Cluneal Nerve Neuralgia
Of the cluneal nerves, the superior and inferior are more likely to be at risk of compression. The superior cluneal nerve branches run from the spine, over the top of the back of the pelvis and down into the buttock. They usually run through fibrous tunnels as they cross the top edge of the pelvis. This is where the small nerves may become compressed or irritated. This is usually associated with a fairly localised area of pain in the upper buttock, in the region of its skin supply (see picture below).
The inferior cluneal nerve branches run across the lower buttock, right over the sitting bone (ischial tuberosity). They can be compressed and irritated by a hard fall onto the bottom or sitting for prolonged periods on a hard surface, particularly if you don’t have much gluteal muscle bulk to cushion the bone. Again, associated symptoms are usually fairly localised to the area of skin supply (see picture above). Sometimes the nearby posterior femoral cutaneous nerve can also be affected. Symptoms may then extend into the back of the thigh (see picture above for region of this nerve supply).
Gluteal Nerve Neuralgia
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 (the ability to make the muscles work/contract) to the gluteal 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).
Need Help? How Can A Hip Pain Professional Help?
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
- 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.
- review if a pressure relief cushion may be of benefit – this is a simple, affordable, transferable cushion that can provide considerable pain relief for many – check out more about this here