Lateral femoral cutaneous nerve

Lateral femoral cutaneous nerve is a tiny slip coming from the upper lumbar spine and supplying the skin only on the side and perhaps front of the thigh in the groin area. It has no motor component and when pinched cannot cause weakness of any muscles.

Predominantly it causes a numb feeling, and sometimes a burning pain on the side of the thigh.

It is the nerve affected by a condition called meralgia paresthetica that causes much grief occasionally. There is no recognised treatment, though the chiropractic management of MP is very effective.

The lateral femoral cutaneous nerve arises from the L2 and 3 lumbar roots. It emerges from the outer border of the psoas muscle, which is not shown, which then joins with the the iliacus, seen in the graphic above forming the iliopsoas muscle complex.

The nerve then proceeds obliquely across the pelvis, toward the so called anterior supererior iliac spine, a hard lump of bone about six inches above and slightly forwards from the hip bone.

Notice how the iliacus, with the psoas, courses down with its tendon inserting into to the femur in the upper thigh.

These muscles, together called the iliopsoas, are in part responsible for the intense tenderness in the groin that may accompany the numbness in these syndromes.

It then passes under the inguinal ligament; can you trace the lateral femoral cutaneous nerve in the graphic above? It then goes to the thigh. This is where it is pinched in meralgia paresthetica, dividing into

  • an anterior branch that supplies the skin of the anterior and lateral parts of the thigh, as far as the knee, and
  • a posterior branch which pierces another muscle called the tensor fascia lata, not shown, and passes backward across the lateral and posterior surfaces of the thigh, supplying the skin from the level of the greater trochanter to the middle of the thigh.

The result is that lower back and upper leg pain can present with a myriad of signs and symptoms, with many different etiologies (causes).

Thus, lumbar pain, buttock pain, groin and lateral hip and anterior and lateral thigh pain may in fact be a referred pain from the thoraco-lumbar region. Only a careful and thorough examination can clearly distinguish between hip pain, sacro-iliac joint pain, low lumbar pain and Maigne’s syndrome, and it's first cousin Meralgia Paresthetica ...

Meralgia paresthetica

Meralgia paresthetica sensory changes in the lateral thigh where there may be a burning feeling, or numbness. It has no motor fibres so when pinched cannot affect the quadriceps muscle; the knee won't give. If it does, then one suspects an entirely different problem.

There's an important distinguishing feature. The femoral nerve is also motor to the quadriceps muscle. When it is pinched in the mid lumbar spine, for example a slipped disc, then there a high likelihood that the knee jerk reflex will be affected. I know as I personally have had this condition, causing severe upper leg pain, numbness extending into the inner lower leg,

The knee tends to give on the stairs with a profound limp being the giveaway; read about it at femoral nerve damage.

A pinched lateral femoral cutaneous nerve never causes weakness of the quadriceps muscles, nor does it affect the reflex.

Lateral femoral cutaneous nerve

Lateral femoral cutaneous nerve is a small slither belonging with its larger brother the femoral nerve.

Because it courses through the abdomen it can be affected by a psoas abscess, though I confess I've never seen such a case; such folk are really sick and will normally find their way through the medical portal.

Because it lies close to the small intestine, colon, kidney and appendix, and the spine, amongst others, infection of these organs can spread to the psoas muscle with subsequent irritation of the lateral femoral cutaneous nerve.

Psoas abscess is a rare condition, with less than 20 cases per year world wide and many are either HIV positive or IV drug users.

These are not a chiropractic case obviously though in South Africa with the soaring HIV pandemic, one could stumble into our clinics.

The lateral femoral cutaneous nerve, like the median nerve in the arm causing carpal tunnel syndrome, is often involved in a so-called "double crush" syndrome.

Successful treatment must address the spinal subluxation and where the LFCN courses under the inguinal ligament in the groin.

Interestingly it passes in the upper leg over the sartorious muscle and is perhaps the reason why the inner thigh is often extremely tender in these cases.


One of the reasons that chiropractic is so successful is that we really try to find and treat the cause of your symptoms. But in the case of an irritated lateral femoral cutaneous nerve, both the pinch in the groin and the subluxation of the thigh have to be addressed.

Medicine tends to treat only the groin, and straight chiropractic just the spine; neither will probably be successful in treating meralgia paresthetica; both must be considered, as in carpal tunnel syndrome.

Lateral femoral cutaneous nerve links

› Lateral femoral cutaneous nerve

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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