Date post: | 17-Feb-2018 |
Category: |
Documents |
Upload: | lindawati-simpel |
View: | 230 times |
Download: | 0 times |
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 1/64
MANUALTERAPIMANUALTERAPIPELVIC-HIP COMPLEXPELVIC-HIP COMPLEX
Oleh:
Sugijanto
Disampaikan pada:
Kuliah manual terapi Reguler
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 2/64
TUJUAN INSTRUKSIONAL TUJUAN INSTRUKSIONAL
ampu mem!edakan topogra"s dan #ungsi antara tiapstruktur jaringan spesi"k $el%i& hip &omple' ampu menghu!ungkan struktur jaringan spesi"k dengan
patologiassessmen dan inter%ensi ampu menjelaskan proses assessment melalui sekuensis
untuk menentukan diagnosis $el%i& hip &omple'( ampu memperagakan asesmen $el%i& hip &omple' dan
merin&i temuan assessment dihu!ungkan dengan struktur jaringan spesi"k) patologi dan gangguan NS*(
ampu menghu!ungkan temuan assessment dengandiagnosis manualterapi) prognosis dan target hasil
ampu menjelaskan metoda dan dosis inter%ensimanualterapi kasus $el%i& hip &omple'
ampu mem!edakan indikasi antara metoda denganpemeriksaan khusus(
ampu mempraktek inter%ensi manualterapi kasus $el%i& hip&omple'
ampu menilai tentang hasil inter%ensi manualterapi kasus$el%i& hip &omple' Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 3/64
$+NDA,ULUAN$+NDA,ULUAN
,u!ungan Sa&rum dg spine s!glum!osa&ral) dg pel%is s!g sa&roilia& joint)dan dg &o&&-geus s!g sa&ro&o&&-gea(Antar pel%is kiri.kanan dihu!ungkan
s-mphisis pu!is dan hungan dg anggotagerak !a/ah s!g hip joint(
$atologi -g !an-ak dlm klinis :osteoarthrosis) #rakture &ollum #emoris)
m-o#as&ial pain) R A) 0a) T10) dll($erlu pengkajian detil agar hasil akurat(Inter%ensi "sio.manualterapi :
penggunaan modalitas elektrik) terapilatihan hingga manipulati%e therap-( Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 4/64
ANATOI T+RA$ANANATOI T+RA$AN
Hubungan lumbale-pelvic-hip complex.
Lum!ale.pel%is.hip mrpk satuan#ungsi kompleks2 dlm gerak tu!uh)am!ulasi dan gerak anggota !a/ahselalu terjadi simultan(
$ada 3eksi.ekstensi lum!ale posisi!erdiri selalu diikuti geraksa&roilia&a dan hip se&araproporsional s!g lumbopelvic!"t!m
Demikian pula gerak 3eksi panggulataupun !erjalan) gerak pangguldiikuti gerak sa&ro ilia& dan lum!ale
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 5/64
$+L*IS$+L*IS SA0ROILIA0 JOINT ◦ 1entuk sendi huru# #L# mrpk jenis Sendi
s-no%ial dan s-ndesmosis$
◦ $ermukaan sa&rum konka#
◦ Ilium: "!ro&artilage) sa&rum h-aline&artilage dg te!al 4 kali) makin tua → ta%ata
◦ 5erak rotasi ke&il dlm !entuk nutasi&
%onta nutasi(◦ Oleh 11 → nutasi → lum!ar lordosis ◦ Sistem ligamenta: Dihu!ungkan lig
sa&rointerosseus 6terkuat7) lig( sa&rospinal)dan lig sa&rotu!eral ↔ menahan nutasi2 Lig
sa&roilia&a anterior 6tertipis7 dan ligsa&roilia&a posterior -g menahan kontranutasi) serta lig iliolum!al(
◦ uskulotendinogen: Tak ada otot -glangsung melekat pada sa&rum dan pel%is(
◦ Inner%asi:Dari seg( L4.S9 dan N( 5luteus
superior 6L4.S97Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 6/64
SYMPHYSISSYMPHYSIS PUBISPUBIS
'ACROCOCC()EAL *OINT
◦ Umumn-a men-atu oleh
dis&us "!ro.&artilage(◦ Tak ada gerak
◦ Sering #raktur → posisi miring
Jenis sendi cartillagenius,
terdapat discus interpubica.
Gerakan : gerak geser
mengikuti gerak nutasi-kontra
nutasi.
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 7/64
,I$ JOINT 6art( 0o'ae7,I$ JOINT 6art( 0o'ae7 Jenis : !all and so&ked joint(
◦
Di!entuk: a&eta!ulum ( pertemuan os ilium)os is&hium) dan os pu!is7 s!g mangkuksendi$
◦ Dilapisi &artilago h-alin dan tertutupa&eta!ular la!rum -g mrpk &artilago "!rosa)keduan-a te!al ditepi dan tipis di tengah(
◦ 0aput #emoris !ola dilapisi &artilagoh-aline kedistal s!g &ollum #emoris 6sering#raktur7) ke distal terdapat tro&hantor ma-ordan minor) selanjutn-a kedistal s!g #emur
Sistem ligamenta: Diperkuat oleh 5 ligamenta yg kuat: lig teres
femoris, lig acetabulare, lig acetabulare
tranversus, lig iliofemorale, dan lig
ischiofemorale Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 8/64
At!o%inematic +osteo%inematic:◦
5erak ,eion dan etension RO ;l':9<== so#t e # dan +'t: 9>= stret&h e #(Arthrokin: spin tidak murni
◦ Ab.uction/a..uction RO ?>=@<>=
elasti& harder@ stret&h e #( Arthokin(&audal translation@ se!alikn-a(
◦ Internal@+'ternal RO 4== @ ?>= elasti& e# 0 arthokin( dorsal @ %entral translation
◦ Seluruh komponen arthrokin Tactionaa! lateal serong %entrokaudal(
◦ L $ $ -aitu ,eion & ab.uction 122
.an se.i%it etenal otation$◦ 0lose $a&k $osition -aitu posisi ,eion
- a..uction & intenal otation penu!◦ 0apsular pattern hip joint RO : internal
rotation < A!du&tion < ;le'ion
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 9/64
Inner%asi
Dari seg( L9.S9
N( ;emoris6L9. 7) N( 5luteussuperior 6L4.S97
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 10/64
ASS+SS+NTASS+SS+NT ANAN+SIS
Anamnesis khusus:◦ 9( Jenis) ketepatan /aktu dan durasi
keluhan@n-eri)6pegal) !ooring.) sharppain7
◦ <( Lokasi dan distri!usi keluhan@n-eri)6inguinal) upper thigh7
◦ 4( $ro%okasi oleh sikap@posisi dan gerak
-g memi&u keluhan@n-eri) morningsi&kness@ start pain(
Anamnesis lain meliputi sistem danorgan tu!uh -ang terkait) tindakan
operasi atau terapi medis lain Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 11/64
INS$+0TION
STATI0 AND DNAI0
INS$+0TION
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 12/64
TOTAL) S+5+NTAL ANDLOKAL INS$+0TION
◦ Inspeksi mulai saat klien
masuk ruangan) perhatikanposisi atau sikap tu!uh saatduduk) !erdiri atau saat akti#2ketika !erjalan adakah
trendelens burg gait) duchene)(◦ Pe!ati%an posisi .an si%ap
tun%-pelvic-!ip-le3-4oot56ua.ant70 coa
val3a/vaa0 3enu val3us-vaus0 ,at-!ollo8 4oot5se3mental70 seta pelvic-!ip secaa tesen.ii5lo%al7$
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 13/64
$++RIKSAAN ;UN5SI 5+RAK$++RIKSAAN ;UN5SI 5+RAK
DASARDASARBUI0K T+ST
◦ 5AIT ANALSIS
$erhatikan gait &-&les: saat initial &onta&t)#oot 3at) loading respons) terminal &onta&t)as&eleration) mid s/ing) des&eleration dankem!ali initial &onta&t
$athologi&al gait seperti trendelenCs gait) du&hene gait)/eddlingCs gait) paral-ti& gait) parkinsonianCs gait) dll(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 14/64
$athologi&al gait o# hip$athologi&al gait o# hip
patholog-patholog-Antalgic gait
Duchene gait
Pelvic torsion gait
Hip flexion gait
Hip abduction gait
Leg discrepancy gait
Joint pain
Bilateral hip arthrosis
Trendelen berg gait Hip abductor weakness
Hip flexion contracture
Unilateral hip flexion contract
Hip abductor contract/ Plantar flx
spasticity/contr
Hip flexion contracture
Sugijanto, 2012
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 15/64
TRUNK ;L+ION.+T+NSION $OSISI
1+RDIRI◦ $erhatikan porsi Lum!o
pel%i& rh-thm momen mana-g dominan dan kurang(
◦ $erhatikan tim!uln-a n-eri)&repitation) dan distri!usikeluhann-a(
◦ +nd #eel(
SBUAT AND 1OUN0IN5
◦ Dilakukan !ilamemungkinkan) tidakdilakukan pada usia lanjut
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 16/64
$++RIKSAAN 5+RAK $ASI;$++RIKSAAN 5+RAK $ASI;
;L+KSI $ASI; $osisi terlentang dg lutut 3eksi:
◦ RO : 99=.9<== so#t end #eel(
$osisi terlentang dg lutut ekstensi:◦ RO : E== spring- end #eel(
$em!atasan oleh ketegangan otothamstrings(
+KST+NSI $ASI;
$osisi terlungkup :◦ RO : 9>.<== spring- end #eel(
$em!atasan oleh ketegangan m( iliopsoas(
◦ 1ila lutut 3eksi penuh◦ RO : 9== spring- end #eel( $em!atasan
oleh ketegangan m( re&tus #emoris(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 17/64
A9:U;'I PA'I<$osisi terlentang gerak
tungkai kesamping(
RO: 4=.>== dg elasti&.spring- end #eel($em!atasan olehketegangan mm( addu&tors
A::U;'I PA'I<$osisi terlentang dengan
tungkai &ontra lateral 3eksidan tungkai -ang diukurlurus di!a/ahn-a) gerak
tungkai kedalam(RO: 4== dg spring- end#eel( $em!atasan olehketegangan mm(a!du&tors(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 18/64
ROTA'I INTERNAL PA'I<$osisi telungkup dg lutut
3eksi E==
RO 4=.?== elasti& end #eel(pem!atasan oleh kapsuloligamenter(
ROTA'I E;'TERNALPA'I<
$osisi telungkup dg lutut3eksi E==
RO ?=.F== elasti& end #eel)pem!atasan oleh kapsuloligamenter
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 19/64
$++RIKSAAN 5+RAK$++RIKSAAN 5+RAK
ISO+TRIK ISO+TRIK
<LE;'I I'OMETRI; Terlentang dg lutut 3eksi F==)
5erakan oleh m( ilio psoas)re&tus #emoris) Sartorius)$e&tenius) 6dan hip addu&tor7(
E;'TEN'I I'OMETRI; $osisi telungkup dg lutut lurus5erakan oleh m( 3luteus
ma%simus) 1i&eps #emoris)Semimem!ranosus)Semitendinosus(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 20/64
A9:U;'I I'OMETRI; $osisi terlentang dg lutut lurus
5erakan oleh m( gluteusmedius.minimus.ma'imus)dan tensor #as&ialatae 6Gsartorius7(
A::U;'I I'OMETRI; $osisi terlentang dg lutut lurus
5erakan oleh m( addu&torlongus.!re%is.magnus) 5ra&ilisdan $e&tenius(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 21/64
ROTASI INT+RNAL ISO+TRIK $osisi telungkup lutut 3eksi E==
5rk m addu&tor longus.!re%is.magnus) gluteus medius.ma'imuspars anterior) tensor #as&ialatae)5ra&ilis dan $e&tenius(
ROTASI +KST+RNALISO+TRIK
$osisi telungkup lutut 3eksi E==
5rk m gluteus ma'imus) O!turator
internus.e'ternus) Huadratus#emoris) $iri#ormis)5amelussuperior.in#erior) Sartorius) dangluteus medius pars posterior(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 22/64
Lo/ 1a&k anou%re ILo/ 1a&k anou%re I
Hip flexion knee flex (SIJ)
+ adduction & internal
rotation (Hip/ Piriformis)Hip flexion external rotation
Patric’s test/kontra
patric’s (Hip joint) Knee extension Kerni
(Hamtrins/Isc!iadicus)
Sugijanto, 2013
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 23/64
Lo/ 1a&k aneou%reLo/ 1a&k aneou%re
IIIIIIP"SISI #$%K'P
Hip extension knee extension
fiksasi pada tu*er isc!iadicum
(Hip Joint)Hip extension knee extension
fiksasi pada sacrum (+Sacroiliac
joint)Hip extension knee extension
fiksasi pada o,er t!oracal
(um*ar spain)
Sugijanto, 2012
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 24/64
'PE'I<IC TE'T'PE'I<IC TE'T
1ON $AL$ATION Titik re#erensi: Ilia& &rest) Anterior Superior
Ilia& Spine 6SIAS7) $osterior Superior Ilia&Spine 6SI$S7) 5reat Tro&hanter) S-mphisis)Is&hiadi& tu!er) 0o&&-g(
US0L+ $AL$ATION $iri#ormis m(
◦ elalui segitiga SI$S) 0o&&-g dan 5reat Tro&hanter) sepertiga tengahn-a(
◦ $alpasi dalam) sejajar sa&roilia&(
5luteus medius m(
◦ Sisi lateral di!a/ah ilia& &rest dantro&hanter(
◦ $alpasi arah anteroposterior Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 25/64
US0L+ $AL$ATIONIlioti!ial !and(
◦ Dari ilia& &rest sampai lateralpaha hingga lateral ti!ia
Addu&tor longus m(◦
$alpasi tendon ujung !a/ahinguinal(◦ Buadri&eps $erlekatan re&tus #emoris pada
SIAS) ke!a/ah sisi anterior pahahingga patella(
◦ ,amstrings Lateral hamstrings 6!i&eps
#emoris7 dan medial hamstringssemimem!ranosus)semitendinosus7(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 26/64
JOINT $LA O*++NT JOINT $LA O*++NT
HIP *OINT :IRECTTRACTION◦ L$$ : untuk orientasi
◦$+1ATASAN RO : untukmengetahui keluasan gerak dankualitas end #eel
◦ Arah selalu ke Lateral serong%entro&audal
COMPRE''ION TE'T ◦ Untuk mengetahui patologi
permukaan sendi 6su!&hondrale7
IN:IRECT TRACTION
◦ Untuk mengetahui pengaruh N1(Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 27/64
S$+0IAL T+STS$+0IAL T+ST
RO◦ MEA'UREMENT
T@US0L+
$+R;ORAN0+◦ US0L+ T+STIN5 *aliditas dan relia!ilitas s(d( nilai
4
◦ , , D @S$5OANO+T+R Untuk T nilai 4 le!ih) ukuran
mm,g atau gram(Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 28/64
US0L+ L+N5T, T+ST
Iliopsoas m(◦ Terlentang pel%is ditepi !ed)
hip 3e'ion &ontralateral dan
gerak hip e'tensionipsilateral(
◦ Se!elum dan sesudahkontraksi2 kualitas
ketegangan otot(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 29/64
,ip addu&tor m(◦ $osisi terlentang tungkai
&ontralateral di"ksasi)
gerak ,ip addu&tionipsilateral(
Re&tus #emoris m(◦ $osisi spt diatas) gerak
knee 3e'ion ipsilateral(,amstrings m(
◦ $osisi terlentang gerakStraight leg rising tungkai
ipsilateral) lutut lurus(Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 30/64
T+S K,USUS LAIN T+S K,USUS LAIN,ip 3e'ion test #or Sa&roilia& 6hip
3e' pel%i& nutation7) $iri#ormis m6hip 3e'.add.internal rot7) hip joint6$atri&Cs test7(
Straight Leg Rising
Leg Length Test
Trendelen!urg test
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 31/64
N+UROLO5I0 T+STN+UROLO5I0 T+ST
◦ Sensor- test in areadermatome and area ner%ina(
◦
-otome test(
◦ Tendon Re3e' test
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 32/64
ME:ICAL :ATAME:ICAL :ATA
C RA◦ ;ra&ture) dislo&ation) arthrosis)
#usion) osteoph-te) dll(
RI◦ 5am!aran detail
O$+RASI
DLL
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 33/64
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 34/64
*OINT MO9ILI=ATION *OINT MO9ILI=ATIONHip >oint :iect Taction
◦ L$$ Tra&tion arah lateral serong %entro&audal
pada posisi 3e' . A!d 4== sedikit e'ternalrot(
&raction in limited 'bduction enguluran medial capsule
&raction in limited (nternal rotation enguluran posterior capsule
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 35/64
Dire&t tra&tion in Limited RODire&t tra&tion in Limited RO
Tra&tion in limited
e'ternal rotation◦ $enguluran anterior &apsule
Tra&tion in limited
horiontal add◦ $enguluran posterior o!liHue
&apsule
Longitudinal tra&tion inL$$◦ $enguluran seluruh &apsule
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 36/64
Hip >oint In.iect Taction◦ $osisi anatomis terlentang
Longitudinal tra&tion arah distal(
◦ Disertai os&illation seluruh RO se!agaimanipulasi &orpus li!era(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 37/64
SA0ROILIA0 JOINTSA0ROILIA0 JOINT
O1ILIATIONO1ILIATION
Nutasi-%onta nutasi◦ :IRECT: $osisi terlentang ganjal sand
!ag !a/ah sa&rum( Doronganiliumkanan.kiri arah laterodorsal(
◦ IN:IRECT ? $osisi terlentang) hip 3e'ionipsilateral) Dorongan is&hiadi& tu!er keanterior tilt(
Anteio )appin3◦ o!ilisasi SIJ) anterior lig( Stret&hed
Posteio )appin3◦ :IRECT: $osisi tidur miring dg hip 3e'ion
F==) dorongan diatas ilium kemedial(
◦ IN:IRECT ? $osisi telungkup) hipe'tension ipsilateral) Dorongan ilium
tu!er ke posterior tilt Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 38/64
MO9ILI=ATION EXERCI'EMO9ILI=ATION EXERCI'E
PA''IVE'TA9ILI=ATION?
◦ SIJ : $el%i& !elt
STABILIZATI N
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 39/64
EVALUA'IEVALUA'I$ain: *AS@ *RS@ *DSRO: 5oneometer
Strength: T@,and held
d-namometer@Spigmomanometer(
Sugijanto, 2014
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 40/64
;ISIOT+RA$I ,I$;ISIOT+RA$I ,I$
0O$L+0O$L+
Sugijanto, 2013
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 41/64
$athologi&al gait o# hip patholog-$athologi&al gait o# hip patholog-
Antalgic gait
Duchene gait
Pelvic torsion gait
Hip flexion
contracture gait
Hip abduction gait
Leg discrepancy gait
Joint pain
Bilateral hip arthrosis
Trendelen
berg gaitHip abductor weakness
Hip flexion contracture
Unilat eral hip flexion
contracture
Hip abductor contract/
Plantar flx spasticity/contr
Hip flexion contracture
Sugijanto, 2013
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 42/64
RedRed
3ag3ag
Sugijanto, 2013
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 43/64
S&reeningS&reening
HuestionairHuestionair
Sugijanto, 2013
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 44/64
SA0ROILIA0 JOINT $AINSA0ROILIA0 JOINT $AIN
N-eri posterior pel%isM gluteal Mhamstrings(
$d /anita hamil@pas&a menglahirkan
unsta!le(
$as&a injur- hipomo!il
Sugijanto, 2012
SACROILIAC JOIN !"SF#NCION
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 45/64
<un3si0 .isabilitas .an<un3si0 .isabilitas .an
se!atse!at
Anatomic impairment
Tight .&ontra&tu
re
Functional
impairment Activity
limitationParticipation
restriction
$ain
us&leim!alan&
e
Muscl
e
eak.
atroph-
0apselsG
ligament
Inter"!er
adhesion0apsel Glig
&ontra&ture
Walking
Sstair
climbing
Work
Sport
Recreation
SACROILIAC JOIN !"SF#NCION
Constetual4actos
Inten
al4actos
Etenal4actos
0apsula
rpattern
Stret&hed pain
0hroni&in3amati
on S-mpathi&h-pera&ti%
it-
Neves
No&isensori&
Jointsur#a&
e
1lo&kad
e
$el%i&torsion
posture
us&uloskele
tal pain
Re#erredpain
Li$ting
antalgi&gait
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 46/64
$el%i& 5irdle o!ilit- De"&its$el%i& 5irdle o!ilit- De"&itsICD-9-CM code: ?F(9 Sprain o# sa&roilia&
ligamentICF codes: A&ti%ities and $arti&ipation Domain
&ode: .1@2 Shi#ting the !od-Cs &entre o#gra%it- 6Adjusting o# mo%ing the /eight o# the!od- #rom one position to another /hilesitting) standing or l-ing) su&h as mo%ing #romone #oot to another /hile standing(7
1od- Stru&ture &ode: sB22 Sa&ral %erte!ral&olumn
1od- ;un&tions &ode: bBD2@ o!ilit- o# pel%isCommon Historical Findings:
Sugijanto, 2012
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 47/64
SA0ROILIA0 JOINT T+ST ISA0ROILIA0 JOINT T+ST I
$alpasi SIAS danSI$S pel%i& torsion
SLR test n-eri
SLR "ksasi pel%istanpa n-eri
Sugijanto, 2012
SA0ROILIA0 JOINT
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 48/64
SA0ROILIA0 JOINTSA0ROILIA0 JOINT
T+ST II T+ST II
Distra&tion test6anterior SIJ gapping
test7 Tight trust) "'ation on
the sa&rum(
Sa&ral thrust test)&ompression on thesa&rum(
Sugijanto, 2012
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 49/64
$el%i& 5irdle o!ilit- De"&its$el%i& 5irdle o!ilit- De"&itsICD-9-CM code: ?F(9 Sprain o# sa&roilia&
ligamentICF codes: A&ti%ities and $arti&ipation Domain
&ode: .1@2 Shi#ting the !od-Cs &entre o#gra%it- 6Adjusting o# mo%ing the /eight o# the!od- #rom one position to another /hilesitting) standing or l-ing) su&h as mo%ing #romone #oot to another /hile standing(7
1od- Stru&ture &ode: sB22 Sa&ral %erte!ral&olumn
1od- ;un&tions &ode: bBD2@ o!ilit- o# pel%isCommon Historical Findings:
Sugijanto, 2012
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 50/64
INT+R*+NSIINT+R*+NSI
Joint mo!iliation
A&ti%e mo!iliation
Sugijanto, 2012
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 51/64
INT+R*+NSIINT+R*+NSI
$assi%esta!ilisation
$el%i& !elt
A&ti%esta!iliation Strength $el%i&.hip mus&les G$el%i& 3oor(
Sugijanto, 2012
HAM'TRIN)' PAINHAM'TRIN)' PAIN -
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 52/64
HAM'TRIN)' PAIN -HAM'TRIN)' PAIN -PIRI<ORMI'PIRI<ORMI''(N:ROME'(N:ROME
Patolo3ilain
'pasm/ti3!t
Entapment n$isc!ia.ic
N"ei3luteal
Paest!esia pa!a
bela%an3
Palpasi?spasm
Contact
ela
Muscle spasm/
tightness
Neural adhesion
M"o4ascial
eleaseContact ela
stetc!in3pii4omis
'ten3t!enin3Ec 3luteal ms
Hin.ai.ompet
.isa%u/be.iiSugijanto, 2012
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 53/64
Lo8 bac% manouve I?,e%si-a..u%si-otasiintenal n"ei 3luteal$
Palpasi m$ pii4omis!"petone .an n"ei$
-ontract relax stretc!
test m$ pii4omisUppe isc!ia.ic nevetest
ASS+SS+NTASS+SS+NT
Sugijanto, 20Sugijanto, 2012
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 54/64
INT+R*+NSIINT+R*+NSI
Rela' massage
Contract relax stretchingm( piri#ormis
enghindari dudukditempat keras
Auto stret&hing
Neural mo!iliation
Sugijanto, 2012
55
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 55/64
N+RI LAT+RAL $AN55ULN+RI LAT+RAL $AN55UL
,IN55A IN5UINAL,IN55A IN5UINAL
) Hipotesis a8al?) Osteoatitis Coae
) :ila%u%an pemei%saansecaa al3oitme .en3anmen33una%an evi.ence
base pactice untu%mene3a%%an ataumenola%
Sugijanto, 2013
Hip Osteo rthritis
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 56/64
Anatomic impairment
Functioning,
disability and health
Vascular Capsul
Ligamen
Otot/
Tendon
Micro
Sirculationontra!tur La"it#
$rosi
%a&an
Sendi
In'lamasi tlSu(c)ondral
Spasme
Tig)tness/
ontra!tur
*e'ormitas
Immo(ilisasi
Penumpu!an+at iritasi
Lema)
Iritasi
,aringan
Osteo'it
In'lamasi
ronis
Capsular
Pattern
-#eri
%egang
.unctional
impairment
Actiit#
limitation
Participationrestriction
H#pomo(ilit#-#eri
!ompresi
-#eri
pagi
-#eri
Inguinal
Contextual
factor
Internal
factor
Lexternal
factor
p
Antalgic gait
Stair climbing
Work
Sport
Recreation
%ersila
In3uinal + pelvicIn3uinal + pelvic
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 57/64
O%er/eight
O%erused
Injur-
;ragmentasi Gerosi ra/an
sendi
,ipertro"su!&hodr( G
osteo"t0orpusli!era
Kontraktu
r Joint
Anamnesis:N-eri G kakuhip
1angun tidur
n-eri
$assi%e testRomter!atas:e'tern rotPA!d P intern
rot ;irm end#eel
Inspeksi 5ait:Du&hene
J$: N-eri akhirRange )elati&@;irm end#eel
In3uinal + pelvicIn3uinal + pelvic
pain - Hippain - Hip
Osteoat!osisOsteoat!osisDegenerasi
Sugijanto, 2013
Capsule
$ # $h i h #
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 58/64
$ro&ess o# $h-siotherap- #or$ro&ess o# $h-siotherap- #or
Joint sur#a&e impairment Joint sur#a&e impairment
Nyeri
kompresi
Akti$& Nyeri
range tertentu
'ait& Antalgic
Compression
test nyeri
!istraction test
nyeri (ilang
!ila
positif
Joint
mobili)ation
Active
stabili)ation
Alignment
correction
Weig(t
bearing
re*uce
9ilane3ati4
3anti!ipotesi
s lain
Sugijanto, 2013
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 59/64
,ip o!ilit- De"&its,ip o!ilit- De"&its
ICD-9-CM codes! "#$% S&rain o' theischioca&sular ligament
ICF codes! cti)ities and *artici&ationDomain codes!.1F22 Gal%in3 s!ot .istances 5Gal%in3 4o less
t!an a %ilomete0 suc! as 8al%in3 aoun. ooms o!all 8a"s0 8it!in a buil.in3 o 4o s!ot .istancesoutsi.e$7
.1F22 Gal%in3 lon3 .istances 5Gal%in3 4o moet!an a %ilomete0 suc! as acoss a villa3e o to8n0bet8een villa3es o acoss open aeas$7
.1@F1 Maintainin3 a stan.in3 position 5'ta"in3 ina stan.in3 position 4o some time as e6uie.0suc! as 8!en stan.in3 in a 6ueue$7
1od- Stru&ture &ode: sBF22@ Hip >oint1od- ;un&tions &ode: bB@22 Mobilit" o4 a
sin3le >ointSugijanto, 2013
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 60/64
T+S K,USUS T+S K,USUS
Tes %!usus
◦ J$ test internal rotasi) adduksi)3eksi hip joint) "rm end #eel(
◦
0ranial &ompression o# the hip joint)
◦ Tes &orpus li!era
Pemei%saan lain
◦ ra-: pen-empitan sela sendi2pene!alan tulang su!&hondrale2osteoph-te
Sugijanto, 2013
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 61/64
INT+R*+NSIONINT+R*+NSION
Inter%ensi◦ Joint mo!iliation
◦ anipulasi &orpus li!era
◦ A&ti%e mo!iliation
e'er&ise◦ eight &ontrol
Ree%aluasi: pain
Sugijanto, 2013
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 62/64
0ollum #emoris #ra&ture0ollum #emoris #ra&ture
Osteoporotic In+ury Fracture collum $emoris
Nyeri inguinal
Jalan nyeri
troc(anter non+ol
Leg *iscrepancy
RO, terbatas
- crepitasi
. ray
/
Operative A,P
Re(ab0 ambulasi
Coservative
0ollum ;emoris0ollum ;emoris
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 63/64
#ra&ture 6,ip#ra&ture 6,ip
redu&tion /ith A$7redu&tion /ith A$7Function1 *isability
an* (ealt(Conte2tual
$actor
Anatomic
impairment
Functional
impairment Activity
limitation
Participationrestriction
Sen*i
,uscleCapsels
Weak3
Atrop(yContracture
ig(t3
contracte*
Nerve
Nerve lesion
Sensoric
*e$icit
Capsular
pattern 4non
Pain
5yomobility
Strengt( an*
en*urance
Internal
$actor
62ternal
$actor
,otoric
*e$icit
Ambulation
Run1 -
Jump
Work
Sport
Recreation
%alance -
Stability
Skin
Cicatri2
ulang
Semente* Non semente*
Stability
Ligamen
La2ity
Woun*
(ealing
:A<TAR PU'TA;A:A<TAR PU'TA;A
7/23/2019 6A. MANUAL HIP Lampiran 6.ppt
http://slidepdf.com/reader/full/6a-manual-hip-lampiran-6ppt 64/64
:A<TAR PU'TA;A:A<TAR PU'TA;A 0ook 0+) Osthopaedi& anual Therap-) $earson $renti&e ,all) Ne/
Jerse-) <==Q
5oodmann G 1oissaunnault) $atholog- impli&ation #orph-siotherap-( 1 Saunders &o) London) <===(
,elting D G Kessler R) anagement o# &ommon mus&uloskeletaldisorder) ippin&ott illiams and ilkins) $hiladelphia) <==F(
ako#sk- ,) Spinal anual Therap-) Sla&k in&) NJ USA) <==4
eado/s JTS) Orthopaedi& Dierential Diagnosis in $h-sisaltherap-) & 5ra/.,ill) N) 9EEE(
*an der +l) A) Luna&ek) $ and agemaker) A) anuele therapie)/er%elkolom onderoek) deel 9) Uitge%erij anu/el) Roterdam) +d(I) 9E4(
*an der +l) A) Luna&ek) $ and agemaker) A) anuele therapieer%elkolom 1ehandeling) deel <) Uitge%erij anu/el) Roterdam)+d( I) 9EE(
D%orak) J and D%orak) *) edi&al &he&klists anual edi&ine) 5erg