What Ails You: Finding the source of pain may lead to surprises

It is not uncommon for folks to come to me complaining they pulled their hamstring, though they are not sure how, and the pain simply won’t go away. The surprise comes when I start looking at their hip or at their low back as the cause of their pain. Posterior thigh pain — sometimes called sciatica — is one example of referred pain.

Referred pain is pain felt somewhere adjacent to or even some distance from the actual source of the problem.

Another example of referred pain is the left shoulder pain which can indicate a heart attack. Does your right shoulder pain seem to come and go according to what you eat? You may have gallstones. Ever have a brain freeze while drinking a smoothie or eating ice cream? This short, but miserable headache is caused by the cold food you are eating cooling the vagus nerve in your throat. You feel the pain where the nerve originates in the brain.

How is it that pain turns up so far away from the structure that is really in trouble? Unfortunately, we don’t have a concrete answer for that. Theories abound to try and explain it, yet there are problems with all of them.

There are some things about referred pain we know to be true. The worse the problem is, the further away or more intensely you will feel the pain. Folks who suffer chronic pain, will have enlarged referred pain areas. Someone who does not have chronic pain may complain of mild posterior thigh pain when they have strained their back moving boxes one weekend. When someone who lives with chronic pain moves the same pile of boxes, they may complain of pain throughout the leg or even in both legs from a similar mild back strain.

While we are talking about leg pain caused by back injury, let’s talk briefly about pain from bulging discs. There are many structures in the back which can cause referred pain to the legs. Stiffness or inflammation of one of the vertebral joints, a sprained ligament, or trigger points in the muscles which lie alongside the spine or in the buttocks can all refer pain to the legs. While it is true that a disc bulge putting direct pressure on the nerve root can cause a predictable pattern of pain felt in the leg, a disc is not always to blame. If you are having leg pain which you suspect is related to your back, be sure you are examined thoroughly before presuming you need surgery.

Referred pain has been widely studied. Your doctor and physical therapist have access to maps describing various patterns of referred pain.

Before you see your doctor or therapist, take time to really think about where you are feeling your pain. Folks with carpal tunnel syndrome often initially say their whole hand falls asleep. When they are asked to really think about where the symptoms are, they realize their pain is only in the thumb and first two fingers rather than the whole hand. If your symptoms truly involve the whole hand, you do not have carpal tunnel. Your accurate description of the pain can help identify the true source of your trouble. 

ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com