When Pain Moves: Centralization vs. Peripheralization

One of the things I pay pretty close attention to when someone comes in with pain is where their symptoms are moving.

Especially with neck or back pain, it’s really common for symptoms to show up in more than one place. You might have low back pain that also travels into your butt or leg, or neck pain that shows up into your shoulder, arm, or hand. And where those symptoms go can actually give us some useful information.

This is where centralization and peripheralization come in. They are technical terms for the direction your pain is moving - towards or away from your spinal cord.

Centralization basically means that your symptoms move closer to the center of your body. Maybe you came in with back pain and symptoms down your leg, and after a certain movement or position, the leg symptoms decrease and the pain becomes more concentrated in your back. That can be a useful sign that we’ve found a movement or position your body responds well to.

Peripheralization is kind of the opposite. Your symptoms start moving farther away from your spine or the area where they started. So maybe your back pain starts traveling farther down your leg, or your neck pain starts showing up more into your arm or hand with a particular movement.

I don't love the idea that there is one ~“correct”~ movement or one exercise that everyone with back or neck pain should be doing. We can pay attention to how your symptoms respond and use that information to figure out what makes sense for you.

Your pain is information. It doesn't have to be a warning that your body is falling apart.

Learning how to listen to those signals without being afraid of them is an important part of getting your confidence back.