Flexibility of lower limb reflex responses to painful cutaneous stimulation in standing humans: evidence of load-dependent modulation.

Abstract 1. In six human subjects standing without support, the reflex response of the tibialis anterior muscle (TA) was elicited by painful electrical stimulation (500 Hz, 20 ms) of the anterior sole of the foot and analysed by post-stimulus averages of rectified electromyography. The threshold intensity for the reflex response was very close to the subjective pain sensation (mean value, 1.05 times). Estimation of the afferent conduction velocity gave a mean value of 26.5 m s-1, suggesting that a contribution from A delta fibres was necessary to evoke the reflex response. The TA reflex response was then used as the pain test reflex. 2. Changes in the TA excitatory pain reflex response (elicited at 1.2 times the pain threshold) were investigated while the subjects maintained different postures in upright stance. Standing on the ipsilateral leg produced a significant decrease in the reflex response with respect to its value in symmetrical stance (standing on both legs), whereas a significant facilitation was observed when the subject was standing on the contralateral leg. A parallel depression of the response in both limbs was present when the subject maintained an upright stance with the lower limbs abducted. Thus, it was apparent that the TA pain responses decreased as the supporting function of the leg increased. 3. A significant inverse correlation between the load to which the limb was subjected and the size of the reflex response was observed in all subjects. We propose that the load to which the limb is subjected, measured from peripheral mechanoreceptors, is used as a measure of the current supporting function of the limb, on the basis of which the reflex is regulated.