Recording of Proprioceptive Muscle Reflexes in the Lower Extremity

Abstract

Electromyography (EMG) is routinely used in diagnostics of root syndromes in the lower extremity. By studying signs of axonal damage of different root levels in the corresponding myotomes of the lower extremity and back muscles with needle EMG reveals, which of the motor roots are injured in patients with suspected root compression. But by EMG study only injuries of the anterior motor roots are diagnosed. Routine electroneuromyography does not disclose specific injury of the afferent sensory posterior roots. However, the integrity of some the posterior roots is readily studied with myotatic reflexes. We have routinely measured a proprioceptive reflex, the H-reflex of the soleus muscle with stimulation of the posterior tibial nerve, and found it to be useful in the diagnostics of the S1 root syndrome. It seems to be possible to record H-reflex of the peroneus longus muscle at the L5 level. We discuss the serious problems with volume conduction, when trials to measure proprioceptive reflexes of the L4 and L5 levels are performed. It may also be useful to record the medium latency reflexes in the area of the posterior tibial nerve, which seems to have a different reflex arch (II-afferents – β-efferents) from H-reflex (Ia afferents – α efferents). These measurements are non-invasive and not time consuming, and we hope to be able to add them for the routine ENMG diagnostics, when appropriate.