Neural Mobilization in Pregnant Women with Meralgia Paresthetica

Javaid et al.

Original Article
Effects of Neural Mobilization of Lateral Femoral Cutaneous Nerve on
Neuropathic Pain and Quality of Life in Pregnant Women with Meralgia
Paresthetica
Hira Bano Javaid1 , Ayesha Jamil1* , Mutahhar Hussain2 , Fariha Khalid1
1*
University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan . 2 National Pain
Clinic Orthopedic and Spine, Lahore, Pakistan.

ABSTRACT
Background: Meralgia paraesthetica is a neurological condition characterized by a tingling, prickling, or
burning sensation on the skin of the anterolateral thigh. It is one of the nerve entrapment syndromes in
pregnant females. There is a need for an effective physical therapy management approach to treat this
disabling condition. Objective: To determine the effects of neural mobilization of lateral femoral
cutaneous nerve on neuropathic pain and quality of life in pregnant women with meralgia paresthetica.
Methods: This quasi-experimental study was conducted from January 2022 to January 2023 in the
physical therapy department of the University of Lahore Teaching Hospital, Lahore. By purposive
sampling technique, 30 pregnant women primarily diagnosed with meralgia paraesthetica and a positive
pelvic compression and neurodynamic test, age ranges from 18 to 40 years and body mass index
≥25kg/m2 were included in the study. Those having other entrapment syndromes or radicular
symptoms and motor weakness, having a history or ongoing cancerous proliferation or active
infection were excluded. Lateral femoral cutaneous nerve mobilization in addition to routine
physiotherapy was provided on alternate days, thrice a week for up to two weeks. Neuropathic pain and
quality of life were the outcome variables measured through the neuropathy pain scale and quality of life
short form health survey-36 respectively at baseline, 1st and 2nd week. SPSS version-24 was used for
statistical analysis. Repeated measure analysis of variance was applied for within group difference of
outcome measure. Results: The mean age of participants was 32.82±3.80 years and the body mass index
was 26.62±1.81 kg/m2 . A statistically significant improvement in pain score was observed from a mean of
62.41±10.39 at baseline to 45.95±10.53 in 1st week and to 29.48±10.90 in 2nd week. All domains of short
form-36 were also significantly improved (p≤0.00). Conclusion: It was concluded that lateral femoral
cutaneous nerve mobilization with conventional physiotherapy in pregnant women with meralgia
paresthetica is significantly effective in reducing neuropathic pain and improving quality of life.

*Correspondence: Ayesha Jamil,

Citations: Javaid HB, Jamil A,
The University of Lahore, Lahore,
Hussain M, Khalid F. Effects of
Pakistan.
neural mobilization of lateral
Email: ayeshabutt031@gmail.com
Access femoral cutaneous nerve on
Keywords: Bernhardt Roth
the article neuropathic pain and quality of life
syndrome; lateral femoral cutaneous
online in pregnant women with meralgia
nerve; neural mobilization; meralgia
paresthetica. The Healer Journal of
paresthetica; neuropathic pain;
Physiotherapy and Rehabilitation
quality of life
Sciences. 2023;3(6):560-568.
DOI: 10.55735/hjprs.v3i6.155

Copyright©2023. The Healer Journal of Physiotherapy and Rehabilitation Sciences.

This work is licensed under Creative Commons Attributions 4.0 International license

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 Neural Mobilization in Pregnant Women with Meralgia Pare sthe tica
Javaid et al.
INTRODUCTION
Meralgia paresthetica (MP) is a peripheral
sensory mononeuropathy of the lateral femoral
cutaneous nerve (LFCN), characterized by
pain, numbness, tingling and burning
sensation over the anterior and outer part of
the thigh, results from compression, or
overstretch of the nerve.1 It can affect any
individual at any stage of life2 and is rare
outside the pregnancy, having spontaneous
and iatrogenic origin.3 The MP is not a
sickness that puts a person's life in jeopardy
but it can lead to morbidity if it is not detected
and treated promptly. Several other
mechanical elements have the potential to
contribute to elevated levels of pressure within
the abdominal cavity such as being
overweight, being pregnant, frequently
extending the hip, sitting for lengthy periods,
wearing clothing that is overly constricting, or
seat belts4 and lithotomy position while
delivery.5 Orthopaedic treatments, in
particular pelvic osteotomies and spine
surgeries are examples of the kinds of
iatrogenic causes that might lead to the
development of MP.6
During the period of pregnancy, the chances
of entrapment neuropathies increase owing to
changes in the physiological, hormonal, and
metabolic system and biomechanics of the
body.7 With the increasing trimester, the
weight of the fetus puts additional forces on
the lower back, pelvic girdle and lower limb,
resulting in musculoskeletal pain8 and
compression or overstretch on lumbosacral
plexus and peripheral nerves7 causing
discomforts and impairments. The selection of
treatment options for neuropathies should be
safe considering pregnancy which may result
in symptomatic relief and alleviate the
development of chronic symptoms.9
Treatment of MP typically begins with more
non-invasive conservative therapy.10 Patient
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education is paramount and includes weight
management and avoiding tight clothing,
prolonged static postures and staying
physically active.11 Medical management
includes the use of anticonvulsants,
nonsteroidal anti-inflammatory medicines,
tricyclic antidepressants and injections of a
nerve block.5,10 Physiotherapy and manual
therapy modalities12 such as icing, soft tissue
and neural mobilization, muscle energy
techniques (METs), Kinesio taping13 and
active release therapy are the common
methods to relieve the symptoms.14
Conservative treatment helps around 85
percent of patients to recover within three
months, whereas cases that are brought on by
pregnancy typically get better after the baby is
born. However, the surgical approach is only
considered if conservative therapies have
failed to produce adequate outcomes, or if the
patient's suffering has reached an intolerable
level.15 Nerve or Neural mobilization (NM) is
prudent to avoid unneeded injury or ischemic
compression of the LCFN. Pain relief,
enhanced muscular endurance and flexibility,
and reduction in neural tension and
mechanosensitivity are the goals of the NM.16
As it increases the flexibility of
neuromuscular tissues, and there is an increase
in both the axoplasmic and intra-neural blood
flow that makes it an effective treatment for
the management of MP.17 Only a small
number of studies have looked into the effects
of therapeutic exercises and manual therapy
techniques on neuropathic pain and quality of
life in meralgia paresthetica.12,13 Moreover, to
our knowledge, there is no such study
conducted on pregnant females besides the
higher incidence of MP during pregnancy.
Therefore, this study aims to determine the
effects of the application of neurodynamics
nerve mobilization of LFCN with
conventional physiotherapy on neuropathic
 Neural Mobilization in Pregnant Women with Meralgia Pare sthe tica
Javaid et al.
pain and quality of life in pregnant women
with MP.
METHODS
This quasi-experimental study was a pre-
posttest design with a single group conducted
in the outpatient physiotherapy department of
the University of Lahore Teaching Hospital,
The University of Lahore, from January 2022
to January 2023. The ethical approval was
taken from the Research Ethics Committee of
the University of Lahore (Ref No: REC-UOL-
259-11-2022). This study was conducted
using guidelines of Transparent Reporting of
Evaluations of Nonrandomized Designs
(TRENDS)18 and following the declaration of
Helsinki ethical principles. The participant’s
enrolment and allocation are summarized in
Figure 1.
Before recruiting into the study, informed
consent was obtained from participants, and
study objectives were explained to them. It
was told that there are no potential risks
involved, and they have the right to withdraw
from the study at any point. Anonymity and
confidentiality of data were maintained. A
sample size of 30 was calculated using a
population proportion of 0.4319 , the
anticipated proportion of 0.20, a level of
significance α=5%, power of test 1-β= 80%
and a 15% dropout rate. Pregnant women
presented with complaints of pain, numbness,
tingling or burning sensation, and diagnosed
with MP in the gynecology outpatient
department were selected using a purposive
sampling technique. Women of age 18 to 40
years, having BMI ≥ 25kg/m2 were included
in the study. Further screened through positive
pelvic compression and neurodynamic test.
Those having other entrapment syndromes or
radicular symptoms and motor weakness,
having a history or ongoing cancerous
proliferation or active infection were excluded
from the study. The participants were given
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conventional physiotherapy including soft
tissue release, psoas major stretch, and
strengthening exercises i.e. pelvic stabilization
and abdominal core exercises along with
LFCN mobilization. Neural mobilization was
performed on the patient while they were
lying on their side with the affected side
facing up and their knee bent to a 90-degree
angle. The therapist then extended and
abducted the patient's hip while performing
the procedure. The nerve stretch was repeated
five times, each time with a hold for 10
seconds, followed by a rest for 5 seconds. The
treatment was given on alternate days, for up
to two weeks.
The total duration of the session was about
thirty minutes and it was given in the physical
therapy outpatient department. Neuropathic
pain was measured by neuropathy pain scale
(NPS)20 and for the evaluation of quality of
life; short form-36 questionnaire21 was used.
Outcomes measures were recorded at baseline
before the start of the intervention and at the
end of 1st week after 3rd treatment session and
in 2nd week after the 6th treatment session by
an independent assessor who was unaware of
the treatment provided. The data was entered
and analyzed using SPSS version-24. The
normality of data was checked by the Shapiro-
Wilk test. The numerical data like age and
score of NPS were presented in the form of
mean and standard deviation. Categorical data
like BMI, occupation, parity were presented in
the form of frequency (percentage). Repeated
measure analysis of variance (ANOVA) was
used for the comparison of repeated measure
analysis of variance within the subjects. The
significance of the results was determined by
p-value (p<0.05). Intention to treat analysis
was used for missing data.
RESULTS
The mean age of the participants was
32.82±3.80 years and the body mass index
 Neural Mobilization in Pregnant Women with Meralgia Pare sthe tica
Javaid et al.

Figure 1: CONSORT Flow Chart

Assessed for Eligibility

(n=50)

Excluded participants (n=20)

Eligibility • Not upto the mark of
inclusion criteria (n=15)
• Refused to take part (n=2)
• Other (n=3)

Non-randomized
Study (n=30)

Allocation

Allocated to group
(n=30)
Received Intervention
(n=30)

Follow up

Lost to Follow-up
(n= 3)
Discontinued
Intervention (n=2)

Analysis

Analysis (n=30)
Intention to Treat
Analysis Applied
(n=5)

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 Neural Mobilization in Pregnant Women with Meralgia Pare sthe tica
Javaid et al.

as 26.62±1.81kg/m2 . The socio-demographic on the SF-36 questionnaire from baseline

details and gynecological history of intervention till 2nd week (p≤0.00) using
participants are given in Table 1. The results repeated measure ANOVA (Table 3).
for the neuropathic pain score on NPS showed
that pain was reduced from 62.41± 10.39 at DISCUSSION
the time of recruitment in the study to
29.48±10.90 in 2nd week (p≤0.00). It is also Meralgia Paraesthesia is a sensation of
significant within-group difference was tingling, prickling, or burning of a person's
observed between domains of quality of life skin with no apparent long-term physical

Table 1: Demographics & Gynaecological Details of Study Participants

Characteristics Variable Mean Std. Deviation

Age (in years) 32.82 3.80

Weight (Kgs) 69.90 3.99

Height (cm) 162.12 3.20

Body Mass Index (kg/m2) 26.62 1.81

Frequency Percent
Upper 14 34.1

Socioeconomic status Middle 22 53.7

Lower 5 12.2
Job 20 48.8
Occupation
Housewife 21 51.2
Primi-gravida 7 17.1
Gravida
Multi-gravida 34 82.9
First 10 24.4

Trimester of Pregnancy Second 8 19.5

Third 23 56.1

Yes 11 26.8
History of Episiotomy
No 30 73.2

Previous History of No 32 78
Abortions/ Miscarriage Yes 9 22

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 Neural Mobilization in Pregnant Women with Meralgia Pare sthe tica
Javaid et al.
Table 2: Neuropathic Pain Score & Quality at Baseline, 1st and 2nd Week
Background
Pain Score
Neuropathic Pain Pain Always
Mean ± SD n (%)
Before Treatment 62.41 ±10.394 34 (82.9%)
At 1 st Week 45.95 ±10.537 12 (29.3%)
At 2 nd Week 29.48 ±10.902 0 (0.0%)
effects. A less common manifestation is
formication, the sensation of insects crawling
on or under the skin.9,22 During pregnancy, a
woman may experience a variety of physical
and mental issues, all of which require her to
find solutions to maintain a healthy pregnancy
for both the mother and the unborn child. This
study aims to address the management of
nerve entrapment neuropathy using nerve
mobilization during pregnancy and the
resulting pain and quality of life. The results
showed that the neural mobilization of the
lateral femoral cutaneous nerve has proved to
have a significant influence on the alleviation
of pain, the enhancement of physical and
emotional health, and the reduction of limits
caused by difficulties of neuropathy to the
body.
MP is relatively a rare condition with less
amount of studies being conducted especially
with pregnant females and very little research
has been done in the past on how
physiotherapy may be used to treat MP. A
study on the efficacy of four-week treatment
of exercise therapy and Kinesio taping on
patients with meralgia paresthetica
demonstrated a substantial improvement in the
symptoms of meralgia paresthetica as well as
the patient's overall quality of life. The
findings of the outcomes showed an
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Single Type Single Type of
p-value
of Pain Time Pain Sometimes
n (%) n (%)
4 (9.8%) 3 (7.3%)
25 (61.0%) 4 (9.8%) 0.00
13 (31.7%) 28 (68.3%)
improvement in neuropathic pain as well as
quality of life, which was consistent with the
findings of our study 13 . Likewise, a study on
determining the effects of nerve flossing on
femoral nerve neuropathy in children with
hemophilia showed significant improvement
in pain scores.23
The current study adapted the position of
neural mobilization in side lying with hip
extension and abduction. A similar study was
conducted on MP patients in which LFCN
neural mobilization and hip flexor self-
stretching were compared. They concluded
that hip flexor stretching with a gradual
gluteal muscle strengthening program reduced
LFCN neural tension more than neural
mobilization exercises.24 But this study had
only one participant who was in good health
and had no substantial family history or any
medical issues or comorbidities. Furthermore,
the exercise position was not suitable for
pregnant females, therefore its findings cannot
be applied to current participants. However,
the current study had a few limitations as well,
such as the control group was not made and
the comparative treatment was not given.
It is recommended that all symptomatic
pregnant females should be referred to
physical therapy for solutions on a physical
basis without the use of chemical substances.
 Neural Mobilization in Pregnant Women with Meralgia Pare sthe tica
Javaid et al.

Table 3: Quality of Life on SF-36 scale at Baseline, 1st and 2nd Week

Std
Outcome Variable Time of Assessment Mean p-value
Deviation

Before Treatment 41.0976 8.59594

Physical Function At 1st Week 56.8293 8.78038 0.000

At 2nd Week 72.5610 9.21968

Before Treatment 37.7561 5.07336

Role Limitations
Due to Physical At 1st Week 56.9512 4.99976 0.000
Health
At 2nd Week 76.1463 5.24195
Before Treatment 42.9756 8.64722
Role limitations
due to Emotional At 1st Week 61.8049 8.91970 0.000
Problems
At 2nd Week 80.6341 9.45716

Before Treatment 44.7317 8.30971

Energy/Fatigue At 1st Week 49.6829 8.31095 0.000

At 2nd Week 54.6341 8.38974

Before Treatment 48.5122 4.85861
Emotional Well- At 1st Week 51.4878 5.05530 0.000
Being
At 2nd Week 54.4634 5.38097
Before Treatment 50.8537 4.59653

Social Functioning At 1st Week 55.8049 4.66487 0.000

At 2nd Week 60.7561 5.21431

Before Treatment 45.2683 5.54988

Pain At 1st Week 60.3659 5.35143 0.000

At 2nd Week 75.4634 5.50953

Before Treatment 45.4878 7.79783

General Health At 1st Week 53.4878 7.72697 0.000

At 2nd Week 61.4878 7.74636

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 Neural Mobilization in Pregnant Women with Meralgia Pare sthe tica
Javaid et al.

Future studies should be conducted with better Review: Update on Presentation,

methodological quality to determine the Pathophysiology, and Treatment. Health
effects of NM on MP treatment. Psychology Research 2023; 11.
5. Zeliha Karaahmet O, Gurcay E, Ozturk
CONCLUSION D, Guzel S, Cakci A. A rare presentation of
meralgia paraesthetica in limb girdle muscular
The findings concluded that neural dystrophy. Scottish Medical Journal 2018;
mobilization techniques in physical therapy in 63(1): 25-7.
pregnant women with meralgia paresthetica 6. Patijn J, Mekhail N, Hayek S, Lataster
were significantly effective in improving A, van Kleef M, Van Zundert J. Meralgia
neuropathic pain quality and level and quality paresthetica. Evidence‐Based Interventional
of life domains including physical function Pain Medicine: According to Clinical
and health, role limitation in physical and Diagnoses 2011: 155-9.
emotional health, pain, social functioning, 7. Ciafaloni E, Thornburg LL, Bushnell
energy, and general health. CD. Neurological Diseases and Pregnancy: A
Coordinated Care Model for Best
DECLARATIONS Management: Oxford University Press; 2018.
8. Aragão FFd. Dor lombossacral
Consent to participate: Written consent had relacionada à gestação. BrJP 2019; 2: 176-81.
been taken from patients. All methods were 9. Gooding MS, Evangelista V, Pereira
performed following the relevant guidelines L. Carpal tunnel syndrome and meralgia
and regulations. paresthetica in pregnancy. Obstetrical &
Availability of data and materials: Data will gynecological survey 2020; 75(2): 121-6.
be available on request. The corresponding 10. Prasetio AD, Hidayati HB. Diagnosis
author will submit all dataset files. and Recent Management of Meralgia
Competing interests: None Paresthetica. Diagnosis and Recent
Funding: No funding source is involved. Management of Meralgia Paresthetica 2022;
Authors' contributions: All authors read and 99(1): 13-.
approved the final manuscript. 11. Sierra-Silvestre E, Bosello F,
Fernández-Carnero J, Hoozemans MJ,
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