RESEARCH REPORT PLATFORM PRESENTATION

EFFECT OF TRUNK ROTATION ON SOLEUS H-REFLEX AND RADICULAR SYMPTOMS IN SUBJECTS WITH SCIATICA. Ali M¹, Elhafez S¹, Balbaa A², Elhafez H³; ¹Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt. ²Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Cairo University, Egypt. ³Department of Basic Science, Faculty of Physical Therapy, Cairo University, Egypt

PURPOSE: The first aim of this study was to test the effect of trunk rotation from side lying (on the pain free side) on soleus H-reflex and radicular symptoms in case of discogenic sciatica. The second aim was to test whether a prolonged use of this position as a home program can reduce the radicular symptoms. RELEVANCE: Controlling or reducing radicular pain without drug intake is the main purpose of effective treatment. This study identifies how this pain could be reduced using positional technique of the trunk in subjects with discogenic sciatica. PARTICIPANTS: Thirty subjects with L5-S1 sciatica were randomly selected and examined. Their age ranged from 25-45 years. They were all suffering from unilateral sciatica with radicular symptoms (pain, numbness, and/or weakness) matching the dermatomal distribution of S1 nerve root. METHODS: H-reflex of the soleus muscle was recorded by stimulating the posterior tibial nerve using 1 ms pulse at 0.2 pps and recording the reflex using surface electrodes. For each subject, H reflex was tested in two positions (the unloading prone lying and the loading standing positions). The H-reflex was tested for three times. The first time was before any treatment. The second time was immediately after the subject had assumed the position (trunk rotation from side lying) for 15 minutes. Then each subject was instructed to assume this position three times per day for 2 weeks as a home program and after that the H reflex was recorded for the third time. The pain intensity was tested using Visual Analogue Scale (VAS) in the three tested conditions and Stanford score was measured in the first session and after the 2 weeks of home program to test how effective the treatment has been. ANALYSIS: The Stanford score was tested using t-test. Two ways ANOVA was carried out by using StatGraphics software with multiple range test to examine the significant difference between the three studied conditions. RESULTS: The results of the study indicated that trunk rotation from side lying position on the pain free side significantly increases (p < 0.05) the amplitude of the soleus H reflex whether tested in loading or unloading position. Similarly the statistical analysis revealed that the level of pain reduced significantly (p < 0.05) after positioning. On the other hand the results indicated that the prolonged use of this position as a home program (for 2 weeks) maintained the improvement of the H reflex of the soleus muscle. The functional performance of the subjects improved significantly (p < 0.05) after two weeks of positioning. CONCLUSIONS: Trunk rotation from side lying position (on the pain free side) improves the H reflex of the soleus muscle and significantly reduces the pain of the affected lower limb. IMPLICATIONS: Using trunk rotation as a treatment program for subjects with sciatica was reported to be effective in reducing the radicular pain in the affected extremity. In addition this position improves the functional performance of the subjects when used as a home program. KEYWORDS: Sciatica, Rotation, H-reflex. FUNDING ACKNOWLEDGEMENTS: This research study was not funded. CONTACT: dr3mpt@yahoo.com, balbaaaa@yahoo.com, egyptsalam@yahoo.co.uk

ETHICS COMMITTEE: Egyptian physical therapy syndicate