Directional preference is a term associated with the McKenzie system of MDT. It has been defined in various ways including the definition below by McKenzie and May and secondly in the study by Surkitt et al Directional preference is always linked to the centralisation phenomenon (response) but is not limited to this response alone.
“An associated, but separate phenomenon is that of directional preference, which has been defined as the repeated movement which induces centralization or abolition of symptoms, but also a decrease in symptom severity, and/or a positive mechanical response, such as an increase in range of movement. Movements in the opposite direction may cause these symptoms and signs to worsen.” ( study Here)
“Assessment of LBP incorporating MLS may identify the presence of centralization, defined as the proximal movement or abolition of distal symptoms originating from the spine in response to the application of MLS. Associated with centralization is the concept of directional preference (DP), which is the direction of MLS that results in centralization, with movement into extension the most prevalent DP identified in the lumbar spine. A DP also can decrease pain intensity or improve restricted spinal movement without producing an associated change in pain location.” (study Here)
So this is why I am not a fan of the term directional preference (DP). DP is a misnomer because often a person may respond positively to a movement when in a certain loading position, but not respond favorably to the same direction of movement under different loading. A common example of this is when patients with lumbar pain issues respond positively (symptomatic and mechanically) to repeated extension in lying for the lumbar spine but do not have a positive response, or even a negative response to extension in standing (initially). This example would imply that the patient does not have a “preference” for the direction of extension.
I would propose a more accurate and clinically applicable term is “preferred directional loading strategy” (PDLS), in the example above the patinet would have a PDLS for extension in lying but not for extension in standing. It’s time for a change to make the terms used more representative of what is happening during repeated movement testing.
As always thanks for reading.
Poulter’s Ponderings 