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One Way to Get Rid of Sciatica: Centralization

Specific Exercises Can Reduce Sciatic Pain

Question: What does it mean to "centralize" leg pain? My physical therapist kept using that word when talking about my sciatica.
—Ottawa, ON

Answer: Centralization is an important treatment principle for sciatica. Sciatica is the "general public" term for radiculopathy, pain that travels away from the pain source along nerves. Sciatica is pain that travels from the low back, down the sciatic nerve, and into the leg.

Centralization is getting leg pain to move to a more central position in the spine. You can think of it as bringing the pain back to the pain source. You can centralize your pain by doing specific exercises; that's what your physical therapist (PT) is there to help you do.

How Centralization Works
Doing specific back exercises consistently can minimize your leg pain and abolish it because the exercises address the cause of the problem. Your leg pain is caused by a nerve problem in your low back. Something is compressing (pinching) or simply just irritating a nerve as it exits the spine, and that is causing the sciatic pain.

To reduce the leg pain, then, it's necessary to deal with the nerve problem in your low back.

I am a McKenzie practitioner in addition to a physical therapist, and I'll tell you how I approach patients who need to centralize their leg pain. I first find their directional preference—a movement that can immediately begin to reduce their pain and actually can take pressure off the nerve or pain-producing tissue. For example, a patient may notice decreased pain when she arches her back or bends backwards; her directional preference is extension (arched).

After assessing the patient's directional preference, I would prescribe and teach specific exercises to be performed throughout the day. These form the patient's home exercise plan, and I make sure every patient understands how critical it is to consistently do the exercises correctly. She would also be instructed in how her posture and normal movements of daily living can adversely affect her leg pain, and how she can manage this with simple corrections.

As the patient follows the exercise plan—and in conjunction with ongoing reassessment by the therapist—the leg pain can centralize. This process can take as little as several visits or several weeks.

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