Photo of a woman performing the upward dog yoga position.
The prone press up is an exercise that may help your low back pain or sciatica.. David Lees/ Getty Images

Centralization is a phenomenon that can be observed in many people who have pain in an arm, leg or buttock that is caused by a problem with the spine. Centralization occurs if the pain you are feeling either disappears or relocates closer to the spine when certain spinal maneuvers are performed.

Centralization was first described by Robin McKenzie, a physical therapist from New Zealand and the founder of the McKenzie Method of Mechanical Diagnosis and Therapy (MDT).

Centralization is defined as the movement of your pain to a central location in the spine. It occurs if you have low back pain or neck pain that is located on one side of your body.

Many people with back pain experience their symptoms on one side of the back or down one leg. If you have neck pain, you may be feeling the pain to one side of your neck or down one arm.

Centralization may occur if you perform an exercise for your pain. If your pain rapidly or slowly decreases in areas away from your spine while increasing in areas close to your spine, then centralization is occurring.

Why is Centralization Important?

Observing centralization is important for two reasons:

  1. When centralization occurs, that usually indicates less serious problem with your spine, and a good outcome can usually be expected.
  2. The movement or exercise that causes your symptoms to centralize is usually itself therapeutic, and can be incorporated into the treatment regimen.

    It is considered a good sign when you perform an exercise for your back or neck and centralization occurs. If your physical therapist asks you to perform an exercise and the pain that you are feeling to the side of your back starts to move to the center of your spine, then centralization is occurring.

    This tells you (and your physical therapist) that the exercise you are performing for your back is the correct one to do.

    Remember that centralization may occur rapidly or slowly, but as long as pain that is felt away from your spine is moving towards your spine, then this is considered a good sign. Even if you have acute, sudden onset back pain, you may be able to rapidly centralize your symptoms and quickly improve your mobility.

    Various positions and exercises may centralize your low back pain. Most frequently, the press up exercise will help to centralize your low back pain, but occasionally other exercises, like the flexion rotation stretch, will centralize your symptoms. It is important to work closely with your physical therapist to find the right exercise for your specific condition.

    Another great aspect of centralization is that you do not need to know the specific structure that is causing your pain in order to properly treat your problem. It is not important if you have a bulging disc, arthritis, stenosis, or any other spinal problem.

    As long as centralization is occurring, then you are performing the correct treatment for your spine.

    What if the Pain Moves Away From My Spine?

    If you are doing an exercise for your back and your symptoms start to move away from your spine and increase in your buttock or leg, then this is a sign that the exercise is not the correct one for you. Continuing with this exercise may cause increased pain or damage if it is continued.

    If your pain is increasing in areas away from your spine as the result of an exercise, you should stop the exercise and seek advice from your physical therapist or doctor.

    Do All Physical Therapists Know About Centralization?

    While many physical therapists learn about the centralization phenomenon during their schooling, only those who are trained in the McKenzie Method of Mechanical Diagnosis and Therapy have proven that they are experts in finding the right exercise to centralize the symptoms coming from your back or neck. The McKenzie International website can help you locate a physical therapist who is certified in the McKenzie Method.

    If you have low back pain or neck pain that is felt to one side of your spine, you should speak with your doctor or physical therapist to find the best treatment for your specific condition. Often postural correction and simple exercises that centralize your pain will help to quickly get you moving again.

    Source: McKenzie, R., & May, S. (2003). The lumbar spine mechanical diagnosis and therapy. (2nd ed., Vol. One). Waikanae: Spinal Publications New Zealand.

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