“Want to hear my sad story?” she asked.

This can’t be good, I thought to myself.

“I think it’s back again,” she said. “It started three or four days ago. I thought this was over for good, but here we go again.”

Months ago, my client Ms. S. had a bout of sciatic nerve irritation that was stubborn and quite complex. It took multiple sessions to resolve the problem, and it was a delicate process to create results without further irritating the nerve. The thought of revisiting this issue wasn’t pleasant for either of us.

“It’s so frustrating not to be able to sleep on this side again,” she continued. “I’ve been able to sleep on either side for weeks, but now if I lie on my left side for more than 30 minutes, I feel a deep aching pain going down my leg,” she said as she brushed her hand over the pain pattern.

Even though my brain was consumed with the idea of revisiting a difficult road, her tracing of the pain pattern caught my attention—something didn’t fit the previous pattern.

“Can you show me again where you feel the pain?” I asked.

Ms. S. traced the pain pattern, which did not follow the path of the sciatic nerve but the lateral and anterior part of the thigh. I instructed her to repeat the tracing yet again, and it was clearly not what she experienced weeks ago. When I mentioned my observation of the difference between the two presentations, she immediately agreed.

“You know, that’s right. I didn’t even notice that until you pointed it out. I was so focused on the fact that I could not sleep on my side, I didn’t notice the difference.”

“Do you ever feel the aching pain go below the knee?” I asked.

“Nope, it always stops about here,” she replied, pointing to the area just above the femoral condyle. “You know, that is also different than the sciatic pain I felt into my calf.”

“That makes me think this might be a different problem,” I answered. “What you describe could possibly be an irritation of the lateral femoral cutaneous nerve, called meralgia paresthetica. Your symptoms fit that pattern very closely.”

I asked Ms. S. to lie on my treatment table and began exploring possible sites of insult to the lateral femoral cutaneous nerve, such as the tensor fascia lata and the sartorius. As I was exploring the tissue, she asked a wonderfully insightful question.

“I assume that when you hit the area that’s the source of the problem, it will recreate my symptoms. Do you want me to tell you when I feel that?”

“What a great question!” I replied. “Many of the issues we’ve addressed over the last couple years have been muscular in nature. In those cases, when I am exactly on the problem area, it replicates your symptoms perfectly, and that tells us we are in the right place. This, however, is a different situation. With many neural problems, replicating symptoms isn’t wise, and with this nerve, it is seldom possible. Unfortunately, you won’t have that sense of validation that we are on the exact area of insult. The guide here might be tissue sensitivity, but not exact replication.”

“What might have caused this in the first place?” she asked.

“There is often some sort of activity that puts pressure on the nerve over time. I’ve seen cases in police officers and construction workers where a heavy belt can compress the nerve, and I’ve seen a few cases that happened during pregnancy. Most cases are from slow compression on the nerve over time. I’m sure it can happen with blunt trauma as well.”

“Oh,” she replied, with a change in her voice; I raised my eyebrows in response. “A few days ago, I was in the kitchen and turned a corner too quickly. The end of the counter hit me right where you are working. Would I have felt it shoot down my leg at the time?”

“Not likely,” I answered. “But that may indeed may have been the incident that sensitized the nerve. Sleeping on your side adds just enough additional pressure to further irritate the nerve. If we can calm it down, everything should improve over the next 5–7 days.”

That is exactly what happened—her pain disappeared in less than five days. She wisely decided not to challenge it by sleeping on her side; best to let the nerve calm down before trying that too soon.

Having not seen someone with meralgia paresthetica symptoms for at least three years, I was slightly amused to discover my very next client presented with exactly the same symptoms as Ms. S.! True to form, the cause turned out to be something completely different. Such is life in the clinic.