Massage & Bodywork

NOVEMBER | DECEMBER 2021

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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 27 "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. Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 20-therapist clinic BodyWork Associates in Champaign, Illinois, and past president of the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit pnmt.org or email him at doug@pnmt.org. TABLE LESSONS 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. "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."

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