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.) More information at www.osteopathy.eu

1. Common Referred Pain Patterns – Low Back
Luc Peeters, MSc.Ost. – Grégoire Lason, MSc.Ost.
Principals of The International Academy of Osteopathy
www.osteopathy.eu
Lumbar 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
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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 facet
The paravertebral muscles can also refer pain. In the case of paravertebral muscle
involvement the pain refers lateral of the involved muscles and downwards, even
going into the leg, posterior or lateral side. Anterior referent patterns on the anterior
crista and inguinal ligament are reported as well as lots over overlap patterns.
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3. Periostal pain in the pelvic region and lower extremity can also come from
lumbar 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 referred
pain 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
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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.
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