Referred Pain Kawana

September 21, 2011

Pain occurring in one area of the body may not be a result of injury or dysfunction in that particular area. Pain may arise from a local structure, but equally, it may be referred to that site from a structure some distance away. For example, pain felt in the buttocks is commonly due to dysfunction in the lumbar spine or pelvis.

There are two types of referred pain; radicular pain and nociceptive pain. Radicular pain arises through irritation of a nerve either as it leaves the spine or along it’s course. This sharp pain is commonly felt in a distinct pattern depending on which nerve is affected. For example, irritation of the L5 nerve will affect the top of the foot and the outside of the thigh. Commonly with nerve irritation, pins and needles, numbness and/or weakness are also experienced.

Nociceptive pain is pain from joints, muscles, skin or organs. It can be felt locally at the site of injury, or at some distance from the injury (referred pain). Referred nociceptive pain is commonly dull and poorly localised and may or may not be associated with pain at the actual sight of injury. For example, a hip injury may cause knee pain without any pain in the hip. It is even possible that the referred area of pain will be tender to touch, despite any injury to the area.

Physiotherapists always consider referred pain as a possible cause of any complaint. This is why when treating the limbs for example, physios will often ask about, or physically assess remote muscles/joints and the spine. If the pain is identified as being referred, treatment will be directed at the site of dysfunction. Once the remote dysfunction is addressed, the referred pain will resolve.