Referred and radiating pain: symptoms, causes, and how to get relief

Referred and radiating pain can be confusing and frustrating. It's when you feel pain in a part of your body that’s not the actual source of the problem. You might have pain in an area far from the actual source of the pain, or pain that begins in one area and spreads out to another location. Referred and radiating pain can make simple tasks, like walking or sitting, more challenging.

Here, learn more about what causes referred and radiating pain and how to treat it with physical therapy, home remedies, and other tips from our Hinge Health physical therapists.

Referred vs. radiating pain

Both types involve pain that begins in a particular location, but is felt elsewhere. Referred and radiating pain might seem similar, but they are actually very different, happen for different reasons, and may benefit from different treatments.

What is referred pain?

Referred pain occurs when you feel pain in one area, but the actual issue is elsewhere. Symptoms often include dull, aching pain and pressure that’s hard to pinpoint. Common referred pain examples:

• Heart pain (angina) that’s felt as pain in your left arm, jaw, or shoulder.

• Gallbladder pain can be felt in your right shoulder.

• Kidney stones may cause pain in your lower back or groin

Referred pain can be a sign of serious conditions that need immediate medical attention. If you have unexplained pain, numbness, or weakness in areas like your chest, back, neck, or arms, see a doctor right away

Referred pain can be due to a variety of conditions and factors, including:

• Organ conditions, such as heart disease, gallbladder issues, and kidney stones.

• Musculoskeletal issues, such as muscle strain, joint problems, and disc changes.

• Nerve compression or irritation, including conditions like sciatica or carpal tunnel syndrome.

• Infections, tumors, and other conditions.

The causes of referred pain are not yet clear, but it may be due to shared nerve pathways. When nerves that supply different tissues come together, or converge, in your spinal cord or brain, your nervous system can mistake the location of the pain. Referred pain might also be due to overly sensitive nerve cells in your spinal cord. 

What is radiating pain?

Radiating pain, on the other hand, is a type of pain that begins in one particular area and then travels or spreads outward to other areas along a nerve path. Sciatica is a common example. It often involves pain that starts in the lower back or buttocks and radiates down the leg along the sciatic nerve. Symptoms can include: 

• Pain that starts in one area and radiates along the path of a nerve.

• Diminished or altered sensation.

• Tingling or pins-and-needles sensation.

• Burning, itching, or sensations of heat or cold.

• Limited mobility due to pain.

Nerves in your body can be affected by surrounding tissues like tendons, muscles, bones, or cartilage. Radiating pain can be due to radiculopathy, a condition that occurs when a nerve root is compressed or irritated. Nerves can be compressed by repetitive motions, injuries, tight muscles, and age-related changes. Nerve irritation or damage can be due to injury, infections, diabetes, and other conditions. Inflammatory types of arthritis, such as rheumatoid arthritis, can also irritate nerves and contribute to radiating nerve pain. 

Common areas for radiating pain include your arm, wrist, shoulder, neck, hip, legs, or upper or lower back, where nerves travel through narrow spaces and may be more prone to compression or irritation.

Other contributors to referred or radiating pain

Scientists are still studying the causes of referred and radiating pain. Some concepts that might play a role include: 

• An overprotective pain system. This theory suggests that an overprotective pain system can make you more sensitive to pain. Chronic or long-lasting pain may lead to a heightened sensitivity in your nervous system. This may cause pain sensations to be produced more easily, seem to spread or move, and be felt in broader areas. For example, pain that started in your elbow might now feel like it’s coming from your shoulder and wrist, too.

• Pain masking. This theory suggests that pain in one area can be “masked” by more intense pain somewhere else. When one painful area eases, you might become more aware of pain in a different place, making it seem that pain is moving from one place to another.

• Brain maps and “pain that travels.” This theory involves your brain’s representation of your body, often referred to as “brain maps.” These maps have specific areas dedicated to different body parts. When two distant places in the body are “mapped” next to one another in the brain, pain can seem to spread from one part to another, unrelated area. Brain maps may also help explain phenomena like phantom limb pain, where people continue to feel pain in a limb that has been amputated.

Diagnosing referred or radiating pain

Diagnosing referred and radiating pain involves a thorough medical history and physical examination. Your healthcare provider may also use imaging studies, such as X-rays or MRI, and other diagnostic tests to identify the underlying cause.

What helps referred or radiating pain?

If referred pain is due to organ problems or other conditions (e.g., heart disease, gallstones, infections, etc.), treatment for the underlying condition is essential. 

For radiating pain and referred pain due to musculoskeletal issues, movement and exercise are crucial for pain relief. While it might seem counterintuitive, resting too much can actually make your symptoms worse. Nerves thrive on movement. Here are some guidelines for movement with radiating pain or referred pain due to musculoskeletal issues:

• Continue daily activities. Stay active and modify how you do things if needed.

• Know it’s safe. Even if movement causes some pain, it’s very unlikely that you are harming yourself. Read more about finding your “movement sweet spot.”

Exercise and physical therapy for referred or radiating pain

Regular movement, including gentle activities like walking and stretching can help calm referred or radiating pain due to musculoskeletal issues. Changing positions frequently can also help. Exercise can help stretch tissues to reduce pressure on nerves and strengthen muscles around the affected area to support and protect it.

If pain is limiting your movement or ability to do daily activities, physical therapy (PT) can help. Physical therapists can assess you, rule out any serious causes of your pain, help you modify your activities, empower you with tools and tips to help you hurt less, and personalize your exercise program.

You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

Exercises for ‘pinched’ nerves

Referred and radiating pain can sometimes be due to compressed or “pinched” nerves. Check out these resources for sample exercises to relieve pain in specific body areas:

• Nerve flossing exercises  (upper and lower body exercises to ease tension in the nerves)

• Pinched nerve in the arm exercises

• Pinched nerve in the shoulder exercises

• Pinched nerve in the neck exercises

• Pinched nerve in the hip exercises

• Pinched nerve in the low back exercises

More treatment options for referred or radiating pain

Movement is key for pain management. Additional treatment options for referred or radiating pain that can help you keep moving with less pain include:

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for referred and radiating pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Dry needling. This technique, performed by a physical therapist (laws vary by state), involves inserting thin needles into specific areas to relieve pain and tension.

• Neural mobilization (NM) is a type of manual therapy, often performed by a physical therapist, that improves nerve movement.

• Transcutaneous electrical nerve stimulation (TENS) uses a small, portable device to deliver mild electrical currents to help relieve pain.

• Oral corticosteroids. If used for a short period of time, oral steroid medications can reduce swelling and inflammation that may contribute to referred or radiating pain.

• Steroid injections. Cortisone (steroid) medications are injected near the affected nerve to reduce inflammation and pain. 

• Other nerve injections, including anesthetics and other medications, can be used to help relieve referred or radiating pain.

• Surgery might be an option if other treatments have not been effective.

These treatment options have different benefits, risks, and side effects. Talk to your provider about the best approach for you.

More ways to relieve referred or radiating pain

Managing referred or radiating pain often involves a combination of strategies. Beyond exercise and physical therapy, here are other effective approaches:

• Massage can soothe the tissues around an irritated nerve. 

• Cold/heat therapy. Using heat and ice can be an effective way to reduce swelling, promote fresh blood flow, and relax muscles in an affected area.

• Acupuncture. Inserting very fine needles into the skin at specific points may relieve pain by releasing endorphins, your body’s natural painkilling chemicals.

• Maintain a healthy diet. A balanced diet rich in anti-inflammatory foods can reduce inflammation and improve overall health.

• Stay hydrated. Drinking enough water can help reduce swelling that may contribute to referred or radiating pain and improve well-being.

• Manage stress. Stress can exacerbate pain. Techniques like deep breathing, meditation, and yoga can help reduce stress and improve pain management.

• Get quality sleep. Adequate sleep is essential for healing and pain management.

• Weight management. Maintaining a healthy weight can reduce pressure on compressed nerves.

When to see a doctor 

Most radiating pain and referred pain due to musculoskeletal issues resolves on its own with at-home treatment, but if your symptoms don't start to improve after a few weeks, see your provider. You should also see them right away if you experience any of the following:

• Muscle weakness. Any change in strength — for example, you can’t grasp things or start dropping things — needs to be evaluated by your provider.

• Numbness, tinging, or weakness that’s severe or progressive.

• Abnormal reflexes.

• Changes in gait or balance, including feeling unsteady while walking.

• Loss of dexterity (such as difficulty writing or fastening the buttons on your clothing).

• Changes in your ability to use the bathroom, including difficulty controlling your bladder or bowels.

• Unintentional weight loss.

• Fever or chills.

Referred pain can be a sign of serious conditions that need immediate medical attention. If you have unexplained pain in areas like your chest, back, neck, or arms, see a doctor right away.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Boyles, R., Toy, P., Mellon, J., Jr, Hayes, M., & Hammer, B. (2011). Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. The Journal of manual & manipulative therapy, 19(3), 135–142. doi:10.1179/2042618611Y.0000000011

2. Childress, M. A., & Becker, B. A. (2016). Nonoperative management of cervical radiculopathy. American family physician. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27175952/

3. Jin, Q., Chang, Y., Lu, C., Chen, L., & Wang, Y. (2023). Referred pain: characteristics, possible mechanisms, and clinical management. Frontiers in neurology, 14, 1104817. doi:10.3389/fneur.2023.1104817 

4. Khorami, A. K., Oliveira, C. B., Maher, C. G., Bindels, P. J. E., Machado, G. C., Pinto, R., … & Chiarotto, A. (2021). Recommendations for diagnosis and treatment of lumbosacral radicular pain: A systematic review of Clinical Practice Guidelines. Journal of clinical medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200038/  

5. Lin, L.-H., Lin, T.-Y., Chang, K.-V., Wu, W.-T., & Özçakar, L. (2023). Neural Mobilization for Reducing Pain and Disability in Patients with Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Life, 13(12), 2255. doi:10.3390/life13122255

6. Louw, A. (n.d.). The "how-to" of teaching patients about pain (recorded webinar). MedBridge. Retrieved November 2, 2021, from https://www.medbridgeeducation.com/course-catalog/details/the-how-to-of-teaching-patients-about-pain-recorded-webinar-adriaan-louw/ 

7. Magnus, W., Viswanath, O., Viswanathan, V. K., & Mesfin, F. B. (2022). Cervical Radiculopathy. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441828/

8. Mayo Foundation for Medical Education and Research. (2019). Pinched nerve. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/pinched-nerve/symptoms-causes/syc-20354746 

9. Mayo Foundation for Medical Education and Research. (2020). Peripheral nerve injuries. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/symptoms-causes/syc-20355631

10. Moseley, G. L., & Flor, H. (2012, February 13). Targeting cortical representations in the treatment of chronic pain: A review - G. Lorimer Moseley, Herta Flor, 2012. SAGE Journals. Retrieved October 28, 2021, from https://journals.sagepub.com/doi/full/10.1177/1545968311433209

11. Moseley, G. L., & Butler, D. S. (2017). Explain pain supercharged. Noigroup.

12. Petroianu, G. A., Aloum, L., & Adem, A. (2023). Neuropathic pain: Mechanisms and therapeutic strategies. Frontiers in Cell and Developmental Biology, 11. doi:10.3389/fcell.2023.1072629

13. Referred Pain. (2010). Physiopedia. https://www.physio-pedia.com/Referred_Pain

14. Shetty, A., Delanerolle, G., Deng, C., Thillainathan, A., Cavalini, H., Yang, X., … & Deer, T. (2024). A systematic review and bayesian meta-analysis of medical devices used in chronic pain management. Scientific Reports, 14(1). doi:10.1038/s41598-024-63499-6

15. Zhang, Y., Adamo, D., Liu, H., Wang, Q., Wu, W., Zheng, Y., & Wang, X. (2023). Editorial: Inflammatory pain: mechanisms, assessment, and intervention. Frontiers in Molecular Neuroscience, 16. doi:10.3389/fnmol.2023.1286215