By Allison Graham, DPT

The sciatic nerve gets a lot of press, as it should! After all, it has more nerve roots at our lumbar spine than any other part of our lumbar PNS (Peripheral Nervous System), exiting at five different vertebral levels. This nerve also presents some anatomical variability from person to person as it travels under, over, or through the piriformis muscle. That’s why, statistically, the sciatic nerve is the guilty party when we have back or spinal pain.

That being said, it’s time another nerve got some attention and exposure. The OBTURATOR NERVE exits ventrally only between L1 & L2, L3 & L4, and L4 & L5. While this nerve is less likely to be the culprit, misidentification of the root cause of the obturator nerve pain subjects the patient to incorrect and inappropriate treatment tactics.

ANATOMY:
As the obturator leaves the front of the spine, its anterior branch travels down through the psoas major muscle, (Watch out for tight hip flexors, People!), through the pelvic brim, through the lower pelvis, and through the obturator canal to the medial thigh. The posterior branch of the obturator nerve goes through the obturator externus muscle (tight buttocks) and progresses down the medial thigh. Sensations from this nerve can reach to the medial knee.¹

IS THIS ME?
Pain is initially felt in the groin, usually during exercise. If you continue to exercise, the pain worsens and usually radiates down the inner thigh. It can be expressed in the forms of reduced range of movement, swelling/inflammation, stiffness, weakness, numbness, spasm.²

HOW DOES THIS CHANGE PHYSICAL THERAPY’S APPROACH?
The obturator nerve experiences pathology in a multitude of ways, but some of the more common include nerve root impingement or entrapment. Nerve root impingement can occur at the spine and flexion versus extension exercises as well as traction may be most appropriate to deal with this diagnosis. Entrapment can happen at any muscle the nerve travels through, but most commonly occurs at the inner thigh. Soft tissue work can aid in removing adhesions that are holding the nerve in one place, causing less mobility and more irritation. Nerve flossing for mobilizing the obturator nerve requires abduction and adduction of the lower extremity rather than knee extension and flexion used in sciatic nerve flossing.

WHAT CAN HAPPEN IF I DO NOT ADDRESS MY OBTURATOR PAIN?

• • • • Unnecessary and inappropriate surgeries
      • Muscle atrophy
      • Pain
      • Reduced quality of life
      • Change in gait pattern that can cause dysfunction and pain to other joints
      • Increased risk of falling

    If you are experiencing any radicular symptoms in your groin or inner upper thigh area, please do not hesitate to reach out to Hampton PT. We are excited to help you start moving and feeling better!

    For a nerve flossing exercise to get your obturator nerve generated pain feeling better, try this!

     

     

    References:

    • 1. 1. https://www.kenhub.com/en/library/anatomy/obturator-nerve
         2. https://www.physio.co.uk/what-we-treat/musculoskeletal/conditions/groin/obturator-nerve-entrapment.php