What is the Difference Between Referred Pain and Radiating Pain?

You might be wondering what it means when you hear “your pain is radiating from” XYZ, or ” it sounds like referred pain.” Radiating pain is a type of pain that starts in one area of the body and then travels down the path of the nerve to another location; sciatica, stenosis are great examples of it. Referred pain is usually contained to a general area, usually an area close to the source of the pain and typically not from a nerve issue. A great example, of a condition that can cause this type of pain is trigger points, or more commonly known as “knots” in the muscle. Now with that said, you can have conditions like Whiplash that can cause both radiation and referred pain depending on the extent of the injury!! Don’t you hate it when there is not a straight answer to your question?!! A fun example I always give for referred pain to make it clear to my patients is the gallbladder. Did you know that gallbladder pain can cause pain in the right shoulder? So if a patient comes into my office complaining of right shoulder pain without any history of trauma to that shoulder, I have to rule out gallbladder issue before I decide referred pain! Now to make it more complex, imagine someone with trauma to the right shoulder who happens to also have issues with the gallbladder as well!! Sheesh, so important to make sure you see a doctor who knows what she is doing!!!

There are many types of treatments that I can use in my office with regards to pain management that can help you feel better, give you pain relief, and increase the quality of your life. 

How Did I Get Radiating Pain?

There is a myriad of reasons that can result in you ending up with radiating pain. In this blog, I will be discussing a few of those. 

• Spinal Stenosis which is a condition the whole that the nerve(s) exit the vertebra or even the actual canal the spinal cord runs through is too narrow and puts pressure on the nerve(s) or cord. Sometimes, the symptoms of this spinal stenosis are: sharp shooting pain that travels down along the nerves and sometimes numbness and tingling. For example, the pain can start in your low back and travel down to your toes. You are not necessarily born with this problem and it can be developed as a long- term degeneration of the spine due to weak and failed posture. In this example, the pain is a radiating pain.
• Whiplash which is a painful neck condition that occurs because of a forceful and very fast back and forth movement of the neck is a great example of ‘it depends’ type of answer. If it is bad enough and impacts the body a specific pain, it can cause radiating pain. This is common in rear end, auto accidents and contact sports. The symptoms of this condition are: neck pain, stiffness, headaches and sometimes pain that travels down to the hands. While whiplash is typically referred to the pain, it can affect the lower back also and cause pain radiating down the leg(s).
• Sciatica is a condition impacting the specific sacral nerve. The symptoms of sciatica are very similar to those of piriformis syndrome, which are sharp, shooting pain that starts at the low back, travels to behind the thigh, and then down to the toes. Piriformis syndrome, however, is a great example of referred pain!! How do I tell if it is piriformis vs sciatica? Watch this video to see.

How do I Fix My Radiating Pain?

The best way to treat radiating pain is to treat the underlying condition or the cause of the pain. When the body is in pain, it is not ready to be rehabilitated. This means that passive care modalities such as electrical muscle stimulation, ultrasound and cold laser are used when pain is present. It is essential to move the body as fast as possible so the whole goal is to get rid of pain so you can start moving around. Vitamin C and increase intake of protein are important for all soft tissue healing so it is a good time to increase the intake of those. I also recommend TENS unit as an electronic painkiller which can be purchased from Amazon and come in a variety of styles. This is an example of what I recommend to my patient.

Once pain is lessened, the number one thing I go to is pelvic floor breathing and strengthening which you can find on my YouTube channel under the playlist ‘Posture”.

Addressing the cause of pain for these types of problems always involves activating the brain to strengthen the parts that are weak due to the lifestyle that led to their weakness. Through Brain-based Neurology and Postural exam, these areas are identified and then just like any exercise that strengthens the body part, the weaker part of the brain, when it comes to posture, is strengthened. This is where I consider the healthcare approach fails! By activating the Brain with regards to posture, your posture is improved and unless there are no irreversible structural changes present, the problem will stay clear. These exercises are so easy to do that you can do them at home and like every exercise, they should be done regularly. Here is an example of what this Martial Arts athlete (2nd degree Black Belt) had to do to restore her posture and balance.

How do I Fix My Referring Pain?

As with radiating pain, to treat referring pain, the underlying cause of this pain must be treated first. There are many causes to referred pain such as visceral pain (the gallbladder example I gave you already), but in this blog, I will be focusing on trigger points and how they cause pain in a general contained area of the body. Trigger points are basically small knots that can exist along the muscle. A small segment of the muscle fiber becomes hyperactive and contracts. It is essentially Lactic Acid build up which is a result of too much carbon dioxide and not enough oxygen. Trigger points can happen because you work out and your oxygen consumption goes up or your muscles are tight because let’s say you are staring at the monitor too much with your elbow on the table while using the mouse. In this situation, the muscles of neck and arm/shoulder blades are overused and need more oxygen. Bottom line is the muscles tense up and cause major issues one of which is referring pain. A commonly seen trigger point is along the trapezius muscle (across your shoulder blade and top of the body area). Trigger points there cause pain in the back of the head, neck, and upper back. Patients will often describe the pain as, “dull, and aching.” This pain can result in headaches, low back pain, neck pain and sometimes even pain in the arms or legs. Many times, patients are convinced they have nerve impingement which is rather loosely used!! Not to digress in this blog, I refer you to this blog I wrote on the very subject of a pinched nerve in case you want to learn more about that.

How Do I Fix My Referring Pain?

When it comes to treating trigger points, one of the best treatments is Active Release Technique or ART. ART is a functional Rehab. modality to address the source of tension and increased muscle tone in the involved muscle and goes deep in the muscle. Massage therapists are experts at releasing the knots and reducing your pain on a more surfaced area compared to ART methods. There are many different types of massage all of which with unique goals and effectiveness. In my clinic, my massage therapists are a part of the support team and, therefore, play their role in achieving the health goal of the patient. They report back their findings that I use those findings to plan the treatment going forward. Once again, Brain-based Neurology and Postural exercises identified from the exam are used to address the postural weakness and failure, and to optimize proper, even balance. Don’t build a structure over an unstable foundation!!

How can I Prevent Referring or Radiating Pain?

There is a multitude of ways you can go about to prevent referring or radiating pain symptoms.

1. Pay attention to your routines. That is where we fail the most! Read this eBook to see how.
2. Proper Exercise! Movement is life, and our bodies are built for it.
3. Make sure to always stretch before and after a workout; this will decrease muscle pain and tightness! 
4. Listen to your body; if you are anxious or stressed, try to give yourself a few minutes to decompress and relax! To help you with such a challenge, I recommend yoga and meditation! A side note, don’t try to get the modernized version of Yoga. Do the real Yoga!!
5. Increase your water intake to reduce the Lactic Acid build up; this will decrease the likelihood of you experiencing muscle soreness the next day
6. Work on making sure you have proper posture! It is not as difficult as you think. Watch this less than 2-minute video to see how this simple move can help you get there. When your posture is off, even staying still is extra work for the muscles and extra work means extra oxygen which you are not even thinking about. When was the last time you thought about your breathing?!! 
7. Pelvic floor and DNS (Dynamic Neuromuscular Stabilization) exercises are so important in keeping your posture strong and thankfully something that every single patient in my practice gets exposed to.

Finally, remember, you do not have to live in pain! You are the Designer and Director of your own life so design and direct it the way you wish to live it!

Dr. Shakib