About 30 years ago, Jeff Schinksy noticed a funny tingling in his thigh.
“I was on my feet a lot [and] I began noticing that, in certain standing positions, the area on the outer-front quadrant of my left leg began having that sensation of pins and needles,” he recalls of his time in the Air Force in the 1980s. “Kind of like when you've been sitting cross-legged on the floor for a while and suddenly stand up, it tingles and burns for a while until your legs recover from sitting in that position.”
But his sensations persisted and worsened over the next 30 years. “Occasionally I'd have to be in military formations, standing either at ‘attention’ or ‘parade rest.’ Parade rest was a killer, because the pins and needles would start almost right away, and it would progress to a strong burning sensation.”
Schinksy has meralgia paresthetica, or “tingling thigh syndrome.” The condition starts with a tingle in the leg, but can worsen: descriptions include numbness and intense burning, sometimes with pain persisting for decades.
MP isn’t some obscure condition that debilitates elderly patients or ends athletic careers. According to a 2013 survey of meralgia paresthetica studies from 1970 in the International Journal of Sports Physical Therapy, there are 4.3 cases per 10,000 patients, which works out statistically to about 140,000 Americans with MP. In recent years, MP has become even more common thanks to the common habit of shoving a cell phone or wallet down a front pocket.
“In private practice, we probably see it 10 to 15 times a year,” Sharon Orrange, an associate professor of medicine at the Keck School of Medicine of USC in Los Angeles, told The Daily Beast. “Next to other classic neuropathies (carpal tunnel is another one) it’s one of the more common.”
Orrange says she increasingly sees the condition among men who carry objects in their front pockets, but traditionally meralgia paresthetica (MP) pops up in professions that require tools worn around the waist. The classic example is a construction worker’s toolbelt, which Orrange says has been a med school “gotcha” question for decades. Police officers’ sidearms are another common cause. Overweight patients and pregnant women are also in danger, especially if they sit a lot. And in the past few years, increasingly popular skinny jeans have been a major culprit as well.
All of these causes have one thing in common: They put pressure on the lateral femoral cutaneous nerve. “That nerve travels in this tight space because it has to slide behind the inguinal ligament, so it just doesn’t have any give,” Orrange explains. “If you have something pressing on there, it’s sort of trapped.” This compression causes irritation, which in turn ignites the thigh like an inextinguishable flame.
Schinksy puts it another way. “[Imagine putting] a bowling ball on a baloney sandwich,” he says. “It's going to compress the hell out of that sandwich. Consider that the average adult is carrying additional weight equivalent to a couple of bowling balls, and you can see how that might impact the work the spinal column has to do to help us stand erect.”
Schinsky’s case is somewhat extreme in that the burning pain has evolved over time into general numbness, accompanied by sharp, electrical, shooting pains if he walks for more than 30 to 40 minutes at a time. “At times, the pain is severe enough that my leg will completely give out on me. I've had to hop on one leg from the grocery store to the parking lot on more than one occasion,” he says.
But other unfortunate aspects of his battle with MP are all too common, like the years it took to get an accurate diagnosis. Doctors offered little help as his pain worsened, until finally in 1991 he received an electromyogram, a painful procedure involving needles that measure how muscles respond to electrical nerve signals.
Orrange explains that doctors can misdiagnose MP as a host of other conditions, most commonly sciatica or arthritis. Part of this problem is innate to the condition, since it can cause pain in the back or hips, throwing off diagnosis. But part of the problem also falls on doctors. Orrange points out that her colleagues in orthopedics and sports medicine see many cases referred from general practitioners who can’t quite figure out the issue.
And not all patients respond to the same treatment. In some cases patients can simply remove the irritation on the nerve by removing weight from the affected area, but others are harder to treat. Orrange explains, “In some people [it] will resolve on its own, in some it resolves with just anti-inflammatories, and in some folks it stays as a painful neuropathy. There’s just no way to predict, sort of like people who get pain after shingles. In some people it persists and in some people it doesn’t.”
Schinsky is more blunt about the issues surrounding MP. “Most doctors blow us off by telling us to ‘lose some weight’ and the problem will go away,” he says. Schinsky tried wearing looser pants and losing weight to no effect. He tried pain-relieving compounds, analgesics, ointments and balms, lidocaine patches, and pain reducers Gabapentin and Lyrica. Most failed to relieve the pain. Those that did either disoriented him or only prevented the pain briefly before it returned even more intensely.
Meralgia paresthetica’s wide range of causes, symptoms and treatments makes it hard to nail down, creating a nightmare for patients like Schinsky. The same 2013 study suggested, “Perhaps the lack of research and global consensus represents a knowledge deficit that makes MP a challenge to diagnose and successfully treat.”
There have been some promising studies in more recent years, improving surgical decompression and testing new strategies like pulsed radiofrequency. Patients with MP will have to wait until that research comes to fruition and an effective treatment discovered, so for now, prevention is the best way to fight the condition. The Mayo Clinic offers the simplest advice: Avoid tight clothing and maintain a healthy weight. And don’t forget to move your phone to another pocket.