah disetujui oleh Dosen Pembimbing untuk diajukan ke Sidang
Seminar Skripsi .
Denpasar,April 2016
Pembimbing I,
(Ni Luh Nopi Andayani, SSt FT, M.Fis)
Pembimbing II,
(dr. I Gusti Ayu Artini, M.Sc)
NIP. 198107192008122005
i
LEMBAR PENGESAHAN
PANITIA SIDANG UJIAN PROPOSAL
PROGRAM STUDI FISIOTERAPI FAKULTAS KEDOKTERAN
UNIVERSITAS UDAYANA
Denpasar,
Komisi Pembimbing
Pembimbing I,
(Ni Luh Nopi Andayani, SSt FT, M.Fis)
Pembimbing II,
(dr. I Gusti Ayu Artini, M.Sc)
NIP. 198107192008122005
ii
DAFTAR ISI
Halaman Judul..................................................................................................
i
Halaman Pernyataan Persetujuan Pembimbing ..............................................
ii
Halaman Pengesahan Panitia Sidang Ujian Skripsi .........................................
iii
Kata Pengantar ................................................................................................
iv
Datar isi
.......................................................................................................
vi
Daftar Gambar..................................................................................................
ix
Daftar Tabel .....................................................................................................
x
BAB I
PENDAHULUAN
1.1
Latar Belakang Masalah .........................................................
1
1.2
Rumusan Masalah ..................................................................
4
1.3
Tujuan Penelitian ...................................................................
4
1.3.1 Tujuan Umum ............................................................
4
1.3.2 Tujuan Khusus............................................................
5
Manfaat Penelitian .................................................................
5
1.4.1 Bagi Ilmiah / Teoritis .................................................
5
1.4.2 Bagi Praktisi ...............................................................
5
1.4
BAB II
TINJAUAN PUSTAKA
2.1
2.2
Anatomi Lumbal ....................................................................
7
2.1.1 Struktur Tulang Lumbal .............................................
7
2.1.2 Diskus Invertebralis ...................................................
10
2.1.3 Facet Joint ..................................................................
12
2.1.4 Ligament .....................................................................
13
2.1.5 Otot – otot Vertebra Lumbal ......................................
14
2.1.6 Biomekanik Vetebra Lumbal .....................................
17
Nyeri Punggung Bawah Miogenik .........................................
18
2.2.1 Definisi Nyeri Punggung Bawah Miogenik ...............
18
i
2.2.2 Etiologi Nyeri Punggung Bawah Miogenik ...............
19
2.2.3 Patofisiologi Nyeri Punggung Bawah Miogenik .......
21
2.2.4 Pengukuran Nyeri Fungsional Dengan Metode
2.3
2.4
Oswestry Disability Index ..........................................
24
Pilates.....................................................................................
25
2.3.1 Definisi Pilates ...........................................................
25
2.3.2 Core Muscle ...............................................................
27
2.3.3 Mekanisme Pilates Menurunkan Nyeri Fungsional ...
28
2.3.4 Bentuk Latihan Pilates ...............................................
30
Mc. Kenzie ..............................................................................
32
2.4.1 Definisi Mc. Kenzie ....................................................
32
2.4.2 Efek Latihan Mc. Kenzie ............................................
33
2.4.3 Mekanisme Mc. Kenzie Dalam Menurunkan Nyeri
2.5
Fungsional ..................................................................
34
2.4.4 Bentuk Latihan Mc. Kenzie .......................................
35
Ultra Sound ............................................................................
37
2.5.1 Definisi Ultra Sound ..................................................
37
2.5.2 Indikasi Ultra Sound ..................................................
37
2.5.3 Kontra Indikasi Ultra Sound ......................................
38
2.5.4 Efek Ultra Sound Terhadap Penurunan Nyeri ...........
38
BAB III KERANGKA
BERPIKIR,
KERANGKA
KONSEP,
DAN
HIPOTESI
3.1
Kerangka Berpikir ..................................................................
40
3.2
Kerangka Konsep ...................................................................
43
3.3
Hipotesis.................................................................................
44
BAB IV METODE PENELITIAN
4.1
Rancangan Penelitian .............................................................
46
4.2
Tempat Dan Waktu Penelitian ...............................................
47
4.3
Populasi Dan Sampel .............................................................
47
ii
BAB V
4.3.1 Populasi Penelitian .....................................................
47
4.3.2 Sampel ........................................................................
48
4.3.3 Besaran Sampel ..........................................................
49
4.3.4 Teknik Pengambilan Sampel ......................................
50
4.4
Variabel Penelitian .................................................................
50
4.5
Definisi Operasional Variabel ................................................
51
4.6
Instrumen Penelitian...............................................................
53
4.7
Prosedur Penelitian.................................................................
53
4.7.1 Prosedur Administrasi Penelitian ...............................
53
4.7.2 Prosedur Pelaksanaan Penelitian ................................
54
4.8
Alur Penelitian .......................................................................
62
4.9
Analisis Data ..........................................................................
63
HASIL PENELITIAN
5.1
Karakteristik Subyek Penelitian .............................................
5.2
Pilates Exercises dan Ultrasound Menurunkan Nyeri Pada Nyeri
Punggung Bawah Miogenik ..................................................
5.3
65
McKenzie Exercises dan Ultrasound Menurunkan Nyeri Pada
Nyeri Punggung Bawah Miogenik .........................................
5.4
64
66
Pilates Exercises dan Ultrasound Lebih Efektif dibandingkan
McKenzie Eercises dan Ultrasound dalam Menurunkan Nyeri
Pada Kasus Nyeri Punggung Bawah Miogenik …………….
67
BAB VI PEMBAHASAN
6.1
Karakteristik Subyek Penelitian .............................................
6.2
Aplikasi Pilates Exercises dan Ultrasound Menurunkan Nyeri
Pada Nyeri Punggung Bawah Miogenik ...............................
6.3
69
70
Aplikasi McKenzie Exercises dan Ultrasound Menurunkan Nyeri
Pada Nyeri Punggung Bawah Miogenik ................................
iii
73
6.4
Efektifitas Aplikasi Pilates Exercises dan Ultrasound Lebih Baik
dibandingkan
McKenzie
Eercises
dan
Ultrasound
dalam
Menurunkan Nyeri Pada Kasus Nyeri Punggung
Bawah Miogenik ……………………………………………
76
BAB VII SIMPULAN DAN SARAN
7.1
Simpulan ................................................................................
81
7.2
Saran ......................................................................................
81
DAFTAR PUSTAKA
iv
DAFTAR GAMBAR
Gambar 2.1
Vertebra Lumbal Dari Pandagan Superior Dan Sagital ...........
9
Gambar 2.2
Discus Intervertebralis .............................................................
11
Gambar 2.3
Anulus Fibrosus Dan Nucleus Pulposus...................................
12
Gambar 2.4
Facet Joint ................................................................................
14
Gambar 2.5
Ligament Columna Intervetebralis ...........................................
15
Gambar 2.6
Otot-otot Abdominalis ..............................................................
16
Gambar 2.7
Otot-otot Paravetebra ..............................................................
17
Gambar 2.8
Breathing Practice....................................................................
31
Gambar 2.9
Bridging ....................................................................................
31
Gambar 2.10 Hundreds ..................................................................................
32
Gambar 2.11 Quadriped .................................................................................
33
Gambar 2.12 Prone Lying ..............................................................................
36
Gambar 2.13 Full Press Up............................................................................
36
Gambar 2.14 Knee To Chest...........................................................................
37
Gambar 2.15 Flex With Hand Beneath Seat...................................................
37
Gambar 2.16 Ultra Sound ..............................................................................
38
Gambar 3.1
Kerangka Konsep Penelitian ....................................................
44
Gambar 4.1
Desain Penelitian ......................................................................
46
Gambar 4.2
Breathing Practice....................................................................
56
Gambar 4.3
Bridging ....................................................................................
57
Gambar 4.4
Hundreds ..................................................................................
58
Gambar 4.5
Quadriped .................................................................................
59
Gambar 4.6
Prone Lying ..............................................................................
59
Gambar 4.7
Full Press Up............................................................................
60
Gambar 4.8
Knee To Chest...........................................................................
60
Gambar 4.9
Flex With Hand Beneath Seat...................................................
61
Gambar 4.10 Alur Penelitian ..........................................................................
62
v
DAFTAR TABEL
Tabel 2.1
Ciri Khusus Vertebra Lumbal ..................................................
10
Tabel 4.1
Interpretasi Skor .......................................................................
51
Tabel 4.2
Assesment Fisioterapi ...............................................................
54
Tabel 4.3
Dosis Latihan ............................................................................
55
Tabel 5.1
Karakteristik Subyek Penelitian ...............................................
64
Tabel 5.2
Uji Normalitas Penurunan Nyeri dengan Aplikasi Pilates Exercises
dan Ultrasound .........................................................................
Tabel 5.3
Uji Hipotesis Penurunan Nyeri dengan Aplikasi Pilates Exercises
dan Ultrasound .........................................................................
Tabel 5.4
67
Uji Hipotesis Penurunan Nyeri dengan Aplikasi McKenzie
Exercises dan Ultrasound .........................................................
Tabel 5.6
66
Uji Normalitas Penurunan Nyeri dengan Aplikasi McKenzie
Exercises dan Ultrasound .........................................................
Tabel 5.5
65
67
Uji Hipotesis Antara Pilates Exercises dan Ultrasound dengan
McKenzie Exercises dan Ultrasound ........................................
vi
68
APLIKASI PILATES EXERCISE DAN ULTRA SOUND LEBIH
BAIK DALAM MENURUNKAN NYERI FUNGSIONAL
DIBANDINGKAN MC KENZIE EXERCISE DAN ULTRA SOUND
PADA PASIEN NYERI PUNGGUNG BAWAH MIOGENIK DI
KLINIK MITRA USADHA DENPASAR
TAHUN 2
011
FAJAR AKBAR PRAHMANA
1302315012
KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI
UNIVERSITAS UDAYANA
FAKULTAS KEDOKTERAN
PROGRAM STUDI FISIOTERAPI
2016
1
PERNYATAAN PERSETUJUAN
Nama
: Fajar Akbar Prahmana
NIM
: 1302315012
Judul Skripsi
: “Aplikasi Pilates Exercise Dan Ultra Sound Lebih Baik
Dalam Menurunkan Nyeri Fungsional Dibandingkan Mc
Kenzie Exercise Dan Ultra Sound Pada Pasien Nyeri
Punggung Bawah Miogenik Di Klinik Mitra Husadha
Denpasar”
Skripsi ini telah disetujui oleh Dosen Pembimbing untuk diajukan ke Sidang
Seminar Skripsi .
Denpasar,April 2016
Pembimbing I,
(Ni Luh Nopi Andayani, SSt FT, M.Fis)
Pembimbing II,
(dr. I Gusti Ayu Artini, M.Sc)
NIP. 198107192008122005
i
LEMBAR PENGESAHAN
PANITIA SIDANG UJIAN PROPOSAL
PROGRAM STUDI FISIOTERAPI FAKULTAS KEDOKTERAN
UNIVERSITAS UDAYANA
Denpasar,
Komisi Pembimbing
Pembimbing I,
(Ni Luh Nopi Andayani, SSt FT, M.Fis)
Pembimbing II,
(dr. I Gusti Ayu Artini, M.Sc)
NIP. 198107192008122005
ii
DAFTAR ISI
Halaman Judul..................................................................................................
i
Halaman Pernyataan Persetujuan Pembimbing ..............................................
ii
Halaman Pengesahan Panitia Sidang Ujian Skripsi .........................................
iii
Kata Pengantar ................................................................................................
iv
Datar isi
.......................................................................................................
vi
Daftar Gambar..................................................................................................
ix
Daftar Tabel .....................................................................................................
x
BAB I
PENDAHULUAN
1.1
Latar Belakang Masalah .........................................................
1
1.2
Rumusan Masalah ..................................................................
4
1.3
Tujuan Penelitian ...................................................................
4
1.3.1 Tujuan Umum ............................................................
4
1.3.2 Tujuan Khusus............................................................
5
Manfaat Penelitian .................................................................
5
1.4.1 Bagi Ilmiah / Teoritis .................................................
5
1.4.2 Bagi Praktisi ...............................................................
5
1.4
BAB II
TINJAUAN PUSTAKA
2.1
2.2
Anatomi Lumbal ....................................................................
7
2.1.1 Struktur Tulang Lumbal .............................................
7
2.1.2 Diskus Invertebralis ...................................................
10
2.1.3 Facet Joint ..................................................................
12
2.1.4 Ligament .....................................................................
13
2.1.5 Otot – otot Vertebra Lumbal ......................................
14
2.1.6 Biomekanik Vetebra Lumbal .....................................
17
Nyeri Punggung Bawah Miogenik .........................................
18
2.2.1 Definisi Nyeri Punggung Bawah Miogenik ...............
18
i
2.2.2 Etiologi Nyeri Punggung Bawah Miogenik ...............
19
2.2.3 Patofisiologi Nyeri Punggung Bawah Miogenik .......
21
2.2.4 Pengukuran Nyeri Fungsional Dengan Metode
2.3
2.4
Oswestry Disability Index ..........................................
24
Pilates.....................................................................................
25
2.3.1 Definisi Pilates ...........................................................
25
2.3.2 Core Muscle ...............................................................
27
2.3.3 Mekanisme Pilates Menurunkan Nyeri Fungsional ...
28
2.3.4 Bentuk Latihan Pilates ...............................................
30
Mc. Kenzie ..............................................................................
32
2.4.1 Definisi Mc. Kenzie ....................................................
32
2.4.2 Efek Latihan Mc. Kenzie ............................................
33
2.4.3 Mekanisme Mc. Kenzie Dalam Menurunkan Nyeri
2.5
Fungsional ..................................................................
34
2.4.4 Bentuk Latihan Mc. Kenzie .......................................
35
Ultra Sound ............................................................................
37
2.5.1 Definisi Ultra Sound ..................................................
37
2.5.2 Indikasi Ultra Sound ..................................................
37
2.5.3 Kontra Indikasi Ultra Sound ......................................
38
2.5.4 Efek Ultra Sound Terhadap Penurunan Nyeri ...........
38
BAB III KERANGKA
BERPIKIR,
KERANGKA
KONSEP,
DAN
HIPOTESI
3.1
Kerangka Berpikir ..................................................................
40
3.2
Kerangka Konsep ...................................................................
43
3.3
Hipotesis.................................................................................
44
BAB IV METODE PENELITIAN
4.1
Rancangan Penelitian .............................................................
46
4.2
Tempat Dan Waktu Penelitian ...............................................
47
4.3
Populasi Dan Sampel .............................................................
47
ii
BAB V
4.3.1 Populasi Penelitian .....................................................
47
4.3.2 Sampel ........................................................................
48
4.3.3 Besaran Sampel ..........................................................
49
4.3.4 Teknik Pengambilan Sampel ......................................
50
4.4
Variabel Penelitian .................................................................
50
4.5
Definisi Operasional Variabel ................................................
51
4.6
Instrumen Penelitian...............................................................
53
4.7
Prosedur Penelitian.................................................................
53
4.7.1 Prosedur Administrasi Penelitian ...............................
53
4.7.2 Prosedur Pelaksanaan Penelitian ................................
54
4.8
Alur Penelitian .......................................................................
62
4.9
Analisis Data ..........................................................................
63
HASIL PENELITIAN
5.1
Karakteristik Subyek Penelitian .............................................
5.2
Pilates Exercises dan Ultrasound Menurunkan Nyeri Pada Nyeri
Punggung Bawah Miogenik ..................................................
5.3
65
McKenzie Exercises dan Ultrasound Menurunkan Nyeri Pada
Nyeri Punggung Bawah Miogenik .........................................
5.4
64
66
Pilates Exercises dan Ultrasound Lebih Efektif dibandingkan
McKenzie Eercises dan Ultrasound dalam Menurunkan Nyeri
Pada Kasus Nyeri Punggung Bawah Miogenik …………….
67
BAB VI PEMBAHASAN
6.1
Karakteristik Subyek Penelitian .............................................
6.2
Aplikasi Pilates Exercises dan Ultrasound Menurunkan Nyeri
Pada Nyeri Punggung Bawah Miogenik ...............................
6.3
69
70
Aplikasi McKenzie Exercises dan Ultrasound Menurunkan Nyeri
Pada Nyeri Punggung Bawah Miogenik ................................
iii
73
6.4
Efektifitas Aplikasi Pilates Exercises dan Ultrasound Lebih Baik
dibandingkan
McKenzie
Eercises
dan
Ultrasound
dalam
Menurunkan Nyeri Pada Kasus Nyeri Punggung
Bawah Miogenik ……………………………………………
76
BAB VII SIMPULAN DAN SARAN
7.1
Simpulan ................................................................................
81
7.2
Saran ......................................................................................
81
DAFTAR PUSTAKA
iv
DAFTAR GAMBAR
Gambar 2.1
Vertebra Lumbal Dari Pandagan Superior Dan Sagital ...........
9
Gambar 2.2
Discus Intervertebralis .............................................................
11
Gambar 2.3
Anulus Fibrosus Dan Nucleus Pulposus...................................
12
Gambar 2.4
Facet Joint ................................................................................
14
Gambar 2.5
Ligament Columna Intervetebralis ...........................................
15
Gambar 2.6
Otot-otot Abdominalis ..............................................................
16
Gambar 2.7
Otot-otot Paravetebra ..............................................................
17
Gambar 2.8
Breathing Practice....................................................................
31
Gambar 2.9
Bridging ....................................................................................
31
Gambar 2.10 Hundreds ..................................................................................
32
Gambar 2.11 Quadriped .................................................................................
33
Gambar 2.12 Prone Lying ..............................................................................
36
Gambar 2.13 Full Press Up............................................................................
36
Gambar 2.14 Knee To Chest...........................................................................
37
Gambar 2.15 Flex With Hand Beneath Seat...................................................
37
Gambar 2.16 Ultra Sound ..............................................................................
38
Gambar 3.1
Kerangka Konsep Penelitian ....................................................
44
Gambar 4.1
Desain Penelitian ......................................................................
46
Gambar 4.2
Breathing Practice....................................................................
56
Gambar 4.3
Bridging ....................................................................................
57
Gambar 4.4
Hundreds ..................................................................................
58
Gambar 4.5
Quadriped .................................................................................
59
Gambar 4.6
Prone Lying ..............................................................................
59
Gambar 4.7
Full Press Up............................................................................
60
Gambar 4.8
Knee To Chest...........................................................................
60
Gambar 4.9
Flex With Hand Beneath Seat...................................................
61
Gambar 4.10 Alur Penelitian ..........................................................................
62
v
DAFTAR TABEL
Tabel 2.1
Ciri Khusus Vertebra Lumbal ..................................................
10
Tabel 4.1
Interpretasi Skor .......................................................................
51
Tabel 4.2
Assesment Fisioterapi ...............................................................
54
Tabel 4.3
Dosis Latihan ............................................................................
55
Tabel 5.1
Karakteristik Subyek Penelitian ...............................................
64
Tabel 5.2
Uji Normalitas Penurunan Nyeri dengan Aplikasi Pilates Exercises
dan Ultrasound .........................................................................
Tabel 5.3
Uji Hipotesis Penurunan Nyeri dengan Aplikasi Pilates Exercises
dan Ultrasound .........................................................................
Tabel 5.4
67
Uji Hipotesis Penurunan Nyeri dengan Aplikasi McKenzie
Exercises dan Ultrasound .........................................................
Tabel 5.6
66
Uji Normalitas Penurunan Nyeri dengan Aplikasi McKenzie
Exercises dan Ultrasound .........................................................
Tabel 5.5
65
67
Uji Hipotesis Antara Pilates Exercises dan Ultrasound dengan
McKenzie Exercises dan Ultrasound ........................................
vi
68