How do I know where my pain is coming from? Understanding pain patterns

Pain is complex. Sometimes it shows up in one part of the body, but the real issue lies somewhere else entirely. The cause of the symptoms may not be anywhere near where the pain actually is. So how do you know where your pain is coming from?

When pain or discomfort in one area is caused by a problem in another, it is known as referred pain. Recognising these patterns can help you manage symptoms more effectively and prevent long-term issues.

What are pain patterns?

Pain patterns are common routes in the body where one area affects another. It’s not always intuitive - just because your shoulder hurts doesn’t mean the shoulder itself is the problem. Pain can “travel” from the spine, muscles, or joints nearby, and this makes accurate diagnosis essential.

Here are a few examples:

• Neck → Shoulder / Arm
  If your shoulder or upper back feels achy or “heavy,” particularly after long periods at a desk, your neck could be the true culprit.

• Lower Back → Hip / Thigh
  Pain shooting down into the glutes or back of the thigh? This could be referred from your lumbar spine - especially if the pain is sharp, shooting or affected by different positions.

• Hip Weakness → Knee Pain
  A common pain pattern with runners. Weakness in the glutes or poor pelvic control can increase knee loading and cause pain at the front or side of the knee.

• Flat Feet or Stiff Ankles → Plantar Fasciitis or Achilles Pain
  Poor foot mechanics don’t just cause local pain - they can also lead to overload of the calf, heel, or even hamstring.

Why does pain refer in the body?

The body works as one integrated unit. Pain doesn’t always stick to one joint or one muscle. The body is a connected system of muscles, nerves, and fascia (a kind of connective tissue), which means tension or dysfunction in one area can impact others.

Here’s how it might play out:

• A tight neck can compress or irritate nerves, which refer pain to the shoulder or arm.

• Weakness in your glute muscles might cause your body to shift the workload to your knees when you run or squat.

• Limited ankle motion can affect your walking or running pattern, creating stress further up in your shin or hip.

This can make it tricky to self-diagnose pain based on location alone, which is where a professional assessment becomes so important.

How can I tell where my pain is coming from?

A proper assessment is key. At First Line Physio, our specialist physios use movement tests, palpating and touching around your joints, strength checks, and sometimes even analysis of you walking to identify the root cause, not just the symptom.

If you’re treating pain in one area and not seeing results, it might be time to zoom out and look at the whole picture.

So how do you work out whether your pain is referred? Here’s what we recommend:

• Don’t chase the pain
  Treating the spot that hurts might bring short-term relief, but if the cause lies elsewhere, the problem will likely return.

• Get assessed by a physio
  We will assess your strength, mobility, and movement patterns—not just where the pain is. We’ll also perform specific tests to rule in or out common pain referral sources.

• Look for patterns, not just symptoms
  When does your pain occur? After activity, during prolonged sitting, first thing in the morning? Does anything make it better or worse? This helps identify what systems are involved.

Most importantly - Rehab the whole chain
Once the cause is found, your rehab will likely include more than just the sore area.
For example:

• Treating shoulder pain may involve neck mobility and postural control

• Rehab for knee pain might target the glutes, core, and ankle

• Fixing lower back pain could include hip flexor stretches, glute work, and thoracic spine mobility

This is where we see most people go wrong, as they work on the problematic area without truly addressing the route cause, or other contributing factors that have lead them to have pain in the first place. This can lead to pain either never fully improving, or returning after just a few weeks or months.

Pain doesn’t always follow logic. Just because you feel it in one spot doesn’t mean that’s where the trouble started. Understanding pain patterns means thinking about the body as a whole, rather than in isolated parts. If you’ve been rehabbing an injury and it’s not improving, or if your pain seems to “move around,” it’s worth considering that the source might lie elsewhere.

A good assessment can help you find the real problem - so your rehab isn’t just reactive, but effective.

Need help figuring out your pain?
Book in with our physio team for a full-body movement assessment. Whether it’s shoulder, back, knee or foot - we’ll help you connect the dots and treat the cause, not just the symptom.