Meralgia paresthetica is a condition that causes pain in the outer thigh. It is caused by compression of the lateral femoral cutaneous nerve, which runs along the outer thigh. The most common cause of meralgia paresthetica is pregnancy, but it can also be caused by obesity, sitting for long periods of time, or wearing tight clothing.
An injury causes meralgia paresthetica to the nerve, and depending on its severity, the expert will tell us what exercises we should do and what measures we can take to treat it[1]Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2001 Sep 1;9(5):336-44..
Parasthetic meralgia occurs when the nerve responsible for providing sensitivity to the skin of the thigh contracts. In this way, the area presents some tingling, numbness, burning sensation or an annoying pain. If you practice sports regularly, the physiotherapist should assess whether you can continue doing that activity or not[2]Harney D, Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Medicine. 2007 Nov 1;8(8):669-77..
Paresthetic meralgia is mononeuropathy due to the entrapment of the lateral femorocutaneous nerve. It is the second most frequent entrapment mononeuropathy in the lower limb.
The symptoms of meralgia paresthetica are numbness and tingling in the outer thigh and knee area. The numbness and tingling may worsen when you walk or sit for long periods of time.
The lateral femorocutaneous nerve is a pure sensory nerve that originates in the first three nerve roots of the lumbar plexus and descends along the posterolateral region of the psoas, above the iliac muscle, into the region of the anterosuperior iliac spine. It enters the anterior region of the thigh by passing under, through, or above the inguinal ligament. The nerve divides into an anterior and posterior fasciculus at a variable distance from the anterosuperorior iliac spine.
The anterior fasciculus penetrates the fascia lata approximately 10 cm. below the anterosuperior iliac spine and innervates the skin from the anterolateral region of the thigh to the knee. The posterior fasciculus, smaller, innervates the skin from the greater trochanter to the area innervated by the anterior fasciculus.
How cycling influences meralgia paresthetica
Cycling involves long periods of sitting in the hard saddle of the bike, which means pressure around the buttocks, tailbone, and sciatic nerve. Even more so if cyclists maintain an abnormal nerve position within the piriformis muscle.
Sitting for long periods is an action that, by itself, can produce stiffness. But if you add continuous activity of the legs and torso, as happens when doing the legs, the pain can be more severe.
To this is added the psychological aspect. Spending a lot of time on the bike can lead to a defensive body response to any psycho-emotional stimulus that it perceives as a threat.
How to prepare for cycling with meralgia
Options to prevent and relieve pain:
- Consult your doctor or physical therapist. It can provide you with a stretching, recovery, and maintenance schedule to relieve and prevent pain.
- Change the saddle. It can compress your muscles and pinch your sciatic nerve, so you’ll want to adjust it well. Or even replace it with a ribbed and cropped one.
- Adjust the handlebars. If you’re leaning too far forward, you may increase the tension in your hip flexors or buttocks. In addition, a handlebar that is not adjusted to the saddle can force a poor position of the back.
- Adjust the saddle. If you are too high, your muscles and nerves will suffer to reach the end of the pedaling cycle. If it’s too low, it can put pressure on your hips and knee.
- Improve your position on the bike. Remember that the back should be straight, not hunched. Otherwise, you’ll increase the pressure of the vertebrae on the lumbar discs.
Causes of Meralgia
The leading causes that trigger meralgia paresthetica are usually overweight, frequently wearing tight clothing, Pregnancy, having carried continuous weight in the area, or that scar tissue has developed near the inguinal ligament due to an injury or previous surgery[3]Seror P, Seror R. Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2006 … Continue reading.
Several factors can favor the onset of the disease, such as:
- External factors (wearing tight clothing, pagers, mobile phones, guns, staying in the fetal position for prolonged periods).
- Obesity.
- Pregnancy.
- Diabetes.
- Hip surgery
- Coronary or endoprosthetic cardiovascular stenting. (Placement of femoral catheters).
- Intra-abdominal diseases that increase intrapelvic pressure (neoplasms, hematomas contained in the iliopsoas muscle).
- Anatomical variations.
Treatment
The specialist should determine treatment after diagnosis.
- Hygienic-dietary measures: The best treatment is to eliminate the cause that causes compression,
- NSAIDs: Many patients respond to treatment with hygienic-dietary measures and NSAIDs.
- Anticonvulsants: Carbamazepine, Gabapentin, or Pregabalin
- Local nerve infiltration: In severe or refractory cases where the local nerve infiltration test with anesthetic has been positive, local nerve infiltration with corticosteroids may be used.
- Spinal cord stimulator: Percutaneous implantation of a spinal cord stimulator, a less aggressive technique than surgery
- Surgery: The most commonly used method is nerve decompression
If you have excessive weight, reduce it through a diet that a nutritionist should prescribe. In addition, it will be advised to avoid wearing tight clothing as much as possible. Sometimes the expert may also recommend the intake of analgesics or anti-inflammatories, as well as other medications to relieve pain.
There are other techniques that our doctor should evaluate depending on how the meralgia progresses. Sometimes, among the recommendations is the practice of exercises that strengthen the abdominal muscles. As for the practice of sports with more intensity, it will have to be analyzed to what extent this discomfort is disabling to carry out our life normally.
Physiotherapy can also address this disorder by stretching the muscle and massages that seek the release of the nerve.
If, with these initial measures, the discomfort persists, sometimes infiltrations are made with specific medications that help reduce inflammation and relieve pain. Experts say that surgery can even be performed in extreme cases after trying various options.
Conclusion
Meralgia paresthetica is an uncommon condition among the general population, and amateur and professional cyclists may experience it. This does not mean that, if you usually use the bike, you will irretrievably experience hip pain.
This condition is not incompatible with cycling, since the benefits of doing sports outweigh the risks. It is often just a matter of undertaking postural hygiene habits on the bike and making the necessary adjustments. A biomechanical study can be very revealing and prevent this and other back problems.
Because of your discomfort or a doctor’s prescription, you may have to leave the bike on time if you suffer from sciatic pain. But, once you treat it and move on, you can use the bike again.
Physiatrist, M.D. Pain Center of University of São Paulo
References
| ↑1 | Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2001 Sep 1;9(5):336-44. |
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| ↑2 | Harney D, Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Medicine. 2007 Nov 1;8(8):669-77. |
| ↑3 | Seror P, Seror R. Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2006 May;33(5):650-4. |