Keys To Managing Back Pain

Sciatica and Low Back Pain

The Peripheralization & Centralization Phenomenon: Why do my low back symptoms change


The symptoms experienced by patients with low back injuries and lumbar pathologies can

present very differently. Some will experience very focal sharp pain in the middle of the back,

a diffuse "ache" on one side of the back, "sciatica" (symptoms that course from the low back

all the way down the back of one or both of the legs), and other patients may just complain

of inexplicable hip, knee, calf or foot pain. In the McKenzie model of examination, physical

therapists try to alter patient symptoms through positions and movements. A term often used

to describe a movement's effect on symptoms is peripheralization: the process of symptoms

moving further down the extremity, the periphery. For example, if bending to touch your toes

causes pain that was initially in your thigh to move all the way to your heel, a McKenzie certified

physical therapist would say your symptoms have peripheralized. The opposite and a goal of

treatment is to cause symptom centralization. For example, if you have pain in your thigh and

repeated backwards bending causes symptoms to move out of the thigh into the low back, a

McKenzie certified physical therapist would say your symptoms centralized towards the origin of

the problem. In this case pain may actual become more intense as it gets closer to the spine; as

strange as it sounds, this is still a desired effect.

"So what?", you may ask. As a patient, what does this mean for you?

It means pay attention to your symptoms throughout your day and its location! Location,

location, location. When you bend over to put on your socks and shoes, does your pain get

worse? How about after a long period of sitting at your desk at work? Do symptoms move from

your back and course their way to your buttock, or farther? Or do they actually improve after

an activity or with a position?? This information can help guide your physical therapist towards

the treatment and lifestyle changes from which you could benefit, resolving your symptoms and

getting you back to a pain free lifestyle.

For the visual learner, here is a 2:00 video showing simple spine anatomy and an example of a

mechanism that causes sciatica.

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