Ligament Pain Referral Patterns
An often overlooked source of pain By Robert Libbey, RMT
Over my 22 year career I’ve recognized a distinct, immediate and ongoing problem: My clients were complaining of pain referral patterns that didn’t seem to match up with the standard trigger points, dermatome or sclerotome patterns. For years I researched scientific journals and resources, while continually charting the referral patterns described to me by my clients. What I discovered was that the ligamentous articular system was the source of their pain.
In the 1950’s George Hackett, MD and Gustav Hemwal, MD researched ligamentous injuries and their pain referral patterns. Their almost 40+ years of combined research and treatments involved almost 20,000 clients worldwide and culminated in the publication of the book Ligament and Tendon Relaxation Treatment by Prolotherapy in which ligament pain referral patterns were documented for the first time.
Current research is confirming that ligamentous articular structures/tissues do in fact refer pain in these characteristic patterns. It’s one of the most unrecognized and overlooked sources of pain.
Research from the Bone and Joint Journal documents that within the femoral acetabular labrum, “pain-associated free nerve ending expression was located showing characteristic distribution profiles of nociceptive and pain-related nerve fibres, which may help in understanding the origin of hip pain.”
Studies have noted that the iliolumbar ligament has a rich nerve supply suggesting that the injury of this ligament might contribute to the low back pain. An Oxford Journal Rheumatology study “demonstrated that the sternoclavicular joint is capable of referring pain to areas distant from the joint.” The paper then states “knowledge of these referral patterns will enable the SCJ to be considered in clients with pain in these areas. “ It has been documented that the “PCLs have constant nociceptive sensory innervation and is the possible source of OA knee pain.”
The American Journal of Orthopaedics advocate using pain maps as diagnostic tools in shoulder clinics. Like trigger point charts, these pain maps can help you better get to the source of your client’s pain by helping you identify typical referral patterns.
If you have clients complaining of referred pain that you just can’t figure out, if you treat joint dysfunction and want to better understand the discomfort your clients are feeling, if you want to a add more value to your practice and your clients… this information is invaluable.
The Ligamentous Articular Strain Technique course teaches therapists to precisely and specifically treat joint dysfunctions. Each course includes pertinent information on each ligamentous articular structure and it’s pain referral pattern.