The Evidence, Please!

The Prognostic Value Of Centralization

Centralization defined:

" I would define this phenomenon as the situation in which pain arising from the spine and felt laterally from the midline or distally, is reduced and transferred to a more central or near midline position when certain movements are performed....                                                                                                                                                    R.A McKenzie 1981

Donelson R, Silva G, Murphy K.; Centralization phenomenon. Its usefullness in evaluating and treating referred pain. Spine; Mar; 15(3); 211-3, 1990

          The centralization phenomenon is found to be a reliable predictor of good excellent treatment outcomes. Of 87 patients centralization ocurring in 100% of 59 patients with excellent outcomes.

Werenke M, Hart DL, Cook D; A descriptive study of the centralization phenomenon. A prospective analysis. Spine; APR 1; 24(7): 676-83, 1999.

          Of 289 patients with acute neck and back pain 31% centralised during repeated movement testing in the clinic and achieved abolition of symptoms on an average of 4 sessions; 46% showed some centralization or reduction of symptoms on an average of 8 sessions. (Partial response); 23% showed no change in symptom site or intensity over an average of 8 sessions.The authors question wether in the partial response group changes where a product of the natural improvement in pain intensity and function, while the non-response group did not. Assessment of initial pain location was reliably assessed.

Sufka A, Hauger B, Trenary M. Bishop B, Hagen A, Lozon R, Martens B.; Centralization of low back pain and perceived functional outcome. J Orth & Sports Phys Ther; Mar 27(3): 205-12, 1998.

          Of 36 patients 70% centralized within 14-day test period- centralization was less amongst those with chronic symptoms and those with more referred pain. Centralization was associated with significantly more improvement on one of the functional outcome measures used.

Donelson R, Grant W, Kamps C, Medcalf R.; Pain in response to sagittal end-range spinal motion. A prospective, randomized multicentered trial. Spine; June 16 (6 suppl): S206-12, 1991.

Donelson found that 47% of back patients with or without referred pain displayed a directional preference to end range sagittal spinal movement-40% preffered extension, 7% preferred flexion.

Werneke M, Hart DL, Cook D; A descriptive study of the centralization phenomenon as a prospective analysis. Spine; Apr 1;26(7): 758-65,2001

In 225 patients with acute back pain 24 psychosocial, somatic and demographic variables were recorded at initial assessment. Patient outcomes at one year were predicted by a range of independent variables. When all these variables were entered in a multivariate analysis only pain pattern classification (centralization or partial centralization vs non-centralization), and leg pain at intake were significant predictions of chronic pain and disability.

Donelson R, Grant W, Kamps C, Richman P.; Cervical and referred pain response to repeated end range testing: a prospective, randomized trial. Nth Am Spine Soc.; 1997

          In-patients with neck and referred symptoms 45% had pain reduced or centralized with sagittal plane movements. Of this 67% had a preference for extension or retraction and 33% had a preference for flexion and protrusion. In the remaining patients 14% showed a preference for extension, but not retraction, and 12% were worse with flexion but not better with extension.

Williams MH. Hawley JA, McKenzie RA, Van Wijmen PM.; A comparison of the effects of the effects of two sitting postures on back and referred pain. Sinpe; Oct; 16(10): 1185-91, 1991

          Over a 24-48 hour period 2 groups of patients with back and referred pain were encouraged to sit lordosis or kyphotic posture. Lordotic sitting group had back and leg pain significantly reduced and pain centralized compared to kyphotic group.

Fortino Gonzalez, PT, Dip MDT, FAAOMPT, OCS  

McAllen Physical Therapy