i
PERBEDAAN EFEKTIVITAS STRAIN COUNTERSTRAIN
DENGAN POST ISOMETRIC RELAXATION TERHADAP
PENURUNAN NYERI LOW BACK PAIN MYOGENIC SISWI
MADRASAH ALIYAH NEGERI TULUNGAGUNG 1
SKRIPSI
Diajukan Sebagai Salah Satu Syarat
Untuk Memperoleh Gelar Sarjana Fisioterapi
OLEH
SITI AINUN MA’RUFA
201310490311095
PROGRAM STUDI S1 FISIOTERAPI
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MALANG
2017
iv
vi
KATA PENGANTAR
Puji Syukur penulis panjatkan kehadirat ALLAH SWT atas limpahan rahmat,
hidayah dan keridhaan-Nya penulis dapat menyelesaikan skripsi dengan judul
“Perbedaan Efektivitas Strain Counterstrain dengan Post Isometric Relaxation
terhadap Penurunan Nyeri Low Back Pain Myogenic Siswi Madrasah Aliyah
Negeri Tulungagung 1”. Skripsi ini disusun sebagai salah satu syarat guna
memperoleh gelar Sarjana Fisioterapi (S.Ft) pada Program Studi S1 Fisioterapi
Fakultas Ilmu Kesehatan Universitas Muhammadiyah Malang.
Penulis menyadari bahwa tugas akhir ini dapat terselesaikan berkat bantuan,
arahan, dukungan dan bimbingan dari berbagai pihak. Penulis tidak lupa mengucapkan
terimakasih yang sebesar-besarnya kepada yang terhormat:
1. Bapak Fauzan, selaku Rektor Universitas Muhammadiyah Malang periode
2016-2020).
2. Bapak Yoyok Bekti Prasetyo, selaku Dekan Fakultas Ilmu Kesehatan
Universitas Muhammadiyah Malang
3. Ibu Atika Yulianti, selaku Ketua Program Studi Fisioterapi Fakultas Ilmu
Kesehatan Universitas Muhammadiyah Malang
4. Bapak Safun Rahmanto, selaku Dosen pembimbing I yang telah memberikan
bimbingan, arahan dan motivasi dalam penyusunan skripsi ini.
5. Bapak Dimas Sondang Irawan, selaku Dosen pembimbing II dan Dosen
pembimbing akademik yang telah memberikan bimbingan, arahan dan
motivasi dalam penyusunan skripsi ini.
vii
6. Kedua orang tua dan saudara yang selalu mendoakan, memberikan motivasi,
mendukung secara moril maupun materil sehingga skripsi ini dapat
terselesaikan.
7. Seluruh Dosen Program Studi S1 Fisioterapi yang telah membagikan ilmunya.
8. Adik-Adik responden penelitian yang telah bekerjasama dengan baik selama
proses penelitian.
9. The Bestie (Della dan Dyta)
10. Teman-temanku Momon, Erina, Yosika, Aini, Irma, Titis, Fahri, Zain, Ashifa,
Enty, Agus, Bella, Sovia, Hayyu, Shelly, Yoga A., Dhani, Wahyu, Anugrah,
Meily, Nanda, Aga E.
11. FISIOTERAPI B 2013
12. HIMATERA FIKES UMM
13. Seluruh pihak yang telah membantu penyusunan skripsi ini.
Penulis menyadari dalam penulisan tugas akhir ini masih terdapat kekurangan
dan jauh dari kesempurnaan. Oleh karena itu, koreksi dari bapak ibu pembimbing dan
penguji serta kritik dari berbagai pihak sangat diperlukan bagi penulis untuk
menyempurnakan penulisan. Semoga skripsi ini bermanfaat bagi masyarakat dan
instansi terkait.
Malang, 10 Juli 2017
Penulis
x
DAFTAR ISI
HALAMAN JUDUL ..................................................................................................... i
SAMPUL DALAM ...................................................................................................... ii
LEMBAR PERSETUJUAN........................................................................................ iii
LEMBAR PENGESAHAN ........................................................................................ iv
SURAT PERNYATAAN KEASLIAN PENELITIAN ............................................... v
KATA PENGANTAR ................................................................................................ vi
ABSTRAK ................................................................................................................ viii
DAFTAR ISI ................................................................................................................ x
DAFTAR BAGAN .................................................................................................... xii
DAFTAR GAMBAR ................................................................................................ xiii
DAFTAR TABEL ..................................................................................................... xiv
DAFTAR LAMPIRAN .............................................................................................. xv
BAB I ........................................................................................................................... 1
A. Latar Belakang .................................................................................................... 1
B. Rumusan Masalah ............................................................................................. 5
C. Tujuan Penelitian ............................................................................................... 6
D. Manfaat Penelitian .............................................................................................. 6
E. Keaslian Penelitian ............................................................................................ 7
BAB II ........................................................................................................................ 11
A. Low Back Pain .................................................................................................. 11
B. Anatomi dan Fisiologi Vertebra Lumbar ........................................................ 18
C. Nyeri ................................................................................................................ 25
D. Strain Counterstrain ......................................................................................... 29
E. Post Isometric Relaxation ................................................................................ 37
BAB III ...................................................................................................................... 43
A. Kerangka Berpikir ............................................................................................ 43
xi
B. Kerangka Konsep ............................................................................................ 44
C. Hipotesis .......................................................................................................... 45
BAB VI ...................................................................................................................... 46
A. Desain Penelitian .............................................................................................. 46
B. Kerangka Penelitian ......................................................................................... 47
C. Populasi, Sampel dan Teknik Sampling .......................................................... 48
D. Tempat Penelitian ............................................................................................. 51
E. Waktu Penelitian .............................................................................................. 51
F. Definisi Operasional ......................................................................................... 52
G. Etika Penelitian ................................................................................................. 53
H. Alat Pengumpul Data ....................................................................................... 53
I. Prosedur Pengumpulan Data ............................................................................ 55
J. Analisa Data ..................................................................................................... 58
BAB V ........................................................................................................................ 66
A. Karakteristik Responden Penelitian ................................................................. 66
B. Uji Normalitas ................................................................................................. 68
C. Analisis Data .................................................................................................... 69
BAB VI ...................................................................................................................... 72
A. Interpretasi dan Diskusi Hasil .......................................................................... 72
B. Keterbatasan Penelitian ................................................................................... 79
C. Implikasi Fisioterapi ......................................................................................... 79
BAB VII ..................................................................................................................... 81
A. Kesimpulan ....................................................................................................... 81
B. Saran ................................................................................................................ 82
DAFTAR PUSTAKA ................................................................................................ 83
LAMPIRAN ............................................................................................................... 88
xv
DAFTAR LAMPIRAN
Lampiran 1. Kuisioner Penelitian
Lampiran 2. Prosedur Pemeriksaan
Lampiran 3. Mc Kenzie Lumbar Assessment
Lampiran 4. Standar Operasional Prosedur
Lampiran 5. Lembar Izin Penelitian dan Permohonan Menjadi Responden
Lampiran 6. Pernyataan Kesediaan Menjadi Responden
Lampiran 7. Surat Keterangan Selesai Penelitian
Lampiran 8. Karakteristik Responden
Lampiran 9. Uji Normalitas
Lampiran 10. T Test
Lampiran 11. Dokumentasi
Lampiran 12. Lembar Konsultasi, Lembar Persetujuan Seminar Proposal, Lembar
Revisi dan Persetujuan Penelitian
Lampiran 13. Curiculum Vitae
83
DAFTAR PUSTAKA
Almoallim, Hani., Alwafi, Samar., Albazli, Khaled., Alotaibi, Manal & Bazuhair,
Tuqa. 2014. A Simple Approach of Low Back Pain. International Journal
of Clinical Medicine, 5, 1087-1098.
American Physical Therapy Association [APTA]. 2011. Guide to physical therapist
practice (2nded., 2003) Electronic version. American Physical Therapy
Association
Arya, RK. 2014. Low Back Pain- Sign, Symptom and Management. Journal, Indian
Academy of Clinical Medicine, 15(1), 30-41
A Virat., M Rimpela., JJ Salmijeu., A Rimpela., A Savolainen & SM Virtanen. 2000.
Neck or Shoulder Pain and Low Back Pain in Finish Adolescent. J Public
Health, 28(3), 73-164
Balague, F., Mannion, A.F., Pellise, F & Cedraschi,C. 2012. Non Specific Low Back
Pain. Lancet, 19, 379
Ballantyne., Fryer & McLaughlin. 2003. The Effect of Muscle Energy Technique on
Hamstring Extensibility: The Mechanism of Altered Flexibility. Journal of
Osteopathic Medicine, 6(2), 59-63
Bhangle, SD., Sapru, S &Panus, RS. 2009. Back Pain Made Simple: An Approach
Based on Principles and Evidence. Cleveland Clinic Journal of Medicine,
76, 393-399
BMJ. 2013. Visual Analog Scale for Pain. London: BMJ Publishing GroupCael C.
2010. Functional Anatomy. Musculoskeletal Anatomy, Kinesiology, and
Palpation for Manual Therapist, Philadelphia : Wolters Kluwer
Carter, A. 2000. Proprioceptive Neuromuscular Facilitation Decrease Muscle Activity
During The Stretch Reflex in Selected Posterior The Thigh Muscles.
Journal of Sport Rehabilitation, 9, 269-278
Chaitow L. 2009. Ligaments and Positional Release Techniques. Journal of Bodywork
and Movement Therapies, 13(6), 115
Chou, R. & Huffman, LH. 2008 Medications for Acute and Chronic Low Back Pain:
A Review of the Evidence for an American Pain Society/American College
of Physicians Clinical Practice Guideline. Annals of Internal Medicine, 148,
247-248.
Chou, R & Qaseem, A. 2007. Diagnosis and Treatment of Low Back Pain: A Joint
Clinical Practice Guideline from the American College of Physicians and
the American Pain Society. Annals of Internal Medicine, 147, 478-49
84
Clarke, CL., Ryan, CG & Martin, DJ. 2011. Pain Neurophysiology Education for the
Management of Individuals with Chronic Low Back Pain: Systematic
Review and Meta-analysis. Manual Therapy, 16, 544-549
Dagenais, S., Tricco, A.C. & Haldeman, S. (2010) Synthesis of Recommendations for
the Assessment and Management of Low Back Pain from Recent Clinical
Practice Guidelines. Spine, 10, 514-529.
Deyo RA., Mirza SK., Turner JA & Martin BI. 2009. Overtreating Chronic Back Pain:
Time to Back off. J Am Board Fam Med, 22(8), 62
Ellythy, A Marzouk. 2012. Efficay of Muscle Energy Technique Versus Strain
Counter Strain on Low Back Dysfunction. Bull. Fac. Ph. Th. Cairo Univ,
17(2)
Encyclopedia Britannica. 2003. Human Anatomy. British: Encyclopedia Britanica Inc
Feneis H & Dauber W. 2000. Pocket Atlas of Human Anatomy 4th Edition. Stuttgar.
New York: Thieme
Flex & Touro. 2016. Effect of Strain/Counterstrain on Cervical Pain & Disability: A
Case Report. International Journal of Complementary & Alternative
Medicine, 3(5)
Frankel, J & Wallen, N. 1993. How to Design and Evaluate Research in Education,
2nd ed. New York: McGraw-Hill Inc
Fryer G. 2013. Muscle energy technique: research and efficacy. In: Chaitow, L
editor(s). Muscle Energy Techniques. 4th Edition (hlm. 42–64). Edinburgh:
Churchill Livingstone,
Gay, RL & Diehl, PL. 1992. Research Methods for Business and Management. New
York: McMillan Publishing Company
Hair, JF., WC, Black., Barbin, RE., Adderson, RL & Tatham. 2006. Multivariate Data
Analysis 6 Ed. New Jersey: Prentice Hall
Haritha, Shanthi & Madhavi. 2015. Efficacy of Post Isometric Relaxation (PIR)
Technique versus Static Stretching in Subjects with Chronic Non Specific
Neck Pain. IJPHY. 2(6), 1097-1102
H Franke., G Fryer., Ostelo RWJG & Kamper SJ. 2015. Muscle Energy Technique for
non Specific Low Back Pain (Review). Cochrane Database of Systematic
Reviews, 2, ID: CD009852
Hidayat, AA. 2008. Metode Penelitian Keperawatan dan Tekhnik Analisis Data.
Jakarta: Salemba Medika.
Hoy, D., Brooks, P., Blyth, F & Buchbinder, R. 2010. The Epidemiology of Low Back
Pain. Best Practice and Clinical Rheumatology, 24, 769-781
Huijing PA & Baar G. 2008. Myofascial Force Transmission via Extramuscular
Pathways Occurs between Antagonistic Muscles. Cells Tissues Organs,
188(4), 400
85
Ibáñez, García J., Alburquerque, Sendín F., Rodríguez, Blanco C., Girao D., Atienza,
Meseguer A & Planella, Abella S. 2009. Changes in Masseter Muscle
Trigger Points Following Strain-counterstrain or Neuro-muscular
Technique. Journal of Bodywork and Movement Therapies, 13(10)
Jagad, BH. 2013. Effects of Ischemic Compression on The Trigger Points in Upper
Trapezius Muscle. Indian Journal of Physiotherapy and Occupational
Therapy, 7(1), 99-104
Johanes, 2010. Hubungan Antara Postur Tubuh dengan Terjadinya Nyeri Punggung
Bawah pada Pasien Poliklinik Neurologi di RSUP H. Adam Malik Medan
2010, USU: Fakultas Kedokteran Universitas Sumatera Utara.
Jones. 2015. Strain Counterstrain in Quadratus Lumborum. England: Jones Institute.
Karnati, Prahalada NV., R. Reddy & Kumar S. 2015. Core Stabilization Program and
Conventional Exercises in the Patient with Low Back Pain – A Comparative
Study. Int J Physioter 2015, 2(1), 352-360.
Kedra, Agnieszka & Czaprowski, Dariusz. 2013. Epidemiology of Back Pain in
Children and Youth Aged 10–19 from the Area of the Southeast of Poland.
BioMed International Research, ID 506823
Koesyanto, Heri. 2013. Masa Kerja dan Sikap Kerja Duduk terhadap Nyeri Punggung.
Jurnal Kesehatan Masyarakat, 9(1), 9-14.
Kisner and Colby. 2012. Theraupetic Exercise Foundations and Technique. 6th ed.
Philadelpia: F. A Davis Company
Klein, DA., Stone WJ., Philips WT., et al. 2002. PNF Training and Physical Function
in Assisted Living Older Adults. Journal of Aging and Physical Activity, 10,
476-488
Kumar, Yatheendra G., Sneha,P & Sivajyothi, N. 2015. Effectiveness of Muscle
Energy Technique, Ischaemic Compression and Strain Counterstrain on
Upper Trapezius Trigger Points: A Comparative Study. International
Journal of Physical Education,Sports and Health, 1(3), 22-26
Lederman. 2010. Fundamental of Manual Therapy. London: Churchill Livingstone
Lewis, Cynan., Souvlis, Tina & Sterling, Michelle. 2011. Strain-Counterstrain
Therapy Combined with Exercise is Not More Effective than Exercise
Alone on Pain and Disability in People with Acute Low Back Pain: A
Randomised Trial. Journal of Physiotherapy, 57, 91-98
Meltzer KR & Standley PR. 2007. Modeled Repetitive Motion Strain and Indirect
Osteopathic Manipulative Techniques on Regulation of Human Fibroblast
Proliferation and Interleukin Secretion. Journal of the American
Osteopathic Association, 107(36), 527
Moeyadi, Massieh & Davis, D Karen. 2013. Theories of Pain: From Specificity to Gate
Control. J Neurophysiol, 109, 5-12
86
Moore KL., Dalley AF., Agur AMR & Moore ME. 2013. Anatomi berorientasi klinis.
Edisi ke−5. Jakarta: Erlangga
Muttaqin, Arif. 2011. Gangguan Musculoskeletal. Jakarta: Penerbit Buku Kedokteran
Nagrale AVGP., Joshi A & Ramteke G. 2010. The Efficacy of an Integrated
Neuromuscular Inhibition Technique on Upper Trapezius Trigger Points in
Subjects with Nonspecific Neck Pain: A Randomized Controlled Trial.
Journal of Manual & Manipulative Therapy, 18, 37-43
Nazir, Moh. 2009. Metode Penelitian. Jakarta: Ghalia Indonesia
Notoatmodjo, S. 2015. Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta
Nursalam. 2008. Konsep dan Penerapan Metodologi Penelitian Keperawatan. Jakarta:
Info Medika
Pearl, ER. 2007. Ideas About Pain: A historical view. Nat Rev Neurosci, 8, 71– 80
Peterson et al. 2003. Diagnostic Classification of Non Specific Low Back Pain. A New
System Integrating Patho-Anatomic and Clinical Categories.
Physiotheraphy Theory and Practice. 19: 213-237
Pearson. 2009. Human Anatomy. London : Pearson Education
_______. 2009. Human Anatomy. London : Pearson Education
Perreault A., Kelln B., Hertel J., Pugh K & Saliba S. 2009. Short-term effects of strain
counterstrain in reducing pain in upper trapezius tender points. Athletic
Training and Sports Health Care. 1(5), 214
Puentedura, J Emilo & Flynn, Timothy. 2016. Combining Manual Therapy with Pain
Neuroscience Education in the Treatment of Chronic Low Back Pain. A
Narative Review of the Literature. 32(5), 408-414
Roudsari B & Jarvik JG. 2010. Lumbar Spine MRI for Low Back Pain: Indications
and Yield. Ame J Roentgenology. 9(195), 550
Salomons TV., Johnstone T., Backonja M., Shackman AJ & Davidson RJ. 2007.
Individual Differences in The Effects of Perceived Controllability on Pain
Perception: Critical Role of The Prefrontal Cortex. J Cogn Neurosci, 19,
993–1004
Selkow, Noelle M., Grindstaff, Terry L & Saliba Susan. 2009. Short-Term Effect of
MET with Non-Specific Lumbopelvic Pain: A Pilot Study. The Journal of
Manual & Manipulative Therapy, 17(1), E14-18
Sharp, RS. 2001. Stability, Control, and Steering Responses of Motorcycles, Vehicle
System Dynamics. I Journal Health, 35(4-5), 291-318
Snell, R. S. 2011. Anatomi Klinis Berdasarkan Sistem, Dialih bahasakan oleh Sugarto
L. Jakarta: EGC
87
Strength Physio. 2017. Muscle Energy Technique for Quadratus Lumborum in Low
Back Pain Condition: www.strengthphysio.com. Diakses pada 14 Januari
2017
Sugiyono. 2014. Metode Penelitian Kuantitatif, Kualitatif, dan Kombinasi (Mixed
Methods). Bandung : Alfabeta
Tamsuri, A. 2007. Konsep dan Penatalaksanaan Nyeri. Jakarta: ECG. Page
Treede RD. 2006. Pain and Hyperalgesia: Definitions and Theories. In: Handbook of
Clinical Neurology, edited by Cervero F and Jensen TS. Amsterdam:
Elsevier, 81, 3-10
Varghese, Shiby. 2012. The Effectiveness of Muscle Energy Technique as Compared
to Manipulation Therapy in Chronic Low Back Pain. International Journal
of Latest Research in Science and Technology, 1(2), D214-D217
Voohra, Poonam., Kasana, Pratap Varun & Arya, RK. 2016. Role of MRI and
Ultrasonography in Evaluation of Multifidus Muscle in Chronic Low Back
Pain Patients. International Journal of Research in Medical Sciences, 4(12),
5302-5309
Williams, C.M., Maher, C.G., Hancock, M.J., McAuley, J.H., McLachlan, A.J., Britt,
H., et al. (2010) Low Back Pain and Best Practice Care: A Survey of
General Practice Physicians.Archives of Internal Medicine, 170, 271-277
Wilson., Payton., Donegan-Shoaf., et al. 2003. Muscle Energy Technique in Patients
with Low Back Pain: a Pilot Clinical Trial. Journal of Orthopedic and Sport
Physical Therapy, 33, 502-512
Wingerden, Van JP. 2009. Functional Anatomy in Low Back Rehabilitation Balance
in the Biopsychosocial Model. Rotterdam: Gildeprint Drukkerijen,
Enschede
Wong, Kevin C. 2012. Strain Counterstrain: Current Concepts and Clinical Evidence.
Manual Therapy, 17, 2-8
World Health Organization. 2011. Global Status Report On Non Communicable
Diseases 2011. Geneva : WHO
Zhou, Linqiu., Holder, KE & Leahy, PH. 2014. Pathophysiology and Treatment of
Discogenic and Radicular Lower Back Pain. Physical Medicine and
Rehabilitation, 2(6)