Physical Therapist's Guide to Meralgia Parasthetica (Bernhardt-Roth Syndrome)
Meralgia parasthetica, or Bernhardt-Roth syndrome, describes a condition in which numbness, tingling, or burning pain is felt in the outer portion of the thigh. It occurs as a result of nerve compression. Meralgia parasthetica most commonly affects middle-aged individuals, and men more than women. However, it can develop in people of all ages. Physical therapy is a safe and effective approach for managing the symptoms, and some causes, of meralgia parasthetica.
What is Meralgia Parasthetica (Bernhardt-Roth Syndrome)?
Meralgia parasthetica occurs as a result of compression to the lateral femoral cutaneous nerve, a long nerve that stretches from the spine through the groin and into the upper thigh. Abnormal compression at any point along the nerve can cause symptoms.
The lateral femoral cutaneous nerve provides sensation to the outside portion of the thigh, but does not aid in the movement of the leg. If the nerve becomes compressed and irritated, individuals may experience the numbness, tingling, or burning pain in the region of the outer thigh associated with meralgia parasthetica.
The most common causes of meralgia parasthetica are those associated with increased pressure in the groin area, including:
- Wearing compressive garments such as a work belt, a military or police uniform, or tight jeans
- Obesity or weight gain
- Recent hip injury
Other causes can include:
- Direct trauma to the nerve, such as from a seatbelt in a car accident
- Repetitive leg motions (extended periods of biking, walking, squatting)
- Muscle spasms
- Postsurgical complications, most common after surgery to the hip or lower back
- Diseases, such as diabetes, alcoholism, or lead poisoning
How Does it Feel?
A person with meralgia parasthetica may experience:
- Numbness, tingling, or burning pain on the outside of the thigh
- Increased tenderness to light touch on the outside of the thigh
- Pain when lying on the involved side
- Increased sensitivity to extremes in air or water temperature
- Increased sensitivity to different textures of clothing
Pain is often worse with standing or walking, and decreases with sitting.
How Is It Diagnosed?
The diagnosis of meralgia parasthetica is based primarily on the findings of a patient’s history and physical exam. Further tests are rarely needed. Diagnostic imaging techniques, such as x-ray or MRI, are not used to diagnose meralgia parasthetica, but may be used by a physician to rule out other disorders.
Your physical therapist will review your medical history and discuss your symptoms with you. You will also discuss your daily and work activities, exercise regimens, and the clothing or uniforms that you typically wear to identify contributing factors of your condition.
Your physical therapist will perform a thorough physical examination of your back, hip, and leg. The goals of the initial examination are to determine the source of your pain or discomfort, and identify any contributing factors. Your physical therapist will assess the mobility and strength of your back, hip, and leg, and may watch you walk, step onto a stair, squat, or balance on 1 leg. Your physical therapist will also gently touch the front, side, and back of your hip and leg to determine exactly where your symptoms are most bothersome.
How Can a Physical Therapist Help?
Each case of meralgia parasthetica is unique. No matter what the cause, physical therapy can implement treatments to help manage your symptoms. In addition, for patients whose meralgia parasthetica is caused by a disorder in the hip or pelvis, physical therapy will also address those areas, with the goal of eliminating compression on the nerve.
You and your physical therapist will work together to develop a plan to help achieve your specific goals. To do so, your physical therapist will select treatment strategies in any or all of the following areas:
Pain Relief. Many pain-relief strategies may be implemented. Desensitization strategies, using items of various textures and temperatures, are used to decrease your leg's extreme sensitivity. Your physical therapist may prescribe a decrease in or avoidance of certain activities, or a change in clothing. Your physical therapist also may apply therapeutic tape to the affected area to help relieve your symptoms.
Range of Motion. Your back, hip joint, or surrounding muscles may be moving improperly, causing increased compression on the nerve. Your physical therapist may teach you self-stretching techniques to decrease tension and help restore normal motion in the back, hip, and leg.
Manual Therapy. Your physical therapist may apply hands-on treatments to gently move your muscles and joints to improve their motion and strength, most likely in your back or hip. These techniques often address areas that are difficult to treat on your own.
Muscle Strength. Muscular weaknesses or imbalances often correlate with an injury to the hip or pelvis, which can contribute to nerve compression. Based on your specific condition, your physical therapist will design a safe, individualized, progressive resistance program for you, likely including your core (midsection) and lower extremity. You may begin by performing strengthening exercises lying down, and advance to exercises in a standing position. Your physical therapist will choose what exercises are right for you, based on your age and physical condition.
Functional Training. Often with meralgia parasthetica, symptoms are caused or made worse by any repetitive movements required in your daily or work activities. Based on your own unique movement assessment and goals, your physical therapist will create a series of activities to help you learn how to use and move your body more correctly and safely.
Patient Education. Your physical therapist will work with you to identify and change external factors causing your pain or discomfort. Your physical therapist will assess you and recommend safe improvements or alternatives. Suggested: Your physical therapist will work with you to identify and change external factors causing your pain or discomfort, and make recommended safe improvements or alternatives.
Can this Injury or Condition be Prevented?
Understanding the causes of meralgia parasthetica, and modifying them when possible (eg, changing tight clothing; altering an aggravating daily, work, or exercise activity; and achieving and maintaining appropriate mobility and strength) are the best methods for preventing many cases of meralgia parasthetica. Other cases, such as those caused by a traumatic injury are more difficult to prevent.
Real Life Experiences
Matthew is a 34-year-old police officer who recently began training for his first sprint triathlon. He trains 5 to 6 days each week, including strength training twice a week.
Over the past week, Matthew has begun to experience burning pain on the outside of his left thigh. He has noticed that his leg is now sensitive to hot water in the shower, and to his pants rubbing against his thigh as he walks. His pain is at its worst when he's wearing his police uniform. Matthew becomes concerned when the pain doesn’t go away for days. He calls his physical therapist.
Matthew's physical therapist conducts a comprehensive assessment of his motion, strength, sensation, balance, and movement, including a detailed examination of his low back and hip joints. She gently touches the front, side, and back of his hip and leg to determine the precise location of his pain. Matthew describes his symptoms and the activities that aggravate it, as well as his typical daily work and training routines.
She notes that with Matthew’s recent increased training for his triathlon, the muscles surrounding his hip have become exceptionally tight. The increased muscle tightness, combined with persistent compression while wearing his police uniform, has resulted in irritation of the lateral cutaneous femoral nerve, causing his leg symptoms. She diagnoses meralgia parasthetica.
Matthew and his physical therapist work together to establish short- and long-term goals and identify immediate treatment priorities, including modification of his work belt, and implementation of desensitization techniques to decrease his pain, as well as gentle hip-stretching exercises. She designs an individual home-exercise program for him to help his recovery.
Together, Matthew and his physical therapist outline a 6-week rehabilitation program. Matthew receives physical therapy treatments 2 times each week, including manual therapy techniques. Matthew also performs an independent daily exercise routine at home, including stretching and strengthening activities.
After 6 weeks of treatment and exercise, Matthew no longer feels burning pain or increased sensitivity in his leg. He is excited to continue his training program pain free, in preparation for the upcoming triathlon.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat meralgia parasthetica. However, you may want to consider:
- A physical therapist who is experienced in treating people with meralgia parasthetica. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have meralgia parasthetica.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and describe what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of meralgia parasthetica. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther. 2013;8(6):883–893. Free Article.
Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(5):336–344. Article Summary in PubMed.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Allison Mumbleau, PT, DPT, SCS. Reviewed by the MoveForwardPT.com editorial board.
Provided by the