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February 8, 20260 citationsOpen Access

The Gray Zone of H-Reflex in Runners: When Should We Suspect Pathology? A Pilot Study

LSL. H. M. P. De SilvaAMA. V. MaznychenkoAGA. V. Gorkovenko

Key Result

Exhaustive treadmill running decreased the mean Hmax/Mmax ratio from 0.61 to 0.31 in trained runners, indicating significant suppression of spinal excitability (p < 0.0001).

Key Points

  • This study aims to explore how exercise affects H-reflex ratios in trained runners from different sports backgrounds.
  • Conducted unilateral H-reflex testing on twenty-two trained athletes before and after treadmill running.
  • Recorded amplitudes of H-reflex and M-wave, analyzing Hmax/Mmax ratios.
  • Classified participants into three groups based on reflex ratios before and after exercise.
  • Utilized two-way repeated-measures ANOVA to evaluate differences between groups.
  • Significant differences were observed in H-reflex ratios across groups and conditions (p < 0.001).
  • Group A maintained stable reflex ratios above the threshold.
  • Group B experienced a 66% suppression, transitioning from normal to subthreshold values.
  • Group C consistently remained below threshold.
  • A small yet statistically significant reduction in H-reflex latency was noted, within normal variability.

Structured PICO

Does treadmill running to exhaustion alter spinal excitability (Hmax/Mmax ratio) in trained runners?

P
Population
22 trained athletes (runners)
I
Intervention
Treadmill running performed to voluntary exhaustion
C
Comparator
Pre-exercise baseline
O
Outcome
Post-exercise changes in Hmax/Mmax ratiosurrogate

Treadmill running to exhaustion induces heterogeneous changes in spinal excitability among trained runners, highlighting different physiological profiles of neuromuscular fatigue.

Main Result

Effect estimate: Partial eta squared for Time effect 0.88 (95% CI 95% CI [0.80, 0.90] for Time effect)

Absolute Event Rate: 0.31% vs 0.61%

p-value: p=<0.0001

Limitations

  • Small sample size of 22 participants
  • Participants exclusively trained runners limiting generalizability
  • Cross-sectional design prevents causal inference
  • No imaging or neurochemical correlates to confirm structural changes
  • Latency reduction within normal physiological variability and mechanistic relevance unclear
  • Group classification exploratory and requires validation in larger cohorts

Abstract

Background/Objectives: Spinal excitability may undergo adaptive modulation in response to training load, sport-specific demands, and fatigue. While high-impact sports are known to influence reflex responsiveness, the extent to which these changes differ from athletes in lower-impact disciplines remains unclear. This study aimed to investigate post-exercise changes in Hmax/Mmax ratio among trained runners with varied sport backgrounds, and to identify emergent physiological profiles that may reflect differential spinal adaptation to fatigue. Methods: Twenty-two trained athletes underwent unilateral H-reflex testing before and after treadmill running performed to voluntary exhaustion. Amplitudes of the H-reflex and M-wave were recorded, and Hmax/Mmax ratios were analyzed. Based on a physiologically relevant threshold commonly used to distinguish normal from suppressed reflex amplitudes, participants were post hoc classified into three groups: Group A (pre- and post-test ratios above threshold), Group B (pre above, post below), and Group C (both below). A two-way repeated-measures ANOVA was used to assess between-group effects. Results: Significant differences were found across groups and conditions (p < 0.001). Group A maintained reflex ratios above the threshold, indicating stable excitability. Group B showed the greatest suppression (approximately 66%), transitioning from normal to subthreshold values. Group C remained consistently below-threshold. A significant interaction (p < 0.0001) confirmed that reflex modulation varied by physiological profile. A small but statistically significant reduction in H-reflex latency was also observed; however, this change remained within normal physiological variability. Conclusions: Postexercise H-reflex modulation revealed heterogeneous neuromuscular responses among athletes. These findings may contribute to understanding how sport-specific demands and fatigue shape spinal excitability and may help identify individuals with adaptive or potentially pathological profiles relevant to sports diagnostics.

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Cite This Study

Silva et al. (2026) studied Healthy trained runners aged 18-23 years without diagnosed musculoskeletal or neurological disorders (n=22). Exhaustive treadmill running vs. Pre-exercise baseline measurement was evaluated on Hmax/Mmax ratio before and 15 minutes after exhaustive treadmill running (Partial eta squared for Time effect 0.88, 95% CI 95% CI [0.80, 0.90] for Time effect, p=<0.0001). Exhaustive treadmill running decreased the mean Hmax/Mmax ratio from 0.61 to 0.31 in trained runners, indicating significant suppression of spinal excitability (p < 0.0001).

synapsesocial.com/papers/698827670fc35cd7a88462c3https://doi.org/10.3390/jcm15031297
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Failed Excitability of Spinal Motoneurons Induced by Prolonged Running Exercise2006 · 105 citations
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