Today's Q&A is from a blog reader via email, it is regarding symptom centralization.
"I have a question regarding sensation with centralization. If a patient has pain down to their ankle and with movements this pain turns to tingling (still down to ankle), is this a good or bad thing? I feel I was always taught this to be a good sign. I have a colleague who feels that this is more of a sign of the nerve being compressed more. How about if it turned from pain to numbness? This is considering their MMT or neural tension signs do not change. I hope this makes sense. "
Thanks for your question! Like many things, the Centralization Phenomenon is not as cut and dry as seminars would have you believe. It is a predictor of good outcome and a sign that you are headed in the right direction with the patient.
There are many times in the clinic where a patient came in with peripheral complaints in their arm or leg, and they centralized with various positions or repeated motions, however
- the pain changed to numbness
- the numbness changed to tingling
- the pain completely centralized and only a mild intermittent tingling was present in some digits of the affected limb
While there are no rules to exceptions you have to look at it all from a practical and patient centered standpoint. Ask yourself and the patient the following questions if centralization appears to be happening, but not as you expected it (or explained it)
- now that the symptoms have changed, do you actually feel better?
- this could be positional, functional, movement based, or hopefully all of the above
- other than checking neurodynamic movement quantity/quality, are there other objectively measurable changes?
- mobility - particular an ability to load the involved spinal side into
- SGIS for unilateral lumbar complaints
- lumbar extension if SGIS was equal prior to centralization
- cervical retraction and SB for unilateral cervical complaints
- cervical retraction and extension if retraction and SB was equal prior to centralization
If function and the patient's perception of intensity is improved, I would call it a step in the right direction. Try not to get hung up on 100% centralization as a marker of improvement. I have discharged people who return to full function and they have mild intermittent paraesthesia that does not seem to be provoked by any amount of loading/unloading, activity or position. When I follow up with them over a year later, they say the last vestiges of remaining Sx just went away, sometimes several months after discharge.
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!
Keeping it Eclectic...