Directional preference exercises are determined during the physical examination of patients with back pain and referred pain from the spine with the use of repeated movements by the patient. There maybe clues to this found during the history taking, such as the patient indicates they are better when walking and worse when sitting – this could be a clue to a favourable response to extension activity and negative response to flexion activity. This would be explored in the physical examination by testing out the response to repeated extension exercises. If the patient reported centralisation of pain, which is the abolition of distal symptoms, or a decrease in symptom intensity or abolition of symptoms in response to the repeated movement they would be deemed to have a directional preference for extension exercises. These would prescribed for the patient self-management exercises. There is considerable evidence supporting the favourable long-term prognosis associated with centralisation. Furthermore there is evidence to support the use of directional preference exercises in favour of non-specific exercises. This presentation will examine the evidence for directional preference in general, but also specifically as it relates to patients who present with back pain and referred symptoms. The evidence provided will demonstrate the value of directional preference exercises for this group of patients in the athletic and non-athletic populations.
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