Journal Search Engine
Search Advanced Search Adode Reader(link)
Download PDF Export Citaion korean bibliography PMC previewer
ISSN : 1598-7248 (Print)
ISSN : 2234-6473 (Online)
Industrial Engineering & Management Systems Vol.18 No.4 pp.667-675

A study on Relationship between Fatigue and the Myofascial Trigger Point Syndrome (MTP) Experienced by Yogya Handmade Atik Artisans

Ika Fitri Wulan Dhari*, Meiza Anniza, Hilmi Zadah Faidullah
Department of Physiotherapy, Universitas Aisyiyah Yogyakarta, Indonesia
Physical Therapy, Mahidol University, Thailand
Corresponding Author, E-mail:
May 7, 2019 September 17, 2019 October 18, 2019


The purpose of this study was to examine the relationship between fatigue and myofascial trigger point syndrome (MTP) experienced by handmade batik artisans who were working in center of batik NakuloSadewo area in Yogyakarta. [Subjects and Methods] An observational study was conducted for handmade batik artisans in center of batik NakuloSadewo area in a 30-day period from April 1-30, 2018. [Results] According to the analysis results of this study showed statistical significance with spearman’s rank between 2 variables, fatigue and MTPit is means correlation were highly positive and significance between fatigue and MTP experienced. Fatigue felt by batik artisans had impacts on MTP experienced; the possibility of MTP symptoms on the neck area particularly upper trapezius muscle increased as the monotonous work attitude and lowlevel muscle contraction activities got worse, interpersonal conflicts of batik artisans increased, organizational system got serious, and stress from psychosocial went up. [Conclusion] We expect that the results of this study would be useful as basic data for efficient management of resources when taking preventive programs to reduce MTP experienced by Yogya handmade batik artisans in the future.



    Nowadays batik has been widely applied in various objects. Batik is one of Indonesia’s cultures that have been worldwide, which are rich of motif and attractive pattern. The unique pattern and motif can be applied to various craft items, including; clothing, bags, home decoration, bed linen, and so forth. Ultimately, batik will be able to reach the community. Although, originate of batik for the nobility in the formal situation. Currently, batik as souvenirs that very interesting both of tourism business including domestic and foreign, therefore this is able to prove that production process of batik is increased and the popularity enables to drive the economy of the community. However, improving the performance of the batik industry cannot be separated from the supervision in the field of occupational health and safety (K3) that applied to the workplace (Markkanen, 2004). In line with this statement the International Labour Organization (ILO) states that around 2 million people die due to workrelated problems. Total number around 354,000 people have a fatal accident. In addition, every year there are 270 million workers who suffered occupational accidents and 160 million occupational diseases (Markkanen, 2004).

    Even though, commonly batik production have been process with traditional manner. Nowadays, the process will be run smoothly if supported by human resources that qualified as craftsmen. Several criteria as a requirement for craftsmen including, general health, physical fitness, nutrition, organization and system of work for instance; rest periods, work attitude, work environment. If all these factors fulfilled, optimal health will be achieved and then the work efficiency will increased. Otherwise, if some of these factors not supported then efficiency will decreased. Eventually, some of artisans experienced fatigue, muscles pain and discomfort which are represent a subjective complaints of the craftsman (Susetyo et al., 2008). Based on the previous study of Japan survey in April 2015 reported the results that out of 1224 samples consisting of 539 men and 685 women. The survey was conducted over a range of ≥ 20 years of age. The prevalence of fatigue is 17.2%. In the sample of women experienced more fatigue with a prevalence of 20.9%, while in males at 12.6% (Aritake et al., 2015).According to Maurits (2010), proposed that fatigue at the workplace can lead to several conditions, namely decreased of work performance, motor decrement, mental problem, the body discomfort. Also, fatigue condition at the workplace that may be influenced by several factors such as; nutritional status, physical condition of the environment, workload, monotonous of work, psychological factors, long time, resting time, and circadian rhythm.

    Specifically, sustained isometric contraction and prolonged dynamic exercise induced muscle fatigue, which are manifested by a reduction in the maximum voluntary contraction (MVC) force and / or task failure process (Place et al., 2010;Madeleine, 2010). Generally reported in several patients with chronic musculoskeletal pain regarding strength of lower muscle and accelerated fatigue development (Maquet et al., 2010;Falla et al., 2010), where active myofascial trigger points (MTrP) contribute significantly to the evocation of motor dysfunction and pain (Simons, 2004;Gerwin et al., 2004). Usually, muscle fatigue in conditions of acute and chronic musculoskeletal pain in which MTrP are involved. The condition of MTrPis a musculoskeletal disorder that is characterized by a trigger point in a sensitive area in the skeletal muscle that is taut band, if given pressure in the area will cause specific pain at a point that is suppressed (tenderness). MTrPs can cause local pain, tenderness, tightness, stiffness, referral pain and muscle weakness which usually occur in the upper trapezius muscle (Montañez-Aguilera, 2010). The MTrPs is one of the most common musculoskeletal pain that discrete and hyperirritable nodules of tenderness in a palpable taut band of a skeletal muscle during physical examination. Ultimately, that possibly to contribute generate of pain and motor dysfunction. Commonly involved the upper quadrant and postural muscles, particularly the upper trapezius the region that the most affected by MTrPs (Bron et al., 2011), because of the response to injury or overload of the muscles.

    The subjective measurement of pain was assessed using a visual analog scale (VAS). Measurement test of soft tissue tenderness to evoke painusing “soft tissue tenderness grading scheme” and active lateral bending of the cervical spine using inch tape were done before the first sessions and after five consecutive sessions of therapy. VAS was used toquantify the perceived pain by the subjects. Origin of the scale is indicated minimum as “NO PAIN” and maximum as “MOST SEVERE PAIN.” The patient was instructed to move the indicator to represent his/her pain perceived. At the back of the scale 0 to 10 numerical with a distance of 1cm between them were marked. The linear analogue rating of the constant pain stimulus is reproducible and changes in rating are likely to be real change in opinion. The “Tenderness grading scale” is a proposed grading system for the soft tissue tenderness. It is also a method for documenting patient responses to “evoke” tests, such as orthopedic tests or the McKenzie analysis (Kannan, 2012). Tenderness grading is as follows:

    • 0. No tenderness

    • 1. Tenderness to palpation without grimace or flinch

    • 2. Tenderness with grimace & or flinch to palpation

    • 3. Tenderness with withdrawal (+ “ Jump sign”)

    • 4. Withdrawal (+ “Jump sign”) to non-noxious stimuli (i.e. superficial palpation, pin prick, gentle percussion)

    2. METHOD

    This study was an observational study to determine relationship between fatigue and MTrPs experienced by Yogya handmade batik artisan. There were fifteen people as the samples in this study. Fatigue is measured using the rate of perceived exertion (RPE) scale. MTrPs conditions are diagnosed using VAS (Visual Analogue Scale) for pain and make sure with palpation techniques to detect trigger points in the upper trapezius muscle. Fatigue measurement is done every day for four weeks in April 2018. Data were analysing using parametric statistical spearman’s rank tests.

    3. RESULT

    3.1 Distribution of Respondent Characteristics

    In this study the number of research subjects was 15 batik artisans. Descriptive analysis of the data subject characteristics that includes age, weight, height, body mass index and work experience are presented in Table 1.

    Based on Table 1 it is known that the mean age of the subject is 59 ± 4.44 years. Body mass index is calculated based on the ratio of body weight to kg with the square of the height in meters in the subject. The mean body mass index of the subject was 22.7 ± 1.59 kg / m² which was included in the normal category. Likewise from the biodata form that has been filled in by the subject, data is obtained that all have had work experience in making labels for more than 5 years. Body posture measurements performed using the mean rula is 6 it’s mean action level 3, the work posture is outside the safe range. Repetitive movements and / or static muscle contractions are needed, and significant expenditure of style may be needed. Recommendation: further analysis and changes are needed immediately.

    3.2 Spearman Rank Statistical Test

    The level of fatigue before and after work is calculated with an average RPE (Rate of Perceived Exertion) scale which is observed for 4 weeks during April 2018 can be seen from the following line 1.1 chart.

    Based on the Figure 1, the line chart showed that the level of fatigue by using a rate perceived exertion (RPE) scale with a range of 1-10, a value of 1 means that there is “very light” fatigue and 10 states the level of fatigue is “very very hard.” In pre-work conditions the range of fatigue levels obtained between 1-3 fatigue is “very light,” “fairly light” and “moderate” while in the conditions after work the range of fatigue levels is 4-6 with fatigue conditions “somewhat hard,” “hard” and “very hard.”

    The relationship between work fatigue and the emergence of MTrPs is indicated by the appearance of pain in the upper trapezius muscle which is measured by a pain scale using visual analogue scale and then performed palpation to determine the trigger point. Test the relationship of fatigue using RPE and MTrPs with VAS tested using Spearman rank correlation test, which can be seen in Table 2 below

    From Table 2 obtained results p < 0.015 which means there is a relationship that the emergence of MTrPs fatigue with the advent of the upper trapezius muscle on batik.


    The static posture during working for a long period of time results in excessive muscle work, so the muscles become tense, spasm, tightness and stiffness. Tense muscles constantly to make microcirculation decreases, occurs in the ischemic tissue. Muscle fibers become abnormal rope bonds forming a band link and trigger pain, because it stimulates hypersensitivity (Makmuriyah and Sugijanto, 2013). There are several factors that affect, among others, age, BMI, length of work, and work attitude

    Postural upper trapezius muscle that functions as a neck fixator and as a fixator when the arms move, then posture errors attempt to forward head will cause static work continuously during activities in a sitting or standing position. In the posture lateral head, the position of the head tilted to one side will also cause overload work on the upper trapezius muscle. Continuous static work and overload work cause trigger points and band links in the muscles. Ergonomics that includes poor body mechanics, the use of muscles in long static conditions, compression of the muscles and poor working mechanism on the neck and shoulders illustrates the workload of the upper trapezius muscle is heavier, described as in the typing position with a screen that is too high or a working position that causes the head tilting or turning continuously (Widodo and Murleni, 2011).

    Acute injuries to muscles, bones and joints will form a trigger area which can be interpreted as a small area limited to firm and hypersensitive to muscles or connective tissue (connective tissue) where if the area is given stimulation or suppression will cause local pain and also attack the nervous system center that causes reffered pain. Called a trigger area because of its stimulation.

    Additional result of a great macro trauma cause obvious symptoms attack and develop rapidly, trauma from a mild injury can also play an equally important role. Mild trauma correlation between injury with pain syndrome is not so clear, and these relationships can be overlooked because the symptoms gradually. Although the frequency is rarely recognized, but this is equally important as the cause of myofacial pain is repetitive injury due to daily activities and muscle strains, especially in individuals with the same activities and settling every day at the age of 35 years.

    4.1 Age

    The age of the subjects involved in this study was between 50-64 years with a mean of 59 ± 4.44 years. According to the World Health Organization there are four stages, namely the elderly, middle age (middle age) aged 45-59, elderly (eldery) ages 60-74, advanced old age (old) age 75-90 years old and very old (very old) > 90 years. Thus, in this study the subject in the category of middle age, in this age of nerve conductivity decreased 10% and that the movement becomes sluggish. Changes result in decreased cognitive function, coordination, balance, muscle strength, reflexes, propioseptive, changes in posture, and increased reaction time (Pudjiastuti, 2003). In this study, subjects with unproductive age ranges, where subjects cannot perform activities with optimal physical strength. In the elderly due to the greater pravalensi postural changes among adults aging is often associated with age-related changes, and sometimes to differences in posture can also be associated with gender.

    In studies Drzal-Grabiec et al. (2013) in entering the degenerative age, a decline in the efficiency of the central and peripheral neurons; decrease in skeletal mass and muscle tissue; and weight loss. In addition, the water and potassium levels in cells are lower and the level of protein biosynthesis in the muscles decreases. A gradual increase in fragility of connective tissue and a reduction in muscle strength directly affect body posture. The movement of the body decreases due to regressive changes of the ligaments and articular cartilage. As a result of reduced muscle strength, a person who is degenerative unconsciously tries to balance himself with supporting tools. This factor causes further damage from the physiological curvature of the spine, which leads to the compensative posture of the legs in the joints of the hip and knee when standing.

    Age-related changes in posture often coincide with a group of other postural changes including forward head, bent shoulders, changes in lordosis of the lumbar, and increased flexion movements in the hips and knees. In a study from Nemmers et al. (2009) which examined women with advanced age, stated that there was a close relationship between age and one’s posture.

    Delgado et al. (2009) said that myofascial pain is common in the community, dominated by age 27.5 years to 50 years, with the preference of individuals with individual sedentary patterns. According to Lubis (2015) there will be chemical changes in the cells and tissues of the body, especially in cross-linking as a person ages. Connective tissue will also lose its contents, such as collagen, elastin, glycoprotein, hylauranic acid and protein contractile. Decreasing the amount of elastin in muscle tissue will reduce the elasticity of the tissue. In muscle tissue there is also a decrease in adenosine triphosphate (ATP) in myosin and a decrease in ATP concentration itself. ATP deficiency causes myosin to be unable to release its bonds with actin and overlapping two types of myofilament positions in the sarcomer, so the sarcomer is unable to return to the initial length before contraction and becomes a contracture. This is a supporting factor for the occurrence of sarcoma contractures and triggers the occurrence of myofascial pain syndrome the upper trapezius muscle. Generally, skeletal muscle complaints are felt starting at 25 years of working age. The first complaint usually arises at the age of 30 years, because at that age the body’s organs function slowly will decline with a variety of different levels in each person.

    Based on several studies showing the prevalence of some cases of musculoskeletal disorders is higher in women than in men. For example, as research which has a greater prevalence of FHP in women than men with a ratio of 24.1% compared to men at 9.1%. This happens because the average muscle strength of women is approximately only 60% of the strength of male muscles, especially for the muscles of the arms, back and legs (Silviyani et al., 2013).

    4.2 Weight, Height and Body Mass Index

    Weight loss research subjects ranged from 50-68 kg with a mean of 60 ± 6.00 kg and height ranges from 156- 173 cm with a mean of 162.4 ± 5.48 cm. Weight and height is one of the important aspects related to the capacity to carry out activities. Weight and height as a benchmark in determining the worker’s body mass index. Measurements and assessments using BMI are related to deficiencies and excess nutritional status. According to Ganong (2008) malnutrition can increase the risk of infectious diseases and over nutrition with excessive accumulation of body fat increases the risk of suffering from degenerative diseases.

    A person with a body mass index greater than 29 kg / m2 (fat) has a risk of developing musculoskeletal disorders 250% higher than someone who has a body mass index smaller than 20 kg / m2 (thin). According to Arisman (2011) to determine the value of BMI can be calculated by the formula IMT = body weight (kg)/ (height (m²).

    From the results of measurements performed on the entire pembatik mean BMI range 20.5-25 subjects with a mean of 22.7 ± 1.59 shows that the subjects in this study are in the ideal weight category. Thus it can be expected that the effect of the condition of the subject including, age, weight, height and BMI on the risk of musculoskeletal complaints and fatigue can be controlled.

    4.3 Work Experience

    In Table 1 it can be seen that the average work experience in batik artisans is 14, 3 years with the duration of work per day with an average of 7 hours per day. The duration of one’s work will affect the resistance of muscles and bones. In accordance with the research of Chaitow and Delany (2008), that the duration of work has a strong relationship with muscle complaints and increased myofascial pain syndrome, so to prevent musculoskeletal disorders in workers who use arms and hands in a complex and continuous manner, the maximum length of work is only four hours per day. So it becomes very logical, that respondents were found to have complaints of myofascial pain. The tenure factor is the accumulation of one’s work activities carried out in the long term. The longer a person’s working period will affect the endurance of muscles and bones. Thus administrative employees who work in a static position for a minimum period of 7 hours and repeat every day, will allow repetitive injury and will accumulate resulting in pain in the region around the neck and shoulders.

    In the study of Wicaksono et al. (2016) which examined the relationship of duration and musculoskeletal disorders to Diponegoro University students majoring in architecture, the results showed that there was a relationship between work duration and musculoskeletal complaints of respondents working with laptops > 2 hours riskier 13,5 times compared to respondents who work with laptops ≤ 2 hours. The length of time that respondents use to use laptops shows that a laptop is one of the most important elements in supporting their activities on campus or at home. Similar to batik, batik makers will complete their batik works as targeted, this causes some batik makers to spend their daily activities for more than 2 hours to pursue these targets. In addition to this, batik is required to align the eyes and head with the object being seen to get a clear visualization and good batik results, in that condition the cervical moves the extension continuously to the muscles. Static muscle can cause blood flow to decrease, so that lactic acid accumulates and results in fatigue in local muscles.

    When this is allowed, the body will maintain an abnormal base of support (BOS) position, which affects the biomechanics of the neck position received with a position of neck flexion of 15 degrees which is equal to giving a load of 27 pounds in the neck area. If allowed, the loading on the cervical becomes larger and increases the risk of Forward Head Posture. And in the long term, the more severe neck posture will be formed and affect other body parts posture to get a base of support that is balanced.

    4.4 RULA Score

    Work measurement based on biomechanics principles, and one method that can be used is the Rapid Upper Limb Assessment (RULA) method. The RULA method analyzes the posture, style, and movement of an activity that can investigate the level of risk generated by the activity by measuring the work posture.

    Good posture is determined by the movement while working. Movements carried out during work include: flexion, extension, abduction, adduction, rotation, pronation and supination. Flexion is a movement where the angle between two bones there is a reduction, the extension is a stretching movement where an increase in the angle between two bones. abduction is a sideways movement away from the middle axis of the body. Adduction is the movement towards the middle axis of the body. Rotation is the rotation of the upper part of the arm or front leg. Pronation is the rotation of the middle (towards inside) of the limbs. Supination is a rotation towards the side (towards the outside) of the body members (Rinawati and Romadona, 2016).

    From Table 1 it is known that the mean RULA value of the sample is 6.50 it’s mean action level 3, the work posture is outside the safe range. Repetitive movements and / or static muscle contractions are needed, and significant expenditure of style may be needed. Recommendation: further analysis and changes are needed immediately. The characteristics of the sample refers to the measurement of the Upper Limb Assessment (RULA) Rappid, because the higher the RULA value the less good the individual’s work attitude is, this is at risk of an individual experiencing musculosceletal disorders. Bad work attitude when using a computer will result in the upper trapezius muscle will work in a static low level contraction. Forward head posture and lateral head posture on batik artisans cause excessive strain on the muscles uppertrapezius The constant work of the tonic muscle is coupled with the factors that aggravate the work of the muscle, so the balance between compression or tension with relaxation in myofascial tissue is not can be maintained again by ground substance, as a result myofascial tissue from the upper trapezius muscle experiences tension or contraction continuously, so that it will cause mechanical stress on myofascial tissue for a long time and will stimulate receptors that are in the muscles and tendons. The more frequent and strong receptors are stimulated, causing spasm which also leads to trigger points in the myofascial band link (Sugijanto et al., 2007).

    Janda said postural muscle has a tendency to shorten, either in normal conditions or pathological conditions. The upper trapezius muscle, levator scapula, and scalenus are the most common postural muscles (Chaitow, 2016). Functional pathology as a result of myofascial pain syndrome causing neck disability include body function / structure impairment, activity limitation, and participation restriction is influenced by internal and external factors. impairment at the anatomic level is in the form of inflammation and adhesion to myofascial, spasm and band links to muscle fibers. impairments will cause pain, limited neck and shoulder motion and forward head posture.

    1. Body Structure

      Body structure impairment in patients with myofascial pain syndrome of upper trapezius muscle is in myofascial adhesions, muscle spasm, taut band, tendernes, trigger points. Tightnes upper trapezius muscle resulting in forward head posture and lower trapezius muscle weakness and weakness in the deep cervical flexor.

    2. Body Function

      The physiological problems in patients with upper trapezius myofascial muscles include hypomobility, when the range of motion lateral flexion is followed by limited range of motion of neck extension and scapular elevation, hypertonus tissue contractile joint.

      Forward head posture can be caused due to the continuous contraction of the upper trapezius muscle, lateral elevation and scoliosis, muscle spasm also occurs in response to local circulation and metabolic changes that occur when the muscles are in a state of continuous contraction, Pain resulting in disability is also the result of changes in the circulation and metabolic (Kisner and Colby, 2007).

      Functional scoliosis can be caused by factors of poor posture in the long term, such as being accustomed to tilting on one side continuously which results in muscle spasms and tightness of the upper trapezius muscles which suppress side muscles and movement limitations that cause disability (Kisner and Colby, 2007).

    3. Activities Limitation

      Activity limitation as a result of functional impairment, such as not being able to sit a long time in front of computers, is unable to drive a car is not capable of doing housework, are not capable of self care eg bathing, difficulty in dressing, difficulty washing the body with soap and water throughout the body, using shampoo, unable to lift and carrying heavy loads or for a long time, having difficulty doingwork with long sitting.

    4. Participation Restriction

      Participation Restriction as a result of Activity Limitation, among others in the form of obstacles in working in the office, disrupted to exercise barriers to doing social activities in the social environment. Patients are not confident and feel less needed by the community environment, obstacles to driving, obstacles when lying down, obstacles to recreation, obstacles to maintaining a standing position, maintaining neck position, obstacles to being responsible for work.

    4.5 Relationship between Fatigue and MTrP

    The work ability of a workforce is different from other workers and is highly dependent on skill level, physical fitness, nutritional condition, gender, age, and body size of the worker concerned. Fatigue for everyone has its own meaning and is subjective. Tired are various circumstances that accompanied the decline in work efficiency and durability. Fatigue is the body’s protective mechanism of the body to avoid further damage, and thus there was a recovery. Fatigue shows different conditions for each individual, but all lead to loss of efficiency and a decrease in work capacity and endurance (Tarwaka et al., 2004). Fatigue is a complex criteria not only on physiological and psychological fatigue but dominant relationship with a decrease in physical performance, feelings of fatigue, decreased motivation and decreased work productivity.

    The level of fatigue caused by work experienced by workers can cause discomfort, disruption and reduce satisfaction and decrease in productivity as indicated by reduced performance speed, decreased product quality, loss of originality, increased errors and damage, frequent accidents, inattention, and inaccuracies in carrying out work . Fatigue can occur due to work environment factors, individual factors, and work factors (Tarwaka et al., 2014).

    In pre-work conditions the range of fatigue levels obtained between 1-3 fatigue is very mild, mild and moderate while in the conditions after work the range of fatigue levels is 4-6 with fatigue conditions a little heavy, heavy and quite heavy. This shows that there is an increase in the level of fatigue before and after working on the batik artisans, this can be caused by several things, one of which is the condition of the batik writing attitude that requires high accuracy to provide patterns on the fabric. work attitudes tend to bend and head down. This causes an increase in muscle workload, one of which is an increase in activity in the neck extensor group in this case is the upper trapezius muscle.

    According to Adiputra (2003) said that the occurrence of fatigue in workers is the existence of body organs continuously receiving external workload without the opportunity to rest or get a workload that goes through their capacity. This is because the batik workers works for 8 hours by day with an awkward posture from 08.00- 16.00 WIB and 1 hour break at 12.00-13.00 WIB for 6 working days. According to Williamson et al. (2011) fatigue is a decrease in the ability to complete a work and biological drive to recover. Fatigue usually shows different conditions in each individual, a subjective feeling but it all leads to loss of efficiency and decreased work capacity and endurance.

    In Table 2 obtained results p <0.015 which means there is a relationship that the emergence of MTP fatigue with the advent of the upper trapezius muscle on batik. Muscle fatigue arises due to reduced energy reserves and increased metabolic waste as a cause of loss of muscle efficiency. Every day humans carry out various activities, to carry out these activities energy is obtained from the metabolic processes in the muscles, namely the process - the chemical processes that change the juice - the food essence into two forms, namely mechanical and heat work. Adiputra (2003) says that the occurrence of fatigue in workers are the organs continue to receive external work load with no opportunity to rest or get past workload capacity.

    This is caused because the upper trapezius a muscle that works with low-level type of contraction that would be at risk of overload when the MTP. Myofascial trigger point symptoms can occur in the muscles of various limbs in response to injury or muscle overload. Injured muscle fibers will shorten (resulting in an increase in voltage) due to excessive removal of calcium ions from damaged fibers, or in response to acetylcolin in large quantities from the motor end plate. Local tenderness or spread occurs because muscle nociceptors are stimulated due to lack of oxygen and an increase in inflammatory mediators at the site of injury (Luo and Dun, 2013). Pain that occurs in the upper trapezius muscle is local pain or radiating pain. This pain is caused by excessive muscle work. Daily activities that use the trapezius muscle for a long time cause the muscles to become tense, spasm, tightness and stiffness caused by a buildup of the body’s metabolic waste. Muscles that are tense for a long time will make microcirculation decrease, resulting in ischemic tissue. In muscle fibers there will be an abnormal cord bond forming the band link and triggering pain, because it stimulates hypersensitivity (Makmuriyah and Sugijanto, 2013).

    The longer hours of work a person on visual work, it will be increasingly at risk of Myofascial trigger point this is because if people experience fatigue, the body will always inclined towards the rear so that it will cause the neck to stabilize the posture of the head by forming a lordosis. While the increasing age of a person, the risk of experiencing Myofascial trigger point is higher, this is due to the presence of degenerative processes.

    Generally perceived skeletal muscle complaints began working age of 25 years. The first complaint usually arises at the age of 30 years, because at that age the body’s organs function slowly will decline with various levels that are different in each person. Another factor that causes complaints is the length of work, according to Chaitow and Delany (2008), to prevent interference musculoskeletal workers who use arms and hands in a complex and constantly, longer maximum working only four hours a day.

    Poor posture can lead to stress and strain on the upper trapezius muscle, for example, forward head posture, the position of the head is constantly falling forward. The worse the work posture, the greater the musculoskeletal complaints (Evadarianto and Dwiyanti, 2017). Poor work ergonomics that occur repeatedly in a long time, will lead to prolonged mechanical stress. For example movements carried out by hospital administration employees occur from the neck, shoulders, arms, elbows and hands. Neck movements that tend to be forward (forward head position). With poor work ergonomics for a long time it will increase stress and repetitive strains in the upper trapezius muscle (Sugijanto, 2008).


    The level of fatigue by using a rate perceived exertion (RPE) scale with a range of 1-10, a value of 1 means that there is very light fatigue and 10 states the level of fatigue is very heavy. In pre-work conditions the range of fatigue levels obtained between 1-3 fatigue is very mild, mild and moderate while in the conditions after work the range of fatigue levels is 4-6 with fatigue conditions a somewhat hard, hard and very hard.Recent progress and results of this study would be useful as basic data for efficient management of resources when taking preventive programs to reduce MTPexperienced by Yogya handmade batik artisans in the future.

    The conclusion from the above theory that when a person experiences a decline Forward Head Posture deep flexor muscles strength due to the imbalance between the muscles suboccipital and scaleni this usually occurs because of the influence of working hours and age.

    The increasing age of a person will further increase the risk of Forward Head Posture, this is due to a degenerative process, so that the strength of the bones and muscles decreases, and will cause muscles to get tired easily. Compensation of the neck in reducing pain and fatigue is to change the position of the neck posture towards lordosis curves and raises thigtness the scalene muscle as well as weakness in the muscles of the deep flexor.

    In addition, this study is also supported by psychological factors and strategy to approach the psychological factors by exchanging stories or sharing about the problems faced by respondents. The results of exchanging opinions made the respondents feel calm and the problem could be resolved so that during the research the respondents could focus and be enthusiastic about doing the exercises in accordance with the procedures of the researcher (Febriana, 2016).


    The author would like to give special thanks to all respondents for their cooperation along study. This study was supported in part by Universitas’ Aisyiyah Yogyakarta. Also, we would like to give the appreciation to all people that involve in the writing of research report.



    Data fatigue pre-post working.


    Physical characteristics data subject

    Relationship of fatigue and MTP


    1. Adiputra, I. N. (2003), Kapasitas kerja fisik orang bali, Majalah Kedokteran Udayana (Udayana Medical Journal), 34(120), 108-110.
    2. Arisman (2011), Obesitas, Diabetes mellitus, & Dislipidemia, Jakarta, EGC.
    3. Aritake, S. , Kaneita, Y. , Ohtsu, T. , Uchiyama, M. , Mishima, K. , Akashiba, T. , Uchimura, N. , Nakaji, S. , Munezawa, T. , and Ohida, T. (2015), Prevalence of fatigue symptoms and correlations in the general adult population, Sleep Biol Rhythms, 13(2), 146-154.
    4. Bron, C. , Dommerholt, J. , Stegenga, B. , Wensing, M. , and Oostendorp, R. A. (2011), High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain, BMC Musculoskelet Disord, 12(1), 139-150.
    5. Chaitow, L. (2016), Hydrotherapy: Wather therapy for health and beauty, Pavilion book, Australia.
    6. Chaitow, L. and Delany, J. (2008), Clinical application of Neuromuscular Techniques, (1st ed.), The Upperbody, Amsterdam.
    7. Delgado, E. V. , Romero, J. C. , Escoda, C. G. (2009), Myofascial pain syndrome associated with trigger points: A literature review (I): Epidemiology, clinical treatment and etiopathogeny, Journal section: Oral Medicine and Pathology, 14(10), e494-8.
    8. Drzal-Grabiec, J. , Snela, S. , Rykata, J. , Podgorska, J. , Banas A. (2013), Changes in the body posture of women occurring with age, BMC Geriatrics, 13(1), 1-14.
    9. Evadarianto, N. and dan Dwiyanti, E. (2017), Postur kerja dengan musculoskleletal disorder pada pekerja manual handling, bagian rolling mill, The Indonesian, Journal of Occupational Safety and Health, 6, 97-106.
    10. Falla, D. , Lindstrøm, R. , Rechter, L. , and Farina, D. (2010), Effect ofpain on the modulation in discharge rate of sternocleidomastoid motor units with force direction, Clin Neurophysio, 121(5), 744-753.
    11. Febriana, B. (2016), Pengaruh terapi kognitif terhadap harga diri remaja korban bullying, Jurnal Ilmu Keperawatan, 4(1).
    12. Ganong, W. F. (2008), Buku Ajar Fisiologi Kedokteran, Edisi 22, Jakarta, EGC.
    13. Gerwin, R. D. , Dommerholt, J. , and Shah, J. P. (2004), An expansion of Simons’ integrated hypothesis of trigger point formation, Current Pain Headache Reports, 8(6), 468-475.
    14. Kannan, P. (2012), Management of myofascial pain of upper trapezius: A three group comparison study, Global Journal of Health Science, 4(5), 46-52.
    15. Kisner, C. and Colby, L. A. (2007), Therapeutic Exercise (5th ed.), Fondations and Technique, Philadelphia, USA.
    16. Lubis, K. D. (2015), Pengaruh penambahan core stability exercise pada muscle energy technique terhadap penurunan nyeri myofacial trigger point upper trapezius pada pembatik pt danar hadi, Skripsi thesis, Universitas Muhammadiyah Surakarta.
    17. Luo, J. J. and Dun, J. N. (2013), Chronic pain: Myofascial pain and fibromyalgia, Int J Phys Med Rehabil, 1(6).
    18. Madeleine, P. (2010), On functional motor adaptations: Fromthe quantification of motor strategies to the preventionof musculoskeletal disorders in the neck– shoulderregion, Acta Physiol, 199(s679), 1-46.
    19. Makmuriyah, M. and Sugijanto, S. (2013), Iontophoresis diclofenac lebih efektif dibandingkan ultrasound terhadap pengurangan nyeri myofascial syndrome musculus upper trapezius, Jurnal Fisioterapi, 13(1), 17-32.
    20. Maquet, D. , Croisier, J. , Dupont, C. , Moutschen, M. , Ansseau, M. , Zeevaert, B. , and Crielaard, J. (2010), Fibromyalgiaand related conditions: Electromyogram profile duringisometric muscle contraction, Joint Bone Spine, 77(3), 264-267.
    21. Markkanen, P. K. (2004), Manajemen Keselamatan dan Kesehtan Kerja, Kantor ILO di Indonesia, Jakarta.
    22. Maurits, S. (2010), Selintas Tentang Kelelahan Kerja, Amara Books, Yogyakarta.
    23. Montañez-Aguilera, F. J. (2010), Changes in a patient with neck pain after application of ischemic compression as a trigger point therapy, Journal of Back and Musculoskeletal Rehabilitation, 23(2), 101-104.
    24. Nemmers, T. M. , Miller, J. W. , and Hartman, M. D. (2009), Variability of the forward head posture in healthy community-dwelling older women, Journal Geriatri Physical Therapy, 32(1), 10-14.
    25. Place, N. , Yamada, T. , Bruton, J. D. , and Westerblad, H. (2010), Musclefatigue: From observations in humans to underlyingmechanisms studied in intact single muscle fibres, EurJ Appl Physiol, 110(1), 1-15.
    26. Pudjiastuti, S. (2003), Fisioterapi Pada Lansia, Jakarta, EGC.
    27. Rinawati, S dan Romadona (2016), Analisa resiko kerja pada pekerja di bagian pemilihan dan penimbangan linen kotor RS. X, Journal of Industrial Hygiene and Occupational Health, 1(1), Oktober.
    28. Silviyani, V. , Susanto, T. , and Asmaningrum, N. (2013), Hubungan posisi bekerja petani lansia dengan resiko terjadinya nyeri punggung bawah di wilayah kerja puskesmas sumberjambe kabupaten jember: The correlation between the position of elderly farmers working with the risk of low back pain in the working area of the health center sumberjambe, jember, Artikel Ilmiah Hasil Penelitian Mahasiswa.
    29. Simons, D. G. (2004), Review of enigmatic MTrPs as a commoncause of enigmatic musculoskeletal pain and dysfunction, Journal of Electromyography and Kinesiology, 14(1), 95-107.
    30. Sugijanto, B. A. (2008), Perbedaan pengaruh pemberian ultrasound dan manual longitudinal muscle stretching dengan ultrasound dan auto stretching terhadap pengurangan nyeri pada kondisi sindroma miofasial otot upper trapezius, Jurnal Fisioterapi Indonusa, 8(1), 1-24.
    31. Sugijanto, Hutagalung, and Ronatiur (2007), Perbedaan Pengaruh Intervensi MWD dan TENS dengan MWD, TENS dan Traksi Leher Manual Terhadap Pengurangan Nyeri Kepala pada Cervical Headache, Jurnal Fisioterapi, 7(1).
    32. Susetyo, J. , Oes, T. I. , and Indoneisani, S. H. (2008), Prevalensi keluhan subjektif atau kelelahan karena sikap kerja yang tidak ergonomis pada pengrajin perak, Jurnal Teknologi ,1(2), 141-149.
    33. Tarwaka Solikhul, H. A. , and Lilik, S. (2004), Ergonomi untuk Keselamatan, Kesehatan kerja dan produktifitas, Universitas Islam Batik, Surakarta.
    34. Wicaksono, R. E. and Widjasena, B. (2016), Hubungan postur, durasi dan frekuensi kerja dengan keluhan muskuloskeletal akibat penggunaan laptop pada mahasiswa fakultas teknik jurusan arsitektur universitas diponegoro, Jurnal Kesehatan Masyarakat (e-Journal), 4(3), 568-580.
    35. Widodo, H. and Murleni, W. M. Z. (2011), Hubungan Antara Beban Kerja dengan Kelelahan Kerja Karyawan Laundry di Kelurahan Warungbroto Kecamatan Umbulharjo Kota Yogyakarta, Jurnal KESMAS, 5(3), 62-232.
    36. Williamson, A. , Lombardi, D. A. , Folkard, S. , Stuts, J. , Courtney, T. K. , and Connor, J. L. (2011), The link between fatigue and safety, Accident Analysis and Prevention, 43(2), 498-515.