H-Reflex-Guided Direction-Sensitive Exercise Versus Standard Extension Exercise for Functional Recovery in Patients With Lumbar Disc Prolapse

Condition(s) studied

Investigational drug(s) / intervention(s)

H-Reflex-Guided Direction-Sensitive Exercise: H-Reflex-Guided Direction-Sensitive Exercise (H-RGDSE) is an individualized physiotherapy intervention in which the participant's lumbar posture and movement direction are selected according to changes in the soleus H-reflex. The H-reflex is recorded using surface electromyography while the participant is tested in lying, sitting, standing, and different lumbar movement positions. Increased H-reflex amplitude is interpreted as a favorable response suggesting reduced neural compression, whereas a reduced response indicates a position or direction that should be avoided. Intervention Procedure Baseline assessment: Record pain intensity, neurological findings, range of motion, functional limitations, and baseline soleus H-reflex amplitude on the symptomatic and asymptomatic sides. H-reflex testing: Measure the soleus H-reflex during unloading and loading positions, including supine or prone lying, sitting, standing, lumbar flexion, extension, side bending, rotation, and relevant combine

Standard Lumbar Extension Exercise: Standard Lumbar Extension Exercise is a standardized physiotherapy program intended to improve lumbar extension mobility, promote upright spinal posture, and strengthen the lumbar extensor muscles. The same exercise sequence is provided to all control-group participants, without using H-reflex findings to select the treatment direction. Exercise Components Prone lying: Lie face down with the legs relaxed and the pelvis supported comfortably. Prone-on-elbows extension: Slowly raise the upper trunk onto the elbows while keeping the pelvis and hips in contact with the mat. Prone press-ups: Place the hands beside the shoulders and gently press the upper body upward while keeping the pelvis relaxed. Standing lumbar extension: Stand with the feet apart and hands supporting the lower back, then gently lean backward while keeping the knees straight. Progressive strengthening: Add controlled trunk-extension, hip-extension, and functional upright-posture exercises as tolerated.

Study summary

This randomized controlled trial will compare H-reflex-guided direction-sensitive exercise with standard extension exercise in patients with lumbar disc prolapse. Participants will be assessed at baseline, after 8 weeks of treatment, and at follow-up. The study will evaluate changes in H-reflex parameters, low-back and leg pain, disability, straight-leg-raising performance, lumbar range of motion, functional performance, perceived recovery, and treatment adherence. The study aims to determine whether individualized exercise based on neurophysiological responses provides greater clinical and functional benefits than standard extension exercise.

Eligibility

Primary outcome measure(s)

• Change in Oswestry Disability Index (ODI) Score — Baseline and immediately after the intervention.
  Functional disability related to low back pain will be assessed using the Oswestry Disability Index. The ODI consists of 10 items, each scored from 0 to 5. Item scores will be summed and converted to a percentage using the formula: ODI (%) = total score ÷ maximum applicable score × 100 The final score ranges from 0% to 100%, with higher scores indicating greater functional disability. If all 10 items are completed, the maximum possible score is 50. Unit of Measure: Percentage (%)

Trial sites (1)

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