Cluneal nerve entrapment is a frequently overlooked cause of chronic low back and pelvic pain. The cluneal nerves are sensory nerves that provide feeling to the skin of the buttocks. There are three sets: superior, middle, and inferior. The superior cluneal nerves are the most commonly entrapped as they pass over the rim of the pelvis (iliac crest) through tight tunnels of connective tissue.
Symptoms often mimic more common issues like sciatica or lumbar disc disease, which can lead to misdiagnosis.
Lower Back and Buttock Pain: A deep, aching, or stinging pain located just above or across the buttock area.
Tenderness over the Iliac Crest: Intense pain when pressure is applied to the top of the pelvic bone, about 7 to 8 cm from the midline of the spine.
Pain with Movement: Discomfort that worsens with trunk rotation, bending forward, or prolonged sitting.
Referred Pain: The sensation may radiate down to the back of the thigh, but it rarely travels below the knee.
Skin Sensitivity: Numbness, tingling, or a burning feeling in the skin of the upper buttocks.
Because this is a nerve entrapment in the soft tissue, it will not appear on standard imaging like X-rays or MRIs.
Physical Examination
Diagnostic Nerve Block: This is the gold standard for diagnosis. An anesthetic is injected near the nerve at the iliac crest; if the pain improves, the diagnosis is confirmed.
Exclusionary Imaging: MRIs are used to rule out herniated discs or facet joint issues that could cause similar symptoms.
Most patients find relief through conservative measures aimed at releasing the pressure on the nerve.
Physical Therapy
Manual Therapy: Specialized massage or myofascial release to loosen the tight fascia and ligaments that are pinching the nerve.
Nerve Gliding Exercises: Specific movements designed to help the nerve slide more freely through its anatomical tunnels.
NSAIDs: Anti-inflammatory medications to reduce swelling around the nerve pathways.
Corticosteroid Injections: Often combined with the diagnostic block to provide longer term reduction of inflammation.
Radiofrequency Ablation: Using heat to temporarily turn off the pain signals from the cluneal nerve in chronic cases.
Surgical Decompression: A procedure to release the tight ligaments or fascia (the osteofibrous tunnel) that is squeezing the nerve.