Wednesday, January 24, 2018

Directional Preference in Low Back Pain

In cases of low back pain (LBP) where pain also radiates into the leg (radicular pain), one of the goals in rehabilitation is to determine if the patient's symptoms can be reduced by placing the spine in a particular position (flexion or extension). If a position is found that reduces pain, this is referred to as the patient's directional preference and is used as a guideline when prescribing exercise/movement.
When radiating pain is present, it is important to understand that if pain leaves the leg and moves closer to the spine (centralization phenomenon), this is a sign of neural desensitization and recovery. On the other hand, if pain spreads farther away from the spine (peripheralization), this is a sign that the condition is worsening.
If you are experiencing LBP that radiates into the leg, it can be very helpful to see if you can find your own directional preference and, at the same time, identify any positions that worsen symptoms. In the picture shown here, this patient may have reported increased symptoms when in spinal flexion (sitting, bending to the ground, etc) and reduced pain with extension (laying on their stomach, standing, etc). In this case (which is actually quite common), extension would be this individual's directional preference and they would be advised to avoid positions of prolonged flexion and use extension positions or repeated movements (i.e. standing and arching the low back 10-15 times) to create centralization and speed recovery.
If you have any questions about radicular pain, directional preference or centralization/peripheralization, please ask as these topics can sometimes be a bit confusing.
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