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When people experience lateral thigh pain, it is frequently associated with the iliotibial band, but it is more frequently caused by joint capsule problems, bursitis, lumbar nerve root pathology, muscle pathology, cutaneous nerve pathology and other issues. Some people get relief with foam rolling, but for many people there are other options that work as well or better.

When people experience lateral thigh pain, it is frequently associated with the iliotibial band, but it is more frequently caused by joint capsule problems, bursitis, lumbar nerve root pathology, muscle pathology, cutaneous nerve pathology and other issues. Some people get relief with foam rolling, but for many people there are other options that work as well or better.

This is particularly important if the pain is due to entrapment of the lateral femoral cutaneous nerve. Also known as meralgia paresthetica, it is a neurological condition that can occur when that nerve is compressed.

Other than pain in the anterolateral thigh, symptoms may include numbness and paresthesias. It often presents unilaterally, and can arise spontaneously due to mechanical factors like compression anywhere along its length, most frequently where it exits the pelvis to enter the lateral thigh.

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Figure 1

People have a lot of anatomical variations in that area, which may affect susceptibility to meralgia paresthetica from a variety of factors. Meralgia paresthetica can also arise as a post-surgical complication, but it usually responds well to treatment.

Relief is Temporary with Foam Rolling

Because meralgia paresthetica is caused by compression of the lateral femoral cutaneous nerve, foam rolling is unlikely to provide more than temporary relief. The additional pressure can aggravate MP, making it worse. This can negatively impact leg strength, range of motion, balance, comfort while sitting, recovery from activity, gaiting and athletic performance.

Risk factors for meralgia paresthetica include compression of the nerve by tight clothing (skinny jeans, etc.) or heavy belts (especially tool belts), age (30 to 60), obesity, surgery of the spine or pelvis, pregnancy, and metabolic factors including diabetes mellitus, lead poisoning, alcoholism and hypothyroidism. It is common to see symptoms of meralgia paresthetica both in people who sit a lot and in people who run or otherwise engage in extensive physical training.

Conservative treatment of meralgia paresthetica may include wearing loose clothing, anti-inflammatories (NSAIDS or local corticosteroid injections), weight loss, stretching and strengthening abdominal muscles. Osteopathic and physical therapy methods may also include manual therapy methods, including contract-relax stretching for the hip and thigh, in addition to the methods presented in this article.

Aside from neurological conditions like meralgia paresthetica, there are other reasons to avoid using methods that include applying pressure along the lateral thigh. These include use of anticoagulants such as warfarin (aka Coumadin and Jantoven), apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Lixiana) and rivaroxaban (Xarelto). Other reasons for caution include recent surgeries or injuries to the hip or leg, Ehlers-Danlos syndromes (EDS), osteoporosis or osteopenia in the hip or leg, a history of clotting or bleeding disorders, cancer, inflammation or edema, varicose veins, sunburn, some skin conditions, etc.

Relieving Compression on the LFCN

The methods presented here focus on relieving compression on the lateral femoral cutaneous nerve. Both therapist-assisted and self-care variations are provided. These methods work equally well whether your client is clothed or not. If they are undressed, be mindful of draping them appropriately.

Lateral femoral cutaneous nerve compression can be relieved through positioning of the leg or gentle stretching of the skin along the lateral hip and thigh. The methods presented are safe and easy for nearly anyone and require very little effort. The self-care variations are easy for clients to do at home, and can be used in bed, as part of exercise preparation or recovery, or whenever else fits the person’s schedule. All they need is a place to lie supine.

People may respond better to one method or variation than to others. I often start with the simplest options, see how they respond, and then explore more complex versions depending on comfort and effectiveness.

Palpation along the lateral thigh can be used to reveal which areas are most tender. It is not necessary to press hard into any of those areas, as the worst will typically be tender to light pressure. In practice, it helps to mark which one(s) are most tender so you can recheck the same point(s) to see how they respond to the method(s) you use.

For best results, ask the person what they feel when you palpate, and let their responses guide whether you need to modify the technique a bit or switch to a different one.

Technique 1: Leg adduction with medial rotation, assisted

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Figure 2

Gently holding the foot, adduct the leg and add some medial rotation. Check the tender area and inquire “How does this feel now?” If no longer tender, maintain the technique without pressing into the tender area. Some physiological processes take two to three minutes, so just wait and ask the person to let you know if they feel anything change, positively or negatively. If they still have tenderness, add some ankle inversion to increase the skin stretch along the lateral aspect of the leg and thigh. For most people, this is effective.

Leg adduction with medial rotation, self-care

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Figure 3

The person should lay supine and move the foot of the affected leg across to their other foot, then cross their other foot over the ankle. This is an easy way to maintain adduction with medial rotation, and they can stay in that position for a few minutes without effort.

Technique 1 Variation: Leg adduction with medial rotation with elevation, assisted

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Figures 4a and 4b

If the basic LAMR method doesn’t relieve their pain quickly, consider elevating their knee to add hip flexion. This can be done with the knee straight or bent, and the weight can be supported manually or over a bolster or other support. Two different ways of manually supporting the leg are shown here.

Technique 1 Variation: Leg adduction with medial rotation, with elevation, self-care

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Figures 5a and 5b

If LAMR with elevation works for the person, they can use a strap to support their leg in an elevated position. They can also choose to place a firm pillow or other support under the elevated leg.

Technique 2: Leg abduction and rotation, assisted

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Figure 6

Gently holding their foot, abduct the person’s leg within their comfortable range of motion. Abduction of 5 to 25 degrees is usually sufficient. The knee can be straight or bent, depending on whichever is more comfortable for them. Once abducted, the leg can be medially or laterally rotated, whichever direction provides the most relief. It is possible to rotate the leg too far, so start with a little and increase as needed. Maintain the position for two to three minutes; ask the person to let you know if they feel anything change, positively or negatively.

Leg abduction and rotation, self-care

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Figure 7

The person should lay supine and move the foot of the affected leg away from their centerline, then rotate the leg medially or laterally based on which feels better. This is easy to maintain for a few minutes without effort.

Leg abduction and rotation, self-care with strap

Alternatives, Effective, Foam, Rolling ⋆ Effective Alternatives to Foam Rolling
Figure 8

If the person finds it difficult or uncomfortable to abduct the affected leg, they can use a strap to assist that movement, and also to change the leg rotation once it is abducted. This is easy to maintain for a few minutes without effort.

Better Pain Management

These methods and variations can be helpful for many people. They are safer and less painful than foam rolling, and it’s easy to modify them as needed for maximum effectiveness. The self-care versions are simple to teach and learn. If you find which assisted version works best for them, the person will quickly understand how to perform the self-care versions so they can better manage their pain or discomfort between visits.

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About the Author

Jason Erickson, BCTMB, CPT, BBA, co-owns and practices at Eagan Massage Center. A former chronic pain patient, Jason is an internationally recognized continuing education provider teaching classes on pain science, dermoneuromodulation, sports massage, research literacy and more. His articles and podcast appearances are widely featured. For current information on his CE classes, visit healthartes.com.

References

“DermoNeuroModulating: Manual Treatment for Peripheral Nerves and Especially Cutaneous Nerves,” by Diane Jacobs, PT.

“Positional Release Therapy: Assessment and Treatment of Musculoskeletal Dysfunction,” by Kerry J. D’Ambrogio, PT, and George B. Roth, DC.

“Jeggings and Tight Jeans Can Cause Meralgia Paresthetica,” by Nabil Ebraheim, MD, on huffpost.com.

“Meralgia paresthetica: diagnosis and treatment,” by M.G. Grossman, S.A. Ducey, S.S. Nadler and A.S. Levy, in Journal of the American Academy of Orthopaedic Surgeons.

“Meralgia paresthetica caused by entrapment of the lateral femoral subcutaneous nerve at the fascia lata of the thigh: a case report and literature review,” by Y. Omichi, I. Tonogai, S. Kaji, T. Sangawa and K. Sairyo, in the Journal of Medical Investigation.

“Anatomy of the lateral femoral cutaneous nerve relevant to clinical findings in meralgia paresthetica,” by S.H. Lee, K.J. Shin, Y.C. Gil, T.J. Ha, K.S. Koh and W.C. Song, in Muscle Nerve.

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