Is Important to highlight that the nerves described in all hip entrapments have the origin at the level of the lower spine, hence the lower back evaluation and treatment should be incorporated when dealing with patients with any hip neurological complaint.
There are three types of classifications based on the location of the nerve irritation:
Inguinal – Is an area in front of the hip joint where important structures can be compromised due to a narrowing of the inguinal canal caused by dysfunctional misalignment patterns of the pelvis and hip leading to the following nerve syndromes.
Femoral Neuropathy: Irritation of the femoral nerve causes pain that radiates into the anterior thigh and inner calf. Weakness of the quadriceps muscles can be quite marked.
Ilioinguinal Neuralgia; Causes burning pain and occasionally numbness over the lower abdomen that radiates into the scrotum or labia.
Genitofemoral Neuralgia: Pain radiates to the inner thigh and into the labia majora in woman and the bottom of the scrotum and cremasteric muscles in men.
Meralgia paresthetica is a condition that cause pain at the outside of the thigh with due to the irritation of lateral cutaneous nerve
Obturator – The obturator canal is an opening passage made up by the pubic and ischium bones where the obturator never runs through. A specific pelvic misalignment is usually responsible for creating an obturator neuralgia. Pain usually radiates into the medial thigh.
Ischium – Due to the close relationship with the posterior part of the pelvis, the sciatic nerve could be compressed due to pelvic misalignments increasing secondary tension on the associated soft tissue as seen in piriformis sciatic neuropathy. Patients complaint with severe pain in the buttocks that may radiate into the lower extremity. Depending on the level of never pressure, significant weakness and numbness develops in the leg and foot area.
Chronic injuries at the hip may also narrow the nerve passage due to the scar/fibrotic tissue at the superficial fascia and by the osteophytic bone formation from the underlying bones.
Assessment
The entire lower extremity biomechanical chain must be evaluated as part of the hip neurological analyses as per the neurological and mechanical influences of the spine, knee and foot..
Clinical assessment of the Pelvic and Hip joints.
Tinel Neurological sign and examination.
X-ray analysis
Lateral and Anterior – Posterior (AP) X-ray pelvic/hip views are essential to check pelvic and hip alignment
MRI analysis
Important exam to verify the level of narrowing of the nerve passage and the exact point of irritation
Rule out any other condition; There are rare disorders that may create similar patterns of dysfunction, is advisable to rule out these conditions prior to the start of the treatment.
Treatment protocol
Restore the biomechanical alignment of the pelvis and hip.
Neuromobilization techniques may be used once the direct compression of the nerve is reduced.
Specific therapeutic essential oils are applied to reduce nerve inflammation and enhance healing.
Depending on the level of nerve compromised and chronicity of the misalignment a minimum of 6 weeks up to 12 weeks of treatment care may be necessary to resolve this deformity.
