In this video, we will show you direction-specific exercises in case of directional preference and/or centralization. Enroll in our online course now. Link is in the video description. Hi and welcome back to Physioutors. Directional preference and centralization are two phenomena described in the derangement classification of the McKenzie concept.
Directional preference means that repeated movements into one direction, so either flexion, extension, or lateral flexion of the lumbar or cervical spine are able to progressively abolish symptoms and/or increase lumbar range of motion. A systematic review of May et al. in the year 2012 found that 70% of patients did exhibit such a directional preference. The McKenzie concept also talks about the phenomenon of centralization. Centralization is a symptom response to repeated movements, which is characterized by the abolition of spinal pain and referred spinal pain symptoms in a distal to proximal direction.
According to the review of May, 44% of patients presented with centralization. The prevalence was higher among younger patients and in acute low back pain with 74% in comparison with patients above 65, or if back pain was persistent, with 42%.
The presence of centralization was also a useful treatment effect modifier in seven out of eight included studies. In case of directional preference and or centralization, a patient’s symptoms can often be modified by performing repeated movements into the preferred direction. In the following, we will show you a couple of examples for the lumbar spine that we find useful in practice for patients with acute low back pain, with or without radiculopathy.
Be aware that this is absolutely no strict application of the McKenzie concept whatsoever. Alright, this was our video on direction-specific exercises for low back pain with or without radicular symptoms. Some patients present with fear avoidance behavior. In this case, exercises that challenge the patient’s fear in a graded exposure manner can be helpful. Click on the video right next to me to get a couple of ideas on how to do that.
A lot of this information and much more can be found in our soon to be released online course for physiotherapy of the spine (released in 2020).
Thanks a lot for watching and I’ll see you in another video. Bye..