A very common condition that often leads patients to see me for help is radicular pain from the neck and back. Radicular pain occurs when nerve roots along the spine are compressed or irritated, resulting in symptoms that radiate into the arms or legs. Understanding the concepts of centralization and peripheralization is crucial in managing and treating this type of pain. In this blog post, we will delve into the concepts of radicular pain, centralization, and peripheralization to shed light on their importance in your recovery in physiotherapy.
What is Radicular Pain?
Radicular pain, also known as a radiculopathy, is a condition characterized by pain, tingling, numbness, or weakness that originates from the spinal nerve roots. A common radicular symptom is sciatica. It occurs when the spinal nerves become compressed or irritated, often due to conditions like a bulging or herniated disc, spinal stenosis, or foraminal narrowing. Radicular pain can affect various areas of the body, such as the neck, shoulder, arm, lower back, or leg, depending on the location of the affected nerve roots. It can also mimic or contribute to many common repetitive strain injuries, such as golfer’s and tennis elbow, plantar fasciitis, carpal tunnel syndrome, and Achilles tendonitis. Differentiating between these conditions and radicular pain requires an in-depth assessment, which is another reason why I prefer to offer longer, one-on-one sessions.
Centralization and Peripheralization:
Centralization and peripheralization are terms used to describe the movement or alteration of symptoms in radicular pain patients. Understanding these concepts can play an important role in helping us determine the effectiveness of your treatment, predicting the progression of symptoms, and knowing when you might be off the track or if a change in course is needed.
Centralization refers to the process where pain or other symptoms move closer to the spine or central area of the body. This is considered a positive sign in the management of radicular pain as it indicates a reduction in nerve compression or irritation. Centralization occurs when there is a decrease in pain intensity or a shift of symptoms from your extremities and towards your spine. This usually means that things are getting better. With physiotherapy, we can use direction-specific movements, exercises, and manual therapy techniques to promote centralization of your symptoms.
In contrast to centralization, peripheralization occurs when symptoms move away from the spine or central area of the body towards your extremities. This can indicate an increase in nerve compression or irritation. This typically indicates that there is an aggravation or spreading of symptoms, such as pain extending further down the arm or leg. Being aware of peripheralization is essential for modifying treatment strategies to alleviate symptoms and prevent further nerve damage, whether it is during hands-on therapy, while completing your exercises, or while doing your day-to-day activities.
Importance in Treatment:
Understanding centralization and peripheralization can be crucial for you and your physiotherapist when we put together a personalized treatment plan for your radicular pain. By monitoring and assessing how symptoms respond to various interventions, we can modify techniques and exercises to promote centralization and avoid peripheralization and promote a faster recovery. Being able to find movements that centralize your symptoms is an excellent prognostic sign and is often associated with a faster and better recovery.
Evidence-based Physiotherapy Treatments for Radiculopathy:
Physiotherapy interventions for radicular pain focus on reducing nerve compression, improving mobility, and promoting healing—and the approaches most supported by science revolve around movement. Some common techniques and approaches include:
McKenzie Method: This is one of the most evidence-based approaches within physiotherapy, and emphasizes repeated movement-based exercises to centralize symptoms and reduce nerve compression. Therapists guide patients through specific exercises that promote self-correction and symptom improvement. Some of you may be familiar with the McKenzie method as simply doing back extensions, but there is certainly more to it than that! Although not 100% effective, when the McKenzie method works, it really works, even for chronic cases of referred pain. (Note: I have completed training in the McKenzie method for neck and low back pain, and have previously worked in the only McKenzie-certified clinic in western Canada!)
Neural Mobilization: Specialized exercises and manual techniques are used to mobilize the nerves and improve their gliding capacity, reducing irritation and promoting centralization. For exercises, I tend to use this approach less often than the McKenzie method, and care must be taken to make sure these kinds of movements are really helping.
Strengthening and Stabilization Exercises: Targeted exercises are prescribed to improve muscle strength, stability, and posture, supporting the spine and reducing stress on the affected nerves. I usually employ this approach when we are unable to find immediate results with the McKenzie method, in adjunct to McKenzie exercises once patients begin to improve.
Movement Re-Education: Often radiculopathies are the result of how we move throughout the day. Therefore, understanding what activities and positions worsen (or peripheralize) your symptoms and what ones improve (centralize) your symptoms is often key to a full and long-term recovery. This might mean improving your mobility and body awareness, altering how you sit or stand, moving more often or taking more breaks, improving your form in the gym, or correcting body mechanics with lifting or going about your daily tasks.
Manual Therapy: hands-on techniques such as joint mobilizations and manipulation, as well as soft tissue work, acupuncture, or dry needling may be used to alleviate nerve compression, restore joint function, and promote centralization. However, unless we are dealing with a mild, short-lived case, in isolation this approach is not often enough to fully resolve radicular symptoms.
Centralization and peripheralization may be very important for you in recovering from pain referred from your neck or back. As always in physiotherapy, the best treatments are grounded in movement. By promoting centralization and avoiding peripheralization, during your physiotherapy session we can work together to reduce nerve compression, alleviate your symptoms, and get you back to doing what matters most. If you're experiencing radicular pain, and located in Calgary, Alberta, by working together at physiobox we can develop a personalized treatment plan to address your specific needs and facilitate the best recovery possible. Book your appointment here.