What is referred Pain?

Referred pain is a topic that comes up a lot in my conversations with patients regardless if the person is rehabbing a sports injury or recovering from a neck strain. Referred pain is tricky to understand because it doesn’t make sense. For example, when someone has pain in the upper back area, it would make sense for the pain to be from the muscles in that area, namely the trapezius or the rhomboid. However, it is extremely rare that there is something wrong with the trapezius muscle or the rhomboid. In fact, rarely is the pain from the thoracic spine or rib structures, unless there is a true muscle strain. So where does the pain come from? The answer comes from understanding referred pain.

Referred pain is pain or pain-like (numbness, tingling, burning, etc) sensations that are felt in areas other than that which is causing the symptom. Usually the sensations are felt in an extremity or away from the pathology (i.e. degenerative changes). Referred pain can be synonymous with a term know as Somatic Dysfunction, the difference being that referred pain only indicates the sensory component of the term. Sensations can be felt as numbness, tingling, itching, warmth, or burning. If the underlying pathology continues to progress, then motor changes such as weakness, coordination, muscular endurance, and soft-tissue changes in muscle tissue, neural tissue and even the joints can occur. These changes can even manifest as areas of tenderness, often called trigger points.

In the above diagram Cloward in 1959 was able to begin the discussion on referred pain from the intervertebral disc. Here you can see the cervical discs, which are in the neck, can refer pain into the upper back. The only way this is explained is through the idea of referred pain.

For physical therapists, knowing the true origin of the pain helps us treat referred pain. Moreover, doing a thorough evaluation of a patient requires looking at the patient from a holistic perspective.   Thus a physical therapist evaluates a client from a biomechanical, neurological, and movement dysfunction approach to determine the true underlying problem or dysfunction. Also, having a physical therapist that is well versed in common and even more rare referred pain patterns of the musculoskeletal and even some visceral organs (in case the problem may be more serious) can help determine the source of your pain and ultimately lead to a faster recover.