Referred Pain


Q:If it’s my back that’s out, why does my leg hurt instead? A: Referred pain
Referred pain comes in 2 main types (3 really. The third being trigger points, a muscle based problem-but that’s a different story for a different day): Sclerotomal and Deramatomal. No, I didn’t just make those up, and hopefully they’re not as boring to you as they may sound. The difference between the 2 is very important in the diagnosis and treatment of pain generating conditions. They also explain the often counter-intuitive: if it’s my back, why does my leg hurt?

Dermatomal is relatively easy. It’s neurogenic pain, i.e pinched nerve. Just like when you kink the hose. It affects the water coming out the end, not where you’re holding it. When you herniate a disc in your spine, the disc innards push out and kink your nerve. That’s why you get burning, numbness and or tingling in your legs when it is in fact your back-All in a very predictive pattern based on which nerve/where is pinched.

Sclerotomal, on the other hand, is not nerve based pain. It’s based on the fact that we were all once worms. As we’re cooking in momma’s oven; we transform from a long, worm-like tube into the handsome devils we are at birth. During this metamorphosis, our tissues twist, turn and intertwine. It puts our backs and upper leg on the same plane; and the same for shoulders and neck. So when something goes wrong in your back, you may not feel it in your back; but in your buttocks and leg and even knee instead.

Hold on, I need some B vitamins, I just put myself to sleep. There, better. Point is pain is not a disease, but a side effect, or sign. Just like the check engine light in the car-doesn’t mean broken light bulb that we should drive around and ignore or cover up with a piece of tape. That leads to a $600 tow charge out of the Harbor Tunnel, so I’ve heard. Just like a problem with the engine makes the light come on; a problem in your back will make your rear-end, thigh, leg, knee, foot and or ankle hurt. Same goes for you neck and shoulder, arm, hand, fingers. And just like covering up the light prolongs and worsens the inevitable; so does covering up the pain with aspirin, oxy and/or Jack Daniels.



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