Back pain and the role of referred pain

By Stephen Pollock, Back pain can be a debilitating and frustrating condition that can bring the whole body to a standstill.

And not all back pain is the same. There’s a range of reasons why people experience back pain.

In my time as a Senior Physiotherapist at Advance, I’ve seen many clients who present withor without lower back pain and complain of referred pain.

Referred pain can be a key indicator to the source of the back pain (or back pain pathology).

Often people who come to see me think that their referred pain is due to a pinched nerve or sciatica (which is not a condition but rather a symptom).

The sciatic nerve runs down the back of the leg and supplies the entire lower leg. To cause sciaticathere will be something else that is causing irritation to the sciatic nerve further up the chain, usually either in the hip or in the back.

Sharp referred pain down the back of the leg and into the lower leg, sometimes down the calf and into the foot, is likelyto be a compressed nerve.

Sometimes there will be tingling, weakness or numbness associated with this.  This will likely be a disc injury and will need to be treated as such.  There are other things that it could be, but this is the most common.   With a disc injury, referred pain will either get further from (peripheralization) or closer to your spine (centralization).

If the referred pain is more “vague” and does not follow a proper nerve distribution, then this will more often than not be a facet joint injury.If the facet joint is inflamed, then it can cause a chemical irritation to the nerve which causes referred pain in a more vague distribution than if the nerve is pinched or compressed.

Again, knowing how your pain is referred will tell us how to treat your back and treating a facet joint and disc injury are quite different.

The differentiation of referred pain is very important as it can tell us what the pathology is, help locate the source of the pain and dictate what the treatment should be.

In a nutshell, it’s important that if you experience back pain, you seek the services of a fully qualified, experienced professional to help identify its cause and appropriate forms of treatment.

A qualified Physio with experience in this area will be able to tell you if it’s a low complexity injury like a niggle or ache or something more serious.

If it is something more complex, your Physio should be able to isolate what is causing the current symptoms and formulate the best treatment plan in the short term, but also look at why it happened and devise a long-term plan to prevent this from happening again.

Stephen recently completed a Certificate in Orthopaedic Manual Therapy (COMT) through the New Zealand Manipulative Physiotherapists Association, which enables him to undertake advanced diagnosis, treatment and management of injuries of the musculoskeletal system, including more complex injuries.

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