S2 E10: S2 Ep 10 – It Hurts Here… But the Problem’s There! Understanding Referred Pain

Hello and welcome to the Pain Free Living Podcast with me, your host, Bob Allen.

This is a solo episode, and in this one we're going to talk about something called referred pain, which you may not have heard of, but I'm sure once I start talking about it, you'll relate to it and then understand what it is and why it can be really important.

From a physical therapist point of view, what is referred pain?

I hear you say?

Well, referred pain is where you feel pain in one area, but it actually originates from a different area.

A good example and something that you may be able to relate to is something like a heart attack, for example.

So a heart attack feel a pain in the chest.

Absolutely.

But people can also feel pain in their left arm or down to the fingers.

It can get pain in the shoulder.

They can get pain in the neck.

They can also potentially get pain in the left side of the jaw, all from a problem that starts from the heart.

Now, the explanation for how that works is that there is only certain number of segments in your spine and that can share nerves coming from different body parts.

For the heart, for example, it also shares the same space, same nerves, as the ones that go into the arm, neck, shoulder, jaw.

Why is this important?

This is important because if.

When you go to see a therapist, if they only treat where the pain is, they could be missing a trick.

Sometimes they will treat where the pain is, and the knee is a really good example for that one.

So sometimes if you treat.

So if somebody's having knee pain and you treat the knee, that can sometimes get rid of the pain.

The thing about the knee joint is that it's basically a hinge joint.

It bends and it straightens.

It doesn't do a lot else.

So unless you've had a traumatic injury to the knee, the knee is probably not the cause of the problem.

A good example of that is somebody that I saw quite recently who had a knee injury 20 years ago.

They identified the cause of the problem, had an operation to repair the knee, not particularly successful.

So then spent another four years of having various procedures done to that knee, and it didn't seem to get any better.

So fast forward 15 years, still getting intermittent knee pain, came to see me, and I examined the knee and treated the knee.

But when you go and see a physical therapist, one of the things that we do is we'll take what we call a detailed case history.

That means we look at not just the pain that you came in with, we'll also look at your past medical history.

Have you broken any bones have you been involved in a road traffic accident?

Have you had any operations?

Because all of these can have a bearing on the pain that you're currently experiencing.

And in this person's case, apart from the knee injury, the rest of the case was fairly non specific.

Nothing major had happened.

So what we then do is we then do a full physical examination.

So I'll get them to move, I'll say, okay, I'll get you to bend forward, back.

I'll assess the knee.

But then I'll also assess particularly for knee, knee joints, like I said, they're generally pretty stable.

So if people are getting knee pain, it's also always worth assessing the ankle and the hip, low back potentially, and see if anything highlighted there.

So what I found with this particular person was that although the knee, yes, source of pain, I actually found that they also had a problem on the opposite hip.

So that the movement in the opposite hip was restricted.

And when I started prodding and poking around a little bit, yes, it was a bit sensitive as well.

So as well as treating the knee, I treated the hip and both knee joints, just general treatment.

And actually that resolved the problem within two treatments.

So the key message from this one is that although you may be feeling pain in one area, whoever you're seeing, they should also do a full check on everything else as well.

Because pain is not just restricted to one area.

The body compensates.

And in this case, I'm speculating a little bit, but what probably happened was long standing problem with the knee meant that they were shifting.

What we naturally do is if something hurts, we shift our body weight or movement to the corresponding limb on the other side.

So if you've got left knee pain, you're going to be putting more weight through the right side.

If you're putting more weight through the right side, then that's putting a little bit more tension on that right side and that can potentially cause problems.

So in this case, that's exactly what happened.

Issues with the left side put more weight through the right side and then for whatever reason, the hip started playing up.

Now, if I just treated the site of the pain, I may well get rid of the pain for a little while.

But because the main issue was the hip, the pain's likely to come back.

And I have seen people where they have had treatment on one side.

They say, yeah, it gets better for a little while, but then the pain keeps coming back again.

That's because they haven't addressed what actually causing the problem.

So if you see a therapist and they're treating, always treat where the pain is because that's just good practice.

But also examine what else may be involved and if necessary, treat that as well and then they won't come back.

Not a great business model because it's always more beneficial and more profitable for the person to keep coming back, but actually very unethical.

So, yeah, I don't do it.

Where you feel the pain is not necessarily where the problem is.

Now, where it gets a bit more complicated.

If it's pain that's been there for a while, I was lucky that it was just the hip, but sometimes it's the hip.

It's also the opposite knee, potentially the low back as well.

So, yeah, key point where you feel the pain is not necessarily where the problem is, especially if it's a pain that's been there for a little while.

So I hope you found that useful.

If you've got any questions, drop them in the comments below.

And yeah, please tell your friends and family that this is a great podcast.

Okay, catch you at the next one.