Q&A Time! Centralization and Residual Numbness or Tingling

Today's Q&A is from a blog reader via email, it is regarding symptom centralization.

It reads....

"I have a question regarding sensation with centralization. If a patient has pain down to their ankle and with movements this pain turns to tingling (still down to ankle), is this a good or bad thing? I feel I was always taught this to be a good sign. I have a colleague who feels that this is more of a sign of the nerve being compressed more. How about if it turned from pain to numbness? This is considering their MMT or neural tension signs do not change. I hope this makes sense. "

Thanks for your question! Like many things, the Centralization Phenomenon is not as cut and dry as seminars would have you believe. It is a predictor of good outcome and a sign that you are headed in the right direction with the patient.

There are many times in the clinic where a patient came in with peripheral complaints in their arm or leg, and they centralized with various positions or repeated motions, however

the pain changed to numbness
the numbness changed to tingling
the pain completely centralized and only a mild intermittent tingling was present in some digits of the affected limb

While there are no rules to exceptions you have to look at it all from a practical and patient centered standpoint. Ask yourself and the patient the following questions if centralization appears to be happening, but not as you expected it (or explained it)

now that the symptoms have changed, do you actually feel better?

this could be positional, functional, movement based, or hopefully all of the above

other than checking neurodynamic movement quantity/quality, are there other objectively measurable changes?

MMT
DTRs
mobility - particular an ability to load the involved spinal side into

SGIS for unilateral lumbar complaints
lumbar extension if SGIS was equal prior to centralization
cervical retraction and SB for unilateral cervical complaints
cervical retraction and extension if retraction and SB was equal prior to centralization

If function and the patient's perception of intensity is improved, I would call it a step in the right direction. Try not to get hung up on 100% centralization as a marker of improvement. I have discharged people who return to full function and they have mild intermittent paraesthesia that does not seem to be provoked by any amount of loading/unloading, activity or position. When I follow up with them over a year later, they say the last vestiges of remaining Sx just went away, sometimes several months after discharge.

image credit

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...