Nerve damage after childbirth or abdominal or pelvic surgery? There's help.

Childbirth is traumatic, no matter how you deliver. It seems pretty unfair that beyond the expected trauma and injury childbirth may have, other injuries are not only possible, but very common.

The injury I'm talking about today is femoral nerve palsy, or injury/damage to the femoral nerve during childbirth, typically from being in the lithotomy position for a long period of time (>20 minutes at a time).

Femoral nerve palsy is another name for an injury of the femoral nerve or femoral nerve damage. The most common causes of injury to this nerve are related to staying in one position for too long, typically during childbirth in the dorsal lithotomy position or during abdominal/pelvic/hip surgery. Other causes of injury to the femoral nerve can be injury from surgery such as hip replacement, prolonged bruising or swelling around the femoral nerve that applies compression to the nerve, or a hip fracture, to name a few.

This nerve has two functions: signal the hip flexors and knee extensors to activate to bend the hip and/or straighten the knee. It also allows us to feel the front and inner thigh and lower leg down to the foot.

When there is injury to the nerve, these functions don't work as they should. In the case of femoral nerve palsy, often these functions are still possible but are altered/weakened/impaired.

You may experience:

• Knee buckling or giving out
• Difficulty walking
• Difficulty going up and down stairs (down is worse)
• Difficulty or inability to stand on the affected leg
• Weakness and difficulty with bending the hip/straighten the knee (like kicking)
• Numbness or tingling on the thigh, lower leg, and/or foot
• Achiness, heaviness, or discomfort in the lower abdomen, pelvis, and/or groin
  

It's an awful injury to sustain at any time that can affect your ability to move and do the things you love for a long time, and what an especially sh*tty injury to deal with after childbirth. You have a newborn baby who requires so much of your energy, time, and attention, and you can't walk or feel safe to stand while holding them. If this describes you, I am so sorry.

The good news is, there are things you can do to feel better and move forward safely with better function. Nerves can take 18 months to heal. That's just physiology, however the way you heal can be more efficient and less painful. We can figure out different ways of doing things while your nerve heals so you can function as optimally as possible.

Some things you can do to help:

• Apply heat to the low back, hip, and knee a few times a day for 20 minutes
• Avoid ice, nerves hate ice
• Elevate the leg and pump the foot up and down or back and forth to reduce swelling
• Wear compression socks or tights

If you are healing from this injury and haven't started physical therapy yet, here are some exercises you can do to get you started:

Quad Sets‍

• Place a small rolled up hand towel or washcloth under your knee.
• Push the back of your knee into the towel by squeezing your quadricep muscles (the muscles on the top of the thigh).
• Hold for 3-5 seconds and perform 30x.

Assisted Knee Flexion:

• Use a towel or other cloth/belt to pull your heel toward your butt.
• The towel is there to help you bend your knee a little further and take some of the pressure off.
• Don't push into pain.
• Perform 20x.
  

Bedside Hip Flexor Stretch:

• Scoot to the edge of your bed or couch and let your outside leg fall off the side.
• Push your lower back into the bed or couch, making sure it isn't arching.
• You should feel a gentle stretch in the front of your hip.
• To make progress the stretch you can tuck your foot further back underneath you.
• Perform for 1 minute, 2x.

Archer:

• Lay on your side with your hips and knees bent with your arms out in front of you.
• You can rest your head on a pillow if that's more comfortable.
• Drag your top arm across your chest as you rotate your shoulder blade toward the other side.
• Reach your arm back the way you came, reaching the top hand past the bottom hand.
• Perform 15x each side.
  

Femoral nerve palsy is not the only nerve that may be affected or injured after childbirth or pelvic/abdominal surgery. Other nerves include:

IIliohypogastric Nerve: most common after an abdominal surgery and presents as numbness/loss of feeling or very intense pain in the low abdomen (above the pubic bone), and groin area.

Ilioinguinal Nerve: Also more common after abdominal surgery, injury to this nerve has similar results to the iliohypogastric nerve, however the pain is deeper in the groin and genitals (scrotum/labia).

Genitofemoral Nerve: Groin pain that usually gets worse with walking and change in sensation on the front ot the thigh

Obturator Nerve: Similar to the femoral nerve, if this nerve is affected you will feel weakness and unsteadiness on the involved leg, notice worsening symptoms with more activity (alking, standing). Deep achiness in the inner thigh and groin is very common.

Tibial Nerve: Not typically a result of abdominal surgery or childbirth, however can be entrapped if there is prolonged swelling in the lower legs which is VERY common in women who have been pregnant or are postpartum. If you feel numbness/tingling along the back of the calf, the bottom of your heal, or along the bottom of the foot, it could be this nerve.

Lateral Femoral Cutaneous Nerve: This is more likely after a hip surgery or from being in one position for too long. This would lead to burning, achiness, numbness/tingling down the side of the hip and thigh that is worse with tight clothes like compressive leggings or skinny jeans.

Saphenous Nerve: Can cause inner thigh and knee pain, numbness/tingling

If you suspect you have a nerve injury or are experiencing any of the symptoms listed on this blog post, seek a physical therapist who specializes in treating the pelvic floor. You deserve to heal and do everything you love and enjoy. It sucks that this happened, and it sucks even more if you've been told that it's in your head or that there is nothing that can be done and it will just "resolve on its own." It won't, not really - but the bright side is that this isn't in your head and there are effective solutions available.