Today’s episode is entitled “How can low back pain radiate to the front?” and the 3 mechanisms covered are:

• Referred pain
• A problem at the front causes pain to radiate to the back
• You have 2 problems
  

By front I mean the abdominal area, but it could include the groin as well. Your lumbar spine has five levels, L1 to L5. In each level, there’ s a pair of nerves that come out right and left. We’ve got our 1, 2, 3, 4, 5, right and left. 10 different nerves. The upper lumbar nerves, L1, L2 and L3, come around to the front, into the abdominal area and they supply sensation. It also carries brunches from your sympathetic nervous system that come right to the abdominal organs. Nerves that originate in the back come to the front.

If you strain something in your back around the L2 level, and that muscle has its original nerve supply from MBL to segments that L2 nerve also supply structures arranged at the front, particularly including the skin. It’s possible to strain something in the back that might give you local lower back pain, but it could also cause pain to be felt anywhere else along that nerve. Because you’ve got irritation to a somatic nerve, the L2 sensory and motor nerve, it could cause dysfunction in your abdominal area.

Referred pain from the back to the front

You strain something in the back and it has the same nerve supply as your abdominal area, causing the pain to radiate to the front. Your brain feels it in both places, that’s referred pain, but then we’ve also got this somato visceral reflex where you strain something in your back, that’s caused the kind of dysfunction irritability within the nervous system, that last segment, and that then has a knock-on effect on the visceral nerve. Sympathetic nerve coming right to the front, going to your abdominal organs, which might then cause them to dysfunction.

Referred pain from the front to the back

You can have a somatic visceral reflex with your abdominal organs, which causes a dysfunction in that segmental level of your nervous system and then a tightening of muscle in the back causing it to be a bit achy. You could also have an abdominal or a structure at the front, which causes pain to radiate to the back by the same mechanism that worked the other way around. Just because the organ at the front has the same nerve supply as the stuff at the back, you can feel it on both areas.

You have two problems

It could be that you have a problem in the front and another one in the back. You might have an irritable bowel, which can cause discomfort in the abdominal area, but you might have recently strained your back, and so you’ve got back pain as well. It’s not that the pain is radiating in either direction. You simply have both problems.