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Anyone have the particulars?
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Anyone have the particulars? - September 16, 2008 9:58:49 AM
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proud
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On this study?
http://www.aptei.com/library/viewReport.jsp?report=415
Particularily, what constituted "peripheralization with lumbar extension movements"? Would it not be better to say....no centralization on mcKenzie evaluation?
Anyone read this study. I think it's an important one.
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RE: Anyone have the particulars? - September 16, 2008 12:17:04 PM
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ptim
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Lack of centralization is different to peripheralization
The most distal symptoms would have to have been produced or increase with extension movement and remain worse as a result to use the term peripheralization.
I haven't read the whole study so don't know what operational definitions they used, but I would assume Fritz et al would have used this as their definition.
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RE: Anyone have the particulars? - September 16, 2008 12:38:25 PM
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Kaden
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I think the terms centralization and peripheralization are often used differently depending on who is talking. I agree with the last post that peripheralization should be a worsening of symptoms, not just, lack of centralization.
I had a guy in about an hour ago with classic discogenic symptoms with L5 fatiguable weakness. Got him prone lying over some pillows and eventually to prone on elbows. His symptoms really did not centralize but this did not increase leg symptoms and he felt better. So, as long as it does not increase leg symptoms I feel okay giving this to him for a HEP.
So, I plan to let him work on some gentle extension to see if he will centralize. If not then I will consider some traction in the next couple of visits.
Clinically this approach has worked for me. Start with directional preference, b/c this is what they can do at home immediatley. But if it just doesn't work continue with rest, modalities, and maybe some traction to calm the symptoms and back to directional preference.
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RE: Anyone have the particulars? - September 16, 2008 12:47:54 PM
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proud
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Yes, I guess I was suggesting that peripheralization with lumbar extension along with the other three variables would not automatically make me think this sub group might apply.
I would be MORE impressed had the article had "lack of centralization with a Mckenzie movement analysis" as one of the variables.....
For example....someone could be shifted....and meet all the other 3 variables. If you sagitally extend that patient....they would likley peripheralize. Now shift correct and they centralize....
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RE: Anyone have the particulars? - September 16, 2008 1:38:57 PM
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Shill
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From the study:
"Centralization was defined as occurring when a movement abolished symptoms, or caused symptoms to move proximally towards the midline of the spine. Peripheralization was defined as occurring when a movement caused symptoms to move distally away from the midline of the spine."
What they seemingly forgot, and is often not emphasized enough is ...."AS A RESULT OF THE MOVEMENT, NOT DURING THE MOVEMENT". Perhaps we need to set a time frame for the "AS A RESULT OF" as well.
It is my opinion that this is how many can miss those who do benefit from repeated movements, but unfortunately because there is some discomfort during, the motion is stopped, or changed, when in reality, had it been continued, the centralization and improvement may have still occurred.
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RE: Anyone have the particulars? - September 19, 2008 11:25:04 AM
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proud
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Just another quick question for anyone who knows the particulars:
I have read in some reports that signs of nerve root compression is a contraindiaction to mechanical traction. I guess it depends on the actual definition of "signs of nerve root compression".
Anyone know how this study defined that?
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RE: Anyone have the particulars? - September 21, 2008 1:25:08 PM
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UTDC
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quote:
ORIGINAL: proud
I would be MORE impressed had the article had "lack of centralization with a Mckenzie movement analysis" as one of the variables.....
Proud,
The inability to centralize was one of the original criteria for treatment-based classification. However, the results were the results, impressive or not. I am not familiar with sources which state that traction not be used in the presence of nerve root compression, however in this study, this was defined as:
"signs of nerve root compression [positive straight leg raise (reproduction of symptoms at <45°), or reflex, sensory, or muscle strength deficit]."
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RE: Anyone have the particulars? - September 21, 2008 8:49:23 PM
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proud
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Thank you UTDC....
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