Understanding Referred Pain – Lumbar Spine
In today’s post, we will be shifting from the upper to the lower body. The most common area we treat as physiotherapists when it comes to pain in the lower body is the lumbar spine or lower back. A systematic analysis of the Global Burden of Disease Study in 2021 indicated that in 2020, low back pain affected 619 million people globally, with a projection of 843 million prevalent cases of low back pain by the year 2050 (1). However, just like the neck, the lumbar spine can cause pain throughout the lower half of your body, from the hips to the knees, and even down to the feet.
What is the Lumbar Spine?
The lumbar spine consists of the bottom five vertebrae (L1-L5). It plays a crucial role in supporting the body’s weight, providing flexibility, and stabilizing the trunk during movement. Like the cervical spine, this region houses nerve roots, which control movement and sensation in the lower body, including the pelvis, legs, and feet.
Common Lumbar Spine Pain Referral Patterns
As discussed in our last post, we as physiotherapists attempt to treat the root cause of your symptoms. This approach promotes long-term solutions and results, rather than repeatedly treating your symptoms alone. Pain can originate from many sources in your low back, such as muscles, joints, ligaments, discs, or in some cases your nerves. Below are some of the most common low back referral patterns I encounter, and their accompanying symptoms,
Common Lumbar Spine Pain Referral Patterns
| Referral Patterns: | Symptoms: |
| 1. Sciatica (Radiating pain down the leg caused by a nerve) |
– Pain: Typically starts in the lower back or buttocks and radiates down the back of one leg. Pain may intensify when bending, sitting or standing for long periods, or lifting objects. – Numbness or Tingling: May be felt along the outer thigh, calf, or foot. – Weakness: In more severe cases, patients may experience weakness in the leg or foot. |
| 2. Pain Referred to the Buttocks and Thighs |
– Dull, Aching Pain: A general ache in the buttocks, which may feel like a deep muscle strain. – Pain May Radiate: Pain can sometimes extend down the thigh, often stopping before the knee. – Worsened with Activity: Pain is often aggravated by activities like walking, standing or sitting for long periods, or climbing stairs. |
| 3. Foot and Ankle Pain |
– Pain in the Foot: This can present as sharp, dull, or burning pain, often affecting the top of the foot, heel, or the outer side of the foot. – Numbness or Tingling: Patients may feel a “pins and needles” sensation in the foot, or a loss of sensation. – Weakness: The affected leg may experience weakness, particularly when attempting to walk on the toes or heels. |
Table 1. Adapted information collected and referenced 2,3,4.
It is worth mentioning that the symptoms listed above are not an exhaustive list of all the referral patterns from the lumbar spine. As discussed in our previous blogs, your pain or symptoms can potentially originate from somewhere else in your body. If you fall into one of the above categories, see one of the physiotherapists at Kamloops Physiotherapy & Sports Injury Centre who can appropriately identify the root cause of your issues and help you begin your journey to recovery. This blog post was written by physiotherapist Jacob Coelho. To book an appointment with Jacob or one of our other experienced therapists, call 250-314-0788 or book online HERE.
References:
- GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 May 22;5(6):e316-e329. doi: 10.1016/S2665-9913(23)00098-X. PMID: 37273833; PMCID: PMC10234592.
- Gray, H., & Standring, S. (Eds.). (2020). Gray’s anatomy: The anatomical basis of clinical practice (42nd ed.). Elsevier.
- Deyo, R. A., & Weinstein, J. N. (2001). Low back pain. The New England Journal of Medicine, 344(5), 363-370. https://doi.org/10.1056/NEJM200102013440507
- Physiopedia. (n.d.). Lumbar spine referral patterns. Retrieved January 21, 2025, from https://www.physio-pedia.com/Lumbar_Spine_Referral_Patterns
Understanding Referred Pain – Lumbar Spine
In today’s post, we will be shifting from the upper to the lower body. The most common area we treat as physiotherapists when it comes to pain in the lower body is the lumbar spine or lower back. A systematic analysis of the Global Burden of Disease Study in 2021 indicated that in 2020, low back pain affected 619 million people globally, with a projection of 843 million prevalent cases of low back pain by the year 2050 (1). However, just like the neck, the lumbar spine can cause pain throughout the lower half of your body, from the hips to the knees, and even down to the feet.
What is the Lumbar Spine?
The lumbar spine consists of the bottom five vertebrae (L1-L5). It plays a crucial role in supporting the body’s weight, providing flexibility, and stabilizing the trunk during movement. Like the cervical spine, this region houses nerve roots, which control movement and sensation in the lower body, including the pelvis, legs, and feet.
Common Lumbar Spine Pain Referral Patterns
As discussed in our last post, we as physiotherapists attempt to treat the root cause of your symptoms. This approach promotes long-term solutions and results, rather than repeatedly treating your symptoms alone. Pain can originate from many sources in your low back, such as muscles, joints, ligaments, discs, or in some cases your nerves. Below are some of the most common low back referral patterns I encounter, and their accompanying symptoms,
Common Lumbar Spine Pain Referral Patterns
| Referral Patterns: | Symptoms: |
| 1. Sciatica (Radiating pain down the leg caused by a nerve) |
– Pain: Typically starts in the lower back or buttocks and radiates down the back of one leg. Pain may intensify when bending, sitting or standing for long periods, or lifting objects. – Numbness or Tingling: May be felt along the outer thigh, calf, or foot. – Weakness: In more severe cases, patients may experience weakness in the leg or foot. |
| 2. Pain Referred to the Buttocks and Thighs |
– Dull, Aching Pain: A general ache in the buttocks, which may feel like a deep muscle strain. – Pain May Radiate: Pain can sometimes extend down the thigh, often stopping before the knee. – Worsened with Activity: Pain is often aggravated by activities like walking, standing or sitting for long periods, or climbing stairs. |
| 3. Foot and Ankle Pain |
– Pain in the Foot: This can present as sharp, dull, or burning pain, often affecting the top of the foot, heel, or the outer side of the foot. – Numbness or Tingling: Patients may feel a “pins and needles” sensation in the foot, or a loss of sensation. – Weakness: The affected leg may experience weakness, particularly when attempting to walk on the toes or heels. |
Table 1. Adapted information collected and referenced 2,3,4.
It is worth mentioning that the symptoms listed above are not an exhaustive list of all the referral patterns from the lumbar spine. As discussed in our previous blogs, your pain or symptoms can potentially originate from somewhere else in your body. If you fall into one of the above categories, see one of the physiotherapists at Kamloops Physiotherapy & Sports Injury Centre who can appropriately identify the root cause of your issues and help you begin your journey to recovery. This blog post was written by physiotherapist Jacob Coelho. To book an appointment with Jacob or one of our other experienced therapists, call 250-314-0788 or book online HERE.
References:
- GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 May 22;5(6):e316-e329. doi: 10.1016/S2665-9913(23)00098-X. PMID: 37273833; PMCID: PMC10234592.
- Gray, H., & Standring, S. (Eds.). (2020). Gray’s anatomy: The anatomical basis of clinical practice (42nd ed.). Elsevier.
- Deyo, R. A., & Weinstein, J. N. (2001). Low back pain. The New England Journal of Medicine, 344(5), 363-370. https://doi.org/10.1056/NEJM200102013440507
- Physiopedia. (n.d.). Lumbar spine referral patterns. Retrieved January 21, 2025, from https://www.physio-pedia.com/Lumbar_Spine_Referral_Patterns