Centralization of Pain in Physical Therapy

Centralization is a term used in a form of physical therapy known as the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). Centralization describes a phenomenon whereby pain in an arm, leg, or buttock suddenly shifts to a spot closer to the spine if the spine is either moved or manipulated.

Woman holding the back of her neck in pain
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The Mckenzie Method of MDT was founded by Robin McKenzie (1932-2013), a physical therapist from New Zealand whose treatments focused addressing the clinical symptoms of lower back or neck pain rather than identifying the anatomical location of the pain

While research has shown that MDT may provide relief to people with acute lower back pain, its benefit in treating other types of spinal-related problems is less certain.

Therapeutic Value of Centralization

According to the McKenzie method, centralization can be used as a form of diagnosis while assisting therapists in drawing up a treatment plan. Observing centralization is considered important for two reasons:

  • The centralization of pain typically suggests a less serious problem of the spine.
  • Any movement or exercise that causes pain to centralize should be considered beneficial and may be incorporated into physical therapy.

As a diagnostic tool, centralization is somewhat counter intuitive. While we tend to think of pain as something to avoid, centralization suggests that pain can sometimes be used to identify movements that are both specific and therapeutic.

Moreover, centralization does not require the therapist to know the exact location of pain in order to treat it. Whether you have a bulging disc, arthritis, or some other spinal problem, centralization offers an intuitive means of treatment without costly interventions or the risk of injury. Various exercises and positions can be used for this including press up exercises and flexion rotation stretches.

On the other hand, if a back or neck pain moves away from the spine, it should be considered non-beneficial and may cause further harm.

Effectiveness of MDT

Research into the McKenzie method has shown it is somewhat effective in treating people with acute back pain. However, a 2012 review of clinical studies concluded that its benefits in people with chronic back pain may be limited at best.

It is not that MDT is necessarily an ineffective practice. It is simply that centralization tends to occur in people with acute back pain rather than chronic pain. Moreover, centralization is seen more commonly in younger people whose back pain tends to be acute and injury-related. It's among this group that back pain is most likely to improve on its own, with or without MDT.

A Word From Verywell

If you have lower back or neck pain that doesn’t seem to be improving, see your healthcare provider and ask for a referral to a physical therapist who may be able to help. In some cases, postural correction and other simple techniques can help resolve a back or neck issue far more effectively than painkillers or anti-inflammatories.

If your pain is chronic, try to think of treatment as a process rather than an event. By doing so, you can affect changes in your lifestyle to better ensure any improvements you experience are long-lasting.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Supp G. Letter to the editor on: Hanna B. Albert, Eva Hauge, Claus Manniche (2011) Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions? Eur Spine J. doi:10.1007/s00586-011-2018-9.

  2. May S, Aina A. Centralization and directional preference: a systematic review. Man Ther. 2012;17(6):497-506. doi:10.1016/j.math.2012.05.003

Additional Reading
  • May, S. and Aina, A. "Centralization and directional preference: A systematic review." Musculoskeletal Science and Practice. 2012; 17(6): 497-506.

  • Machado, L.; Maher, C.; Herbert, R. et al. "The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial." BMC Medicine. 2010; 8:10.

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.