Electrodiagnosis-based management of patients with radiculopathy: The concept and application involving a patient with a large lumbosacral disc herniation

Objectives: The evaluation of patients with lower back pain (LBP) is based mainly on clinical examinations and imaging procedures that are subjective or anatomic in nature. The treatments, either physical therapy or osteopathy, lack evidence-based protocol and may be disruptive to the spine. Therefore, a neurophysiologic-based approach to managing such patients is necessary. Methods: A 40-year-old female complained of LBP and radiculopathy for more than 12 years, a condition that was accompanied by numbness, tingling and weakness in the left leg. This study examined the effectiveness of using an innovative concept and method on a patient with a 19-mm disc herniation. An electro diagnosis-based evaluation and treatment approach testing tool, Soleus H-reflexes, was applied during unloading (with the patient lying down), loading (with the patient standing or sitting), and various trunk position protocols. A structured treatment was based on the results of H-reflex, including direction-sensitive exercises and manipulation, progressing from unloading to full loading. A custom-based home program was developed for sleeping and sitting positions, with all being directed at non-invasively decompressing the compromised nerve root. Data was analyzed using descriptive statistics. Intervention and results: Stepwise application of the developed procedures resulted in complete resolution of the radicular and spinal symptoms, with a reduction in the size of the herniated disc from 19 mm to 4 mm and recovery of the H-amplitude by the end of the treatment. Functional recovery was also complete by the end of the program. A follow-up after 12 months showed maintained results. Conclusions: The discussed concept and method exhibited their effectiveness in this case study, and the results obtained are due to the consistency and maintenance of the neural decompression using a direction sensitive therapy protocol. Significance: Direction sensitive exercise therapy based on H-reflex testing is effective in treating large herniated lumbar discs. Keywords: Herniated lumbar disc, Lower back pain, H-reflex, Non-surgical therapy, Direction sensitive exercise, Spinal rehabilitatio