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What it measures:

This test is used to obtain information with regard to centralization or peripheralization of pain or other symptom behavior as a response to testing in specific directions (directional preference) or mechanical loading.

Centralization is characterized by referred spinal symp¬toms that migrate in a distal-to-proximal direction. (1)

Target Population:

Individiuals with low back pain or lumbar radiculopathy.

Conditions & Test Variations Included in this Summary:
This summary includes information for assessment of both lumbar spine and cervical spine. (2,3)

Clinical Practice Guideline Recommendations

One clinical practice guideline recommends using repeated move¬ments, exercises, or procedures to promote central¬ization to reduce symptoms in patients with acute low back pain with related (referred) lower extremity pain. (5)

One clinical practice guideline (CPG) recommends the use of repeated end-range testing to determine if pain can be centralized, which can then be used to improve patient outcomes by informing exercise prescription. (11)

Another CPG states that centralization found via directional preference testing is a prognostic indicator for a favorable outcome, including avoidance of surgery. Exercises employing the preferred direction are recommended for the first 2 weeks of treatment. If the patient is improving, then exercises employing the nonpreferred direction should be added. (12)

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