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

man who feels pain in front of the leg of cruralgia type

You have pain that radiates down your leg, and which sometimes prevents you from sleeping. You were told that it might be a sciatica, but your pain is not necessarily located behind the thigh.

Indeed, 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 that 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 written by a physiotherapist will discuss everything you need to know about cruralgia, including symptoms, duration, positions to sleep well at night, and treatment for recovery.

(As a bonus, I offer the 5 exercises with which I have had the most success in treating my patients suffering from cruralgia). 

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, the crural nerve is made up of nerve fibers originating 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 inner side 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.

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 (symptoms and medical imaging)?

Obviously, the best way to detect, confirm, or clarify a diagnosis of cruralgia is to consult a qualified health professional. Most often, it will begin with a clinical examination.

Here are the main signs and symptoms that will lead to 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). Most often, the crural nerve is irritated, and almost never “stuck” as one might think..

In my practice, I have treated patients who consulted for what they thought was a knee problem, when in reality it was cruralgia!

Numbness and tingling

Apart from pain, the patient may also feel altered sensation near the painful region. For some, it may be an electric shock or complete anesthesia. In some cases, patients initially complain of tingling in the front of the thigh.

Unfortunately, these symptoms can wake you up at night. If this is your case, read this article to know the best positions to optimize your night's sleep.

To understand this alteration of perception, we must refer to the notions of anatomy discussed above. Indeed, the crural nerve has a sensory role allowing cutaneous sensation in its innervated region. If it is irritated, conduction will be impaired, and it may result in altered sensations felt in its nerve pathway.

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 help 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). It allows in particular the contraction of the hip flexors and knee extensors.

As the quadriceps (the muscle at the front of the thigh) exerts its 2 actions, it is not uncommon to notice a reduction in strength when the crural nerve is affected.

For example, the patient might complain of difficulty going up and down stairs. Some use crutches to make walking easier (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 moving your leg or foot. We then speak of paralyzing cruralgia.

Reflexes

We can observe a reduction (or even an absence) of the patellar reflex compared to the healthy side.

This is a test where the healthcare professional uses a reflex hammer and taps the patellar tendon to cause rapid extension of the knee.

Clinical tests

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 push us to continue the investigation.

Medical imaging

There are several imaging tests and examinations that can clarify the diagnosis. Unfortunately, these tests can also complicate. 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 cruralgia first appear? (Possible causes)

There are several reasons why the crural nerve may be irritated. What you need to understand is that the symptoms are often linked to damage to the lower back.

So, even if you complain of pain or other symptoms in the thigh, the cause of the problem may originate in your lower back 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.

Indeed, remember that the crural nerve originates from the L2 to L4 nerve roots, while the sciatic nerve originates from the roots of the L4 and L5 roots in addition to the nerves in the sacrum region.

Other causes are lumbar osteoarthritis and degenerative disc disease. This causes a reduction in the space where the nerve roots emerge from the foramen. Compression at this level can cause 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.

Other, less common, causes of cruralgia 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 a 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 explaining the cause of your symptoms. This is why the diagnosis of cruralgia should ideally be made by a qualified professional (and not your work colleague who had similar pain 2 years ago!).

What to expect? (Prognosis and duration of cruralgia)

If you are reading this, your doctor may have diagnosed you with cruralgia. Maybe it's even chronic at this point.

One of the questions that bothers you is probably duration of cruralgia ? In all honesty, it is very difficult for a healthcare professional to answer this common question.

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.

Good to know: 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 massive compressing the L3 root and consistent with the clinical picture will be more complex to treat than a slight lumbar arthritis.

Furthermore, 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 background can have an influence on 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 reduces 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 allows you to reduce 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 the legs helps reduce lumbar twisting (which can indirectly reduce pressure on the crural nerve).

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

How can I relieve my pain? (Treatment of cruralgia)

In the case of cruralgia, it is easier to establish a treatment plan once the source of the problem has been identified. As each condition is different, it is best to consult a professional who will be able to adjust their 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 understand 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 we 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, particularly for their anti-inflammatory power.

It is essential to consult a doctor beforehand, mainly to avoid drug interactions and side effects.

Some natural remedies that may help your symptoms include (click on the product you are interested in for purchasing options):

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.

Powerful Turmeric Capsules 500mg with 95% Curcumin Extract – 180 Vegan Capsules (6 Months) – Turmeric (50:1), Black Pepper (30:1) and Ginger – High Absorption Turmeric Capsules – Made in EU
  • WHY CHOOSE OUR TURMERIC AND BLACK PEPPER CAPSULES? – Turmeric is a very well-known plant…
  • POWERFUL TURMERIC CAPSULES - Turmeric is an excellent source of Vitamin C, antioxidants,…
  • IDEAL AND PRACTICAL FORMULA – The powders we use are delicately harvested,…

Last updated on 2024-06-18 / Affiliate links / Images from the Amazon Partners API

Ginger

In addition to the particular flavor it brings to cooking 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).

Ginger Foot Patches, Pack of 30 Ginger Detox Patches, Anti Swelling Ginger Detox Patch, Foot Detox Patch for Deep Cleansing, Improve Sleep
  • 【Natural Ginger Foot Patches】: Natural Foot Detox Patch with Ginger and…
  • 【Ginger Anti Swelling Detox Patch】: Ginger Detox Patches are natural,…
  • 【Removes Body Toxins】: Ginger Foot Patches helps reduce the buildup of…

Last updated on 2024-06-18 / Affiliate links / Images from the Amazon Partners API

Omega-3

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 to be 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. 

Omega 3 Wild Fish Oil 2000mg – 240 Capsules (120 Days) – High Concentration of EPA (660mg) & DHA (440mg) Supports Heart Function and Normal Vision – Manufactured by Nutravita
  • ✔ WHY NUTRAVITA OMEGA 3 FISH OIL? – Our omega 3 comes naturally from the rich waters of the Peruvian coast. The oils are then distilled for increased purity to provide the highest levels of contaminant-free acids – EPA and DHA, removing metals, PCBs and other toxins. 2 capsules daily, our supplement provides a maximum strength of 660 mg EPA and 440 mg DHA. 240 capsules per bottle for a 4 month supply.
  • ✔ WHY OMEGA 3? Each recommended daily dose of our premium Omega 3 fish oil supplement provides high-potency essential fatty acids – Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) which both help support various functions bodily, especially in the normal functioning of the heart. DHA supports the maintenance of normal brain function and normal vision. All these claims are supported by EFSA
  • ✔ WHAT INGREDIENTS ARE USED AT NUTRAVITA? – We have a dedicated team of pharmacologists, chemists and researchers who work to find the finest and most beneficial ingredients, allowing us to provide advanced, high strength vitamins and supplements that do not contain dyes or flavorings artificial. From *fish* which may NOT be suitable for people with allergies. The soft capsule is made from (bovine) gelatin.

Last updated on 2024-06-18 / Affiliate links / Images from the Amazon Partners API

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.

Promo
Mystic Moments Lemon Eucalyptus Essential Oil – 100ml – 100% Pure
  • Eucalyptus Citriodora Essential Oil.
  • 100% pure.
  • Botanical name: eucalyptus citriodo.

Last updated on 2024-06-18 / Affiliate links / Images from the Amazon Partners API

wintergreen

Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the essential oils most used in aromatherapy. This oil, extracted from the shrub of 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.

Promo
Puressentiel – Wintergreen Essential Oil – Organic – 100% pure and natural – HEBBD – 30 ml
  • PROPERTIES ORGANIC WINTERGOOD ESSENTIAL OIL: Wintergreen essential oil is…
  • DIRECTIONS FOR USE: Refer to the instructions or ask your pharmacist for advice, This…
  • PURESSENTIEL DNA: A range of 55 essential oils essential for well-being in the…

Last updated on 2024-06-18 / Affiliate links / Images from the Amazon Partners API

Other forms of alternative medicine used in the treatment of cruralgia include:

Accessories and products

In addition to the treatments mentioned above, there are several products and accessories available on the market to relieve pain related to cruralgia.

It should be remembered that these tools generally provide temporary relief, do not treat the cause of the problem, and therefore should be used sparingly.

Among the products recommended by our professionals, we have:

Mckenzie method

We mentioned that the prognosis was generally better when the symptoms of low back pain could be centralized.

A frequently used assessment and treatment method in physiotherapy (physiotherapy) is McKenzie technique. This is an approach where the patient is made to repeat movements (or adopt certain postures for a while).

Depending on the response to these movements or postures, we are able to identify movement directions to relieve symptoms and treat cruralgia.

For more details on this famous method, see our article on The McKenzie Method. 

Lumbar traction

The lumbar pull-ups are often used in the treatment of lower back pain. Their aim is to exercise spinal decompression.

This treatment helps, among other things, to reduce stress on the discs, stretch tendons and ligaments, and relieve irritated nerve roots.

However, be aware that these techniques have not been shown to be effective in the long term in scientific studies.

Since they generally provide a feeling of well-being, pull-ups can be useful for temporarily reduce symptoms (for example in an acute crisis, or to allow more physical activity with a more acceptable level of pain).

Ideally, the healthcare professional is the person of choice to perform safe and specific lumbar tractions.

Osteopathy

Osteopathy is an option of choice in the treatment of cruralgia. During his evaluation, the osteopath will first seek to eliminate a serious cause explaining the symptoms, and which would require a referral to a doctor.

Then, he will look for potential causes that can explain the symptoms and functional repercussions. These can be at:

  • Lumbar vertebrae (hypomobile or unstable), and even the dorsal and cervical vertebrae
  • The pelvis, hips and sacroiliac joint
  • The muscles (in particular the psoas which is located near the crural nerve)
  • The viscera in the stomach and pelvic region
  • The crural nerve as such in its nervous course

Essentially, the osteopath will seek to identify dysfunctions in the regions mentioned above, then apply manual techniques aimed at correcting these joint, muscular or nervous disorders.

The modalities used to relieve the symptoms are massages, mobilizations, joint manipulations, myofascial release, sacrocranial therapy, etc.

Although some theories are not supported by solid scientific evidence, many patients observe a significant relief of their symptoms. 

Medication

When a nerve root or the crural (femoral) nerve is irritated, intense pain such as burning, electric shock, tingling, numbness, etc. can result.

Although it is always better to opt for more "natural" strategies such as ice or heat, sometimes you have to resolve to drug treatment.

Since everyone reacts differently to pharmaceuticals, it is important to consult your doctor to determine the type, quantity and dose.

The medications generally prescribed following an attack of acute cruralgia are anti-inflammatories, painkillers, and/or muscle relaxants. Your doctor may also prescribe pregabalin (Lyrica), an anti-epileptic medication used in the presence of neuropathic pain.

Exercises for cruralgia

For many, the first instinct when suffering from pain is to rest until the symptoms disappear. Unfortunately, this is a monumental mistake.

Indeed, many scientific studies have shown that people who are inactive following an episode of low back pain take longer to heal, and have more long-term recurrence episodes.

Although a relative rest  can sometimes be beneficial, it should be avoided at all costs avoid complete bed rest.

obviously, a qualified professional such as a physiotherapist will be able to guide you and prescribe optimal exercises based on your condition.

In the meantime, here are 5 effective exercises that will relieve you and speed up your healing if your cruralgia is causing you pain.

Infiltration and surgery

In certain specific cases (such as chronic cruralgia), your doctor may suggest a cortisone infiltration to relieve your symptoms, or even a surgery.

Obviously, your doctor is best placed to determine the optimal treatment based on your diagnosis. For example, this may depend on the disc or joint origin of your pain. Or even your level of pain and quality of life.

However, keep in mind these few tips.

First, don't make the mistake some of my patients make when they have back pain. Indeed, I see people receiving an infiltration for acute cruralgia before even trying medication or consulting a therapist.

Also, many people wrongly imagine that their femoral nerve is stuck, and that the infiltration will unblock it.

In general, injections should be considered only in cases of persistent, incapacitating pain that has not responded to conservative treatment for at least 6 weeks (often when the condition becomes chronic).

Then, if you ever have to decide to have an infiltration, discuss with your doctor the possibility of it being done under fluoroscopy.

Indeed, although infiltrations in the doctor's office are appropriate, they will be more effective if they are done under radiological control. This means that the doctor will use a medical imaging to better target the place to poke.

As for surgery, don't consider it until you've tried all the strategies mentioned above. Unless it is a surgical emergency, for example if you have any of the symptoms described in this article on red flags.

Cruralgia and walking

Here is a question that often comes up from patients with groin pain: Can I walk when I have cruralgia?

The answer to this question will depend on several factors, and a healthcare professional is best able to answer you based on your personal situation.

In the meantime, remember this:physical activity is strongly recommended to improve your condition and reduce your symptoms over the long term. If walking is well tolerated, it will clearly be encouraged in the treatment of your condition.

Here are situations where it is best to avoid walking, and consult a healthcare professional:

  • Constant pain in the lower back and/or leg
  • Numbness and tingling in the foot
  • Pain increased when standing
  • Heart or lung condition

If you decide to take up walking, at least make sure you take it gradually. To make sure you don't aggravate your condition, start by walking short distances on level ground, at low speed, and shortening the length of your steps.

Then progress by increasing one parameter at a time (distance, slope, walking speed, step length).

And above all, do not try to force yourself against the pain, especially if you are not being followed.

Conclusion (the take-home message)

I hope you understand more about the diagnosis of cruralgia, and how it differs from sciatica problems.

Above all, I hope that you realize that the term cruralgia is restrictive, and does not really explain where your pain comes from. Indeed, to identify the source of the problem, it is necessary to identify the structure in question (often located at the lumbar level, and not at a trapped crural nerve!).

Obviously, your best ally in this sometimes complex process remains the healthcare professional.

Resources

Back to top