Treatment based on H-reflexes testing improves disability status in patients with cervical radiculopathy

Abstract

Postural modification in patients with lumbosacral radiculopathy either causes further H-reflex suppression, indicating increased root compression, or it effects recovery, indicating decompression of the spinal root. The posture that effects maximum recovery of the H-reflex amplitude is called optimum spinal posture (OSP) and is suggested as a therapeutic exercise to decompress the compromised nerve root. The focus of this study was to identify the OSP that effects the maximum recovery of the flexor carpi radialis (FCR) H-reflex and to study its effect on the disability status in patients with cervical radiculopathy. Fourteen patients (46 +/- 12 y) with confirmed symptoms of C7 radiculopathy for the previous 6 months volunteered for the study. The FCR H-reflex was elicited by electrical stimulation of the median nerve at the cubital fossa (0.5 ms, 0.2 pps at H-max). Signals from the FCR muscle were recorded using a Cadwell 5200A EMG unit. The FCR H-reflex was recorded in natural sitting position with the head in natural position and in the OSP. Four traces of the H-reflex were recorded and averaged. The disability status was evaluated, using the Neck Disability Index (NDI), before exercising in the OSP and after 2 days of exercise in the OSP. Paired t-test and Spearman's correlation coefficients were used. The H-reflex amplitude and latency were significantly different in the OSP and with the head in a natural position (P < 0.004; P < 0.011). Larger reflex amplitude and shorter latency were recorded in the OSP. The NDI scores were considerably improved after exercising in the OSP (P < 0.001). Spearman's correlation coefficient showed negative association between the H-reflex amplitude and the NDI scores (r = -0.64 to -0.54; P < 0.05). Exercising in the OSP increased the H-reflex amplitude and decreased latency of the compromised cervical root. It resulted in decreasing the disability status in this group of patients.