If compression on the nerve is the cause, the goal will be to relieve the compression. Manual therapy interventions in the form of soft-tissue mobilization can be directed to musculotendinous structures entrapping the nerve followed by specific neural mobilization techniques. Although there is limited evidence to support soft-tissue mobilization for lower extremity nerve entrapments, these techniques can address goals of increasing range of motion, reducing pain, decreasing swelling, increasing flexibility, and/or improving muscle performance.

In addition to manual therapy techniques, stretching and strengthening exercises, aerobic conditioning, and cognitive-behavioral education have been shown to be valuable in the treatment of those with nerve entrapments in the hip region. Graded exposure stretching, whether performed independently by the client or by the manual therapist appears to be helpful in relieving femoral nerve compression due to lumbar spine pathology (L2-L4) or musculotendinous entrapment. However, aggressive stretching can be irritating to the nerve and must be controlled in a slow and progressive manner.

Targeted strengthening exercises are also helpful to facilitate proper load transfer between the lumbosacral spine, pelvis, hip, and lower extremity when alterations or deficiencies of these relationships have been identified. For those with chronic pelvic pain, non-symptom provoking strengthening and training of the pelvic floor muscles is recommended. Aerobic conditioning can be useful because of the general positive effect it has on overall pain management and cognitive behavioral therapy may assist the client in gaining a sense of control over pain by providing an understanding of pain mechanisms and coping strategies. Here are a couple of techniques I’ve found helpful in reducing pain and improving function is those clients presenting with femoral nerve symptoms.