♪ Bob and Brad ♪
♪ The two most famous physical therapists on the internet ♪
- Hi folks, I am Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
- We can say that with a straight face.
Today we're gonna talk about upper thigh leg pain
from a pinched femoral nerve,
or from meralgia paresthetica.
- Ah, that's a tough one.
- Yeah, we're gonna show you a self test
to see which one you might have.
And we're going to show you a fix.
- That's right, how to self treat.
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- Large loops for exercising, hanging,
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Zen, I think, Zin. - Zen.
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Okay, here we go.
What are we talking about? - Here we go.
- Upper thigh pain, leg pain.
It could be numbness, tingling.
And it happens in this area and it can be easily
from a pinched nerve, but there's two nerves
in that area and they have different jobs they do.
- Characteristics. - Exactly.
- We're gonna tell you about that.
What is the femoral nerve?
And the other one is the--
- [Both] Lateral femoral cutaneous nerve.
- And that's, and I don't know.
- That's just more of a sensation type nerve.
I'm gonna get to that, Bob, just wait, just wait.
- Jumping ahead.
- The meralgia paresthetica is the medical term,
and I shoulda looked that up
to see how they came up with that.
You know, sometimes they do that, but anyways
that's what they call it.
So if you're having pain, numbness, tingling here
there's a difference between the two.
If you have femoral nerve,
you may have the symptoms down into the shin.
If you've got lateral femoral cutaneous nerve problems.
- It's gonna stick right here.
- It's gonna stay up here.
It may refer over to the buttock area a little bit.
I'm gonna get Sam over here.
And we're gonna show you a little bit of anatomy about this
before we get into the treatment so you understand it.
Oh, that's right, I wanted to use this.
- As a nerve? - Yup, this is a nerve.
It actually, 'cause we got the yellow nerves right up here.
It comes from L2-L3.
- The femoral nerve?
- [Brad] They both do, they come from the same level,
so they both come up here.
- I can hold that.
- Yeah. Could you hold that?
- And nerves are kinda yellow-like.
This is kinda close for a demonstration.
Comes down in front of the ilium or the pelvis.
Now there's some muscles in here.
You got the hip flexors that could be a problem.
And it goes through the abdominal.
Now the cutaneous nerve actually pierces through
the abdominal area and goes to the superficial
just below the skin, into that fascia area.
Now that particular nerve,
the lateral femoral cutaneous nerve
does not innovate any muscles.
So it's just for sensation.
So that's a key thing to remember.
- When he says innovate,
he means he does not supply.
The muscle does not get its strength from that nerve.
- That nerve does not turn on any muscles on and off.
- Right. - But the femoral nerve,
that does control the quadriceps.
So that's a big, big difference.
- So why do they get in trouble, Brad?
The nerves, are they getting pinched by the muscles?
- Right, right.
They can get pinched,
and it could be a pinch up in the back.
- Sure, it could be actual disc problem.
- Yeah, a disc problem.
Something of that nature.
Some scar tissue if there was an injury there.
It could be where that cutaneous nerve comes out.
It can be pinched right in there,
and they have the surgery for this.
- Sure.
- Obviously we don't wanna go there.
- You got to try this first.
- Exactly right.
Now to test if you have...
- To try to determine which one you have.
- Right, whether you have the femoral nerve
or a meralgia paresthetica.
You do a manual muscle test to yourself.
It's not that hard.
The first thing you can do,
let's say this is my right leg.
This is where I have the symptoms,
and I'm going to kick out like this and down
and you're gonna compare one leg to the other.
Now, if you have difficulty--
- [Bob] Even straightening. - Straightening it,
that's a pretty severe case.
You probably wanna see a doctor.
- [Bob] Yeah, and not only that,
there's a slight chance you coulda tore the muscle too.
- Sure.
- You could have trouble with it too.
- Right, yeah, so maybe a crossover of symptoms.
So the next thing to do is a single leg sit to stand test.
You need a firm chair with armrests,
and what you gotta do is test your good leg first.
So I'm gonna bring this leg up,
and I'm gonna stand up with this leg only.
You may need, you know, unless you're really strong.
You may need and likely need to push up from here.
Now I can do pretty easy with both arms,
and I'm gonna take one off and I can go like that.
And then okay, I'm gonna go just to a finger tip,
and ooh, that's about it for me.
- Sure. - Okay.
Now the other leg, if I need both hands to push up,
and I go to one hand and it's not going up,
it's pretty clear you got a weakness.
- Sure.
- So you probably have the femoral nerve.
- Involvement. - Pinched, yup.
Now you might say 'cause the next thing I'm gonna say
is the treatment we're gonna show you is the same for both.
- Sure.
- Because the treatments cross over,
and there's no harm in doing one
'cause the first one is more for the femoral nerve.
- And all of them, you really wanna make sure
there's no pain all while doing these.
In fact, we are hoping the pain starts going down
some of these, right? - Right, right.
You should feel a decrease in that.
And sometimes when nerve, when you have numbness,
tingling, those things, and the nerve starts to feel better.
I've had patients as well as myself say,
"Well, it feels like cold water running through now.
"It seems like it's getting better,
"but it changes it for the better."
- And sometimes it can take a while before it changes,
especially if it's a stretch. - Exactly.
- So it might be a couple of weeks before
you even notice any difference,
but you surely don't want to make it worse.
- Right, exactly.
- You know, while you're doing it
or before or after you're done doing it.
- Yeah, the afterwards is really important
and not just two minutes after,
but you know, with the next hour or even throughout the day.
- If the tingling gets worse after you did the exercise,
it's not the right thing. - Yup, exactly.
Okay, so let's show the first one.
Do you wanna show?
We're gonna. - Extension line.
- There's three options that we're gonna show here.
So you can try all three of them
and then monitor if it's better or worse.
So now Bob has, let's say left leg numbness and tingling.
- So I'm putting my hands right below my shoulders
and I'm doing a press up,
and now I'm not lifting up my pelvis.
I'm not bringing that up with it.
If you're really tight, sometimes it comes up like that.
If that's the case, just work on small micro press-ups here
or mini press-ups and work your way up further and further,
again, keeping the pelvis on the floor.
Now this does two things.
One, you're working on the back
if it's a disc problem, but it's also working
on the hip flexors.
- Right. - And stretching them out too.
So you're getting kinda two for one here.
- And you're still getting some of that superficial muscles
in the abdominal for that cutaneous.
- Right, right, yeah, yeah. - You're stretching that too.
- There's really nothing go wrong with this.
If you happen to have spondylolisthesis
or a stenosis, this one is probably not gonna be for you.
- Yeah, and you're gonna wanna do these
actually not just once a day,
you could do these throughout the day.
- Exactly.
- You could do it four to six times,
spread out throughout the day
and do like repetitions of 10.
- Yep.
- And see again how it responds.
If it makes it worse, you're gonna stop it and not do it.
If it seems to be helping, you're gonna continue to do it.
- Exactly.
- Should we go to number two?
- Sure. - Sure.
All right.
- Supine hip extension? - Yeah.
You wanna do it
or you want me to do it? - Yeah, I can do it.
- Okay, good.
You can do this off the edge of your bed.
You can do it off your couch if it's a firm couch.
- Yeah, and you wanna have your shoulders well onto the bed.
You don't wanna get to the edge,
and some beds where you kinda slide right off.
So I'm bringing the leg, this is my involved leg,
we'll say now. - Yup.
- Not my bad leg, my involved leg.
- Yeah, 'cause everyone, if you've gotta leg, it's good.
- Yeah, right.
- Better than not having one.
- Yup, so I'm gonna bring leg this up like this
'cause this sets the pelvis
and you can actually see if I go like this,
it actually pulls up.
So I'm really stretching that muscle here.
And Brad, you can actually bring your foot back
even a little bit more, if you wanna stretch
your rectus femoris there a little bit more.
- Right, yup.
- So this is a really easy stretch to do.
You know, you can do it in the morning when you wake up,
and this can be done a couple of times a day too.
- And you could hold this up to 30 seconds
or you can just, you know, shorter bursts if you wanna.
- Yeah, you can do pressure on, pressure off.
- Now, if I was in the clinic,
and I had someone who had good results with this,
it's like, "Oh, that's doing pretty good."
I might even offer a little, little stretch
gently, very gently, stretching that
as long as it feels clearly better.
The thing about this is you may wanna do it
on your good leg first and see how it feels
and then do your involved leg. - That's a good idea.
- And compare the good to the bad
and it's gonna give you a good indication
on if it's improving or not.
- To tell you right away how tight that one is.
- Yup.
- It might feel tighter or it might look tighter.
- Exactly, Bob.
Should we do the last one?
- Sure, the kneeling?
- Yeah, you might as well do that one too.
- Sure.
So I can't remember which way should I always go, this way?
You don't like it
(Brad laughs) this, this, this way?
- Nah, do the other way.
I think it's easier.
- I knew I always get it wrong.
- It's just easier for the viewers to see.
There we go, yup.
- All right, so I'm gonna stretch.
I'm stretching to hip flexor here.
So I'm keeping very good posture.
I can actually even use my hand
and push forward a little bit here
like this and really stretch her out.
- So we're really stretching the same muscle groups
and structures, but it's a different angle.
And sometimes it helps.
- Yeah, and I usually definitely put a pillow down
at my age because it's a little rough on the floor.
Can you try facing the camera?
I wanna show him my one little trick
that can just accelerate or modify the stretch.
Now for this, you gotta have a balance.
You might wanna hold on to this
just for balance. - Sure.
- Okay, actually with the other arm
because so you do your stretch forward.
Now take this hand
and do this.
There, that's his balancing,
so he's gonna lean this way
and you feel a little bit more of a stretch.
- Yeah, yeah, you do actually.
Yeah, and they say that you get a little flossing
with that nerve.
- Oh, sure. - With that as well.
So it's always good to add on
if things are good. - Interesting.
- Yeah, so that's the three and again with that one,
test right to left.
- Yep.
- And see how things go.
- I'm almost to your height again.
- (laughs) Wow, yeah, it is kinda neat
because that must be how you are
when you're standing together.
It must be how you-- - Pretty close right here.
- Yeah. - So that's weird.
- Well, we're getting off on another subject,
but good luck with this stretch.
You know, all three of those stretches,
do the one that works best
and get rid of that numbness, tingling, and pain.
- Thanks for watching.
(upbeat music)