Centralization of symptoms and lumbar range of motion in patients with low back pain

Abstract

This quasi-experimental repeated measures study examined the relationship between centralization of symptoms and lumbar flexion and extension range of motion (ROM) in patients with low back pain. Rapid and lasting changes in lumbar ROM have been noted with centralization of symptoms. However, no study has objectively measured the changes in lumbar ROM occurring with centralization. Forty-two adult subjects (mean age, 45.68 years; SD=15.76 years) with low back pain and associated lower extremity symptoms were followed by McKenzie trained physical therapists. Subjects' lumbar ROM was measured at the beginning and end of each patient visit by using double inclinometers, and pain location was documented. Subjects were grouped as 1) centralized, 2) centralizing, or 3) noncentralized for comparisons of symptom and ROM changes. Data were analyzed by using multivariate analysis of variance and one-way analysis of variance. Significance was set at 0.05. A significant difference was found between initial and final mean extension ROM in the centralized and centralizing groups (p=0.003). No significant difference was found in the noncentralized group (p<0.05). Subjects (n=23) who demonstrated a change in pain location during the initial visit also showed a significant (p<0.001) change in extension ROM, whereas patients with no change in pain location (n=19) did not (p=0.848). Lumbar extension ROM increased as centralization occurred.

Centralization and directional preference: A systematic review

“…A number of variables were associated with the presence of centralization, or noncentralization. Centralization has been shown to have a significant association with pain during movement, more improvement in extension range of movement over time, and confound the association between depression, somatisation and fearavoidance beliefs and chronic disability (Bybee et al, 2005(Bybee et al, , 2009Werneke et al, 2009;Edmond et al, 2010). Non-centralization has been shown to have a significant association with mental distress and depression (Christiansen et al, 2009), and nonorganic signs, pain behaviours, somatisation and fear of work (Werneke and Hart, 2005).…”

Prevalence of classification methods for patients with lumbar impairments using the McKenzie syndromes, pain pattern, manipulation, and stabilization clinical prediction rules

“…5,10 Although the validity for classifying patients into one of the three MDT mechanical subgroups has not been determined, numerous research studies support CEN as an important prognostic factor and classification category for identifying patients who respond favorably from specific CEN-based interventions. [10][11][12][13][14][15][16][17][18][19][20] Classification by patient response criteria including CEN and directional preference for directing treatment have been frequently recommended by clinicians and researchers. 11,[13][14][15][21][22][23][24][25][26][27][28][29] Similar to the three McKenzie syndromes, a substantial proportion of patients (estimates range between 31 and 87%) seen in physical therapy clinics for treatment of low back pain can be classified into a CEN category at intake.…”

Low Back Pain Response to Pelvic Tilt Position: An Observational Study of Chiropractic Patients

“…2 Posterior tilting of the pelvis has been recommended as an exercise for relief of LBP since at least as far back as the 1980s 3,4 and can still occasionally be found in patient education literature and Internet sites. Nor is the concept unique to this exercise; there are many published examples of directional preference-the identification of which positions and movement patterns relieve or aggravate pain-for lumbar flexion, as well as for extension and lateral bending [5][6][7][8][9][10][11] -and use of that information for therapeutic decisions.…”