(Keywords: MERALGIA PARESTHETICA, upper thigh pain, chiropractic, Carpal tunnel syndrome (also a double entrapment syndrome)
ME is caused by a trapped nerve in the groin causing pain classically on the side of the thigh, but also sometimes the front of the thigh and a variant to the groin.
The trapped nerve is called the Lateral Femoral Cutaneous Nerve. It originates from the upper lumbar spine (L2-L3), meanders down a large back muscle called the Psoas, crosses another muscle in the pelvis called the Iliacus, and then is trapped as it passes under the Inguinal ligament.
There is usually no acute low back pain, though there may be a dull ache in the upper lumbar spine. Fixations are usually found here by your Chiropractor.
But, with groin pain, various impingement syndromes in the hip should also be considered. Conditions like Femoro acetabular impingement syndrome in the younger person, causing hip arthritis in the older.
It's what we call a double crush syndrome. Like the Carpal Tunnel syndrome where the Median nerve is trapped somewhere in the neck, shoulder, forearm and the wrist.
The result is the same: a burning, nerve type pain in the thigh, with minimal back pain.
Classically pain on the outer side of the thigh, but because the femoral nerve has so many small off shoots, variants may be in the groin and front of the leg.
Whilst this is not true meralgia paresthetica, to all intents and purposes the result is the same, only the pain is in the front of the thigh. Here your chiropractor will be even more careful however, as the femoral nerve is also a motor nerve: you may start to get weakness of the quadriceps muscle, the large four part muscle on top of the thigh. If you hop on that leg, does it tend to give? Report it immediately.
Your chiropractor will do a test which stretches the femoral nerve, and it's likely to cause much pain in the front of your thigh.
In the above graphic, can you trace both the lateral femoral cutaneous nerve, side of the thigh pain, and the femoral nerve, anterior thigh pain, as they make their way through the groin?
If you run your thumb down through the muscles of the groin (careful, you may cross the Femoral artery pulsating under you finger, avoid it) you are likely to encounter extreme, and I mean extreme tenderness of one or more muscles in the groin. However, this is not always the case.
Most syndromes come in variant forms. Diabetes may cause you to go blind and a toe might go black and fall off, but that isn't always the case fortunately. Follow the diabetes rules, and you can live to a healthy eighty with your eyesight and ten toes intact.
Likewise with Meralgia Paresthetica, follow the rules, and this too will pass.
Some of these features may also occur in the so-called SLIPPED DISC SYMPTOMS ... the distinguishing "differential diagnostic" features being the lack of serious low back pain, and the extreme tenderness in the groin where the nerve is being pinched.
So too, no loss of refex or muscle weakness as the LFCN is not motor.
Complicating factors ...
Let it be said, this can be a very painful and serious condition. Mostly it is benign and well managed by your Chiropractor. However these nerves can be affected by an abscess in the Psoas muscle (are you feeling sick, running a temperature, history of TB?), by bowel tumours (have you lost weight? are your bowels working normally? has there been a change in your bowel habits?). If in doubt, also consult your physician.
Is the pain in your thigh brought on with exercise? Read this strange tale by chiropractor Bernard Preston. Intermittent claudication ...
SPECIFIC MUSCLE WEAKNESS
This is important: The Lateral Femoral Cutaneous Nerve is a sensory
nerve. When irritated it does not cause specific muscle weakness in the leg. However, if the femoral Nerve itself is affected, there may be
Quadriceps weakness, and loss of the Knee jerk reflex. Plus sensory
change in the skin of the upper leg and/or inner lower leg.
Whilst Femoral nerve damage also responds to careful thorough
chiropractic care, any specific weakness in the quad must be noted and
In this short YouTube clip you can yourself determine if there's specific muscle weakness in your leg.
FROM THE COAL FACE
Whilst meralgia paresthetica is not uncommon, it is fairly unusual that I am consulted in the same week by two women with severe meralgia paresthetica upper leg pain. Because it is a serious condition, I started treatment immediately, but also referred both patients to their doctors for xrays. Chiropractors cannot order xrays in the netherlands.
After three treatments both were considerably improved, there was less pain in the leg and they were not unhappy.
Mrs j continued to improve, and the pain and numbness was completely alleviated within about 6 to 8 weeks. She is a very satisfied patient and is coming in currently in every two months for a checkup.
Mrs p's doctor decided this was far too serious a condition for a quack, and advised her to stop the treatment. After all he said, there is no known cure for meralgia paresthetica, which is quite true, there is no research confirming that there is any effective medical or chiropractic care. That was five months ago.
Yesterday her daughter phoned to say her mother was going for a back operation. Did I miss something? Is her doctor just anti chiropractic? Was she over compliant to her doctor's overbearing demands?
Frankly I don't know. What I can tell you is that chiropractors treat in the upper thigh pain with great confidence. Sure, if you have been losing weight, or are running night fevers, or have a change in bowel habits, if you're a heavy smoker then a second opinion is definitely on the cards.
The first step of chiropractic help, of course, in the treatment of meralgia paresthetica is a proper history and examination to rule out other diseases. An aneurism in the pelvis caused by smoking; it really does knock ten years off your life, fifteen years if you are a woman, heart attack, tumours and the like really should be considered, though rarely do they cause meralgia paresthetica.
Chiropractic care may include some or all of the following:
CORE EXERCISE @ Meralgia Paresthetica
This simple core muscle exercise should be done by EVERY low back sufferer before arising from bed EVERY morning. It only takes 60 seconds after all...
This chiropractic treatment programme would probably cover a 6-8 week period, with perhaps 10-15 treatments. Every person obviously is different. Some may require less, other more. Talk honestly to your Chiropractic.
If after 3-4 weeks there is no definite progress then a medical consultation should be considered.
IlioTibial Band stretch (ITB)
Another condition that needs to be considered when faced with lateral thigh pain is the Tensor Facia Muscle and its long tendon, the ITB. The definite test is called Noble's test... iliotibial band stretch
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Interesting challenges of the day
1. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
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