The Most Common Lower Back Pain You've Probably Never Heard Of
Cluneal Nerve Pain
Lower back pain shows up in all kinds of ways dull aches, sharp stabs, tight spots you can't quite stretch out. One cause I see again and again in clinic, though it's often missed, is cluneal nerve pain.
It’s more common than people realise and the symptoms can be confusing. Some people feel a nagging ache near the back of the hip. Others get sharp pain that travels down the leg and feels a lot like sciatica. That’s part of what makes it so tricky to spot.
But when we’ve ruled out the big, serious stuff like herniated discs, joint instability, etc it’s often these tiny cluneal nerves that are the culprits.
So, What Are Cluneal Nerves?
The cluneal nerves are small sensory nerves. They branch off from your spine, travel over the top of your pelvis, and supply feeling to the skin over your lower back, glutes, and hips.
The most common troublemakers are the superior cluneal nerves, which cross just above the back of the pelvis. When they get irritated or compressed, they can cause very specific and annoying pain often in one spot, right near the SIJ (sacroiliac joint), but not quite on it.
Hows this for confusing, sometimes it is right over the SIJ too! The range of pain experiences is vast with these nerves.
What Does Cluneal Nerve Pain Feel Like?
Everyone’s experience is a little different.
Some people describe a sharp or zappy sensation that shoots down the leg and is mistaken for a disc problem. Others feel a tight, nagging spot that never really goes away and flares up during:
Sitting too long
Bending forward
Lifting something heavy
Twisting awkwardly
People often come in thinking their pelvis is out of alignment or that something's “stuck” and they’re pointing exactly to the spot where that nerve runs. They aren’t wrong that something is “stuck” but it isn’t their pelvis.
Why It Gets Missed
This kind of nerve irritation can feel a lot like other common lower back issues and unfortunately, that means it often gets treated as something else.
You might feel better after an adjustment or some rehab… but the pain relief is always short lived. Often you can feel anxious about missing treatment or not doing your exercises for fear the pain will come back if you don’t.
How I Treat It
Treatment usually involves one or both of the following:
Manual Soft Tissue Therapy
Shockwave Therapy
The goal is to reduce pain and improve how freely the nerve can move.
What about adjustments?
When cluneal nerve pain is the main issue, adjustments don’t tend to provide lasting relief. That’s not because adjustments aren’t valuable, they’re an excellent tool when used for the right problem and the right person. But in this case, they just don’t target the root cause effectively.
A Thought on Core Tension and Nerve Irritation
Something I see quite often in clinic, and this is part theory, part experience, is patients who are months into recovery but still getting pain despite doing what they’ve been told: “engage your core” and “keep your spine straight.”
That advice is helpful early on, particularly during the acute phase. But as recovery progresses, those same strategies can start working against the body rather than with it.
Over-bracing, especially through the obliques, can compress these nerves pass over the top of the pelvis (the iliac crest). Holding tension in these muscles for too long can irritate those nerves and reignite pain.
Recovery beyond the acute stage needs to involve re-learning how to move with ease. That means being able to brace the spine without over-contracting, and gradually reintroducing safe spinal flexion under low loads without triggering symptoms.
Preventing It From Coming Back
Once the pain settles, rehab matters. We need to get the body moving again in a safe, controlled way not just avoid the pain. Rehab doesn’t always mean exercise programs for everyone. Sometimes a little re-education about moving safely and fully goes a long way. Save the full program for when that fails.
One of my go to rehab exercises for this is the Jefferson Curl. It helps reintroduce controlled bending in the lower back without fear, and teaches the body that bending doesn’t have to mean danger.
Because here's the truth:
You could learn to avoid bending forever, you might feel OK… until you don’t. When suddenly something bends you (think a toddler jumping on your back) or your back bends under load it all comes rushing back. Teaching your spine how to move with control through its full pain free range of motion is a much better long-term strategy for long term spinal health.
Why It Comes Back So Often
Modern life isn’t kind to our lower backs.
Soft couches, deep beds, long hours sitting, we just don’t move like we used to. Not that you needed me to tell you that.
Pain doesn’t always come from a major injury. Often it’s something small, like: reaching into the backseat, tying a shoe too fast, picking up a shopping bag wrong.
But the good news is: when we catch it early, it usually clears up quickly.
If this sounds familiar to you then maybe we can help.
What You Can Do Next
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