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which is one of the locations where it is frequently entrapped (Image 6). Just after the nerve passes under the inguinal ligament, it passes through the fascia lata of the thigh. The fascia lata is a connective tissue sleeve encompassing all the thigh muscles. When nerves pass through muscles or connective tissues, as they often do, they are highly susceptible to compression. There are a few different anatomical variations in the pathway of the LFCN. In some cases, the nerve may pierce through the inguinal ligament or the sartorius muscle as it is leaving the pelvis and entering the anterior/lateral thigh region. It is common for nerve compression to occur in this region from clothing such as tight jeans, especially if the individual is sitting for long periods. Nerve compression can also occur from belts, girdles, military armor, seatbelts, or in diabetic or obese people. Symptoms from LFCN compression can include burning sensations, coldness, numbness, pain, paresthesia, and/or disturbances in sensation or itching, or buzzing sensations in the skin of the lateral hip or thigh. Some people find pain sensations from LFCN compression so strong, they won't put things in their pocket on that side because of additional pressure on the nerve. LFCN pathology is often mistaken for other conditions, such as abductor muscle pain, hip joint pain, iliotibial band pain, joint capsule problems, lumbar nerve root pathology, myofascial trigger points, or trochanteric bursitis. It is common for manual therapy practitioners to engage direct treatment of these tissues in an effort to address the pain problem. However, in many cases, this treatment approach might cause further aggravation of the problem if they do not recognize that the disorder is coming from nerve compression. Manual compression of nerves from soft-tissue work can further aggravate the condition. The LFCN is a very small nerve and often the region of compression is simply a small area where the nerve perforates through another tissue, where it becomes constricted. One of the more effective ways to address this type of disorder is simply applying traction to the skin and pulling the skin over the upper anterior thigh in an inferior direction (Image 7). This treatment actually helps to mobilize the nerve tissue and decrease the degree of binding between the nerve and adjacent tissues that are interfering with it. The first step in resolving many clinical problems is accurately determining what the problem is to begin with. Medical references don't cover many of these superficial nerves in much detail, so it is no surprise that there is often little attention paid to nerve dysfunction from them. Now that you know a bit more about their existence and roles, and how they may contribute to your clients' complaints, you can consider them as potential factors in your assessments. Notes 1. W. J. Mixter and J. S. Barr, "Rupture of the Intervertebral Disc with Involvement of the Spinal Canal," New England Journal of Medicine 211 (1934): 210–15. 2. Nerves and Nerve Injuries: Vol 1: History, Embryology, Anatomy, Imaging, and Diagnostics, eds. R. S. Tubbs et al. (Amsterdam: Elsevier, 2015). 3. Yoichi Aota, "Entrapment of Middle Cluneal Nerves as an Unknown Cause of Low Back Pain," World Journal of Orthopedics 7, no. 3 (March 2016): 167–70. doi:10.5312/wjo.v7.i3.167. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. 6 7 Lateral femoral cutaneous nerve. Image is from 3D4Medical's Essential Anatomy 5 application. Applying traction to treat LFCN restriction (yellow arrow). Image is from 3D4Medical's Essential Anatomy 5 application. C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 101 Lateral femoral cutaneous nerve