Femoral Nerve Entrapment By Scar Tissue

[Sasha Pachev]

First, a bit of background. I am currently almost 37 years old.

In 1986-87 (from late 12 years old to early 14) I did an inordinate amount of running on the indoor track at high speeds. We are talking 4 workouts a week that would be something like 3x1000 in 3:15, or 6 K at 5:45 per mile pace, or 8x400 in 70. Yes, I could do that at the age of 13.

Around the age of 14 I noticed tightness in the right adductors. At the age of 15 during a medical (still in Russia) the doctor looked at my hips, was puzzled for a moment, and then said I needed to do some exercises for my abdominal and back muscles.

From what I remember, when I ran 3000 in 10:08 at the age of early 13 I felt smooth and running fast was enjoyable. However, by 15 I felt like an elephant and running fast did not carry the same level of enjoyment anymore. It never has since. I was able to improve slightly, mostly from just being bigger. At the age of 16 I ran 9:36 3000. Middle distance speed went from 1000 in 3:03 shortly before turning 13 to 2:49 at the age of 18. In the same period of time, the height increased from 4'11 to 5'10.

In 1994 I took a swimming class at BYU. When they tried to teach me breast stroke I was completely unable to get my legs into the breast stroke position due to excessively tight adductor on the right side.

I have always run since I started in 1984. Overtime I figured out how to train for endurance efficiently, and by 2001 ran a PR of 2:33:20 in the Top of Utah Marathon. Around that time I realized that I was close to maxing out what I could reach through endurance alone, and turned my attention to biomechanics. I have been able to push the PR past that barrier since due to what I consider miraculous endurance and health breakthroughs, but it is clear to me at this point that I have a big fat zero chance of ever running in the Trials unless I solve this hip problem. As a side note, few people really know how big and fat and ugly that zero is after 25 years of solid training.

Since then I've been going around in circles trying to figure out what's up and tried a number of things that led to dead ends. However, it helped me gain a better understanding of anatomy, and the problem itself.

So here are some things I feel rather confident about. There is some kind of a nerve issue on the right side. My right quad feels like it is not really there. When I stand on my right leg, something feels out of whack. However, the difference is not easy to detect in an objective strength test. The right hip flexors feel bumpy compared to the left. When I massage them I get a pleasant feeling of relief. Of course, I would not care about that at all if it did not manifest itself in running. Landing on the right foot feels wrong and ugly. The whole experience can be compared to a duet of a good piano player playing the left hand, and a not so good playing the right.

I have seen specialists of various kinds in the past, and in the amount of time that my money could buy they did not succeed in figuring out the problem. So I decided I needed to go a different route - become as much of a specialist in this area myself as is possible with the resources available to me. So I've been studying and studying.

My current hypothesis is entrapped femoral nerve due to the scar tissue buildup in the right hip flexors and adductors from going through the curve at an early age excessively. I am looking for as much information in this area as I can get. If you have personal experience, links, medical knowledge, anything else remotely relevant, please share.

[Cheryl Keith]

 Did you/do you do the ab and back exercises that the doctor in Russia told you to do?  Core work (daily 15-30 minutes per session) has helped me solve a lot of nagging problems.  I was wondering how much time you've put into that and if you think it helps.

[dave rockness]

Basic "core training" + work with weights can have very positive benefits as you age.  This is an area you may want to explore (if you have not already). 

[Sasha Pachev]

I have done plenty of core work in my lifetime. Zero results.

The doctor was going on a limb. This happens quite often, and not just in Russia. I totally understand how that works. If you show me a difficult computer problem and ask me what's wrong and how to fix it, the best guess I come up with in 5 minutes is usually wrong. If you give me a couple of hours to think about it and run some tests, I can be right sometimes and have a workable fix. If you give me more time, I will have a fix a whole lot more often than sometimes, which is how I manage to get paid for doing my job.

Now computers are a whole lot easier than the human body.

[Paul Petersen]

I don't have any links or particularly good knowledge, but perhaps some form of trigger-point massage could help. Or maybe ART or something like that. Also, since it took you years to get to this point (ie - years to reinforce the issue), I would think that it could take you years of consistent treatment for your muscle to unlearn their mistakes. I can guarantee there is no quick fix. Perhaps you could take a year off work, and just lie on a tennis ball.

[Sasha Pachev]

Paul - that is pretty much what I've been doing in the last couple of months, except not all day long as my family does need to eat.

According to what I've read and confirmed through experiment tennis ball is not very effective in the hip flexor/adductor area due to the difficulty of putting a good portion of the body weight on it. But it did wonders for my thoracic muscles.

It would be interesting to get hold of EMG sensors, learn how to use them, and test the performance of the left and right femoral nerve. It would be particularly useful to have this setup at home so that I would not need to rely on feel alone, or do a killer workout to get an idea if my treatment did some small amount of good.

[Paul Petersen]

Maybe you can offer Linux/website services to a doctor for exchange of their EMG sensors.

[Sasha Pachev]

Good idea. Or partner with somebody who is not scared of wiring a couple of circuits and do something like this:

http://www.biomed.engsoc.org/node/30

[Dan Varga]

When I was having my horrible hip problems I came across Cranial-sacral massage technique and a very good practitioner of this out of Lehi, she works out of her home, and very inexpensive, her treatments were $25 for an hour.  I had several treatments from her and the amount of muscles that would relax and let go during these very light touch massage sessions is quite remarkable.  At the time I still had something wrong around my L4 and L5 which would trigger the muscles to spasm back up, but a great chiropractor out of Orem fixed that problem for me after 2 visits as well, he does muscle testing to find the source of the weakness/trigger points/ whatever you want to call it, but he tests using your own body to find the problem and can correct it, and then retests to make sure that the strength has returned, either one or both may be worth a shot.  Send me an email if you want either of their names and phone numbers.  dan.varga.utah@gmail.com   Dragonvulture

I had tried several other chiropractors who did  not do this muscle testing and they would end up leaving the one main thing that was the cause of my issues unresolved so soon after they got things moving again they would lock back up.  But once the key was moved my recovery has been very quick.  From the sounds of it though, you sound more like a soft tissue issue than a skeletal issue, so the cranial sacral massage may be a good place to start.

[Sasha Pachev]

For reference, a link below describes cranio-sacral massage:

http://www.massagetherapy101.com/massage-techniques/cranio-sacral-therapy.aspx

[adam]

located in right in provo is the rocky mountain university of health professions with a very skilled and prominent clinical electrophysiologist (and doctoral program)

they would probably like a case study like you

561 East 1860 South
http://www.rmuohp.edu

[Sasha Pachev]

Adam:

Thanks for the info. Do you have a suggestion on who to approach and from what angle?

[adam]

I just took this from the website under contact us:

These are the program directors:

Clinical Electrophysiology (DSc)
Michael Skurja Jr., PT, DPT, ECS
mskurja@rmuohp.edu

Lisa DePasquale, PT, DSc, ECS
ldepasquale@rmuohp.edu

I would just ask if they would be interested on running a few tests on an elite level marathoner experiencing some of your symptoms, or if any of their students would like test subject for a case study. Or just ask if you could get tested. Electrophysiology is an interesting field; it attempts (fairly successfully) to determine where there is a nerve block, how much is blocked, and more

[Sasha Pachev]

Adam - thanks for the info. I wrote to Dr. Skurja. Have not received a response yet, but hopefully something will come out of it.