When most people visit a healthcare professional for musculoskeletal pain, they are usually told that movement is advantageous. They may be given a few stretches or exercises for their ailing body part, or are simply instructed to keep moving.
That advice is common and well-accepted in the medical community. Unless someone is in the early stages following a significant traumatic injury, we know that movement is helpful for nearly all musculoskeletal conditions.
What many people do not realize, however, is that a single direction of movement is often much more beneficial than others. That favored movement is found in roughly 75% of people with musculoskeletal pain.
Directional preference is defined as the phenomenon where rapid and lasting improvements in symptoms, motion and function are made as a result of performing a very precise movement. The movement that elicits directional preference is specific to the individual and can only be determined through an assessment done by a healthcare provider trained in the McKenzie Method.
By having the patient move in a standardized manner, the provider can establish if the pain exhibits the unique characteristics consistent with directional preference.
When people have a directional preference, there is a high probability that an excellent outcome will be achieved if they consistently exercise in that direction. That was highlighted in a study where 95% of low back pain patients with a directional preference were improved or resolved within two weeks of performing their specific movement.
In contrast, the same study shows that if low back pain patients with a confirmed directional preference performed traditional stretches and exercises, only 40% improved or resolved as a result.
And it’s not just back pain. Directional preference is just as prevalent in people with neck pain as well as those with pain in the upper and lower extremities. The same story holds true in those areas of the body. When people exercise in their preferred direction, they almost always have better outcomes compared to those who do not.
We also know that directional preference can be found in those deemed to be at the extreme end of the pain continuum, where an operation appears to be their only chance at recovery. Research shows that 40% of people on a waitlist for knee replacement surgery and 50% of people on a waitlist for lumbar disc surgery had a directional preference. Those patients did very well with their specific exercise, and nearly all of them were removed from the surgical waitlist.
So while we know that movement, in general, is beneficial for those with musculoskeletal pain, moving in the right direction can make a tremendous difference. Sadly, most patients don’t know if they have a directional preference because they are never assessed for it. That is unfortunate, as they could be one movement away from dramatically turning things around.
Dr. Jordan Duncan was born and raised in Kitsap County and graduated from the University of Western States in 2011 with a doctorate of Chiropractic Degree. He practices at Silverdale Sport & Spine.