📘 Understanding Centralization and Peripheralization in the McKenzie Method

by Son’s Rehabilitation Medicine & Chiropractic Clinic in Seoul

– What Your Pain Pattern Might Be Telling You –

When it comes to back or neck pain, some people may also feel discomfort radiating down into their arms or legs. Interestingly, the direction in which pain moves isn’t random — it often gives us valuable insight into your spine’s condition and helps guide treatment.

In the McKenzie Method (Mechanical Diagnosis and Therapy, MDT) — a globally recognized approach in rehabilitation medicine — two key concepts help clinicians understand the behavior of spinal pain:
Centralization and Peripheralization.

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✅ What Is Centralization?

Centralization refers to a phenomenon where pain that was once felt in the extremities (such as the leg or arm) begins to move toward the spine (lower back or neck) after certain repeated movements or postural corrections.

🔹 Why It Matters:

• It suggests the source of pain is mechanical, often related to a spinal disc issue.

• It’s a positive sign — a strong indicator that the chosen exercise or movement is working.

• Centralization often points to a better prognosis and guides the direction of therapy.

Example: A patient with both low back and leg pain starts doing extension exercises. Over time, the leg pain disappears, leaving only low back discomfort. This is a classic example of centralization.

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❌ What Is Peripheralization?

Peripheralization is the opposite: pain moves away from the spine and radiates further down the limb after a movement or exercise.

🔹 Why It Matters:

• It’s often a sign that the movement is aggravating the condition, possibly worsening nerve irritation or compression.

• It indicates that the current treatment direction may be inappropriate.

• Peripheralization is usually associated with a poorer prognosis.

Example: A person with low back pain feels that after doing a certain movement, the pain now shoots down to the foot — this is peripheralization.

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🔍 Clinical Significance

Understanding whether pain centralizes or peripheralizes helps therapists and doctors:

• Identify whether the pain is mechanically reducible,

• Choose the right exercise direction, and

• Predict treatment outcomes more accurately.

Concept	Centralization	Peripheralization
Pain movement	From limb → toward the spine	From spine → further down the limb
Prognosis	Good	Poor
Treatment guide	Continue the current movement	Stop or modify the movement
Common in	Discogenic pain, sciatica, neck radiculopathy	Progressive nerve root irritation

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🩺 Final Thoughts

Pain is more than a symptom — it’s a message from your body. By observing how your pain changes with movement, we can determine whether you're on the right path toward recovery.

At Son Cheolho Rehabilitation Clinic, we apply the McKenzie principles to carefully evaluate these pain patterns and provide you with personalized, evidence-informed care.

If you’ve noticed your pain changing direction lately — especially during certain postures or exercises — it might be time to have it assessed professionally.

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)