When patients present with low back pain (LBP), they are frequently nervous and worried about whether they’re going to respond to the treatment—especially when it comes to getting out of pain and returning to their normal activities. A variety of studies have shown chiropractic care to be an effective option for the LBP patient, and though there is no “crystal ball”, there are some tests that doctors of chiropractic can perform during an examination that can help predict outcomes!
In fact, a meta-analysis of data from 43 studies published since 2012 suggests that centralization and directional preference, which may be present in 60-70% of LBP cases, offers important prognostic clues. Directional preference means that it’s possible to move the body in a manner that feels better to the patient. Centralization implies that it’s possible to move in a way that reduces the range of the pain to a specific region.
Here’s an example… Let’s say an LBP patient presents with radiating leg pain from their lower back with numbness and tingling in the leg and foot. The focus is to find a movement that REDUCES the leg pain/numbness, so their doctor of chiropractic asks the patient to bend forward, backward, and sideways, and to rotate their torso, looking for which direction is preferred, i.e., directional preference. When pain decreases AND centralizes (the leg pain disappears), then extension is the directional preference.
When centralization occurs, this is a favorable prognostic sign indicating that improvement can be expected. Likewise, when all positions or directions increase leg pain, this is a poor prognostic sign, meaning this is likely a more challenging case.
This helps doctors better advise patients about their condition and what to expect from care in both the short and long term so the patient can make REALISTIC goals and timely plans. Over or under reassuring patients is simply not appropriate! Directional preference also allows providers a means of determining what type of treatment to emphasize. For example, if the patient feels better bending backward and leg pain disappears, the provider will approach treatment and exercise recommendations from that direction.
Patient education is an important part of treatment, and educating patients on how this process can predict treatment outcome instills trust and places realistic goals in perspective so patients know what to expect. This improves compliance with care and confidence for both the healthcare provider and the patient.
