Is Your Referred Pain Due to Joint Instability?

By Debra K. Brinker, RN

Pain radiating into your arms or legs?
Why many treatments miss the mark
If you have been chronically complaining about pain that radiates down your arms or legs, most likely you have received the traditional recommendations. These can include anti-inflammatory medications, muscle relaxants, physical therapy, posture corrections, and maybe even a surgical consultation. If the pain continues to creep back up on you, flares up, or requires pain medication, it may indicate that the treatments are not addressing the true underlying problem or that you are missing an important diagnosis.

Referred Pain Due to Joint Instability
The majority of chronic musculoskeletal joint pain cases are actually due to joint instability caused by ligament laxity. When ligaments are subjected to forces that are too great, whether from a trauma or progressive wear and tear, they begin to fail. This results in further joint injuries and overall joint instability. One of the main symptoms of joint instability is pain, and instability can occur in almost every joint of the body. Additionally, ligaments contain free nerve endings. When a weakened ligament is stretched, the sensory nerves within them become irritated, causing both local and referred pain through the body. (See Figure 1.)

Is your pain positional?
At times, pain and symptoms occur only with movement or upon change of position. They are positional. This means that the nerves have enough room at rest, but when the person moves, or stands or walks, the room for the nerve is decreased. When someone has cervical radiculopathy, for instance, positional pain will cause shooting, burning pain down the arm when the head is moved in a certain way. The symptoms are dependent on position. When a nerve is actually being pinched or compressed, the pain is excruciating and will stop you in your tracks.

Positional symptoms are a good indication of joint instability and warrant a physical exam by a practitioner who understands referral pain patterns. This can include a number of very common nerve syndromes with their associated joint instabilities. (See Figure 2.)

Additionally, technology such as musculoskeletal ultrasound and Digital Motion X-ray can provide a way for the practitioner to recreate the pain or other symptoms in order to see what is happening to the bones and soft tissue of the joint. These may be preferable to an MRI performed when the patient is laying down and not able to recreate the pain and other symptoms. (See Figure 3.)

The   excess   movement that occurs in an unstable joint may aggravate the damaged nerve in the ligament producing a shock-like sensation. This may seem like a pinched nerve, but the pain is due instead to the ligament that is being stretched, and the nerves inside the ligament are sending shock-like pain to distant sites.

Do you really have sciatica?
The referral patterns of the sciatic nerve and the sacroiliac ligaments are similar. Pain traveling down the back into the leg and foot is commonly the result of ligament weakness in the sacroiliac joint, rather than pinching of the sciatic nerve. Sacroiliac ligament injury may result in a misdiagnosis of “sciatica.” (See Figure 4.)

The ligaments of the hip refer pain to the big toe. When a person presents with back pain radiating to the big toe, the pain likely involves the hip area. Ligament weakness or injury, when determined to be the cause of the pain, can be effectively treated with Regenerative Medicine options. Yes, proper posture, muscle strength, and exercise are important. However, patients with chronic referred pain conditions may want to seek an opinion on joint instability if these did not fully resolve the issue.

Non-surgical regenerative options
Except in a life-threatening situation or impending neurologic injury, surgery should be viewed as a last resort after conservative treatments have been exhausted. Regenerative injection therapies are an excellent consideration for chronic referral pain conditions. Positional pain is also a hallmark feature of conditions that respond well to regenerative injection therapies. Specifically, Prolotherapy is utilized for stimulating ligament and tendon repair in order to stabilize the joints and prevent further encroaching on the nerve. By strengthening the ligaments, the nerves in the ligaments do not fire from excessive movement, ending the instability cycle and resolving the pain. (See Figure 5.)

Another treatment, known as Nerve Release Injection Therapy frees up entrapped nerves through a guided injection technique. It gives almost immediate pain relief while the long-term repair of the ligaments is stimulated with Prolotherapy. Practitioners using these techniques can offer a proper opinion for patients who want to know if they are a candidate for one over the other, as well as a combined approach with exercise to get patients back to an active, pain-free life!

. Stem Cell Therapy
. Prolotherapy
. Platelet Rich Plasma

Regenerative Medicine Specialists
CaringMedical.com
239-303-4546
with locations in Fort Myers and Chicagoland