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Centralisation in low back pain and sciatica.

Centralisation is a key part of the McKenzie Method. It is so well researched that it should be a routine part of all physiotherapy examination, at the very least for spinal problems.

The centralisation response is really helpful for both the therapist and the patient.

It provides vital information about the type of problem, gives a guide about how quickly it will get better, and what kind of result you can expect, and what you can do yourself to help improve.

 

What is centralisation?

Someone’s symptoms are said to be centralising if ‘‘in response to the application of loading strategies, distal symptoms are decreasing or being abolished. This change can occur instantly, over days or may take one to two weeks’’.

Let’s simplify that a bit.

Let’s say you have back pain with leg pain to the foot.

If there is a movement or position that reduces or gets rid of the pain that is the most distant eg your the foot pain, even if it increases your back pain initially, that is centralisation.

You can then expect that with the right movement or position, the pain would continue to improve. It is almost be ‘chased’ out of your leg, towards the centre of your back and then disappear completely.

 

How quickly does centralisation take to happen?

It can happen very quickly.  It can happen within minutes, often within the physio session.

 

What does centralisation tell you?

If centralisation does happen, there is a whole bunch of information that it provides.

It provides valuable information about:

  • whether you are likely to improve, or whether your problem is one that won’t change with treatment
  • how quickly you are likely to improve
  • exactly how to treat the problem and most importantly
  • how much you will be able to do yourself to get better.

 

What we have learnt about centralisation

I was a student of the McKenzie Method from the 1990s, and did my first formal course in 1998. At that stage, it was taught that the outer layers of the disc, the annulus, needed to be intact in order to see a centralisation effect.

We now know that isn’t true. Many patients can achieve centralisation despite the annulus being not intact and ‘compromised’ by injury.

Albert et al in 2012 performed a study on people with back with leg pain that radiated below the knee. They found that no matter what type of disc lesion was found on MRI and despite the severity of the symptoms and neurological findings, it was possible for a majority of these patients to positively affect their symptoms by centralisation.

This is a huge finding!  It is so easy to go to the MRI report and see words like bulge, herniation and extrusion and dismiss treatment possibilities and potential for improvement with conservative measures based on the written report.

In fact, in this study they found that despite the idea that patients with sequestrated or extruded discs ‘should not be able to centralise’, in fact, 93.5% did centralize, which was 10% more than the group with a normal intact annulus.

They commented that it could be of great value for these patients to know how to gain relief while natural healing takes its course.

 

Take home messages:

In patients with sciatica, centralisation is common if your therapist knows what to look for.

The way to find out if your problem centralises is by structured assessment by a physio experienced in the McKenzie Method.

Centralisation is very common in ruptured disc presentations, and if it occurs it is associated with better outcomes.

Most importantly, don’t judge your potential for improvement by the words on the MRI report!

 


 

The McKenzie Method is the most researched and validated method of assessment and treatment in the world.  It is widely used across the globe, in particular in USA and Europe.  For even more information, check out the McKenzie Institute of Australia website at www.mckenzieinstituteaustralia.org

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If you are looking for a solution for your painful problem, then call us on 8356 1000 and have a chat with one of our physios.  You can also click here to organise a call back or a FREE 15 minute pre-assessment consult.  Alternatively, email us at admin@adelaidewestphysio.com.au.

 

 We are proud of our McKenzie background.  We are the only clinic in Adelaide with listed Credentialled McKenzie Therapists on staff.

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About the author

Russell Mackenzie
Russell Mackenzie
Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
Russell Mackenzie

Russell Mackenzie

Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
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