Methodological considerations contributing to variability of the quadriceps H-reflex.

The clinical usefulness of the quadriceps H-reflex is limited because of the difficulty of elicitation and its inherent variability in amplitude. In the present study we attempted to identify the influence of methodological variables (head position and remote muscle contractions) on the amplitude of the H-reflex evoked in vastus medialis, vastus lateralis and rectus femoris from the right leg of 13 healthy adult subjects. Square wave stimuli (1-ms duration) were delivered percutaneously to the femoral nerve. The 50% maximal amplitude H-reflexes were evoked while the subject reclined with head facing to the right, left, up and down or while the subject performed Jendrassik's maneuver. The results show a significant increase in the reflex amplitude when the subject's head was turned to the right; there was either a mild increase or no change in amplitude of the response when the subjects faced to the left, up and down. The evoked potential tended to decrease when the subjects closed their eyes; however, the tendency to increase with neck position was not changed. Remote muscle contractions enhanced the amplitude of the response. These results present further evidence of the characteristics of the quadriceps H-reflex and identify postural influences as one controllable source of variability in the L3-L4 root electrodiagnostic test.