Effect of Reading and Neck Retraction on Patients with Radiculopathy: Electrphysiological Based Study.
Sami S. Al-Abdulwahab; King Saud University, Faculty of Applied Medical Sciences; Rehabilitation Department.
Objective: Repeated neck retraction has been routinely prescribed for patients with cervical radiculopathy. It is believed to reduce cervical muscle tension and radicular symptoms. In contrast, reading has been reported to aggravate radicular symptoms. These differences in radicular symptoms could indicate possible compression decompression effects of retraction and reading on the compromised root. There is no objective study that investigated the effect of reading and retraction on the neuro physiology of the compromised nerve root and on segmental behavior. Therefore, the purpose of this study was to evaluate the effect of reading and  retraction on the flexor carpiradialis (FOR) H-reflex and to determine the relationship between the FOR H-reflex and the intensity of radicular pain. Study Design: Ten healthy subjects (271 4y) and thirteen patients (351 9y) with 07 radiculopathy volunteered for the study. The H-reflex was elicited by electrical stimulation of the median nerve at the cubital fossa (0.5 ins, 0.2pps at H-maximum) and was recorded from FOR, before and after 20 mm of reading and after 20 repetitive neck retractions, using a Oadwell 2500A EMG unit. The H-reflex was monitored by the minimal M-response to ensure stimulation/recording condition was fully maintained throughout the experiment. Subjective intensity of the radicular pain was reported before and after reading and after 20 repetitive neck retraction, using visual analog scale. Results: Repeated measure ANOVA showed significant decreases in the H-reflex amplitude and increase in radicular symptoms after reading (p<0.00l), increase in the
H-reflex amplitude and decrease in pain intensity after repeated neck retraction in patient group (p<0.00l). The changes in the H-reflex amplitude and radicular pain intensity were negatively associated (r=0.86-0.60). However, results showed no significant changes in the H-reflex amplitude in the healthy group (p<0.52). In both
healthy and patient groups, the H-reflex latency showed no measurable changes after both interventions (p<0.76). Conclusions: Neck retractions were effective exercise to recover the compromised H-reflex, to promote cervical root decompression and to reduce radicular pain in patients with 07 radiculopathy. In contrary, reading caused the opposite.