The Use of Lumbar Extension in the Evaluation and Treatment of Patients With Acute Herniated Nucleus Pulposus

Centralization: Its Prognostic Value in Patients With Referred Symptoms and Sciatica

“…Other potential prognostic factors, such as gender, straight leg raise, neurologic signs and symptoms, and smoking, were not significantly different between the groups. As in previous studies, 40,41 the response to mechanical evaluation was a better predictor of outcome than traditional orthopedic signs.…”

“…36 The ability of any of these tests to determine whether conservative or surgical treatment is appropriate has not been shown. 40,41 Thus, when making treatment decisions, such as whether to recommend surgery, confirmatory tests are needed to select the appropriate treatment pathway. The purpose of this study was to evaluate the prognostic significance of the centralization phenomenon in patients with subacute sciatica using a prospective study design, particularly evaluating its prognostic value for determining whether surgical or conservative treatment was required.…”

A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain

“…In chronic stages, many patients (one study of lumbar radiculopathy patients [104] suggested approximately 50%) will exhibit centralization signs, in which cases end range loading in the direction of centralization is the recommended first-line approach. In those who do not exhibit centralization signs, or who have residual radicular symptoms, a treatment approach that holds promise is neural mobilization [31] which attempts to mobilize the involved nerve root to improve its mechanics and decrease its sensitivity [105-107].…”

Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions?

“…This is consistent with the literature as reviewed by [27] but contrary to Sufka et al [14] found that the more distal the pain, the less likely that the patients would centralize. Kopp et al [28] however, found that 52% of patients with neurological deficits were able to reduce their pain and recover their full ROM in comfort within 3-5 days of starting extension exercises.…”