A patient is referred to physical therapy with a diagnosis of low back pain. Radiographic studies, including MRI, have ruled out disc pathology. The patient reports pain that radiates toward the thorax and anteriorly into the abdominal region. Which area should the therapist consider as a potential source of discomfort?

A patient is referred to physical therapy with a diagnosis of low back pain. Radiographic studies, including MRI, have ruled out disc pathology. The patient reports pain that radiates toward the thorax and anteriorly into the abdominal region. Which area should the therapist consider as a potential source of discomfort?

• A. Dura mater
• B. Diaphragm
• C. Kidney
• D. Urinary bladder

Answer: (C)

Visceral pain can be referred to somatic regions because visceral afferents travel with the same spinal segments that receive cutaneous and musculoskeletal input. The kidneys send sensory signals to the spinal levels around T10 to L1. When the brain interprets this input, it may localize pain in areas served by those segments rather than at the actual organ, so kidney problems can present as pain felt in the chest, flank, or anterior abdominal wall, even in the absence of spine pathology. In this scenario, imaging has ruled out disc disease, yet the patient describes pain radiating toward the thorax and anterior abdominal region. That pattern aligns with renal referred pain due to the T10–L1 innervation. Other options are less consistent: irritation of the dura mater tends to produce radicular or segmental signs aligned with nerve roots; diaphragmatic irritation more commonly refers pain to the shoulder via the C4 distribution; bladder-related pain is typically suprapubic or pelvic. Therefore, the kidney becomes the plausible source of discomfort to explore.

Visceral pain can be referred to somatic regions because visceral afferents travel with the same spinal segments that receive cutaneous and musculoskeletal input. The kidneys send sensory signals to the spinal levels around T10 to L1. When the brain interprets this input, it may localize pain in areas served by those segments rather than at the actual organ, so kidney problems can present as pain felt in the chest, flank, or anterior abdominal wall, even in the absence of spine pathology.

In this scenario, imaging has ruled out disc disease, yet the patient describes pain radiating toward the thorax and anterior abdominal region. That pattern aligns with renal referred pain due to the T10–L1 innervation. Other options are less consistent: irritation of the dura mater tends to produce radicular or segmental signs aligned with nerve roots; diaphragmatic irritation more commonly refers pain to the shoulder via the C4 distribution; bladder-related pain is typically suprapubic or pelvic. Therefore, the kidney becomes the plausible source of discomfort to explore.