Cluneal Nerve Low Back pain



The Cluneal Nerve (referred to as Clinoril Nerve in some older texts) splits into three divisions to cross over the iliac crest.  As these nerves pass in to the buttock they pass through the tough (fascial) covering of the buttock (gluteal) muscles. In many instances the nerves pass through a (osseo-fibrous) slanting tunnel to do so. In some patients each division consists of several nerves. The main divisions cross over the iliac crest in three sites:

  • The inner (medial) site is in the lateral lumbosacral angle
  • The middle division is found at the junction of the medial and middle third of the Iliac crest
  • The lateral (outer) division crosses over the crest where this widens under the traction of the fascial covering of the gluteal muscle.


Since 1990 we have observed that these nerves can cause significant and disabling pain:

  • It may produces pain in the lumbosacral angle and be confused as pain arising from the sacro-iliac joint.
  • It can produces significant buttock pain to be distinguished from Piriformis spasm pain
  • It can produce pain radiation to the outer buttock and may be confused with trochanteric pain.

These pains can radiate and be described as 

  • Deeply within the pelvis and occasionally to the coccyx
  • Extending into the groin and inner thigh to the knee (mimicking hip joint pain)
  • Passing down the posterior thigh to the upper calf (mimicking proximal sciatica)
  • Radiating along the anterior and outer thigh (mimicking irritation of the lateral femoral cutaneous nerve of the thigh)


The nerve may be sensitised at its origin from the nerves of T11-L4 or their posterior branches.   So the irritation may arise from:

  • Direct irritation of the nerve roots where there may be additional attenent symptoms by:
    • Slipped Discs (Disc Protrusions) 
    • Irritation of the nerve in the exit tunnel where this is narrowed (Lateral Recess Stenosis) 
    • Inflammation within the disc (High Intensity Zone)
  • Irritation of the posterior branches of the nerve roots (Posterior Primary Rami) within the muscles as they pass to the buttock.
  • Irritation within the boney fibrous (osseo-fibrous) canal as the nerves enter the fascial tunnels to the buttock. 

The causal factors of the nerve and its divisions  irritation centre on:

  • Malposture where abnormal pelvic forward or backward rotation causes the nerves to be kinked as they pass into the osseo-fibrous canal. This can be aggravated by factors scoliosis or lateral pelvic tilting caused by leg length or local anatomical asymmetry. These factors can also affect the nerve as it passes from its origin to the iliac crest. This behoves holistic treatment of postural function
  • Lipomatosis or Obesity.  We have noticed that the middle division is often surrounded by fatty accumulations (Lipomatosis) which appear to be tender but in fact it is the Cluneal nerve branches impacted upon by the fatty lumps which are the source of the pain
  • Local Trauma.  Direct accidental injury can set up bruising and swelling of the nerve. In turn this can set up protective postural changes which perpetuate the swelling and irritation and pain production
  • Bone Graft harvest required during some spinal procedures such as fusion surgery may distort or directly injure these nerves and cause pain from the nerves either as they try to heal or due to their distortion.

We have established treatment pathways for this condition.  To find out more about how we may be able to help you, please register as we would really like to help you.