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The Case of the Mysterious Pain

Identifying referred pain and what can be done for it

Author: Dr. Britt Dalton, PT, DPT, OCS, COMT, FAAOMPT

In honor of the Halloween season, we are talking this month about a mysterious type of pain, what’s called “referred pain”. Referred pain is when one structure of the body is causing you to feel pain in another part of the body. While our organs, such as our heart and kidneys, can be sources of referred pain, for the sake of keeping things concise, we will speak directly of referred pain that comes from muscles and joints, how to recognize it, and what can be done for it.

Referred pain from muscles is often felt as a dull, aching type of pain. It is often provoked with activity and may be found to intensify the more the activity is done. It may gradually expand away from the origin to encompass a large area. Often, in the case of muscles, pressing into the painful muscle may cause you to feel pain in another area of the body. For instance, pain referred from one of your gluteal (buttocks) muscles can be felt down your entire leg to your ankle. Pain referred from the rotator cuff (shoulder) muscles can be felt down the arm to the wrist.

Similarly, joints can refer pain. The joint where our pelvis and spine connect, known as our sacroiliac joint, can cause pain into the groin and/or down the back of the leg to the knee. Likewise, joints in your neck can cause pain into your mid back or shoulder blade area.

The cause of referred pain is not 100% clear but is thought to be a problem of repeated stress to one structure (i.e., a muscle repeatedly getting strained) causing the nerve attached to it to get overly excited. Too much activity in the nerves may start to confuse our brain, and therefore it starts to become uncertain as to where the problem is coming from. Other areas of the body that share a similar nerve origin as the problem muscle or joint will start to become more sensitive as a result, and therefore pain may be felt in those shared areas.

So, what can be done about this? Well, to start, we need to try and identify what the source of the pain is. We know the patterns to how this pain arises and is felt, and research has provided us with knowledge of where particular muscles and joints tend to refer pain to. Once we identify the origin of the pain, then there are multiple options used to address it. Identifying activities or factors that may contribute to excessive stress on the involved muscle or joint is a must. Dry needling, joint mobilization/manipulation, and soft tissue mobilization are all tools to help diminish the pain. Developing an exercise program to help build support around the irritable joint or to build strength and endurance in the painful muscle is often required as well.

There is not a one-size-fits-all approach, and resolving the source of the referred pain can take some time, but with the right program the case of the “mysterious”, or referred pain, can be closed!