Patients with low back pain (LBP) are often nervous and worried about responding to the treatment — especially when it comes to getting out of pain and returning to normal activities. Osteopathic care has been shown by a variety of studies to be an effective option for the LBP patient, and although there is no “crystal ball,” there are some tests that Osteopaths can perform during an exam that can help predict results.
A meta-analysis of data from 43 studies published since 2012* indicates that centralisation and directional choice, which may be present in 60-70 percent of LBP cases, provide significant prognostic clues. Directional choice means that the body can be moved in a way that makes the patient more comfortable than others. Centralisation means moving in a way that reduces the spread of pain to a given region.
Let’s say an LBP patient shows up with radiating leg pain from their lower back with numbness and tingling in both leg and foot. The emphasis is on seeking a movement that REDUCES the pain / numbness of the legs, and their Osteopath asks the individual to lean upward, backward and sideways and twist their body, searching for which position is preferred, i.e. lateral inclination. When pain decreases, and AND centralises (leg pain disappears), then the directional preference is the extension.
If centralisation happens, this is a positive prognostic sign indicating that positive change can be expected. Likewise, if all positions or directions raise pain in the legs, this is a bad prognostic sign, which means this is potentially a more difficult situation.
It helps doctors better advise patients about their condition and what to expect from treatment in both the short and long term so that the patient can make REALISTIC goals and plans in time. Directional preference also helps Osteopaths to decide which type of treatment should be emphasised. For example, if the patient feels comfortable bending backward and leg pain disappears, the Osteopath may approach care from that direction with exercise suggestions.
Patient education is an important part of treatment, and educating patients on how to predict the outcome of treatment instils confidence and puts realistic goals in perspective so patients know what to expect. This improves both the health care provider and the patient’s respect for care and trust.