terapi latihan pada ektremitas bawah

Summary

The video discusses exercises focused on the lower extremities, particularly the knee and ankle joints. It highlights the importance of these exercises for preventing conditions like knee osteoarthritis and ligament issues, which often stem from muscular imbalances. The speaker explains key concepts such as open and closed kinetic chains, emphasizing how improper alignment and muscle shortening can affect joint stability. Various exercises, including isometric training and ankle pumping, are covered to improve muscle strength, reduce pain, and enhance joint function. The video aims to educate on the importance of proper exercise techniques to prevent injury and improve mobility.

Takeaways

• 💪 The video discusses the importance of exercises for the lower extremities, especially the knee and ankle, due to conditions like osteoarthritis (OA) or ligament injuries.
• 🦵 Knee joint pathologies can be caused by imbalances in the surrounding muscles, leading to problems like patella alta (elevated patella).
• 🧠 The discussion highlights that proper alignment and muscle function around the knee are crucial for preventing joint damage, especially in areas like the medial or lateral sides of the knee.
• 📉 Overstretching of ligaments, such as the anterior cruciate ligament (ACL), can result from muscle instability around the knee, often due to poor landing techniques in sports.
• 🏋️‍♂️ Closed Kinetic Chain (CKC) exercises, like bridging, are recommended for knee stability as they involve fixed distal points (feet on the ground), compared to Open Kinetic Chain (OKC) exercises where the distal part is free.
• 🧘‍♂️ Isometric exercises (where muscle length doesn’t change) are beneficial for reducing muscle atrophy, minimizing spasms, and reducing pain through contraction and improved blood flow.
• ⛓ The video discusses how muscles that cross two joints (such as the quadriceps) need special attention during exercises to prevent hyperextension or improper muscle shortening.
• 🔄 Exercises like straight leg raises (SLR) target the quadriceps and are a combination of concentric (lifting), isometric (holding), and eccentric (lowering) contractions.
• 🦶 Ankle exercises are highlighted for their importance in improving venous return and preventing conditions like deep vein thrombosis (DVT).
• 🩺 Elevation and support during certain exercises are important to consider for patients with heart issues, as increased blood flow can put strain on the heart.

Q & A

Why are exercises for the knee and ankle joint important in rehabilitation?

Exercises for the knee and ankle are important because they help address pathologies such as osteoarthritis or ligament injuries. Strengthening muscles around these joints can prevent conditions like joint misalignment and excessive pressure on certain areas, which may lead to cartilage damage.

What role do muscles play in knee pathologies such as osteoarthritis?

Muscles play a key role in knee pathologies because imbalances or tightness in the surrounding muscles, like the quadriceps, can affect joint alignment. For example, shortening of the quadriceps can cause the patella to shift upward, leading to further complications like patella alta.

What is the difference between medial and lateral knee osteoarthritis?

Medial knee osteoarthritis occurs when there's degeneration or excessive pressure on the inner side of the knee, while lateral knee osteoarthritis affects the outer side. The imbalance in muscle strength around the knee can influence which side becomes more affected.

Why is it important to assess stability in the knee joint for athletes?

Assessing stability in the knee is crucial for athletes to prevent injuries. Stable knees help maintain correct alignment during activities like jumping or landing, reducing the risk of ligament strain or other injuries caused by excessive joint movement.

What are Close Kinetic Chain (CKC) and Open Kinetic Chain (OKC) exercises?

Close Kinetic Chain (CKC) exercises involve movement where the distal part of the limb (like the foot) is fixed, such as during a squat. Open Kinetic Chain (OKC) exercises involve movement where the distal part is free, like a leg extension. CKC exercises are generally preferred for joint stabilization.

How does isometric exercise benefit muscle function?

Isometric exercises involve muscle contractions without changing the length of the muscle, which can minimize muscle atrophy, reduce spasms, and alleviate pain. They also promote muscle strengthening, especially for stabilizing muscles around joints like the knee.

What is patella alta, and how is it caused?

Patella alta is a condition where the patella (kneecap) is positioned higher than normal. It is caused by the shortening of the quadriceps muscle, which pulls the patella upward. This misalignment can lead to joint instability and other knee issues.

Why is proper positioning important during exercises targeting the quadriceps?

Proper positioning is important to avoid hyperextension of the knee and to ensure the correct muscle groups are activated. For example, using supports to keep the heel in the right position during quadriceps exercises can prevent knee strain and enhance muscle activation.

What are the benefits of ankle pumping exercises?

Ankle pumping exercises are important for improving blood circulation, particularly in preventing venous thrombosis. These exercises help the veins move blood back to the heart by using the one-way valve system, reducing the risk of blood clots.

What is the Burger's exercise, and when is it used?

Burger's exercise is used to improve blood flow in cases of arterial insufficiency, such as in patients with vascular problems caused by smoking. It involves elevating the legs and performing specific movements to encourage arterial circulation.

Outlines

00:00

🦵 Introduction to Lower Extremity Exercises

The paragraph introduces the importance of exercises targeting the knee and ankle, especially in addressing various pathologies like osteoarthritis (OA) and ligament injuries. It emphasizes that such issues are often influenced by surrounding muscles rather than just being direct injuries. The alignment of the knee joint, affected by muscle imbalances, can lead to problems such as patella alta, knee instability, and hyperextension. The text stresses the role of muscles like the quadriceps in stabilizing the knee and how imbalances can cause damage to ligaments and other joint components.

05:00

💪 The Role of Isometric Exercises

This section explains the benefits of isometric exercises, which involve muscle contraction without changing muscle length. Isometric exercises help minimize muscle atrophy, reduce spasms through post-contraction relaxation, and alleviate pain by improving blood flow and changing pH levels in the muscles. The paragraph also discusses how different postures affect muscle contraction, emphasizing that proper alignment and muscle length are key for effective isometric exercises. The focus is on the quadriceps, highlighting the need for graded extension exercises for balanced muscle development.

10:03

🦶 Importance of Functional and Ankle Exercises

The final paragraph covers functional exercises like bridging for strengthening different parts of the body, including the anterior, posterior, medial, and lateral muscles. It also introduces ankle pumping exercises to prevent thrombosis, emphasizing the importance of blood flow and how valves in veins prevent backflow. Elevation techniques are also discussed, with a caution to consult with a medical professional in cases of heart conditions to avoid overwhelming the heart with increased blood flow. The section concludes with a brief mention of 'Burger exercises' for arterial health, particularly relevant for smokers.

Keywords

💡Lower extremity

The lower extremity refers to the lower limbs, particularly focusing on the knee and ankle joints in the context of this video. The speaker emphasizes the importance of exercises targeting these areas to address various pathologies like osteoarthritis or ligament injuries. The lower extremity is crucial for mobility, and its stability and strength play a significant role in preventing further damage or injury.

💡Osteoarthritis (OA)

Osteoarthritis (OA) is a degenerative joint disease where cartilage deteriorates, leading to pain and stiffness, especially in weight-bearing joints like the knee. In the video, the speaker refers to OA as 'pengapuran' (calcification) and discusses how muscle imbalances can cause undue stress on the medial or lateral parts of the knee, potentially leading to this condition.

💡Ligament

Ligaments are bands of tough, elastic tissue that connect bones and provide joint stability. The speaker mentions ligament injuries, such as strains or overextension of the anterior cruciate ligament (ACL), which can result from instability in the knee. Strengthening surrounding muscles helps in reducing the risk of ligament damage by maintaining proper joint alignment.

💡Patella Alta

Patella Alta is a condition where the kneecap (patella) is positioned higher than normal. The speaker explains that this is often caused by shortened quadriceps muscles, which pull the patella upward. The focus of the exercises mentioned in the video is not only on lowering the patella but addressing the root cause—shortened muscles.

💡Closed Kinetic Chain (CKC)

Closed Kinetic Chain (CKC) exercises are movements where the distal part of the limb (like the foot) remains fixed, often providing more stability and functional benefits for rehabilitation. In the video, CKC exercises such as 'bridging' are highlighted as being crucial for strengthening muscles while stabilizing the knee.

💡Open Kinetic Chain (OKC)

Open Kinetic Chain (OKC) exercises involve movements where the distal part of the limb is not fixed, allowing more freedom of motion. These exercises are also mentioned in the video, but the speaker suggests starting with CKC exercises first, as OKC might not provide the necessary stability in initial rehabilitation phases.

💡Isometric exercise

Isometric exercises involve muscle contractions without changing the length of the muscle, commonly used to maintain strength and prevent muscle atrophy. The video highlights isometric exercises as particularly useful for targeting specific muscle groups without causing joint movement, which is important for conditions like ligament injuries or knee osteoarthritis.

💡Quadriceps muscle

The quadriceps are a group of four muscles located at the front of the thigh, responsible for knee extension. The video frequently references these muscles, explaining that their shortening can lead to improper alignment of the knee and patella. Strengthening and stretching these muscles are essential in stabilizing the knee and preventing issues like Patella Alta.

💡Functional exercises

Functional exercises are movements that mimic daily activities, aiming to improve muscle coordination and balance. In the video, exercises like 'bridging' are given as examples of functional exercises that improve both anterior and posterior chain strength, helping to stabilize the knee and ankle during common movements like standing and walking.

💡Venous return

Venous return refers to the flow of blood back to the heart, particularly from the lower extremities. The video discusses how exercises like ankle pumping help in promoting venous return, reducing the risk of blood pooling and thrombosis, especially in bedridden patients or those recovering from injury.

Highlights

Discussion on the importance of lower extremity exercises for the knee and ankle, particularly in addressing pathologies like osteoarthritis and ligament issues.

Clarification that knee issues such as medial calcification are often influenced by surrounding muscle imbalances, not just joint problems.

Explanation of how shortened quadriceps can lead to patella alta (elevated kneecap), affecting knee alignment and function.

Focus on stability and alignment in knee joint exercises to prevent ligament overstretching and injuries.

Introduction to Closed Kinetic Chain (CKC) and Open Kinetic Chain (OKC) exercises, with CKC being prioritized in therapy.

Demonstration of CKC exercise examples, such as bridging, where the foot remains in contact with the ground to enhance stability.

Detailed explanation of isometric exercises and their benefits in minimizing muscle atrophy, reducing spasms, and decreasing pain.

Discussion on how quadriceps exercises can vary in focus, depending on the position (e.g., seated vs. lying down), and how this impacts muscle contraction effectiveness.

Guidance on proper positioning during isometric exercises to avoid hyperextension and ensure effective engagement of targeted muscles.

Illustration of three types of muscle contractions during quadriceps exercises: concentric (lifting), isometric (holding), and eccentric (lowering).

Explanation of ankle pumping exercises to prevent deep vein thrombosis (DVT) by promoting blood flow and preventing venous stasis.

Discussion on the significance of vein valves in preventing backflow of blood and the potential complications if they malfunction.

Recommendation for elevating the legs during certain exercises and consulting with a physician in cases involving heart issues.

Introduction of the 'Burger's exercise,' which is used to address arterial blockages and is particularly relevant in patients with smoking-related conditions.

Conclusion with an invitation for further questions and discussion about the presented exercises and rehabilitation strategies.

Transcripts

alualaikum warahmatullah wabarakatuh

Hari ini kita mau bahas tentang lower

extremity latihan pada lutut dan

pgelangan kaki ya

terutama kita lihat Kenapa sih harus

dilakukan lati-latihan ini karena banyak

patologi misalnya patologi pada lutut

misal

oa osis at pengapuran ya atau

kasus-kasus pada ligamen itu sebenarnya

bukan cuma kasus

yang benar-benar tanda kutip masalah itu

aja artinya bukan karena ya memang

legamennya strein atau adanya pengapuran

di medial atau lateral tapi kita melihat

ee kenapa bisa terjadi pengapuran di

bagian medial kenapa enggak lateral

misalnya itu atau kebalikannya Nah itu

semua dipengaruhi oleh otot yang bekerja

di sekitar lutut

ini atom lutut ya lutut ada fernya ada

tibianya dan juga patela untuk lutut

sendiri sebenarnya cangnya ini ya ini

Ini ada fibula tapi kalau dibilang

bentuk sendi lutut fibula tidak termasuk

sendi lutut ya

tapi

dan nah ini e contoh sendi yang bagus

Misalnya ini bagian medialnya tidak ada

pengapuran bayangkan kalau misalnya ada

sebuah alignment yang menyebabkan

terkenakan penekan berlebih pada bagian

medial maka kerusakan pada pada

permukaan ini akan terjadi misal pada

pengapuran atau adanya patela Alta

misalnya adanya temprungnya naik ke atas

gitu itu kan bukan karena patelannya

Manjat ya atau bergeser ya tapi karena

eh quadrepnya shorten memendek gitu kan

sehingga menarik patelanya Mak yang kita

intervensi bukan cuma pnya kita turunkan

gitu selama itu masih memendek ototnya

maka pat tap akan naik ya atau

posisi-posisi di mana unstab ni lututnya

enggak stabil sehingga terjadi

genatumnya hipkstensi misalnya tentunya

mempengaruhi ligamen misalnya crusatum

anterior ya terjadi eh over terusmenerus

akhirnya ligamennya bermasalah gitu kan

Nah kitaokus ini kan sudah over mau

diapain lagi tidak kita lihat Kenapa dia

bisa overstetch di luar dari misalnya

cedera ya cedera pun sebenarnya kita

bisa analisis di mana kalau misalnya

punya stabilitas lutut yang baik maka

posisi lutut tuh tetap di tengah makanya

kita lihat atlet-atlet yang berprestasi

gitu saat loncat lalu jumping dan

landing itu lututnya tetap di tempat

karena memang punya namanya stabilitas

pada lutut

Oke sebelum ke latihannya kita harus

tahu tentang close Kinetic chain dan

Open Kinetic chain menurut saya sih ini

Sudah dipelajari di terapi latihan dasar

ya ya apa tapi kita review sedikitlah

Apa itu e ckc yaitu gerak aktif di mana

bagian distal tubuh terfiksasi seperti

tak kaki menyentuh tanah ini contohnya

pada bridging ini ini kakinya kan yang

distalnya tempel di tanah kan lalu dia

latihan seperti ini ya kebalikannya

Kalau open kinetik

gerakan aktif bagian tubuh tidak

terfiksasi ini

contohnyaing ini ya dia naik ke atas ini

gak menyentuh tanah

ya yang sifatnya terapek

maka di mulai D dahulu sebelum Open k

Oke ini Conto tah

padaiak seak juga ya ini

gline-nya Leadernya buat ni nanti kita

lihat masing-masing eh pasien Seperti

apa ada masih dikhususkan gitu kan

misalnya yang seperti kita lihat tadi

ternyata pasiennya eh masal imbalance

nih bagian medialnya lebih shorten gitu

kan sehingga menyebabkan posisi lututnya

Berubah itu kan tentu Enggak seperti ini

ya Oke kita mulai dari yang pertama

yaitu setting exercise Apa itu ituan

latihan isometrik ingat ya ini isometrik

jadi tidak ada perubahan panjang otot ya

isometrik Dar otot grup

ototadr otot berapa ada EMP otot ya

tanpa melawan tahanan ya Gunanya buat

apa minimalisir atropi otot hampir semua

fungsi isometrik sih sebenarnya jadi

bisa

buaturangat karat dikraks pergak

Kenapa bisa mengurangi spasme isometrik

karena ada

teori apaation after contraction dan

Tunya mengurangi nyeri mengurangi karena

apa dari mulai teori

eh asam basa juga bisa mengurangi nyeri

ya karena adanya kontraksi adanya flow

sehingga menyebabkan eh Odo lebih banyak

maka ph-nya Berubah itu kan mengurang

Nyeri ya Saya sudah pernah Terangkan dan

juga menguatkan Kuad itu sendiri Ini

salah satu contohnya ya walaupun nanti

kita lihat lagi di mana Ini kan otot

yangartikuler ya artinya otot yang

melewati dua sendi seperti ini maka e

dua sendi itu diperhatikan misalnya

apakah e pasiennya harus duduk seperti

ini atau l down misal Terentang gitu kan

Coba bedanya gimana ya kalau misalnya

dia duduk seperti ini maka e

otot yang bagian Superior ya bagian atas

itu cenderung memendek kan ini memanjang

nah krak ppengaruhi oleh panjang awal

otot ya kalau ototnya semakin panjang

maka kontraksinya semakin maksimal lalu

juga not-nya ini ada ee ganjelan

sebaiknya memang tidak benar-benar di

sini tapi cenderung ke atas ya cenderung

ke sini menghindari apa menghindari

hiperekstensi dan dilihat karena ini

close Kinetic maka heal-nya tetap di

sini kita lihat contohnya latihannya

I kalau di

sini ini mulai Angkat angkelnya

dulu nah ini seharusnya dia tidak

ngangkat Nah dia langsung langsung

mengkoreksi

ya Iya ya berapa

lama Berapa lama kontraksinya kira-kira

6 sampai 8 detik Ya seperti halnya

kontraksi isometrik

Oke ini kebalikannya buat quad resisep

ya dari posisi

eh from position ya hampir sama ya nanti

bisa dilihat di emas ya videonya yang

kedua

adalah ya kalau ini kan Dilihat dari ee

mengangkat kaki lurus ya maka otototot e

quadrisep bagian Superior lebih ee

terstimulus dibandingkan yang inferior

maka sebenarnya kalau untuk quad kita

butuh selain tapi juga apa ini extension

ya ini extensionnya dengan bergrading

derajat-derajatnya

Oke ini

contohnya Ini dia dipt ya

mudah-mudahan UI segera jadi

dipt ya Ini awal nah ini yang strikler

rise jangan lupa Ini bisa ada tiga macam

kontraksi dari mulai konsentrik saat

nenek ke atas lalu isometrik tahan di

atas lalu turun pelan-pelan bentuknya

eksentrik ya

oke Lalu ada latihan fungsional lainnya

ya yang bisa kita desain salah satunya

mungkin ee bridging misalnya bridging

bagus juga bridging nanti kita lihat

untuk yang bagian anterior Seperti apa

latihannya posterior Seperti apa medial

dan leral seperti apa nanti saya upload

di di emas ya

Insyaallah lanjutah anle pamping

exercise anle pamping itu penting ya

satunya untuk mencegah termopabtis ya

Ee dalam bentuk gerakannya sebenarnya

hampir

Bu hampir semua gerakan pada ya

baikantar

fleksi lateral

dan apa itu inflamasi

padaenaa nih Coba kita lihat di sini ini

kan Ya itu kan dari keimal ya ke arah

jantahisaaot

parahnya Lalu ada kontraksi menekan maka

dia naik ke atas kok Gak balik lagi

yaenanya ya karena sifatnya ada one Val

ada Val yang satu arah jadi saat darah

naik ke atas lalu dia akan turun lagi ke

bawah darahnya ke bawah tapi gak akan

masuk ke bawah lagi tapi karena Val

tidak kebuka Bagaimana kalau

kebalikannya Nah akhirnya

terjadi seperti

ini ini p

Oke sebaiknya tetap diupport ya kalaupun

misalnya di kita mau support 45 derajat

maka supportnya full

segini 45 derajat ya Ee melakukan

elevasi sebaiknya dikonsultasikan untuk

kasus-kasus pada jantung ya dianyakan

dulu karena takutnya flownya banyak

sekali sedangkan jantungnya enggak ready

untuk itu

Oke selanjutnya kita ngomong bergerak

siise itu menangani

sumbatan Arteri kalau tadi kan Vena ya

ya awalnya itu burger dulu lalu ada Elen

ditambahin ya Ditambahin lagi latihannya

nanti kita lihat ini

fase-fasenya seperti

ini ini contoh latihannya dari mulai

dielevasi

dulu Ini 45 derajat ya

ya lalu selanjutnya seperti

ini dan yang terakhir

posisinya Terentang ini burger size

contohnya burger diisi itu apa sih

contoh pada kasus-kasus rokok ya wi jadi

burger B pemudarannya

bermasalah

harterinya seperti itu ini referalnya

bisa dilihat di ini Terima kasih banyak

kalau ada pertanyaan boleh ya nanti kita

bahas lagi Terima kasih asalamualaikum

warahmatullahi wabarakatuh