femoral nerve entrapment following release of piriformis?

[Jayne]

Hi there, and thank you already.

I have a new client who had sciatic pain down the left leg for 6 months, after tussling with his son. His left piriformis was the tightest I had ever seen. This was actually not why he came---he was coming for chest (muscle) pain he'd had for 5 years following a shrimp gun incident, but that resolved quickly.

Over our first two sessions, while working on the chest injury, I also relaxed the leg and back, and, maybe too spurred on by how well his chest had responded, in the second session I released the left piriformis---not gently---and he seemed to respond really well---he wasn't sore, and has been sciatic-pain free for 2 weeks. But about 9 days after the session he got off the couch and felt this new sensation in his leg that sounds like femoral nerve impingement: the patellar tendon went numb, then he started to feel pain over the medial knee, and then (progressively) in his adductors. When he lifts his leg, the patellar tendon numbness increases, so that sounds like hip flexors. I'm seeing him tomorrow. He now remembers that after the initial injury 6 months ago, he had more pain in the leg and back, but that over time it seemed to 'resolve' into the simple case of sciatic pain. I wish I could tell you more about his anterior hip; his left hip is a posterior tilt, but for some reason I didn't properly palpate iliopsoas (I'm afraid because he is a new client and a man, I wait a few sessions). I now of course deeply wish I had done more to balance the whole leg and hip out before releasing the piriformis. I'm also aware that this man's spine has been through a whole lot that we don't know about, and I need to tread carefully. Could this be a low-back injury that's expressing itself everywhere but the low back? I'm concerned about releasing another compensation only to be met by something worse. Should I request x-rays before proceeding?

Any thoughts or input would be really welcome, of any kind. Thank you!!

 

[heaven mclovin]

femoral nerve entrapment following release of piriformis?

Femoral Nerve entrapment at psoas does not usually cause local symptoms. Are there? Symptoms are caused more distally. Quadricep weakness and tingling/paresthesia/numbness are the major symptom patterns. Whether it be femoral nerve or genitofemoral nerve I would use the same treatment.

Because you mentioned medial knee I would be sure to rule out saphenous nerve. If nerve symptoms are local and to the leg and foot this is good indication of saphenous nerve entrapment.

Spend lots of time palpating. With nerve entrapments you can waste a lot of treatment time if you're unable to find the entrapment site.

 

[Wes]

femoral nerve entrapment following release of piriformis?

Athletica, thank you so much, I will check the saphenous nerve. No, there are no local symptoms at the psoas, and there isn't any quad weakness or numbness. The numbness is only in the patellar tendon. But pain started to go high into the groin---it sounds like top of the adductors. That could be muscle guarding. I just learned that he's also having a pain up the inside of the lower leg to the medial knee when he pushes off the big toe (for example, if he's prone and using the toes to push himself up higher in bed). I'll know more tomorrow, but thank you, the saphenous sounds promising.

 

[Aaron]

femoral nerve entrapment following release of piriformis?

Kool I will be interested to know how it goes!

 

[Sad Face]

femoral nerve entrapment following release of piriformis?

Manipulation of saphenous nerve seemed to work, Athletica! The patellar tendon started out ice cold and he couldn't feel it. I used the very very very very gentle nerve stretching technique in "Manual Therapy for the Peripheral Nerves," and massaged adjacent muscles. When I came back to the tendon later he said, "I feel that!" and sure enough the tendon was very warm. Thank you again.

 

[moon]

femoral nerve entrapment following release of piriformis?

Good to hear!

 

[Adviser! :)]

femoral nerve entrapment following release of piriformis?

Great work, both of you!