Meralgia paresthetica: What is it, and what to do? (6 tips)

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

Meralgia paresthetica is a complex syndrome found most often in adults who practice sports that particularly solicit the muscles of the hip and the abdominal wall (athletics, running, football, bodybuilding, etc.).

If you suffer from pain or a burning or tingling sensation in the front and outside of your thigh, you may have meralgia paresthetica.

This article tells you everything you need to know about meralgia paresthetica, including anatomical reminders, causes, symptoms, and steps to take to treat the symptoms. 

Meralgia paresthetica definition

Meralgia paresthetica, also called femorocutaneous neuralgia, is a common neurological disease. It occurs when the lateral cutaneous nerve of the thigh is compressed by the inguinal ligament (at the groin) during its passage under the crural arch. This condition then constitutes a tunnel syndrome of the hip and thigh.

A tunnel syndrome is defined as a pathological interaction between an anatomical structure (here it is the inguinal ligament) and a peripheral nerve trunk (the lateral cutaneous nerve of the thigh). During this interaction, the affected nerve can be compressed, stretched or pinched.

As in all neuralgia (affecting a nerve), meralgia paresthetica causes the patient to experience various symptoms in the territory innervated by the lateral cutaneous nerve of the thigh.

Some anatomical reminders

The lateral cutaneous nerve of the thigh, also called femorocutaneous nerve, is a purely sensory nerve. It originates at the level of the second vertebrate lumbar (L2). In its course, this nerve crosses several structures which are successively, the large psoas muscle, the square muscle of the loins and the iliac muscle. Then it enters an osteofibrous canal in which it passes under the inguinal ligament.

At the level of the thigh, this nerve divides into a gluteal branch (buttock) and a crural branch (thigh). It then crosses the Sartorius muscle and the Tensor Fascia Lata (TFL) muscle. The crural branch sensorially innervates the anterior and lateral part of the thigh to the knee.

Damage to the lateral cutaneous nerve of the thigh in meralgia paresthetica is therefore caused by an impingement with the inguinal ligament. The Sartorius and TFL muscles may also be responsible for mechanical impingement. What then are the circumstances in which this conflict can arise?

Causes of meralgia paresthetica

Mechanical damage to the lateral cutaneous nerve of the thigh is caused by a pathological interaction with another anatomical structure along its course. They can be compression, stretching, pinching, nerve irritation. This nerve damage can be caused by the following causes:

• pregnancy
• un overweight or obesity
• local malformations
• hip muscle spasms
• wearing tight clothes: jeans, belt, military armor
• a metabolic abnormality such as diabetes (sugar weakens the nerves and installs diabetic neuropathy), hypo or hyperthyroidism, alcoholism
• a neuroma or schwannoma (benign nerve tumor)
• un psoas hematoma
• trauma occurring during the practice of sport
• microtraumas such as repeated efforts during sports leading to irritation of the nerve
• an operative complication after total hip prosthesis, after surgery of the abdomen, lumbar region or inguinal...
• a post operative scar
• a femoral neck fracture
• a static or dynamic anomaly: unequal leg length, Scoliosis, coxarthrosis (hip osteoarthritis)
• complications from infectious diseases such as typhus or Lyme disease (transmitted by ticks)…

In short, the causes of meralgia paresthetica are diverse, but the most common contributing factors remain obesity, diabetes and the wearing of tight clothing.

Symptoms of the disease

The main symptom of meralgia paresthetica is a sharp, intense, throbbing pain in the region located on the anterior and lateral aspect of the thigh. This pain can be associated with many other symptoms usually felt on the lateral aspect of the thigh.

These are: burning, tingling, tingling, and numbness. There may even be a decrease in sensitivity along the path of the nerve or a feeling of cardboard skin.

These pains and various sensations are amplified during prolonged static sitting or standing, during walking, during hip adduction (bringing the hip closer to the body) or during its extension.

These symptoms are independent of the movements of the affected limb because the lateral cutaneous nerve is only sensory. However, they can intensify during repeated friction with tight clothing, for example.

Positive diagnosis and differential diagnosis

The diagnosis of meralgia paresthetica is not complicated, and is based on the clinical elements and the patient's description of the characteristic signs of this pathology. In addition, the doctor may request additional examinations necessary to confirm the diagnosis.

This is primarily the electromyogram (EMG). It helps to differentiate between meralgia paresthetica and radiculopathy lumbar spine and diabetic femoral neuropathy.

X-rays of the back, hip and pelvis should allow the medical specialist (neurologist or orthopedic surgeon) to exclude hidden bone pathology in patients with meralgia paresthetica. To be able to rule out a herniated disc, a spinal stenosis or an extensive lesion, the doctor will order Magnetic Resonance Imaging (MRI).

In summary, additional assessments are requested according to the patient's clinical picture. For example, if an infection is suspected, the doctor will request a complete blood count, sedimentation rate, Protein C Reactive and if necessary a level of uric acid and the search for anti nuclear antibodies.

Treatment: How to treat meralgia paresthetica?

The definitive treatment for meralgia paresthetica is that of its cause. However, in order to relieve the symptoms, medical treatment may be prescribed.

Indeed, painkillers such as analgesics (paracetamol, tramadol) and non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, etc.) can be prescribed. As for pain resistant to the usual painkillers, they can be treated with antiepileptics (clonazepam).

In addition, some specialists may offer treatment by cortisone infiltration or local anesthetics (lidocaine, procaine). In addition, a supply of vitamin B1 (Thiamine) improves the functioning of the affected nerve and, by extension, reduces the symptoms.

In some cases, adapted functional rehabilitation carried out by the physiotherapist as well as osteopathy give good results in pain relief.

In exceptional cases, specialists may perform surgery that involves freeing the trapped lateral cutaneous nerve of the thigh, sometimes cutting off a portion of it. This surgery is called neurolysis.

Before any medication or invasive treatment for meralgia paresthetica, it is important to adopt an adequate lifestyle that can help alleviate the pain. The measures to be adopted are the following:

1. wear less tight clothes
2. avoid wearing belts
3. sleep with a cushion between the legs to reduce pain
4. wear insoles if there is a difference in leg length (ask a specialist for advice)
5. losing weight : be accompanied by health professionals (nutritionist, dietitian, sports coach, etc.)
6. doing stretching and strengthening exercises for the pelvis and hip muscles

Osteopathy

The osteopath intervenes in the management of paresthetic meralgia by using numerous techniques which make it possible to reduce the mechanical tensions in the pelvis by working the articular structures such as the inguinal ligament as well as the muscles of the groin (Muscle Sartorius and TFL). These techniques then make it possible to release all the compressions caused by these structures along the course of the lateral cutaneous nerve of the thigh.

In the particular case of pregnancy, it is the pressure exerted by the baby on the pelvis which is the basis of the compression of the nerve, causing a disturbance in the mobility of the mother's pelvis.

The goal of the osteopath is to reduce the stresses exerted on the nerve and readjust the forces exerted on the pelvis. All the practices of the osteopath are gentle and without inconvenience for the baby. To do this, he works mainly on the diaphragm, the lumbar, the sacrum, the coccyx, the perineum and the abdominal system of the mother.

Tools and accessories

In addition to the treatments mentioned above, there are several products and accessories available on the market to relieve the symptoms related to meralgia paresthetica. It should be remembered that these tools usually provide temporary relief, do not address the cause, and should be used sparingly. Among the products recommended by our professionals, we have:

• acupressure mat

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• massage gun

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• Foam roller (sport massage roller)

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• Compex and TENS (electrical stimulation)

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What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

• 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.

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• 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).

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• Omega-3s : Omega-3 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. Sciatica, being most often linked to an inflammation secondary to a herniated disc, it can also respond to omega-3 provided it is consumed regularly. 

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• 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.

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• 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.

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Conclusion

We can then conclude that paresthetic meralgia is a frequent pathology in athletes. It is manifested by pain or a burning sensation or tingling on the anterior and external face of the thigh.

It appears when the lateral cutaneous nerve of the thigh is compressed by another anatomical structure of the hip (at the level of the groin).

The main factors that promote the occurrence of meralgia paresthetica are obesity, diabetes and wearing tight clothes.

Adequate management therefore involves eliminating these factors by adopting a good lifestyle and calling on a specialist if necessary.