Meralgia Paresthetica

Upper thigh pain

Keywords; meralgia paresthetica, upper thigh pain, chiropractic, tingling in legs and feet.


This condition 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 upper leg and a variant to the groin.

The trapped fibres are called the Lateral Femoral Cutaneous Nerve. It originates from the upper lumbar spine, L2 and L3, meanders down a large muscle deep in the belly called the Psoas, crosses another 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 and in our opinion is large part of the problem.

But, with groin pain, various impingement problems in the hip should also be considered. Conditions like Femoro acetabular impingement syndrome in the younger person, progress to hip arthritis in the older patient.


Meralgia Paresthetica

It's what we call a double crush syndrome. Like the Carpal Tunnel syndrome where the median nerve is trapped, often in several places 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 the pain is 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?


Extreme tenderness in 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.

Slipped disc symptoms

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 ...

  • So too should CHIROPRACTIC HELP Lumbar Stenosis be considered.

  • 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 monitored.
    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:

    1. A Chiropractic adjustment of any spinal or sacro-iliac fixations found. This is not normally painful.
    2. Deep massage of any trigger points found in the groin muscles. This may be extremely painful. You may develop bruising. Ice helps.
    3. Stretching of your spinal joint and the muscles. Not particularly painful.
    4. In the rehab phase some vigorous exercises. These may include exercises such as:


    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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    IMPORTANT CONSIDERATIONS

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    Interesting challenges of the day

    1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

    2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

    3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

    4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

    5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

    6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

    7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

    8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

    9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

    10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

    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. 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. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

    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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