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Common Referred Pain Patterns – Low Back


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Common Referred Pain Patterns – Low Back

Document by Luc Peeters, MSc.Ost. and Grégoire Lason, MSc.Ost.
Joint principals of the International Academy of Osteopathy (I.A.O.)

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Common Referred Pain Patterns – Low Back

  1. 1. Common Referred Pain Patterns – Low BackLuc Peeters, MSc.Ost. – Grégoire Lason, MSc.Ost.Principals of The International Academy of Osteopathywww.osteopathy.euLumbar somathic dysfunctions can cause referred pain elsewhere: • Pain radiating to the buttock or trochanteric region occurred mostly from the L4 and L5 levels, while groin pain is produced from L2 to L5. • The nerves supplying the facet joints give rise to distal referred pain significantly more commonly than the joints themselves. Let’s not forget that some 40% of the causes for low back pain come from the facet joints. T12 T12 L1 L1 L2 L2 L3 L3 L4 L4 L5 L5 Figure 1 - Pain pattern from T12 – L1 Figure 2 - Pain pattern from L1-2 facet facet, referral to the groin is possible 1
  2. 2. T12 T12 L1 L1 L2 L2 L3 L3 L4 L4 L5 L5 Figure 3 - Pain pattern from L2-3 Figure 4 - Pain pattern from L3-4 facet facet T12 T12 L1 L1 L2 L2 L3 L3 L4 L4 L5 L5 Figure 5 - Pain pattern from L4-5 Figure 6 - Pain pattern from facet L5 –S1 facetThe paravertebral muscles can also refer pain. In the case of paravertebral muscleinvolvement the pain refers lateral of the involved muscles and downwards, evengoing into the leg, posterior or lateral side. Anterior referent patterns on the anteriorcrista and inguinal ligament are reported as well as lots over overlap patterns. 2
  3. 3. Periostal pain in the pelvic region and lower extremity can also come fromlumbar spine dysfunctions: • The upper part of the ilium: from T12 – L4. • The middle part of the ilium: from L2-4. • The lower part of the ilium: from L2-5. • The sacrum and coccyx area: from S1-5. • Femur: from L3-5. • Below the knee: from L4-5. • Foot: from S1-2.Pain arising from the lower intervertebral discs (L4-5 and L5-S1) can give referredpain in the lower extremity, even below the knee.Visceral referred pain also occurs in the lumbar area: • Dysfunctions from kidney, ureter, pelvic organs, intestines can cause referred pain in the lumbar area through segmental irritation T12, L1, L2. • Kidney problems can mechanically irritate parts of the lumbar plexus and cause pain along the iliohypogastric, ilioinguinal, lateral cutaneous and genitofemoral nerves. Figure 7 - Possible nerve irritation through kidney problem such as ptosis 3
  4. 4. Bibliography 1. Carragee E. & Hannibal M. (2004) Diagnostic evaluation of low back pain. Orthopedic Clinics of North America; 35 (1). 2. Donelson R., April C., Medcalf R. & Grant W. (1997) A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and annular competence. Spine 22: 1115-1122. 3. Lippit A. B. (1984) The facet joint and its role in spine pain: management with facet joint injections. Spine 9: 746-750. 4. Wyatt L. H. (2004) Handbook of clinical chiropractic care. Jones and Bartlett Publishers, Inc.; 2nd edition. All rights reserved. © 2012. No part of this article may be reproduced or made public by printing, photocopying, microfilming, or by any means without the prior written permission of the publisher. iNeuro APP iCranialNerves APP 4