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Referred Pain

According to Doctors Janet Travell and David Simons in their widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual, referred pain is the defining symptom of a myofascial trigger point.

Referred pain is felt most often as an oppressive deep ache, although movement can sharpen the pain. Referred myofascial pain can be as intense and intolerable as pain from any other cause, including surgery. Myofascial pain can do a very good job of mimicking a heart attack.

Many Forms of Referred Pain

Some common examples of referred pain are headaches, sinus pain, and the kind of pain in the neck that won’t let you turn your head. Jaw pain, earache, and sore throat can also be expressions of referred pain. Another is the incapacitating stitch in the side that comes from running too hard.

Aching legs, sore feet, and sprained ankles are other examples of referred pain. Stiffness and pain in a joint should always make you think first of possible trigger points in nearby muscles that have been subjected to strain or overwork.

Pain in such joints as the knuckles, wrists, elbows, shoulders, knees, and hips are almost always nothing more serious than referred pain from myofascial trigger points.

Why is Pain Referred?

With certain muscles, the reality of referred pain can often be demonstrated by simply pressing on a trigger point that is bad enough to reproduce part of its referred pain pattern. It’s a little harder to explain why pain is referred at all.

Research on pain referral is difficult because the mechanisms of the human nervous system are so unimaginably small. The tiny electrochemical impulses in the nerves can be detected and measured to some extent, but not with accuracy or great discrimination.

In addition, there are ethical limits on how far you can go in pain experiments, whether with animals or humans. Nevertheless, scientists have made a number of suppositions about how pain can be displaced from its cause.

The easiest theory to accept regarding referred pain is that the signals simply get mixed in your neurological wiring. Sensory inputs from several sources are known to converge into single neurons (nerve cells) at the spinal level, where they are integrated and modified before being transmitted to the brain.

Under these circumstances, it may be possible for one electrical signal to influence another, resulting in mistaken impressions about where the signals are coming from.

The Functional Advantage of Referred Pain

On the surface, this looks like bad design, but the displacement of pain seems too consistent to be accidental. Referred pain occurs in very predictable patterns in everyone, with only small variations. This predictability implies that there may be some functional advantage to the referral of pain.

It’s notable that referred pain occurs very often in or near a joint, where pain is more likely to make you modify the activities or conditions that have created the problem.


Fortunately, it’s not necessary to understand why trigger points send their pain elsewhere. All you need to know is that they do. After you’ve worked with referred pain for a while, you develop an intuition about it and self-treatment becomes remarkably easy.

trigger points workbook

In The Trigger Point Therapy Workbook, nationally certified massage therapist Clair Davies has simplified Travell and Simons’s extensive research into referred pain and made it accessible to the layman. Self-applied trigger point massage will relieve referred pain, numbness, and other abnormal sensations when trigger points are the cause.

To find out more about the book and the method, please visit the homepage. To read a growing number of reviews by people who have been helped by the book, take a look at the book’s page at Amazon.com.

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