One of the key issues to understanding the cause of pain is whether the pain being experienced is referred pain or point tender pain. The difference lies in whether the tissue that is creating the pain signal is at the point where the pain is being experienced or whether it is located somewhere else. Referred pain can result from a nerve being affected or a strained muscle. The best example of a referred pain is pain running down the left arm associated with a heart attack. If you were to press on the arm, there would be no increase in pain because the pain is coming from the heart.

Point tender pain identifies the tissue where the pain is being experienced as the tissue creating the pain signal. In this case if you pressed on a muscle, for example, and the pain intensified, that indicates that the pain being experienced is point tender pain and the muscle is creating the pain signal.

The area where this determination is more crucial than other areas is in neck and back pain. Due to the fact that most diagnoses are achieved through diagnostic tests such as MRIs and x-rays, the most commonly found causes for neck and back pain are herniated discs, arthritis, stenosis and degenerative joint disease. The premise is that, regardless of which of these structural abnormalities is found, the cause of the pain is that somehow a nerve is being impinged upon creating the pain signal. If this were the case and you have pain across your lower back; furthermore, if you pressed on your lower back muscles, there should be absolutely no increase in pain since the pain is being created by an impinged nerve at the spine. The way to create increased pain at the lower back would be to press on the vertebral level where the nerve root is being impinged and that would refer pain across your lower back.

I have found in nearly all of the cases I have treated that when I press on the lower back muscles or muscles in the gluteal region, the pain the person is experiencing rises significantly. This is an indication that the pain being experienced is point tender and that the muscles are the tissue creating the pain signal. This confirms that the pain is not referred pain created by an impinged nerve at the spine. This is critical to understand because with the diagnosis determined through the MRI or x-ray, most medical personnel will try to treat the impinged nerve root even though the differentiation between referred pain versus point tender pain clearly proves the cause of pain is not from the spine.