Have you ever had pain in your shoulder, hip, or leg and wondered why it hurts there but if you try to treat that area, it doesn’t seem to help? The problem might actually be somewhere else. This is a common conversation we have in the clinic at Inspired Physiotherapy!
Sometimes pain comes directly from a structure in the area where you feel it, such as having a strain in your quadricep muscle. Other times, the pain you experience is related to another area of the body. This is where understanding the difference between referred pain and radiating pain can be helpful.
What Is Radiating Pain?
Radiating pain occurs when pain travels from the spine, along a nerve pathway, to another part of the body. This can happen when a nerve is irritated, compressed, or otherwise affected. Depending on the location and cause, symptoms may travel from the neck into the arm or from the lower back into the buttock and leg.
Patients often describe nerve-related pain as sharp, shooting, burning, or feeling like an electric shock. It may also be accompanied by tingling or changes in sensation.
Two terms that are important to understand are radicular pain and radiculopathy. Although they are related, they are not the same thing.
Radicular pain occurs when a nerve root is irritated, causing pain that travels along the nerve's pathway. This pain will follow a specific pattern, called a dermatome, which describes the area of skin supplied by a particular nerve root. Radicular pain can occur without measurable muscle weakness, sensory loss, or changes in reflexes.
Radiculopathy occurs when a nerve root is affected enough to cause changes in nerve function. These changes may include:
- Myotomal weakness: Weakness in muscles supplied by the affected nerve root.
- Dermatomal sensory changes: Reduced or altered sensation in an area of skin supplied by that nerve root.
- Reflex changes: Reduced or absent reflexes associated with the affected nerve root.
A person may have one or more of these findings, depending on the severity and location of the nerve involvement.
For example, someone may come into physical therapy complaining of pain traveling down the back of their leg. While it may seem like a hamstring or knee problem, the symptoms could be related to irritation of a nerve root in the lower back.
Numbness and tingling are not the same thing. Tingling is an unusual sensation, often described as pins and needles. Numbness refers to reduced or absent sensation in an area. Both can occur with nerve-related conditions, but understanding the difference is helpful for diagnosis and treatment.
What Is Referred Pain?
Referred pain is pain that is felt in an area different from where the problem originates. Unlike radicular pain, referred pain does not necessarily follow the pathway of a nerve. It can occur when the brain has difficulty pinpointing the exact source of signals coming from deeper tissues, such as muscles, joints, or internal organs.
Referred pain is often described as a diffuse, dull ache, soreness, pressure, or throbbing. It may feel more spread out, making it difficult to identify one specific spot.
For example, irritation in the infraspinatus muscle (rotator cuff muscle) can cause symptoms in the same upper extremity all the way to the hand. Therefore, sometimes we have to treat the shoulder, to make the hand feel better.
An important thing to remember is that pain location does not always tell us where the problem is coming from. That is where our training as physical therapists, helps us to peel back the layers of your symptoms to find the root cause so we can treat it appropriately.
