Cruralgia from A to Z: How to relieve yourself naturally?

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

You have (chronic) pain which radiates into the leg, and which sometimes prevents you from sleeping. You were told that it might be a sciatica, but your pain is not necessarily behind the thigh. This is because your symptoms may reside near the groin, on the front or upper thigh (like a burning effect), or towards the inside of the knee.

What if it was cruralgia? Maybe you think your crural nerve is "stuck"? This condition, often confused with sciatica (but less common) involves different structures, and therefore needs to be treated differently.

This article will discuss everything you need to know about cruralgia, including symptoms, how long it lasts, how to sleep well at night, and how to cure it. (As a bonus, I offer 5 exercises often prescribed to my patients suffering from cruralgia in my physio practice). 

What is cruralgia?

Impossible to tell you about cruralgia without taking a basic anatomy course. crural nerve, does that remind you of something?

Also called the femoral nerve, it is made up of nerve fibers from the 2nd, 3rd, and 4th vertebrae lumbar (L2, L3, L4). This nerve is sensory-motor. In other words, it allows the contraction of certain muscles such as the hip flexors or knee extensors (motor aspect), as well as providing sensation to the front and inside of the leg (sensory aspect).

The term cruralgia can be separated into “crural” and “algia”. Thus, cruralgia refers to pain in the region of the crural (or femoral) nerve. No, the crural nerve does not get “stuck”. It is a myth, like that of the displaced vertebra.

Cruralgia mainly affects adults over the age of 50. It is a very general term, and does not take into consideration the potential causes as to why the crural nerve was irritated in the first place.  

In the next section, we will identify the most common signs and symptoms seen in cases of cruralgia, then explain the causes and structures potentially responsible for your symptoms.

How to diagnose cruralgia (and the symptoms)?

Obviously, the best way to detect, confirm, or clarify a diagnosis of cruralgia is to consult a qualified health professional (and even more so if your condition is chronic!). Most often, it will begin with a clinical examination. Here are the main signs and symptoms that will lead him to issue a diagnosis of cruralgia:

Pain

Typically, the patient complains of groin pain. On the other hand, there are sometimes symptoms of pain at the top of the thigh, or even radiation to the inside of the knee. This actually depends on the irritated root (between L2 and L4). As mentioned, the crural nerve can be irritated, but not "stuck" as such. 

In my practice, I have treated patients who presented with what they thought was a knee problem, when it was actually cruralgia! (I often joke to my patients that we don't come in spare parts).

Numbness or tingling

Besides pain, the patient may also feel altered sensation near the painful area. For some, this may be an electric shock or complete anesthesia, but most often patients initially complain of tingling in the front of the thigh.

Unfortunately, these symptoms can wake us up at night. (If so, browse this article for the best sleeping positions to optimize healing).

To understand this alteration of perception, it is necessary to refer to the notions of anatomy discussed above. Indeed, the crural nerve has a sensory role allowing the cutaneous sensation in its innervated region. If it is irritated, the conduction will be altered, and it can follow "strange" sensations felt in its nerve path.

Please note that cruralgia should not be confused with meralgia paresthetica, a common condition caused by damage to the lateral cutaneous nerve of the thigh, resulting in pain, numbness and tingling on the front and outside of the thigh. 

Strength

Since you are now familiar with the anatomy of the crural nerve, you might as well use another notion of anatomy to make you understand the loss of strength associated with cruralgia. We have already mentioned that the crural nerve has a motor role (in addition to sensory). In particular, it allows the contraction of the hip flexor and knee extensor muscles. As the quadriceps (the muscle at the front of the thigh) exerts its 2 actions, it is not uncommon to notice a decrease in strength when the crural nerve is affected.

LFor example, the patient may complain of difficulty going up and down stairs. Some use crutches to facilitate walking (especially in the acute phase). In more severe or chronic cases, it is even possible to observe visible atrophy of the quadriceps muscle, or difficulty in moving the leg or foot. This is called paralyzing cruralgia.

Reflex

We can observe a decrease (even an absence) of the patellar reflex in comparison with the healthy side. This is a test where the healthcare professional uses a reflex hammer and taps the patellar tendon to cause the knee to extend rapidly.

Clinical signs

The most common test used when a crural nerve injury is suspected is the Lasègue sign inverted (also called Leri's sign). The objective of this test is to put tension on the crural nerve to identify any dysfunction. If we ever observe a difference with the healthy side, this may lead us to continue the investigation.

Medical imaging 

There are several imaging tests and examinations that can clarify the diagnosis. Unfortunately, these tests can also COMPLEXIFY. Before we elaborate on this concept, let's look at the potential causes that may explain how cruralgia appears in the first place.

How does it appear in the first place (causes of cruralgia)?

There are several reasons why the crural nerve can be irritated. What you have to understand is that the symptoms are often linked to an attack on the lower back. So, even if you complain of pain or other symptoms in your thigh, it may be that the cause of the problem originates in your lumbar region.

But what are these causes potentially responsible for cruralgia?

One of the main causes of damage to the crural (femoral) nerve is herniated disc. On the other hand, contrary to the irritation of the sciatic nerve, the lumbar levels concerned are higher in the spine (Remember that the crural nerve originates from the L2 to L4 nerve roots, whereas the sciatic nerve originates from the roots of the L4 and L5 roots in addition to the nerves in the region of the sacrum).

Other causes are lumbar osteoarthritis and degenerative disc disease. This causes a reduction in the space where the nerve roots emerge from the foramen. Obviously, compression at this level can cause the symptoms associated with crural nerve irritation. There is also the narrow lumbar canal, a condition associated with a decrease in the space of the Spinal canal, and causing indirect irritation of the crural nerve.

The other causes of cruralgia, less frequent this time, can be:

• Pregnancy
• Crural nerve compression in the abdomen
• A infection, a tumor that puts pressure on the lumbar nerve roots
• A cyst on the crural nerve
• Idiopathic cruralgia
• Emotional causes (difficult to quantify, therefore not scientifically demonstrated)

Obviously, the best way to confirm the presence of a herniated disc or other is to have a Lumbar MRI or an lumbar scan. However, we mentioned above that themedical imaging could complicate the diagnosis instead of allowing us to see more clearly.

Without going into details (if you're interested, it's by here), imaging results are not always representative of what is actually observed.

Thus, a hernia may be present without however explaining the cause of your symptoms. It is for this reason that the diagnosis of cruralgia should ideally be issued by a qualified professional (and not your co-worker who had similar pain 2 years ago!).

What to expect: Prognosis and duration of cruralgia?

Well, your doctor may have diagnosed you with cruralgia. Maybe she's even chronic at this point. Or, that you seem to have all the signs and symptoms consistent with this diagnosis.

Your next question is probably: What is the duration of cruralgia ? In all honesty, it is very difficult for a health professional to answer this famous question about the duration of cruralgia.

But let me reassure you, cruralgia (even chronic) CAN be managed.

In general, I often tell my patients that the duration of cruralgia may take up to two months to heal (especially if the pain radiates to the foot). Moreover, it has been shown that the irradiations are usually associated with a poorer prognosis.

Pain that radiates to the top of the knee is usually easier to treat than chronic symptoms that reach down to the toes. Likewise, if we are able to centralize symptoms (bring the pain down the back) in the short term, the patient has a better chance of healing quickly.

To offer a more precise prognosis over time, you must first know the exact cause of your problem. For example, a herniated disc mass compressing the L3 root and consistent with the clinical picture will be more complex to treat than mild symptomatic foraminal osteoarthritis.

In addition, several personal and environmental factors can influence the duration of cruralgia. As surprising as it may seem, factors such as your state of mind (stress, depression, etc.), your personal and professional relationships, and even your genetic makeup can influence your recovery period.

Note: If your cruralgia is chronic, it would be interesting to learn about the psychosocial factors responsible for chronic pain.

Positions for sleeping with cruralgia

It is easy to conceive that if the back and the leg make us suffer, it will inevitably affect the quality of sleep. This is why it is important to find a comfortable sleeping position which decreases the stress on the lumbar vertebrae and the affected leg. I often recommend that my clients adopt one of the following two positions to optimize their night's sleep:

• Lying on your back with a pillow under your knees: This position reduces the anteversion of the pelvis (lumbar hyperlordosis), which reduces stress on the facet joints. Basically, keeping your knees slightly bent will prevent your back from arching excessively, reducing the stress on your vertebrae.

• Lying on your side with a pillow between your legs: Keeping a pillow between your legs helps reduce lumbar torsion (which can indirectly reduce pressure on the crural nerve).

Consult the products of Cervi-Care if you are looking for a orthopedic, ergonomic or shape memory pillow.

How do I treat my pain? (The treatment of cruralgia)   

Sorry to disappoint those who wish to benefit from a miracle recipe allowing the disappearance of their chronic cruralgia in the blink of an eye. Back pain is complex, and requires a multi-factorial approach to overcome it.

In the case of cruralgia, it is easier to establish a treatment plan once the source of the problem has been identified (and again!). As each condition is different, it is best to consult a professional who will be able to adjust his treatment according to your specific condition.

In the meantime, here are some treatment options that can be considered to relieve your symptoms and improve your condition:

Ice or heat

To relieve cruralgia-type pain (especially in the early stages), it may be appropriate to use the ice or heat. Often patients make the mistake of applying these modalities in the leg. You will have understood that since the source of the pain generally comes from the lumbar region, it is preferable to put heat or ice in the lower back to optimize the treatment.

Now, how can one choose between the two? In reality, there are no right answers, and each person may react differently and have certain preferences. Generally speaking, it is recommended to use ice for the first 24-48 hours due to its anti-inflammatory abilities. It can even be applied regularly to control the acute phase (15 minutes with a compress, repeated every 2 hours).

After a few days, you can apply heat to reduce muscle tension by using a heating bag, a towel soaked in hot water, or a hot water bottle. Some prefer to take a warm bath altogether to benefit from the heat effect. 

Natural products and home remedies for cruralgia 

Although they are not supported by solid scientific evidence, several natural products and grandmother's remedies are used to treat pain related to cruralgia, in particular for their anti-inflammatory power. It is essential to consult a doctor beforehand, mainly to avoid drug interactions and side effects.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation. The products are available on the site Country. Use promo code LOMBAFIT15 if you wish to obtain one of the following products, or any remedy aimed at relieving your symptoms and improving your quality of life:

• Turmeric. Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.
• Ginger. In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. the gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
• Omega-3s. Omega-3s are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 
• Lemon eucalyptus. Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
• wintergreen. Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.