File
Sabbahi M.1, Ovak Bittar F.2, Badghaish M.3, Sabbahi W.2
1Texas Woman's University, Physical Therapy, Houston, United States, 2Texas Physical Therapy and Electrophysiology Services, Research, Houston, United States, 3Medical Physical Therapy Clinic, Physical Therapy, Jeddah, Saudi Arabia
Background: Management of spinal disorders use clinical and imaging procedures that are either subjective or non physiologic. Electrodiagnostic procedures may fill that gap by being objective, reflecting pathophysiology. These procedures have been in development in our laboratory for the last several years. These procedures are dependent on the concept of neurally based origin of most of the spinal disorders. It is based on testing H-reflexes during unloading, loading as well as during dynamic postural changes. If the cause of the pathology is neurally-based and mechanically driven, the H-reflex amplitude (H/H ratio) may be decreased and eventually recover during certain postural direction.
Purpose: The purpose of this study is to present the validity of this approach in a number of pathologies originating from spinal dysfunction.
Methods: Patients with low back pain (LBP) and radiculopathy (n=500) up to 19 mm. disc; patients with Knee (150) pain and patients with stress incontinence (SI; n=10), patients with Adolescent Idiopathic scoliosis (AIS) (n= 26) with radiculopathy, were tested using clinical and electrodiagnostic protocol. Routine clinical evaluation includes pain intensity (VAS), Straight leg raising (SLR), gait performance and imaging studies. Soleus H-reflexes, was recorded measuring H-amplitude of the symptomatic/non-symptomatic leg, during lying and standing to identify the degree of neural compromise. Dynamic postural testing of the H-reflex for the symptomatic leg was completed during standing (in side bending; rotations, forward and backward bend; right side bend+ left rotation, and left side bend+ right rotation). The Optimum Spinal posture (OSP, decompression posture) and Unwanted spinal posture (USP, compression postures) were identified. Exercise and therapy protocol were structured to promote the OSP and avoid the USP, in a direction-sensitive exercise protocol, while monitoring the patients symptoms. A home exercise and postural program (sitting and sleeping postures) were prescribed. Pre and post treatment data were compared using descriptive statistics.
Results: Patients with LBP, Knee, AIS and SI showed significant reduction in H/H ratio at initial evaluation (LBP, 77.6%; knee, 57%, AIS, 80%; SI, 64.8%) with the smaller amplitude on the ipsilateral painful knee and smaller on the convex side of AIS patients. H-reflexes showed significant shift in values toward normal post treatment. Knee pain decreased to 2/10 by the end of the lumbosacral treatment. This was associated with improved knee function. AIS showed limited increase in its H/H ratio although radicular pain was eliminated from 6 to 2/10 with no significant change in the scoliotic curve (measured by scoliometer). Patients with SI showed normalized control over their urinary functions (reduced urgency; complete independence off using pads). This was associated with increased H/H ratio approaching normal value with full return to social life. In all patients SLR increased to the 90 degree normal level and was symmetric in both lower limbs. Similarly, gait pattern showed normal tiptoe and heel walking pattern.
Conclusion(s): This concept showed to be valid in patients with LBP, AIS, SI, and Knee pain. Sample case reports will be presented as well as population studies.
Implications: We recommend electrodiagnosis-based technique to be incorporated in rehabilitation clinics.
Funding acknowledgements: No funding
Topic: Orthopaedics
Ethics approval: IRB of Texas Woman´s University, Houston Campus
All authors, affiliations and abstracts have been published as submitted.
