Impingement of the femoral nerve
Case:
A few months back I had a call asking if I could squeeze in an emergency appointment, they had been suffering for two months with pain that week by week was only getting worse. They were sure the catalyst had been doing a few hours gardening and lifting some compost bags, but couldn’t put their finger on what they had done.
The GP had XRAY’s of the hip and femur, blood tests and pain killers prescribed, luckily everything came back clear, but this was not the issue. All the pain, discomfort to the leg was not coming from the leg itself, but the back.
After testing them it was very clear they were suffering with Femoral nerve impingement and from here, due to a number of factors, he was referred straight to a Nuffield Health physio, whereby he was seen by a specialist consultant.
The Anatomy:
The femoral nerve begins as the largest nerve to extend from the lumbar plexus in the lower back as a combination of fibers from the L2, L3, and L4 spinal nerves. From the lumbar plexus it extends with the fibers of the psoas major muscle inferiorly through the abdomen along the anterior surface of the hip bone. As it passes through the abdomen, a branch of the femoral nerve extends to provide nerve connections to the iliacus muscle, a flexor of the thigh. From the abdomen the femoral nerve next passes deep to the inguinal ligament in the groin and crosses the hip joint to enter the femoral region. In the femoral region, the femoral nerve separates into two nerve trunks - the anterior and posterior divisions - before further dividing into many smaller branches throughout the anterior and medial thigh.
Symptoms:
Shooting pains down the leg
Numbness of the leg
Lack of control over the quadriceps and potential knee buckling
Potential causes:
Direct trauma to the femoral nerve
Scoliosis
Prolonged pressure on the nerve
Compression or entrapment of the nerve by nearby parts of the body or disease-related structures (such as a tumor or abnormal blood vessel)
A broken pelvic bone
Diabetes, which can cause widespread nerve damage
Internal bleeding in the pelvis or belly area (abdomen)
Lying on the back with the thighs and legs flexed and turned (lithotomy position) during surgery or diagnostic procedures
Tight or heavy waist belts
Treatment:
Rest– Avoiding exercise that aggravates the already inflamed nerve pathway will help ease the inflammation.
Medication – Anti-inflammatory and muscle relaxers can temporally ease the pain that you’re in, making every day chores much easier. Of course this should be prescribed by your GP and taken regularly as advised.
Treatment from a professional therapist can make all the difference, and decrease time in which it takes the pain to go away. Treatment such as nerve gliding, stretching, traction and other techniques can release the trapped nerve, thus alleviating pain.
Once you have gotten to the bottom of why you have occurred such a painful injury, using preventative methods such as exercise and treatment can prevent the injury from ever re-occurring.
In some cases, surgery will be used if all other remedial methods prevent pain and do not alleviate the issue.
Important Info:
Dealing with a compressed nerve is something only a professional should be doing. Once inflamed and trapped deep and vigorous massage in the wrong areas can actually increase pain and cause more compression to the nerve.
