Femoral Nerve Entrapment

Pain in the front of the hip and groin is a common complaint. It can be challenging to diagnose as it could be several overlapping pathologies. Arthritis, SI dysfunction, tight musculature, hernia, or lumbar pathology to name a few. A less understood pathology is entrapment of the femoral nerve. 

This can cause numbness, tingling, pain, and weakness along the distribution of the femoral nerve. This includes the quads, adductors, sartorius, and the medial lower leg if the saphenous nerve is involved. Going up and down stairs can be difficult, particularly down, with a sensation that the leg will give way. 

If the femoral nerve is the problem, you would expect altered knee jerk reflexes, and pain with hip extension or knee flexion. There is a test called the prone knee bend test which can be viewed here. You have to be wary of a false positive as someone with a strained or restricted quad will also test positive on this test.

The femoral nerve can become entrapped by the iliacus (the hip flexor that lines the inside of the pelvis) or in the adductor canal (Martin et al. 2017). It also can happen from having abdominal or hip surgery (Kim et al., 2004). It is important to correctly identify if it’s neural tension causing the pain because all too often, pain in the front of the hip is blindly diagnosed as a hip flexor problem. When the hip flexor is indicated, most practitioners will recommend a hip flexor stretch. One thing we know about nerves is they do not like stretch and hip flexor stretching could exacerbate the issue. As always, it’s important to get a thorough assessment before treating it.  

If the femoral nerve is indicated, nerve flossing may help. This is one that I prescribe to my patients. It’s important to keep it pain free. 

References: 

Kim, D., Murovic, J., Tiel, R., & Kline, D. (2004, June 01). Intrapelvic and thigh-level femoral nerve lesions: Management and outcomes in 119 surgically treated cases. Retrieved December 03, 2020, from https://thejns.org/view/journals/j-neurosurg/100/6/article-p989.xml

Martin, R., Martin, H. D., & Kivlan, B. R. (2017, December). NERVE ENTRAPMENT IN THE HIP REGION: CURRENT CONCEPTS REVIEW. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29234567