Referred pain is pain that occurs far from the primary lesion and can be caused by autogenous dysfunction or by external stimuli. Low back pain with referred pain is most commonly associated with pain into the buttocks, thigh or lower leg that may be worsened by flexion of the lumbar spine such as sitting. This occurs in 17-84% of patients with low back pain. The most common structures involved in referred pain are intervertebral discs, facer joints and sacroiliac joints. Referred pain may be felt in designated areas in patients with varying spinal disorders such as spinal injuries, disc degeneration, spinal canal stenosis and lumbar spondylolisthesis. Patients will typically describe referred pain as dull, aching, gnawing, annoying, drilling or pressing.
Frequently Asked Questions
What’s the difference between radiculopathy and referred pain?
Referred pain is pain that occurs far from the primary lesion and can be caused by autogenous dysfunction or by external stimuli. Once referred pain is present, it will become fixed in a certain region and it is difficult to locate an exact origin site. In comparison, Radiculopathy is neuropathic and is diagnosed as an irritated or compressed nerve root in the spine, typically from a herniated disc of spinal stenosis. This usually causes radicular pain or paresthesia, diminished reflexes and weakness in the respective regions that nerve innervates.
What are common injuries that will refer?
Referred pain is common in low back conditions including lumbar disc herniation, sciatica or degenerative disc disease. Pain will often be referred to the legs and along the sciatic nerve, radiating to the buttocks, thighs, calves and feet.
How is referred pain diagnosed?
A treating practitioner will collect a patient history, identifying any red flags for referred pain as well as pain patterns. A physical examination may include postural and movement analysis, palpation of the areas that are tender, a neurological assessment looking for sensory deficits, motor weakness and reflex changes, and special tests such as the straight leg raise. This will also aid in ruling out any differential diagnoses and determine the need for medical imaging. If medical imaging is required, your practitioner may refer you for an MRI, CT, X-ray or Ultrasound.
What are the best treatments for referred pain?
A physiotherapist may treat referred pain with manual therapy, exercise, heat and cold therapy, or TENS. Manual therapy techniques include joint mobilisation and manipulation, soft tissue mobilisation or neural mobilisation. These are used in conjunction with exercise to strengthen and improve mobility of the affected joints. To complement these modalities, the physiotherapist will provide education on the referred pain and how to manage the impairments identified.