Monday, August 27, 2007

(Post # 14) Referred Pain

What is referred pain?

Pain that is felt in an area other than the lesion.

Why is this important?

A patient is treated for thigh pain, and receives treatment for the quadriceps muscle. The reason? Pain is felt there. After endless treatments of stretching, strengthening, ultrasound, electric stimulation, etc,...etc...etc..., she gets to the right clinician who performs a functional assessment. It becomes clear that resisted knee extension (which is one of the test that test the quadriceps' contractile ability) shows negative proving that the function of the quadriceps muscle is not disturbed. Further examination, this time of the lumbar spine, shows that the patient is not able to perform lumbar extension (backward bending) without pain, and that repeated lumbar flexion (forth ward bending) increases the pain, which is referred into the thigh (L-2 dermatome). We can conclude, that the lesion lies in the lumbar spine, most likely nerve root L-2, and not in the quadriceps muscle.
Although this is just one piece of the puzzle, we can now create a plan to figure out the best treatment approach for the lower back and for the entire kinetic chain. Here is a list of some but not all of the treatment option we can explore:

  1. Trunk stability exercises.
  2. Nerve mobilisation exercises (nerve flossing).
  3. Walking 20-30 minutes.
  4. Sitting habits (finding a new neutral zone for the spine every 20-30 minutes).
  5. Lifting habits (training the legs by doing squats).

And remember to listen to the body by asking: are you better? worse? or no change?

Thank you David for your comment.

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