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Paul Phillips PT, August 23 2023

From Backache to Reflexes: How Your Physiotherapist Decodes Back Pain

You have finally taken the time in your busy work schedule to make a physiotherapy appointment to tackle that low back pain that has been gradually getting worse.  As you delve into a detailed discussion of your symptoms and settle in for your assessment, your physiotherapist surprises you by asking to test your reflexes.  Reflexes? Intrigued, you might be wondering: Why on earth would my reflexes matter if the pain is in my back pain? 

We understand how that can leave you a bit perplexed and this is why we would love to bring clarity to your questions, shed some light on the significance of reflex testing and help unveil your back pain's perplexing journey. 

So, let's roll up our sleeves and dive into the world of reflex testing!

The Relationship Between Reflexes, Nerves and Back Health

By testing reflexes, Physiotherapists are able to uncover potential connections between your lower back and the nerves that extend to your legs.  We are especially interested in assessing reflexes if your back symptoms radiate into one, or both legs. 

Reflex testing is part of a neurological assessment that physiotherapists call, “conduction tests”. These tests show how well nerves are conducting messages from the spinal cord to the limbs. Two other tests most often combined with reflex testing, include key muscle tests and sensation tests. By combining the results of these three tests (reflex, key muscle tests and sensation), we are determining if a nerve in the low back is pinched and resulting in symptoms or altered function in the lower extremities. 

Ready, Set, Test!

Reflex testing is performed using a small rubber hammer. Your physiotherapist will gently but firmly tap just below the kneecap on the tendon that attaches our thigh muscles to the lower leg.  When this occurs, the muscle senses this tap as a small but fast stretch to the thigh muscles.  This signal travels to the spinal cord via a nerve and in reaction, the spinal cord sends a signal to the thigh muscles to contract.  As a result the lower leg will move, or flinch. This movement is graded by your physiotherapist to determine if the reflex is normal, or altered. There are other locations to test leg reflexes such as the foot and the achilles tendon.  Each of these locations correspond to a specific nerve level in the low back. 

Key muscles testing is done by asking the patient to contract specific muscles in the leg and hold this contraction for about 10 seconds.  Your Physiotherapist may ask you to repeat this contraction a few times as they are looking for weakness and decreased endurance of the muscle in question.  This premature fatigability is a classic sign that the nerve is having difficulty sending a signal to that specific key muscle. This test is also graded by the physiotherapist and this time on a scale of 0-5.  Once again there will be several muscles that will be tested, in both legs to determine if a specific nerve in the low back is having a problem sending signals. 

Sensation tests are the last of the three conduction tests. They are performed with the patient’s eyes closed, with light touch on the skin of the legs, usually with a tissue. We use this to determine if the patient’s sensation is normal, altered or reduced.  This is usually performed on specific locations, that again correspond to specific nerve level in the low back. Comparisons in the sensations are compared between the right and left leg to determine if one diminished. 

Neural Examination: Exploring Beyond the Legs

Contrary to popular belief, reflex testing isn't confined to the lower limbs.  The nerve conduction tests encompass the upper extremities as well. For individuals grappling with cervical concerns, such as neck issues, reflex assessments on the arms offer insights into the health of cervical neural networks.

The decision to do more neurological tests depends greatly on your specific symptoms and pattern of presentation.  Your physiotherapist may decide to test the function of your Central Nervous System which includes the spinal cord.  There are several in clinic tests that could be chosen, including the Babinski response in which the metal end of the reflex hammer is used along the bottom of the foot, causing the toes to move.  Movement in a distinct and specific way indicates to the physiotherapist that there may be a spinal cord problem.

Interpreting Nerve Findings: Implications and Consultations

Although nerve complications may elicit concern, they are a rarity. However, when detected, their significance cannot be understated. Physiotherapists assume the role of vigilant gatekeepers, inquiring about sensitive indicators like bowel and bladder functionality as part of a comprehensive neural evaluation. Should alterations in neural function emerge, your Physiotherapist can expertly gauge the necessity of medical referrals and imaging procedures, while simultaneously assessing whether physiotherapy interventions can yield favorable outcomes.

Key Takeaways

At MOOV Physiotherapy our physiotherapists act as the Sherlock Holmes of your body, decoding and solving the mystery of pain and nerves. Armed with the latest research and evidence-informed tools they will help you navigate the twists and turns of your health journey.  So, next time you hear the word "reflex," get ready to embark on a nerve stimulating journey with your Physiotherapist!

Written by

Paul Phillips PT


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