Femoral Nerve Damage

Femoral neuropathy, or femoral nerve damage, refers to any disorder that results from damage to the femoral nerve.

The femoral nerve is one of the largest nerves in the leg. It begins in the pelvis near the groin. It then separates into several smaller branches as it moves down the leg. It controls the muscles that help straighten the leg and move the hips. It also provides feeling (i.e. when there is pressure) in the front of the thigh and the inner calf.

Image Courtesy of Physiopedia: Femoral Nerve

Damage to the femoral nerve can cause numbness, weakness, or paralysis of the legs. It affects the ability to walk and may cause problems with sensation in the leg and foot. The leg or knee might feel weak, and pressure may not be able to be put on the affected leg. Some experience pain, from mild to extreme.

Furthermore, femoral nerve damage can lead to other injuries. The loss of sensation can lead to accidents, while having weak leg muscles creates a risk for falling.

Image Courtesy of Physiopedia: Femoral Nerve

Signs of Femoral Neuropathy

  • Muscle weakness in your legs (can be from the hip down or just part of you leg)
  • Difficulty extending or inability to extend the knee
  • Feeling like your leg or knee is going to give out (or have it actually buckle/give out)
  • Numbness in any part of the leg (most often the front and inside of the thigh, but can be all the way down to the feet)
  • Tingling in any part of the leg
  • Pain (can be mild or extreme, dull or sharp, intermittent or constant)
  • Dull aching pain in the genitalia region

Diagnosing Femoral Neuropathy

To diagnose femoral nerve damage after childbirth, first and foremost bring up any of the signs written above to your doctor or medical staff, as well as any other issues you are having. Many labor and delivery personnel are not familiar with nerve damage from childbirth so be clear, be firm and advocate for yourself.

Due to this lack of knowledge, many women have not had good support from their OBs and midwives. If this is happening to you, often primary care physicians work well as a primary contact, or if your insurance allows, going directly to a neurologist works well.

After discussing symptoms, your doctor will generally perform a physical exam. Often a neurologist will be called in to do this regardless of what doctor is your principal contact.

To look for weakness, they will test specific muscles that receive sensation from the femoral nerve. Your doctor will probably check your knee reflexes and ask about changes in feeling in the front part of the thigh and the middle part of the leg. The goal of the evaluation is to determine whether the weakness involves only the femoral nerve or if other nerves are also affected.

Depending on the extent of damage, there are several other or next steps. If you haven’t already been seen by a neurologist, the doctor may recommend it. If you have seen a neurologist, he or she might recommend further testing, described below.

You do not have to see a neurologist. If you need referrals for insurance purposes, your primary care physician can write prescriptions for physical therapy, chiropractic services, acupuncture, massage therapy, devices to assist walking and more. However, the nerve conduction and EMG are performed by a neurologist.

Nerve Conduction

Nerve conduction checks the speed of electrical impulses in your nerves. An abnormal response, such as a slow time for electrical signals to travel through your nerves, usually indicates damage to the nerve in question. Some find this test uncomfortable or painful, some do not. This is conducted by a neurologist.

Electromyography (EMG)

Electromyography (EMG) is performed after the nerve conduction test. It tests to see how well your muscles and nerves are functioning by recording the electrical activity present in your muscles when the nerves that lead to them are active. The EMG will identify whether the muscle responds correctly to stimulation. Because nerves stimulate and control your muscles, the test can determine problems with both muscles and nerves. This is conducted by a neurologist.

MRI Scan

A MRI scan can look for tumors, growths, or any other masses in the area of the femoral nerve that could cause compression on the nerve. MRI scans use radio waves and magnets to produce a detailed image of the part of your body that is being scanned. A MRI scan is also used after childbirth to check for damage caused by an epidural, if applicable. This can be requested by a OB, primary care physician, or neurologist.

Recovery

  1. First and foremost, advocate for yourself. Be clear about your symptoms. Do not let any doctor or staff tell you it is normal and to move on.
  2. Find a doctor who is willing to help you. This could be your OB or midwife. Often it is a primary care physician. Many see a neurologist as well. If one is not helpful or at the least willing to help, move on and find another.
  3. Get any assisted devices you need. This can be a knee brace to try to keep the leg from buckling. This can be a wheelchair if you can’t walk at all. This can be a walker or cane. Many progress from a wheelchair, to a walker, to a cane, before walking without any assistance. A shower chair can be helpful as well as a toilet safety rail.
  4. Set up your space to be with baby in as easy of a way as possible. For example, have everything you need on one floor. Put diaper changing supplies in a basket within easy reach. Put nursing pillow or bottles within easy reach.
  5. Figure out a rehabilitation plan with your supportive doctor. Discuss the following options with her/him:
    • Physical therapy – most women with this injury find this most helpful in their recovery. It keeps your muscles from atrophying too much, strengthens them when they do get weaker, and helps nerves reconnect by just trying to use them. If you can’t drive to physical therapy, request in-home services.
    • Acupuncture
    • Chiropractic services
    • Electrical Muscle Stimulation (EMS) – the goal is to strengthen the muscle without involving the nervous system, helping your muscles not atrophy as much when not able to be used; often used at physical therapy.
    • Transcutaneous Electrical Nerve Stimulation (Tens Machine) – aims to relieve pain using an electrical current; if having nerve pain, can even use at home.
    • Walking
    • Femoral Nerve flossing – watch how to here.
    • Water therapy
    • Massage therapy
    • Stretching
    • Foam rolling
    • Taking B vitamins
  6. Be careful – this injury increases your risk of falling. You don’t need further injuries.
  7. Be patient – nerves take time to regenerate and heal. Then it takes time to strengthen your muscles back to pre-childbirth levels. Just keep putting one foot in front of the other (literally and figuratively!).
  8. Don’t forget to ask for help! From family, friends or others. This is hard.

Initial Exercises

Below are a list of basic exercises that are helpful for recovering femoral nerve damage. As always, please consult a physician before starting any exercises.

  1.  Quad sets – sit down, straighten leg, tighten quad muscles, hold, release, repeat (good to do with an EMS machine on).
  2. Leg raises – sitting up or lying down, raise your leg, bring back down, repeat.
  3. Ball squeezes – squeeze ball between your inner thighs
  4. Seated marches – sit on chair, lift one leg at a time like you are marching.  
  5. Exercise bike
  6. Walk

Once strength comes back, here are a few more advanced strengthening exercises:

  1. Squats – with or without weight
  2. Knee extensions with weights,
  3. Above exercises with weights or resistance bands
  4. Stairs/steps

References:

  1. Femoral Neuropathy. Healthline. 2017 Sep 13. https://www.healthline.com/health/femoral-nerve-dysfunction#outlook
  2. Femoral Nerve Damage. MedlinePlus. 2019 Sep 17. https://medlineplus.gov/ency/imagepages/8786.htm.
  3. Femoral Nerve. Physiopedia. 2020 Sep 28. https://www.physio-pedia.com/Femoral_Nerve
  4. What to Know About Femoral Neuropathy. Medical News Today. 2019 Jan 3. https://www.medicalnewstoday.com/articles/324084#outlook
  5. Transcutaneous Electrical Nerve Stimulation (TENS) vs Electrical Muscle Stimulation (EMS). OMRON. 2020 Jan. https://www.omron-healthcare.com/eu/health-and-lifestyle/pain-management/managing-pain/transcutaneous-electrical-nerve-stimulation-tens-vs-electrical-muscle-stimulation-ems.html

This website is for informational purposes and is not intended nor a substitute for medical advice. Information on the website is not for diagnosing or treating any medical or health condition. Please see your healthcare professional for all medical or health conditions or questions.

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