meralgia paresthetica

by James Seton
(New Orleans )

Meralgia paresthetica

Hello Dr Lewis!
The reason I entered this as the subject is due to what my newest chiropractor told me which is that the LFCN is being pinched by my very tight psoas muscle on the right. He didn't tell me this exactly though but just happened to show me on a chart of the nervous system. I then came home and started looking around on the web.

My previous chiropractor thought I had piriformis syndrome or a very tight hamstring on that side which turned out to be wrong. Sitting seems to be my biggest problem as well as going to a standing position. I usually have to stop about 3/4 of the way up to prevent a stabbing pain in the area where the gluteus transitions to the back of my leg and then continue to erect postion very slowly. Getting dressed in the morning is also a real challenge. Just changing position while sitting can cause a sudden pain in the back of the knee or gluteus although I will be pain free until doing so.

Ibuprofen seems to help but I must take it at least 2 times a day (400 mg ). I've also been applying ice to the gluteus and back of the leg which also helps for a little while. Standing and walking are not really a problem at all once I get moving in the morning and the ibuprofen starts to work. I'm hoping the new chiro I"ve got is going to help me but I'm losing hope. I will say that he worked on me more than any other chiropractor has by massaging all kinds of knots out of my upper gluteus , lower back and right hamstring. He is listed as a trained Active Release Technique provider in the New Orleans area. If I had insurance I think at this point that I would be making an appt with a doctor to get an injection or surgeon to fix this once and for all.

I continue to see that this is more of a disorder with overweight people but I am not at all nor do I wear tight clothes. At 5'8'' I weigh about 135 pounds and have always been in good shape now age 46. Ive read your page on this subject and see that you seem to recommend stretches and exercises for another syndrome although I'm not sure this is what you are doing (MAIGNES SYNDROME EXERCISES). Thank you for any input you have for me,
James

Hello James,
I'm reminded of the Chinese curse: may you live in interesting times! You have interesting signs and symptoms, and I'm sure you'd rather be plain James!
Obviously I'm not there to examine you, so I won't be presumptious. But... MP causes pain either on the side of the leg, or the front of the thigh. As I understand it, your pain is more in the butt and back of the thigh.
I'm inclined to think that "tight hamstring on the right" is very significant. It's more likely a tight sciatic nerve.

So, a few questions:
1. If you bend forward, is your right hamstring much tighter than the left?
2. Take the Slump test, and let me know the result: http://www.chiropractic-books.com/Slump-Test.html

If the answer is yes in both cases, I would be focussing more on the lower lumbar joints, and a sacral fixation, and less on the higher lumbars (where both MP and Maignes originate).

With MP pressure in the groin is usually excruciatingly painful, though you may have to prod around to find it. So, yes it may well be related to the psoas muscle. If it's MP. From what you tell me, I suspect it's not.

Have you had Xrays? Do they show anything significant. When I'm struggling with a back I often ask three questions:
1. Are you faithfully doing a simple basic back exercise programme before getting out of bed every morning?
2. Should I be adjusting the sacrum instead of the ilium?
3. Do you have a short leg, and should be wearing a heel lift, or inner in the sole of your shoe?

Biggie: is the Slump test positive? Sciatica.

I hope this has contributed. Keep me updated. Don't feel alone, there are thousands of people exactly where you are. I know, because I'm struggling with some of them too!
Barrie Lewis DC

PS. If your chiro is open to it, invite him to give us his thoughts. That ART on the hamstring will often help with a tight sciatica.

Try sitting a lot less. Especially the car and 'comfortable' chairs.