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). 

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.  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. 

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