Lateral Femoral Cutaneous Nerve Pinched by Knotted Iliopsoas Muscle

by Garry
(North Vancouver, BC, Canada)

First some background, then my question.

This happened to me 4 years ago:

By sitting cross-legged on the floor for one hour, my left-side iliopsoas muscle became really tight, and my left knee locked in the bent position (hamstrings in cramp). Later on, I discovered that my left Iliopsoas muscle had locked-up in knots and was the cause of all the problems.
I noticed that my left Lateral Femoral Cutaneous Nerve was being pinched somewhere, and the outside of my left leg became numb to the touch, and almost all power was lost in the left leg, with considerable knee pain. All leg pain was referred, and attempts to release the leg muscles were futile, because they were not the problem; they were the symptom.

After about 3 months of trying to find the problem, followed by 5 weeks of alternating chiropractic adjustments (which did not last because the adjustments were pulled out of position within 15 minutes by the knotted muscles), and Trigger Point Massage with ART on the left hip-flexor muscles (Iliacus, Psoas, Piriformis, QL, Gluts, TFL), finally, with Trigger Point pressure on the left Psoas muscle combined with forced full-range of leg motion by the practitioner, the Psoas knots suddenly released, and all symptoms disappeared within a few seconds. The Nerve came back to life, the knee started to work, and all leg-muscle cramps vanished. I was off the table and fully mobile within a few minutes (except for some memory-induced anticipation which had developed over the months).

At that time, the ART practitioner and I theorized that the knotted Psoas was pulling down somewhere on L1, L2, L3, or L4 creating sufficient pressure to pinch the Femoral Nerve, most likely at L2-L3 (where the Lateral Femoral Cutaneous Nerve emerges). Once the Psoas knot was released so was the compression, thus allowing everything to return to normal. All of the opinions I had heard from various practitioners, like knee arthritis, herniated disc, etc., could not explain the sudden cure when the knot was released.
Clearly, the instantaneous release of the knotted muscle remove some pressure somewhere and allowed the Nerve to function again. It is possible that the L2-L3 disc was being herniated by the knotted muscle force down on the lumbar spine, but after I was fixed, there was no sign of any herniation in these discs.

Now that I was fixed, I implemented a regime of morning Yoga and stretches combined with regular walking exercise every day. I keep this up for 4 years, then I made the excuse that I was too busy, had too much work to do, had too many more important things to do, and consequently stopped my regime. I started to tighten up but ignored the signs. Big mistake.

Now for the current situation.

This happened to me 2 months ago (August 2012):

After sitting too long (driving, flying, working, etc.) with no regular stretching or Yoga exercises, my left Iliopsoas muscle became very tight and my left Lateral Femoral Cutaneous Nerve became pinched somewhere, resulting in numbness on the outside of my left leg (the same as before) followed by the left knee and leg problems which I had before. Now I was back to square one, as before, with the same symptoms and lack of mobility.

This time, knowing the possible solution, I did the Chiropractic, Trigger Point massage, and ART treatments as before (except with a different ART practitioner since the former one had moved out of town). Extreme ART on the Psoas, QL, and Piriformis combined with full range of motion on the leg, provided about 90% improvement in mobility, but the internal knots responsible for the Nerve pinching were not fully released.

This 90% improvement in mobility indicated that we were on the right track. However, after sleeping that night, the leg and mobility problems had returned by the next morning. So, I brought the original practitioner back into town to do his magic, but he was not able to release the Psoas knots during his visit. Perhaps the rush fix I was attempting to induce, was too rushed, and my body needed time to recover between treatments.

Since then, I have tried other alternatives such as GunnIMS into the QL, Gluts, Piriformis, and those treatments have released local knots, but not the Psoas knots which are hidden underneath the intestines. GunnIMS practitioners will not use IMS on the Psoas because of the risk of other damage to the intestines and other organs. After IMS treatment on the QL, there is always an improvement in mobility and leg pain, but not a permanent improvement. So, again my theory appears to be valid. By releasing knots in the QL, and other muscles which may pull on the spine, I gain temporary improvement.

Since I have not been able to get the Nerve working correctly as yet, I am theorizing that I may have a compound issue where several muscles are contributing to the problem. Also, I read somewhere that the Lateral Femoral Cutaneous Nerve goes through the Psoas muscle, then passes by the Iliacus muscle, providing a couple of opportunities for pressure to be applied along the path of the Nerve and not necessarily the L2-L3 region.

However, this "en-route" theory does not support the relief I achieved when Trigger Point massage was applied to the QL near the L3 attachment of the Psoas underneath QL. Also, Nerve pinching along the route of the Nerve is not supported by the evidence that the spine is pulled out of whack 15 minutes after Chiropractic adjustments.

Now that my Never has been pinched for a couple of months, I am developing a Neuropathy and my entire body aches. All muscles are sore, and the right side is starting to give up, just like the left side. I am going downhill every week with no end is sight. I am clinging to the hope that this can be fixed, as it was before. I just need to find the right technique to release the Nerve compression.
The MacKenzie Chiropractic testing did not reveal any spinal problems. My spinal range of motion is not the issue because just prior to this most recent event (2 months ago) my monthly Chiropractic visit indicated that my skeleton was in excellent shape and adjusting very well.

I have also tried the "Yoga for Psoas Stretching" but I cannot do most of the moves because of the pain involved. Also, it is difficult if not impossible to "stretch" a muscle which is in knots. I have also tried the Bula Ball Psoas massage, but it does not produce any improvement. I am sure all these techniques work well when the muscle is not knotted, and may be incorporated as part of the maintenance to prevent a future occurrence, but they do not work when the muscles are already in knots.

Here is my opinion:

Instead of the usual causes suspected by most doctors (arthritis, disc herniation, etc.), we must not overlook the Iliopsoas Syndrome and knotted muscles therein as being the cause of spinal compression and nerve pinching. If knotted muscles are at fault, any surgery on the back would be unnecessary and useless, unless the knots happened to be released during surgery. My problem came on without any trauma or damage, except sitting too long. My problem was previously cured by releasing Psoas knots. My problem will go away within seconds, once the Nerve is no longer pinched.

Here are my questions:

1. Has anybody experienced what I have, and if so, how did they fix it?

2. Does anybody have any suggestions what I can do to fix my problem?

3. Does anybody have any alternate theories as to what may be going on in my case?

4. Does anybody know how to release Iliopsoas knots, other than Trigger Point and ART massage techniques (I have though about ultrasound or electricity but the muscle is very deep and difficult to reach)?

Any and all comments would be greatly appreciaged

Garry Anderson 21 October, 2012.

Dear Garry,
Thank you for your thoughtful and challenging letter.
Firstly a few basics. The LFCN is a sensory nerve only. The fact that your leg became weak suggests that the Femoral nerve itself was involved. Was the Knee jerk reflex affected, and did you have weakness when bouncing on the left leg? Was the Femoral nerve stretch test positive?

It's a much debated chicken and egg situation. Does the muscle cause the spinal condition, or vice versa? Personally I think it can work in both ways.

Another thought: Meralgia Paresthetica is a condition where the LFCN is involved in a double crush syndrome: an upper lumbar facet syndrome PLUS an impingement in the groin. Both areas need to be addressed. Has anyone examined and worked in your groin area where the LFCN escapes from the pelvis?

Maigne's syndrome is a first cousin of MP affecting the cluneal nerves, rather than the LFCN.

You've obviously had a lot of opinions and treatment. My best shot is: start doing the Maigne's syn exercises you can find using the Search this site function at C-H. EVERY morning before getting out of bed.

Let me know about the reflexes etc.

Dr B

Click here to read or post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Femoral nerve.

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

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.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.