When I assess back pain, I ask where you feel it as well as how much it hurts. A change in the location of symptoms can help me decide which movements to use in treatment.
What centralization means
Imagine you have pain in your low back and calf. After a particular movement, the calf pain eases or disappears, and symptoms are felt closer to the back. That retreat of symptoms toward the spine is called centralization. This is an example, not a description of a particular patient.
Simply feeling less pain, or noticing pain closer to the middle of your back, does not by itself establish this pattern. I compare your symptoms before and after movement and check whether the change lasts.
How I use that information
The McKenzie Method, also called Mechanical Diagnosis and Therapy, uses an assessment of how symptoms and movement respond to different positions and repeated movements. It is more than a set of back-extension exercises.
If extension repeatedly helps during your assessment, it may become part of your home program. Someone else may respond better to a different direction, or need another approach. I also look at whether sitting, standing and walking become easier.
Centralization is a useful treatment clue. It does not prove that a disc has moved back into place or identify the exact tissue causing pain. My aim is to find a manageable starting point, then build your movement and activity as your response allows.
What to tell me between visits
Tell me where your symptoms are before and after your prescribed exercises, whether relief lasts, and what happens later that day. New or increasing symptoms farther down the leg are a reason to contact me and review the plan. Do not repeatedly force an exercise that worsens your symptoms.
Seek urgent medical care for new bladder or bowel changes, numbness around the groin, or significant new leg weakness.
I provide one-on-one physical therapy in your home. Call me at 267-647-9097 to discuss your back pain and daily goals.
Related advice
Back pain after yoga: how I adjust the plan
When a home exercise hurts another joint
Browse my physical therapy and movement articles
Research: Long, Donelson & Fung (2004) supports matching exercises to an assessed directional preference. Halliday and colleagues (2019) found similar pain and function at one year with McKenzie and motor-control exercise in the group studied. No one exercise approach is best for everyone.
General education; exercises should follow an individual assessment.
