Meralgia Paraesthetica vs dermatome

[PhysioL]

Hello,

I have a patient presenting with lateral thigh paraesthesia and numbness. No clear trigger other than doing normal gym work without any specific incident. No aggravating factors making it worse.
No back pain. Lumbar spine examination and hip was normal. Neurological examination normal apart for reduced light sensation to lateral thigh on one side.

Really bad body awareness, lordotic posture, poor core control and strength, head into forward position. Was able to get his weight down recently and is now just slightly over weight.

Questions:
anything specific you would advise regarding gym work? (I find this problematic as the history is unclear) :/
Is there really any way under these circumstances to clinically differentiate from the origin of the problem being in the lumbar spine or lower into the hip?
Other than core rehab and postural work - anything else you would do?

Also, did not mention it has now been 2 months

Thank you!

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[kcho]

I once had an elderly pt with longstanding problem that she would describe as mostly "coldness" with a bit of numbness. Nil incident before onset, and no obvious aggravating factor. She said that the Sx is constant, moving around and resting have no effect on it.

On examination, I found that her ITB were tight, especially on the symptomatic side. So I did Heat, followed by ITB release. It was painful for her but she got 40% improvement after the first session, and by the end of the 8 sessions she had around 10% left.