One reason your osteopath takes such a detailed case history is that sometimes, things are not what they seem. Referred pain is an example of this- where the pain is felt in one place, but the problem is somewhere else.

What is Referred Pain?

Pain is complicated, and there’s a lot we still don’t understand about how it works. When pain is referred, it is felt somewhere other than where it should be. But the distribution isn’t random, it follows patterns that are generally consistent across the board. These patterns are not just limited to pain originating from muscles and joints. Internal organs can refer pain too, and these distributions are well documented. Lung and diaphragm issues can cause pain over the shoulders and neck, which could easily be mistaken for simple muscular tension. Kidney pain might only be felt as lower back pain. Detailed screening is therefore key to ensure we don’t miss something serious.

What Causes It?

Exactly why some problems lead to referred, rather than local pain is unclear. But when it does happen, it isn’t a problem with wiring as such, but the brain making an educated guess that just isn’t right this time.

Let’s use the lower back as an example. When a pain signal is sent to the brain, the brain knows roughly where it came from. If it’s the joint at the back of the pelvis, the signal reaches the brain with a tag saying “from S1”- the nerve responsible for that joint. But for some reason, the brain picks another area within S1’s territory to feel the pain. As a result, the pain may be absent in the pelvis joint, but felt in the back of the leg instead.

Is Sciatica Referred Pain?

Not quite. Sciatica is a “trapped nerve”, whereas referred pain is a mistake in the way the brain interprets a signal. There are some similarities: both sciatica and the joint mentioned above cause pain in the back of the leg. But with sciatica, pain is likely in a defined line, and may be shooting in character. Referred pain may inhabit the same space, but in more of a splodge shape than a line. The pain itself is likely to be more of an ache than a shooting pain. But both would be irritated by provoking the problematic area- the irritated nerve for sciatica or the joint for the referred pain. Testing this is key for getting the diagnosis right.

How Can Osteopathy Help?

As mentioned above, the history and examination will do most of the work when it comes to diagnosing referred pain. Once we have the diagnosis, we can treat as normal. Techniques like massage and mobilisation might be appropriate, and exercises to help you improve between sessions may be prescribed too.

To summarise, almost any ache or pain could be referred, and once the root cause is identified we can treat it much the same as we normally would.

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