PSA: your knee pain might not actually be to do with your knees. Here’s everything you need to know about referred pain.
We tend to treat aches and pains at the source. We rub our sore shoulders and ease ourselves into pigeon pose to combat tight hips. But what if all that massaging and stretching doesn’t work? What if we’re focusing on the area that hurts, rather than the area causing the pain?
“The majority of pain in the body is multifactorial, meaning it’s caused by many different factors,” says osteopath Anisha Joshi. One of those factors is ‘referral’ – the idea that we can feel discomfort in parts of our body that are to do with injury, tightness or weakness in other areas. That means your aching knees, for example, might not be because you have knee problems, but an issue further up the leg.
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Referred pain can be visceral – meaning it stems from organs. An extreme example is the pain felt in your left arm during a heart attack. But it can also be somatic, coming from your muscles, joints and bones. “For instance, if someone is playing football and gets kicked in the knee, they might wake up withlower back pain,” says Joshi.
Referred pain is complicated and there are many theories that not all practitioners agree on, ranging from closely connected signals in the spinal cord to the body’s ability to direct pain from insensitive areas to highly sensitive areas in order to alert you to discomfort.
But when it comes to tissue, the simplest reason is that the whole body works together. Muscles aren’t isolated, but instead work in harmony with each other: when one lengthens, others tend to shorten. Restriction or weakness in one area can lead to other areas overcompensating.
How to spot and treat referred pain
If you have pain, it’s best to visit an osteopath, physiotherapist or another professional who can help you figure out the cause. But if you are curious about whether the pain is referred or local, start by touching the area. Referred pain doesn’t usually get worse with load or pressure, as there’s no underlying injury in that area.
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It also tends to feel like a dull ache that spreads around an area, rather than something that’s easy to pinpoint.
As with all aches, the best way to handle it is by prevention. That means paying attention to the whole body when you exercise, sit and walk. How often do you go on a run and then only stretch out your legs, despite the whole body taking on load? Or twist through your spine after a day at a desk when, really, that pain would ease if you strengthen your glutes?
Common examples of referred pain:
Headaches
Most commonly referred from: tightness and knots in the shoulders and neck.
“When I massage someone’s shoulders, I often find that it can induce the type of headaches people report,” says Joshi. In a2007 study, researchers found that pressing trigger points in the cervical spine (that’s the neck and upper back) induced headaches, showing that it’s these areas that refer pain to your head.
Referred headaches tend to be persistent, rather than one-off, so if you find you’re getting them regularly it could be worth seeing someone who can loosen the muscles in your neck.
Knee pain
Most commonly referred from: hips or lower back.
Your knees are likely to take on whatever is happening further up in the body. Because your knees are powered by nerves that originate in your spine, low back issues can show up in the knees. But the joints are also guided by your hips – they work in unison when you walk, jump, squat, or do any form of movement.
“99%, if not 100%, of my patients with knee problems have biomechanical problems with the hip,” physiotherapist Lyndsay Hirst had previously told Stylist. “What we’ll find is that they have weakness in their glute muscles, and in particular in their gluteus medius muscle. The glute meds job is to externally rotate the femur [thigh bone]. If the glute med is weak, then as you’re running the femur will internally rotate instead, causing an inward twisting of the knee.”
Low back pain
Most commonly referred from: glutes.
Your glutes stabilise and move your legs. You use your legs a lot. If the glutes are too weak, they often end up pulling on surrounding muscles to do the work for them: the quads take over, or the lower back starts to be overused when stepping and running. It isn’t a coincidence that now we spend so long sitting down, weakening the glutes, instances of back pain are on the rise.
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