The purpose of this case study was to investigate reflex inhibition of the quadriceps femoris in a subject with postsurgical edema of the left knee. The subject was a 45-year-old male with a traumatic knee injury with resultant edema who underwent elective arthroscopic surgery. Reflex inhibition was assessed by H-reflex elicitation in the femoral nerve and surface electromyography of the quadriceps. To assess the degree of edema, direct circumferential measurements were taken. On the first presurgical visit, the left knee demonstrated mild edema with a decrease in H-reflex amplitudes. Two days after surgery, a further reduction in amplitudes and more swelling were demonstrated followed by an increase in amplitudes and a reduction in edema on the 28th postoperative day. These findings document a relationship between reflex inhibition and joint swelling that was previously described in experimental models where joint edema was simulated.
Andrew L. McDonough and Joseph P. Weir
J. Ty Hopkins and Christopher D. Ingersoll
To define the concept of arthrogenic muscle inhibition (AMI), to discuss its implications in the rehabilitation of joint injury, to discuss the neurophysiologic events that lead to AMI, to evaluate the methods available to measure AM1 and the models that might be implemented to examine AMI, and to review therapeutic interventions that might reduce AMI.
The databases MEDLINE, SPORTDiscus, and CIHNAL were searched with the terms reflex inhibition, joint mechanoreceptor, Ib interneuron, Hoffmann reflex, effusion, and joint injury. The remaining citations were collected from references of similar papers.
AMI is a limiting factor in the rehabilitation of joint injury. It results in atrophy and deficiencies in strength and increases the susceptibility to further injury. A therapeutic intervention that results in decreased inhibition, allowing for active exercise, would lead to faster and more complete recovery.
Adam S. Lepley and Lindsey K. Lepley
controlled by ligaments via reflexive motor control. The establishment of a reflexive motor control arc from the ligaments of a joint to the surrounding musculature also led early researchers to believe that AMI is primarily reflexive in nature, caused by a presynaptic reflex inhibition of alpha motor
This study investigated the effect of psychological pressure on spinal reflex excitability. Thirteen participants performed a balancing task by standing on a balance disk with one foot. After six practice trials, they performed one nonpressure and one pressure trial involving a performance-contingent cash reward or punishment. Stress responses were successfully induced; state anxiety, mental effort, and heart rates all increased under pressure. Soleus Hoffmann reflex amplitude in the pressure trial was significantly smaller than in the nonpressure trial. This modification of spinal reflexes may be caused by presynaptic inhibition under the control of higher central nerve excitation under pressure. This change did not prevent 12 of the 13 participants from successfully completing the postural control task under pressure. These results suggest that Hoffmann reflex inhibition would contribute to optimal postural control under stressful situations.
Komeil Dashti Rostami, Aynollah Naderi, and Abbey Thomas
. PubMed ID: 16721346 doi:10.1097/01.blo.0000223977.98712.30 10.1097/01.blo.0000223977.98712.30 16721346 9. Snyder-Mackler L , De Luca PF , Williams PR , Eastlack ME , Bartolozzi AR . Reflex inhibition of the quadriceps femoris muscle after injury or reconstruction of the anterior cruciate
Erik H. Arve, Emily Madrak, and Aric J. Warren
, Grung B . Knee effusion and reflex inhibition of quadriceps. A bar to effective retraining. J Bone Joint Surg . 1988 ; 70 ( 4 ): 635 – 638 . doi:10.1302/0301-620X.70B4.3403614 10.1302/0301-620X.70B4.3403614 11. Suter E , Herzog W , Bray RC . Quadriceps inhibition following arthroscopy in
Nilüfer Kablan, Nuray Alaca, and Yaşar Tatar
have reported its reducing effect on stiffness. 7 , 8 It has been stated that the decrease in stiffness may be due to the cross-bridge breakage effect of PM via pressure and stretching, 7 decreasing motor neuron excitability, 26 creating local reflex inhibition, 23 and increasing intramuscular
Komeil Dashti Rostami and Abbey Thomas
, Bartolozzi AR . Reflex inhibition of the quadriceps femoris muscle after injury or reconstruction of the anterior cruciate ligament . J Bone Joint Surg . 1994 ; 76 ( 4 ): 555 – 560 . PubMed ID: 8150823 doi: 10.2106/00004623-199404000-00010 5. Swanik CB , Lephart SM , Giraldo JL , DeMont RG
Omid Kazemi, Amir Letafatkar, and Paulo H. Marchetti
(decrease in motor unit activation, firing frequency, and reflex inhibition from afferent types III and IV) that reduce muscle activation, (b) mechanical factors (changes in the viscoelastic properties of the musculotendinous unit or changes in the angle–torque relationship) that affect the transmittal of
Zakariya Nawasreh, David Logerstedt, Adam Marmon, and Lynn Snyder-Mackler
ME , Bartolozzi AR III . Reflex inhibition of the quadriceps femoris muscle after injury or reconstruction of the anterior cruciate ligament . J Bone Joint Surg . 1994 ; 76 ( 4 ): 555 – 560 . doi:10.2106/00004623-199404000-00010 10.2106/00004623-199404000-00010 44. Snyder-Mackler L