1. Lenny Agustaria Banjarnahor, SSt, M. Fis Materi disampaikan pada mahasiswa/i Fisioterapi Program reguler UEU Jakarta 2013

2. Wajib  Kisner, Carolyn & Allen Colby, Lynn Therapeutic Exercise (Foundations & Techniques) Penunjang  Basmajian, John V, Therapeutic Exercise (Third edition)  Hollis Margaret, Practical Exercise Therapy  Licth, Sidney, Therapeutic Exercise  Situs/web relevan

3.  Kemampuan otot/grup memproduksi tegangan utk menghasilkan tenaga dgn upaya maksimal scr statis & dinamis  Faktor-faktor pengaruh : 1. Ukuran cross-sectional otot 2. Hubungan length-tension otot saat kontraksi 3. Rekruitmen motor unit

4. TONE PRODUCED THROUGH THE ACTIVATION OF MOTOR UNITS TONE PRODUCED THROUGH THE ACTIVATION OF MOTOR UNITS MOTOR UNIT THE MOTOR NEURON ALL THE MUSCLE FIBERS IT INNERVATES ALL THE MUSCLE FIBERS IT INNERVATES

6. FG Fast-twitch Glycolytic (involved in phasic movement) FOG Fast-twitch Oxidative Glycolytic SO Slow-twitch Oxidative (involved in tonic movement) WHITE B. HWANG 1999 PINK RED

7. Muscle Number of Motor Unit InnervationRatio Extensor Rectus 29709 1st Lumbricals 96108 Brachioradialis333410 Tibialis Anterior 445562 Gastrocnemius5791934 NUMBER OF MOTOR UNIT & INNERVATION RATIO NUMBER OF MOTOR UNIT & INNERVATION RATIO

9.  4. Tipe kontraksi - Isometrik - Isotonik - Eksentrik - Konsentrik - Isokinetik 5. Distribusi fiber type 6. Cadangan energi & suplai darah 7. Kecepatan kontraksi 8. Motivasi pasien

10. Relationship between fiber type, motor unit type and histochemical profiles of muscle fibers MOTOR UNIT

11.  Perubahan sistem neuromuskular yg mengarah kpd peningkatan kekuatan 1. Hipertropi 2. Rekruitmen  Perubahan kekuatan pd jaringan kontraktil

12.  Tipe endurance 1. Muscular endurance 2. General (total) body endurance  Perubahan sistem muscular, cardiovascular & pulmonal  Soft tissue mobility/flexibility  Joint mobility  Tipe mobility exercise

13.  Koordinasi sinergis pd sistem neuromuscular utk dasar stabilisasi thd gerakan-gerakan fungsional & aktifitas  Mengarah kpd struktur-struktur proksimal  Usaha utk menurunkan ketegangan otot  Penempatan pd posisi nyaman (comfortable posistion)

14.  Koordinasi Otot yg tepat pd waktu yg tepat dgn sekuensis & intensitas tepat  Keseimbangan Mempertahankan COG  Functional skills Motor skills utk fungsi ADL

15. © 2007 McGraw-Hill Higher Education. All rights reserved 3-15

16. © 2007 McGraw-Hill Higher Education. All rights reserved 3-16  Biomechanics - study of the mechanics as it relates to the functional and anatomical analysis of biological systems and especially humans  Necessary to study the body’s mechanical characteristics & principles to understand its movements

17. © 2007 McGraw-Hill Higher Education. All rights reserved 3-17  Mechanics - study of physical actions of forces  Mechanics is divided into  Statics  Dynamics

18. © 2007 McGraw-Hill Higher Education. All rights reserved 3-18  Statics - study of systems that are in a constant state of motion, whether at rest with no motion or moving at a constant velocity without acceleration  Statics involves all forces acting on the body being in balance resulting in the body being in equilibrium

19. © 2007 McGraw-Hill Higher Education. All rights reserved 3-19  Dynamics - study of systems in motion with acceleration  A system in acceleration is unbalanced due to unequal forces acting on the body

20. © 2007 McGraw-Hill Higher Education. All rights reserved 3-20  Kinematics & kinetics  Kinematics - description of motion and includes consideration of time, displacement, velocity, acceleration, and space factors of a system‘s motion  Kinetics - study of forces associated with the motion of a body

21. © 2007 McGraw-Hill Higher Education. All rights reserved 3-21  Mechanical advantage  Load/effort or load divided by effort  Ideally using a relatively small force, or effort to move a much greater resistance  Musculoskeletal system may be thought of as a series of simple machines  Machines - used to increase mechanical advantage  Consider mechanical aspect of each component in analysis with respect to components’ machine-like function

22. © 2007 McGraw-Hill Higher Education. All rights reserved 3-22  Machines function in four ways  balance multiple forces  enhance force in an attempt to reduce total force needed to overcome a resistance  enhance range of motion & speed of movement so that resistance may be moved further or faster than applied force  alter resulting direction of the applied force

23. © 2007 McGraw-Hill Higher Education. All rights reserved 3-23  Musculoskeletel system arrangement provides for 3 types of machines in producing movement  Levers (most common)  Wheel-axles  Pulleys

24. © 2007 McGraw-Hill Higher Education. All rights reserved 3-24  Humans moves through a system of levers  Levers cannot be changed, but they can be utilized more efficiently  lever - a rigid bar that turns about an axis of rotation or a fulcrum  axis - point of rotation about which lever moves

25. © 2007 McGraw-Hill Higher Education. All rights reserved 3-25  Levers rotate about an axis as a result of force (effort, E) being applied to cause its movement against a resistance or weight  In the body  bones represent the bars  joints are the axes  muscles contract to apply force

26. © 2007 McGraw-Hill Higher Education. All rights reserved 3-26  Resistance can vary from maximal to minimal  May be only the bones or weight of body segment  All lever systems have each of these three components in one of three possible arrangements

27. © 2007 McGraw-Hill Higher Education. All rights reserved 3-27  Three points determine type of lever & for which kind of motion it is best suited  Axis (A)- fulcrum - the point of rotation  Point (F) of force application (usually muscle insertion)  Point (R) of resistance application (center of gravity of lever) or (location of an external resistance)

28. © 2007 McGraw-Hill Higher Education. All rights reserved 3-28  1 st class lever – axis (A) between force (F) & resistance (R)  2 nd class lever – resistance (R) between axis (A) & force (F)  3 rd class lever – force (F) between axis (A) & resistance (R) Modified from Hall SJL Basic biomechanics, ed 4, 2003, McGraw-Hill.

29. © 2007 McGraw-Hill Higher Education. All rights reserved 3-29 AFR 3rdAFR 3rd | Resistance Arm | ARF 2ndARF 2nd | Force Arm | FAR 1stFAR 1st A F R Force Arm | | Resistance Arm | A R F A R | Force Arm | F

30. © 2007 McGraw-Hill Higher Education. All rights reserved 3-30  The mechanical advantage of levers may be determined using the following equations: Mechanical advantage = Resistance Force or Mechanical advantage = Length of force arm Length of resistance arm

31. © 2007 McGraw-Hill Higher Education. All rights reserved 3-31  Produce balanced movements when axis is midway between force & resistance (e.g., seesaw)  Produce speed & range of motion when axis is close to force, (triceps in elbow extension)  Produce force motion when axis is close to resistance (crowbar) Modified from Hall SJ: Basic biomechanics, ed 4, 2003, McGraw-Hill

32. © 2007 McGraw-Hill Higher Education. All rights reserved 3-32  Head balanced on neck in flexing/extending  Agonist & antagonist muscle groups are contracting simultaneously on either side of a joint axis  agonist produces force while antagonist supplies resistance Modified from Booher JM, Thibodeau GA: Athletic injury assessment, ed 4, 2000, McGraw-Hill

33. © 2007 McGraw-Hill Higher Education. All rights reserved 3-33  Elbow extension in triceps applying force to olecranon (F) in extending the non-supported forearm (R) at the elbow (A)

34. © 2007 McGraw-Hill Higher Education. All rights reserved 3-34  Force is applied where muscle inserts in bone, not in belly of muscle  Ex. in elbow extension with shoulder fully flexed & arm beside the ear, the triceps applies force to the olecranon of ulna behind the axis of elbow joint  As the applied force exceeds the amount of forearm resistance, the elbow extends

35. © 2007 McGraw-Hill Higher Education. All rights reserved 3-35  A lever in which the muscular force and resistance force act on opposite sides of the fulcrum * A see-saw

36. © 2007 McGraw-Hill Higher Education. All rights reserved 3-36  Produces force movements, since a large resistance can be moved by a relatively small force  Wheelbarrow  Nutcracker  Loosening a lug nut  Raising the body up on the toes Modified from Hall SJ: Basic biomechanics, ed 4, 2003, McGraw-Hill

37. © 2007 McGraw-Hill Higher Education. All rights reserved 3-37  A lever in which the muscular force and resistance force act on the same side of the fulcrum, but the resistance force acts at a point closer to the fulcrum than the muscular force

38. © 2007 McGraw-Hill Higher Education. All rights reserved 3-38  Plantar flexion of foot to raise the body up on the toes where ball (A) of the foot serves as the axis as ankle plantar flexors apply force to the calcaneus (F) to lift the resistance of the body at the tibial articulation (R) with the foot  Relatively few 2 nd class levers in body Modified from Booher JM, Thibodeau GA: Athletic injury assessment, ed 4, 2000, McGraw-Hill

39. © 2007 McGraw-Hill Higher Education. All rights reserved 3-39  Biceps brachii in elbow flexion Using the elbow joint (A) as the axis, the biceps brachii applies force at its insertion on radial tuberosity (F) to rotate forearm up, with its center of gravity (R) serving as the point of resistance application Modified from Booher JM, Thibodeau GA: Athletic injury assessment, ed 4, 2000, McGraw-Hill

40. © 2007 McGraw-Hill Higher Education. All rights reserved 3-40  Brachialis - true 3 rd class leverage  pulls on ulna just below elbow  pull is direct & true since ulna cannot rotate  Biceps brachii supinates forearm as it flexes so its 3 rd class leverage applies to flexion only  Other examples  hamstrings contracting to flex leg at knee while in a standing position  using iliopsoas to flex thigh at hip

41. © 2007 McGraw-Hill Higher Education. All rights reserved 3-41  A lever in which the muscular force and resistance force act on the same side of the fulcrum, but the muscular force acts at a point closer to the fulcrum than the resistance force

42. © 2007 McGraw-Hill Higher Education. All rights reserved 3-42  Anatomical leverage system can be used to gain a mechanical advantage  Improve simple or complex physical movements  Some habitually use human levers properly  Some develop habits of improperly using human levers