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Withdrawal Reflex

The withdrawal reflex is a spinal reflex intended to protect the body from damaging stimuli. It is a polysynaptic reflex, causing stimulation of sensory, association, and motor neurons. In this article we will discuss the basic anatomy, the neural pathways and also the clinical relevance of this reflex.

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Section of the spinal cord showing the spinal membranes and nerve roots.


The withdrawal reflex is defined as an automatic withdrawal of an extremity (e.g. a hand) from a painful stimulus. Unlike deep tendon reflex, the withdrawal reflex is polysynaptic.

The basic mechanism by which it works is the following:

  • Posterior horn of spinal cord - ventral view

    Posterior horn of spinal cord - ventral view

    a noxious stimulus, such as heat or pain, will excite the sensory nociceptor e.g. a heat receptor on the person’s skin
  • the signal travels through a primary sensory neuron, which will enter the dorsal horn of the spinal cord
  • the neuron will then will synapse with an interneuron within the spinal cord itself
  • next, the interneuron will synapse with an alpha motor neuron 
  • Anterior horn of spinal cord - ventral view

    Anterior horn of spinal cord - ventral view

    subsequently, this will leave via the ventral horn, and will supply excitatory input to the ipsilateral (same side) flexor muscle group 
  • in parallel, motor neurons that supply the ipsilateral extensor compartment will receive signals from inhibitory neurons and supply the antagonist muscles. This is known as ‘reciprocal inhibition'. The overall result will consist of pulling the limb away from the noxious stimulus within half a second.

It is worth noting, that at the same time the sensory neuron synapses with the ipsilateral motor neuron, it also synapses with the contralateral motor neuron. This will send signals up the spinal cord and cause the person to contract muscles that will move the centre of gravity of the person to prevent them falling once they withdraw from the stimulus. This will act to stabilize the contralateral part of the person’s body. For example, it will prepare the contralateral leg in order to stabilize the body and prevent the person falling. The stimulation of the contralateral half of the body for stabilization is known as the crossed extension reflex.

Under normal conditions, a noxious stimulus will occur before the flexor reflex will occur. However, squeezing a limb can cause the same response. This suggests that the spinal cord can modify and modulate the sensitivity of the local circuitry to a variety of sensory inputs.

Clinical Notes

Overriding of the reflex

Drunk, drugged or unconscious patients will not exhibit this reflex. The body can also be made to override the reflex.

Transverse Myelitis

This is a demyelinating condition of the spinal cord caused by multiple sclerosis, viruses (herpes simplex, enteroviruses, cytomegalovirus) and certain fungal infections (mycoplasma pneumonia). It often leads to:

  • motor weakness
  • diminished reflexes
  • autonomic dysfunction
  • sensory dysfunction
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Show references


  • Frank H.Netter MD: Atlas of Human Anatomy, 5th Edition, Elsevier Saunders, Chapter 1 Head and Neck.
  • Chummy S.Sinnatamby: Last’s Anatomy Regional and Applied, 12th Edition, Churchill Livingstone Elsevier, Chapter 6 Head and Neck and Spine, Page 375.
  • Richard L. Drake, A. Wayne Vogl, Adam. W.M. Mitchell: Gray’s Anatomy for Students, 2nd Edition, Churchill Livingstone Elsevier, Chapter 8 Head and Neck: Nasal Cavities, Page 1014 to 1020.
  • Richard L. Drake, A. Wayne Vogl, Adam. W.M. Mitchell: Dorland’s Gray’s Pocket Atlas of Anatomy, Churchill Livingstone Elsevier , Chapter 8 Head and Neck, Page 361.
  • Manji H: Oxford Handbook of Neurology, Second Edition. Chapter 5, Neurological disorders. page 310.

Author, Review and Layout:

  • Shahab Shahid
  • Uruj Zehra
  • Catarina Chaves


  • Posterior horn of spinal cord - ventral view - Rebecca Betts
  • Anterior horn of spinal cord - ventral view - Rebecca Betts
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