Centralization and Direction Preference Systematic Review

May S. et al. Centralization and directional preference: An updated systematic review with a synthesis of previous evidence. Musculoskeletal Science and Practice: 2018
  • The presence of centralization has been associated with reduced pain, improved function, and return to work in both short and long term
  • The most recent systematic review was over 5 years ago and since then, a number of additional studies have come out.
  • This current review included 43 articles of 5,135 patients with spinal pain. Seven papers (720 pts) related to people with neck pain and the rest to low back pain.
  • Most studies involved patients with nonspecific low back or neck pain but some also included specific pathology including radiculopathy/sciatica, discogenic pain, candidates for surgery, and spinal stenosis
  • Out of the 5,135 spinal patients, centralization occurred in 39.5%, directional preference in 26%, and neither centralization nor directional preference in 33.5%
  • This total included centralization in 56% of the 720 patients with neck pain, directional preference in 18%, and neither in 26%. In chronic low back pain, centralization was found to occur in 44%.
  • The movement of directional preference was extension in 80% with lateral movements making up 10-14% and < 10% for flexion
  • In this review, only a small percentage of patients with acute and sub-acute LBP were included (250) with a majority being mixed or chronic duration of symptoms.
  • Overall, a combination of centralization and directional preference still occurred in 60-70% of patients with spinal pain
  • Authors conclude that reasonably good evidence that both centralization and directional preference are positive prognostic indicator of outcome, regardless of applied management strategy