Learn about Referred Pain: Feeling What, Where, and How

People everywhere experience pain. Whether it is physical, a sensation, chronic, or from an injury – at some point in most lives’ people experience some sort of pain. Many times, chronic pain comes about in an inconclusive manner which makes it difficult for the person experiencing it to understand what started the pain, and where it is coming from. The brain and the sensation of pain are a tricky partnership, which makes treating pain and determining how to heal it much more difficult.

Let’s say you experience chronic back pain. Maybe it’s when you walk, or when you sit, or when you’re standing up. Your back hurts, so you are assuming that the problem must be coming from your back.This is a common case of misplaced pain generators and many are not aware that your back pain might not be the true source of your pain and that it could be coming from another region of your body. This is very common with the hip joint; One of the most interesting aspects of pain is that the true cause of pain can actually refer to the sensation of pain to other body regions. This is called Referred Pain.

Because the low back and hip are in the relatively same anatomical regions, it is important for your doctor to not only evaluate your low back but also your hip region in the physical examination. Oftentimes patients come to the office with a history of low back pain and no relief after multiple injections in the low back region. This is because the true source of pain was not the low back region. It’s VERY important for your physician to spend time identifying the source of the pain through the physical examination. Many times, we uncover the hip being the true source of your pain and treatment directed towards the hip thereby alleviates the referred low back pain.

Usually, hip pain comes from degenerative changes over time. This is also consistent with the cause of low back pain as well. Degenerative changes occur with time/age and can occur as a result of overuse.

Signs that your hip is the cause of your referred pain areas

Groin pain can be a common indication that your pain is coming from your hip. Because the hip joint actually sits behind the groin this is in the closest proximity and makes the most sense. Individuals with hip pain often experience worsening symptoms and prolonged periods of a static position like sitting or lying in bed at night. In addition to low back and groin pain, the patient will also complain of pain in the buttock, front of thigh and the knee even when the true source is the hip. 

These are also common referred pain patterns. Patients may also limp when they walk and the pain may worsen with more activity and actually improve with rest at times. These are the changes most consistent with degenerative osteoarthritis.

While osteoarthritis is the most common cause of hip pain, there are other issues that can cause hip pain like sacroiliac joint issues, piriformis syndrome, avascular necrosis of the hip (lack of blood supply to the hip joint) and impingement syndrome of the hip.

Identifying the true cause of your pain

A thorough physical exam is imperative in identifying either hip, low back or other causes of your pain. There are very specific physical exam maneuvers of the hip that can be performed in various ways to identify subtle issues within the hip. For instance, certain physical examination rotations of your hip can indicate and identify arthritis from impingement syndrome.

Imaging is also oftentimes involved in identifying your pain. For the hip itself, typically x-rays are evaluated first and sometimes an MRI will be performed to look further at some of the more detail of the soft tissues and cartilage structures within the hip itself.

At the Pennsylvania Pain & Spine Institute the practice is actually able to perform a diagnostic and therapeutic hip injection under x-ray machine to not only visually identify the cause of your pain but to alleviate it as well.  Through injections, a medication can be precisely injected under the x-ray visualization. The outcome of this injection tells us further details about the source of your pain. After the injection, there can be immediate relief of not only the hip issue source but the referred back pain as well.

Identifying the source of your pain and planning for relief

Once your doctor has identified your hip as the source of your pain, there are many treatment options available to you. This can simply include exercises and/or physical therapy which help restructure imbalances around the hip. Sometimes, oral anti-inflammatory medications targeted towards arthritis can be the key to relief. Injection therapies utilizing multiple different medication options and novel therapies like platelet rich plasma (PRP) therapy can be utilized.

Now you know, for those of you who suffer with acute or chronic low back pain, it is imperative that you and your provider carefully evaluate your symptoms and consider your hips as the source of your pain. 

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Learn More about Referred Pain by visiting the article here.

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