Centralization and directional preference…again

Manual therapy 17, 2012 

When we take the time to examine patients’ preferential motions (very often extension and lateral bending) and prescribe them for daily repetition we can typically improve response and reduce therapy dependence or iatrogenic chronicity.

 Centralization is a symptom response to repeated or sustained movements that can be used to classify patients into sub-groups, prognosis and treatment strategies. These facilitated-exercises appear to have an effect in up to 70% of LBP patients with a higher prevalence in acute pain (70%) vs. (44%) in cLBP in studies to date. Studies suggest reliability is good.

The associated but separate phenomenon is that of directional preference which is defined as the “repeated or sustained movements” that induces centralization or abolition of symptoms. Movements in the improvement direction are considered “key” movements, those in the opposite direction considered “locks”. A finding of a directional preference at baseline has been shown to predict a significantly better response to DP exercise than non-specific/generalized exercise movements. Non-centralization was generally a negative predictor of outcome and more likely associated with psychosocial issues.