Pain over the side of the hip (and/or pelvis) can be nerve related. How? Pain related to nerves at the side of the pelvis, hip and thigh may develop due to a problem along the pathway of a peripheral nerve, outside the spine. Pain related to a nerve is called “Neuralgia”. You can read more about neuralgia in our previous blog.
How Can Pain Over The Side of The Hip (and/or Pelvis) Be Nerve Related?
Nerves that supply the outer side of the hip and thigh include: These are shown in the image below.
- the ilioinguinal nerve (IInN)
- the posterior branch of the iliohypogastric nerve (IHGN)
- the lateral cluneal nerves
- the lateral femoral cutaneous nerve (LFCN)
- the gluteal nerves don’t have a skin supply but can give a deep cramping feel in the buttock. They supply the gluteal muscles ability to function (GN)
Nerve Related Pain/Neuralgia in the Lateral Hip Region
Neuralgia related to the posterior branch of the iliohypogastric nerve most commonly develops due to excessive compression of the nerve as it crosses over the bony edge of the top of the pelvis to travel into the side of the hip. Here it may be affected by overly tight jeans or trousers, or from a fall onto this region, such as a fall off a bicycle or motorbike. Pain is felt in the area of its skin supply (see picture above).
The lateral femoral cutaneous nerve may be compressed between the hip flexor muscles as it exits the pelvis just inside the bony point at the front of the hip (anterior superior iliac spine or ASIS). It may also be compressed by tight belt/jeans/trousers or a large abdomen sitting down over the front of the hip (which is also more likely during pregnancy). This nerve may also be stretched or damaged during an anterior approach Total Hip Replacement (where the scar is at the front of the hip). Symptoms developing after hip replacement surgery usually diminish or disappear over time. Symptoms present in the outer thigh region that the nerve supplies and are only sensory, with no impact on muscle function.
The gluteal nerves do not have a sensory supply to the skin, but gluteal neuralgia may be felt as a deep buttock pain, sometimes like a cramping feeling. These nerves provide important motor supply to the gluteal (buttock) muscles and the tensor fascia lata (TFL) muscle at the side of the hip. Damage to these nerves may alter your ability to stand on one leg, walk without a limp, climb stairs, and lift the leg out to the side or behind you. The nerves may be irritated or compressed as they pass out into the back of the pelvis and run through the soft tissues of the buttock. Very occasionally, these nerves may also be damaged by surgery, such as a posterior approach Total Hip Replacement (where the scar is at the back of the hip).
Your Hip Pain Professional can:
- perform specific tests in the clinic to see if nerve involvement is likely
- provide treatments and give you exercises that may improve the health or movement of the nerve
- help improve health of the muscles and tendons beside the nerve (this may be the source of nerve irritation)
- review the positions you spend time in and activities you perform daily and provide strategies when performing these tasks that might help protect the nerve, thus reducing your symptoms. This may include changing your sitting or lying posture, or changing stretches or strength exercises that you have been performing that may be contributing to the irritation the nerve. You can read more about sitting and lying postures and the aids that you can use that may help: click here.
- provide nerve gliding or mobility exercises that can be useful in some situations
- refer you for further tests or to a neurologist, orthopaedic specialist or other pain specialist if required.
This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.
Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.
Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.
- Martin et al (2017) Nerve Entrapment in the hip region: Current concept review. Int J Sports Phys Ther. 2017 Dec; 12(7): 1163–1173.
- Schmid AB Nee RJ Coppieters MW. Reappraising entrapment neuropathies–mechanisms, diagnosis and management. Man ther. 2013;18:449-457.
- Lee SH Shin KJ Gil YC Ha TJ Koh KS Song WC. Anatomy of the lateral femoral cutaneous nerve relevant to clinical findings in meralgia paresthetica. Muscle Nerve. 2017;55:646-650.
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Check Out More You Can Read on this Area at HipPainHelp:
Buttock Nerve Pain – The Upper & Lower Buttock Regions (Including Sciatica, Piriformis Syndrome, Deep Gluteal Syndrome, Cluneal Neuralgia, Gluteal Neuralgia): pain in the buttock region may be related to nerves – understand how this can happen, the symptoms and the structures involved.
Is My Hip Pain Nerve Pain (Neuralgia or Radicular Pain)? Nerve pain can occur around the hip and pelvis. Nerve pain can be caused by many things. Radicular pain relates to the back, neuralgia to local nerves.
Lateral Hip Pain (Side): Learn about many of the reasons why you may experience pain over the outside of the hip and/or pelvis region.
Understanding Pain: What is Pain? What is Pain? Pain is an experience that the brain creates for the purposes of stimulating you to change your behaviour or seek help for a perceived problem with your body. Learn more here.
Are You A Hip-Hanger? Ideas on How Not to Stand for Hip Pain Relief: Prolonged hip-hanging may contribute to certain types of hip pain – learn why. There may be better ways to stand for hip pain relief.
How Do I Find The Right Hip Pain Professional? Looking to figure out the right hip pain professional for you and your situation. Learn which type of professional may be best.
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