Meralgia paresthetica is anatomy speech for thigh pain not caused by injury to the thigh itself. Translation of the Greek roots of meralgia paresthetica means “thigh pain with abnormal sensations”. Admittedly this is an uncomfortable problem, but rest assured that it is not serious or permanent. The nerve to blame for these uncomfortable sensations is the lateral cutaneous femoral nerve which can become entrapped or pinched. Numbness and hypersensitivity are characteristic of lateral cutaneous femoral nerve entrapment. A pinched lateral femoral cutaneous nerve is most likely to occur in the middle ages of both men and women. It mostly affects only one side, but 20% of people who suffer from meralgia paresthetica will experience these symptoms on both sides.

The Anatomy of your Lateral Cutaneous Femoral Nerve

Your lateral cutaneous femoral nerve is a mouthful name that indicates the nerve’s function and location. Like calling a mug “the tea container above the kettle”.

So that means your lateral cutaneous femoral nerve is a sensory nerve that supplies your outer thigh, one for the right and another for your left side. It is formed by nerve roots L2-3. These two roots merge and travel down your psoas major muscle, outward over your iliacus muscle toward your anterior superior iliac spine. Your anterior superior iliac spine is the bony part of your hip bone that your index finger reaches when you pose with your hands on your hips. Your psoas and iliacus muscles, or iliopsoas, are your hip flexors’ anatomical names.

Once the lateral cutaneous femoral nerve reaches your hip bone it passes between your inguinal ligament and sartorius muscle. This is a common place where entrapment can occur because of the small space.

What does this nerve do?

Your lateral cutaneous femoral nerve’s job is to relay sensory messages from your outer thigh to your brain. Like the fabric of your paints, is someone touching your thigh or are you being pickpocketed? The nerve is also responsible for sending information regarding temperature change and pain.

The lateral cutaneous nerve has no motor fibres, which means it is not responsible for movement. Meralgia paresthetica does not lead to weakness because the lateral cutaneous femoral nerve is not responsible for muscle contraction.

How did I get meralgia paresthetica?

Nerves rely on freedom of movement to do their jobs. Entrapment or impingement to a nerve will influence its ability to do its job almost in the same way as a garden hose cannot transport water when kinked or blocked.

Most often entrapment happens where your lateral cutaneous femoral nerve travels underneath your inguinal ligament. Anything that influences the size of this space can cause a potential entrapment.

Factors from outside include tight-fitting clothing or a heavy tool belt. Seatbelts can also cause injury to this nerve during an accident. Compression from the inside can happen during pregnancy, weight gain or scar tissue after surgery in the area, like an inguinal hernia repair or cesarean scar. Inflammation also occupies space. Repetitive movements that cause injury can also contribute to meralgia paresthetica, like cycling, running and hiking. Cysts or tumors can also be responsible for this compression that causes meralgia paresthetica symptoms.

Causes of pinched lateral cutaneous femoral nerve

Direct trauma to your lateral cutaneous femoral nerve:

  • Seatbelt injury with motor vehicle accident
  • Complications with inguinal hernia repair

Repetitive hip flexion/extension movements:

  • Hiking
  • Cycling
  • Step ups
  • Squats
  • Deadlifts

Direct pressure can cause ischaemia:

  • Tight clothes, like leggings or tight belts
  • Heavy loads, like a tool belt
  • Excess weight, unfortunately a growing baby during pregnancy can also contribute

Symptoms of Meralgia Paresthetica

The symptoms severity listed below is not an indication of the amount of nerve damage, but rather how badly your lateral cutaneous femoral nerve entrapment is affecting your quality of life and driving your behaviour.

Mild

  • Paresthesia – abnormal sensation that is not painful
  • Sensation of itching

Moderate

  • Dysthesia – abnormal, unpleasant sensation
  • Burning
  • Tingling
  • Numbness
  • Stinging

Serious

  • Allodynia – pain from a stimulus that normally doesn’t cause pain, like touch
  • Hypersensitivity to temperature change
  • Avoidance of certain materials (clothes)

Tests that you can do to see if you have meralgia paresthetica

  • Sit upright on a chair with your thighs exposed
  • Use a brush or cotton wool
  • Close your eyes
  • Slowly glide your brush or cotton wool up the outside of your thigh from your knee to your hip
  • Does it feel the same on both sides?
  • If you have less sensation or excess sensitivity you may have a lateral femoral cutaneous nerve entrapment
  • You can repeat this test to cover different surface areas of your thigh from outer most to inner most

  • Stand comfortably on a chair
  • Place your hands on your hips like Peter Pan with your fingers aiming forward
  • Find your anterior iliac spine (if your pelvis had headlights to aim forward this would be where they shine from)
  • Slide your fingers in and down just off the bone
  • Do you feel the tingling or burning down the outside of your thigh?
  • This indicates that you have a pinched lateral femoral cutaneous nerve

  • Sit comfortably on a chair
  • Lift and drop your unaffected side from the chair repeatedly for 1 minute
  • Repeat on the affected side
  • Do you feel tingling or burning of your affected outer thigh?
  • This shows that you have a lateral femoral cutaneous nerve entrapment

How severe is my pinched lateral cutaneous femoral nerve?

Lateral cutaneous femoral nerve entrapment is not dangerous or life-threatening. Everyone will experience their symptoms differently, from slightly bothersome to avoiding certain outfits because of hypersensitivity. It is worth having your meralgia paresthetica symptoms examined if you are avoiding activities because of the severity.

Diagnosis of Meralgia Paresthetica

Physiotherapy diagnosis of lateral cutaneous femoral nerve entrapment

Our knowledgeable physiotherapists are biomechanic experts. We understand how movement patterns influence anatomical structures and will be able to diagnose your meralgia paresthetica accurately.

Our physiotherapists follow a structured plan to diagnose, classify the severity, and determine the hierarchy of priority that your problem needs. We stress test and screen all the possibilities that could be contributing to your lateral cutaneous femoral nerve impingement.

We understand the physiological healing stages you’ll go through, and custom-fit your treatment program. By knowing the extent of the tissue damage we can guide you through a structured program to recover faster and safely return to the things you love doing.

X-rays

Nerves cannot be seen on an X-ray, so it will not be effective to diagnose meralgia paresthetica. If your physiotherapist suspects that your back or hip is contributing to your symptoms, they will request the necessary views to confirm or rule out other pathology.

Diagnostic ultrasound

Diagnostic ultrasound can be used to visualise the path of the lateral cutaneous femoral nerve. If compression from a cyst or tumor is suspected a sonar will be able to show this.

If you need an ultrasound, your physio will refer you.

MRI

An MRI scan can image all of the structures that may contribute to lateral cutaneous femoral nerve entrapment. This is a costly image that needs to be ordered by a specialist, in the absence of regressing neurological symptoms it is unnecessary.

If your physiotherapist suspects anything more than meralgia paresthetica, you will be referred to the right specialist.

Why is my pinched lateral femoral cutaneous nerve pain not going away?

Meralgia paresthetica symptoms are caused by entrapment of the lateral femoral cutaneous nerve somewhere through its course. If you do not address the cause, you cannot expect the symptoms to just disappear. The wait-and-see approach can postpone early intervention and prolong the duration of your symptoms unnecessarily.

You risk getting stuck in a pain-rest-recurrence cycle if you do not get the help you need. If rest from a specific activity decreases your symptoms we need to evaluate your movement patterns, as something you do during training or your sport is causing you lateral femoral cutaneous nerve entrapment.

Prolonged entrapment can lead to increased symptoms and cause complete sensory loss.

 

What NOT to do

  • Continuous use of anti-inflammatory medication, as they have side effects

  • Manage the pain by only taking pain medication or muscle relaxants. You are only masking the symptoms of something more serious

  • Stretch through the pain

  • Walk, run, jog through the pain

  • Do not ignore numbness/tingling in your outer thigh

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

What you SHOULD do

  • Rest as needed

  • Avoid activities that is flaring up your pain, like repetitive hip bending

  • Make a list of movement or activities that brings on your pain and rank them

  • Make an appointment to confirm the diagnosis and determine how severe the tissue damage is

  • Finish your treatment and rehabilitation programme for better long-term results

Making it worse

  • Long, uphill walks

  • Prolonged standing

  • Wearing tight clothes/belts

  • Climbing stairs

  • Wearing heavy tool belts

  • Overhead work, like painting

  • Tight seatbelt

Problems we see when patients come to us with meralgia paresthetica

Medication

Oral analgesics, anti-inflammatories and muscle relaxants will give you temporary relief. If increased intra abdominal pressure contributes to your lateral cutaneous femoral nerve entrapment, and you get constipated with prolonged medication use, your symptoms will get worse.

Misconceptions about treatment

People tend to think about their bodies like a car, fix the faulty part and off you go. Unfortunately, it is not as easy as that. You need to address the root cause and stick around while the process takes effect.

Waiting too long

Nerves are finicky. Like little divas, treat them wrong and they’ll make you pay. Once your lateral cutaneous nerve “gets used to being mistreated”, guess what? It forms a memory of inflammation and at the slightest aggravation, it will do it again. Get help sooner rather than later to prevent chronic recurrent symptoms.

Compensation strategies

Avoidance of certain movements may make you feel better for a short while. Once established a compensation strategy, like avoiding hip extension, can cause you to walk hunched forward. This will cause problems of its own.

Physiotherapy  lateral cutaneous femoral nerve treatment

Our first priority is to determine the correct diagnosis of your lateral thigh pain. Lateral cutaneous femoral nerve pain is a diagnosis of elimination, our physiotherapists will ask you questions regarding your symptoms and evaluate your lumbar spine and hip to make sure you are not experiencing referred pain from these joints. We must protect the lateral cutaneous femoral nerve, correct the compensation, and retrain the correct firing pattern. This allows time for the lateral cutaneous femoral nerve to adapt and heal. Our practitioners bring on a change and monitor the results until it’s working, and then we magnify the effects to get even better outcomes.

Phases of rehabilitation for lateral cutaneous femoral nerve treatment

1st Phase of lateral cutaneous femoral nerve treatment: Education & pain relief (weeks 0 – 2)

Your physiotherapist will explain the relevant structures and contributing factors to you. You will know what to avoid and how to aid your healing. Pain relief strategies include manual therapy, desensitization, electrotherapy and neural mobilisations. We may also opt to support the structures surrounding your symptoms or immobilise movement contributing to your pain with strapping.

2nd Phase of lateral cutaneous femoral nerve treatment: Range of motion (weeks 3 – 4)

Your lower back and hip joints or surrounding muscles may be limited and contributing to your symptoms. Joint mobilisations, muscle activation and self-mobility drills will be included to rectify these restrictions. You can expect some home work in the form of exercises during this phase of your lateral cutaneous femoral nerve treatment.

3rd Phase of lateral cutaneous femoral nerve treatment: Muscle strength (weeks 5 – 6)

Muscle weakness or imbalance, discrepancies between right and left, can be at the root cause of your thigh pain. Joint stiffness can be a symptom of this. With muscle activation and specific strengthening drills we will get the lazy or weak muscles on board to help with all the load transfer and work that the back and hips need to do daily as we walk and climb stairs. You can expect some resisted exercises as part of your home work now with squats, step ups and weights part of your plan.

To progress to the next phase of your rehabilitation you should be able to comfortably complete single leg drills with fair balance.

4th Phase of lateral cutaneous femoral nerve treatment: Functional training (weeks 7 – 12)

If repetitive movements contributed to your symptoms we can now, with your newfound mobility and strength, get you into patterns required in your day to day of work and training. For athletes, this may be agility and quick direction changes and for the elderly, this can be overhead weight training.

We will customise your program to get you back to what you love to do.

Healing time for pinched lateral cutaneous femoral nerve

Nerves are sensitive structures because they serve such an important function. Contrary to what was thought about nerve’s inability to heal, we now know that the brain and nerves have the capacity of change and healing through neural plasticity. But like all good things, the process is slow. Healing of meralgia paresthetica can take up to 3 months. The cause of your entrapment will determine how often you need physiotherapy treatment. Once we have made the diagnosis and identified all the contributing factors we will be able to give you answers.

Other forms of treatment for femoral cutaneous nerve pain

  • Your doctor (GP) will probably prescribe oral medication to alleviate your symptoms. This may include analgesics, anti-inflammatories, gabapentin or pregabalin and muscle relaxants.
  • Stretching or foam-rolling might increase your pain temporarily because you won’t feel the depth or misjudge the time you spent rolling because of decreased sensation.
  • Lumbar manipulation won’t increase the diameter or route that your lateral cutaneous nerve travels through.

Is surgery an option for my pinched lateral cutaneous femoral nerve pain?

Surgery is very rarely considered for meralgia paresthetica. Scarring after surgical intervention may worsen symptoms.  Neurolysis, where scarring is removed around the nerve, or neurectomy, where part of the nerve is removed, poses the risk of complication. Surgical complications can cause permanent nerve damage and loss of sensation. In some cases meralgia paresthetica develops because of scarring from inguinal hernia repair.

Corticosteroid injection or nerve block can be considered if your lateral cutaneous femoral nerve does not respond to non-surgical treatment. Even after these interventions you need rehabilitation. Post-surgical rehabilitation includes physiotherapy to regain full movement, strength and endurance.

What else could my thigh pain be?

Hip pain localised to the outside of hip only, wore when lying on affected side.

  • Gluteus medius tendinopathy

Pain outside of hip and thigh worsens after cooling down from vigorous movement, like stair climbing or hill walking.

Severe pain and weakness of quadriceps muscle, usually after heavy lifting or repetitive loaded flexion, like packing and moving.

Meralgia Paresthetica is also known as:

  • Lateral cutaneous femoral nerve pain
  • Pinched lateral cutaneous nerve
  • Bernhardt-Roth Syndrome
  • Femoral cutaneous nerve entrapment
  • Lateral femoral cutaneous nerve entrapment