The Influence of Centralization and Directional Preference on Spinal Control in Patients With Nonspecific Low Back Pain.

DP/CEN and DP/non-CEN are common pain pattern responses assessed by Mechanical Diagnosis & Therapy (MDT). Although there is evidence that MDT can reduce pain and disability in the short term by treating the patient with direction-specific exercises concordant with the patient’s DP, the mechanism responsible for this is unclear. The objective of this study was to¬†determine if clinical signs of impaired spinal control improve immediately after eliciting a directional preference with centralization response (DP/CEN), or a directional preference without centralization response (DP/non-CEN), in patients with nonspecific low back pain (LBP).¬†Participants underwent a standardized MDT assessment and were classified in a pain pattern subgroup; DP/CEN, DP/non-CEN, or no-DP. Clinical signs of impaired spinal control were assessed pre- and post-MDT assessment by an independent examiner. Four spinal control tests were conducted: aberrant lumbar movements while bending forward, the active straight leg raise (ASLR) test, the Trendelenburg test and the prone instability test. Differences in spinal control pre- and post-MDT assessment were calculated for the three pain pattern subgroups and compared with Chi-square tests. The authors¬†hypothesized that a larger proportion of patients in the DP/CEN subgroup would improve on spinal control than patients categorized as DP/non-CEN or no-DP. Of 114 patients recruited, 51 patients (44.7%) were categorized as DP/CEN, 23 (20.2%) as DP/non-CEN, and 40 (35.1%) as no-DP. Before MDT assessment between 28.9% (Trendelenburg test) and 63.7% (ASLR test) of patients showed impaired spinal control. After MDT assessment a larger proportion of patients in the DP/CEN subgroup (43%) showed improvement than those in the no-DP subgroup (7%) on aberrant lumbar movements (P = .02). Likewise, more patients in the DP/CEN subgroup (50%) improved on the ASLR test than in the no-DP subgroup (8%, P < .01) or the DP/non-CEN subgroup (7%, P = .01). Changes in Trendelenberg and prone instability tests did not reach statistical significance.

Immediately following MDT assessment, a larger proportion of patients with a DP/CEN pain pattern showed improvement in clinical signs of spinal control compared to patients with a DP/non-CEN or no-DP pain pattern.

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Peter Schoch
Peter Schoch
April 4, 2016 at 9:57 pm

Centralisation is a very well researched phenomenon, yet still overlooked / misunderstood by much of mainstream medicine, in its continued search for ‘pathoanatomical’ diagnoses and treatments. Direction preference is somewhat less studied, but no less useful in clinical practice and will likely be shown in years to come to encompass an even bigger cohort of patients. The most recent systematic review on these phenomena illustrate their potential clinical utility – – across a number of domains.

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