Tuesday, 3 April 2012

Referred Pain

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Many of you will have heard of referred pain, especially those who have seen a physiotherapist or their GP about back or neck pain, but what do we mean by "referred pain"? Is it pain that someone else has recommended to me? Pain which is passed on to somewhere else?

Thankfully, not the former. The latter is pretty close.

Referred pain is pain which is felt in a location other than the actual area of injury. So for example, people with sciatica most likely have pinched nerve roots in their lower backs but frequently feel horrible hot or shooting pains in their buttocks and thighs. Sometimes right down into their feet. It's not the thigh, or the foot that is injured, but the nerve itself, which then sends on these "pain" messages along its length (how very kind of it).

Nerves are like the electric wires of our body, and they connect our brain and spinal cord (our central nervous system) to the rest of our body. For instance if you want to wave to Jean over there, your brain will "tell" your hand to move by passing an electric signal down the spinal cord to the shoulder, arm and hand which will then activate your muscles to move.

Similarly, when you touch something cold or hot, or when you hold something solid or soft, your nerves pick up that message and send it up to your brain to interpret the sensation

We covered a fair bit of anatomy in the last post (scroll down to The Demon Back Pain for more information...) so we have a better idea of how the nerves leave the spinal column in neat spaces between the vertebrae. If the spaces become narrow, the nerves are pinched or "impinged". Likewise, the impingement can happen if you have extra tension along the nerve pathway (you see, nerves don't just travel on a path between things to get to their destination, they weave in and out, they branch off and they reach almost every structure in your body).

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As soon as the nerve picks up this impingement, the messages which it sends to the brain become confused. Instead of a perceiving a pinching at the neck or in the lower back, the electric signals are passed outwards from the spinal column (so into your shoulder or arm, or into your thigh or calf) where they can be misinterpreted as pain, or tingling or even numbness. If the messages being carried back down the nerve to power the muscles are confused, sometimes the problem becomes a weakness in those muscles.

A physiotherapist will determine where the referred pain is coming from as he/she will know which nerves come out from the spinal column in each space and which structures they supply.

Once this has been determined (by testing your sensation and the power of specific muscles) we can use manual therapy to help alleviate the pain, and give you exercises to help widen the spaces and help resolve the impingment. Happy days all round!

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