The Hidden Cause of Lower Back Pain (Updated 2026)
Cluneal Nerve Pain
Lower back pain presents in many ways: dull aches, sharp stabs, or tight spots you can’t quite stretch out. One cause I see repeatedly at Southside, though it’s often overlooked, is cluneal nerve pain.
It’s more common than people realize, but the symptoms are various. It can manifest as a nagging ache near the back of the hip or a sharp sensation traveling down the leg that mimics sciatica. Once we’ve ruled out herniated discs or joint instability, these tiny nerves are often the primary culprits.
The most common presentation I see is a patient who has had their pelvis adjusted repeatedly. While you might get short-term relief initially, over time the adjustments become less effective. Eventually, the area becomes so sensitized that even standard treatments are painful, and low-force interventions are the only thing tolerable. This is a classic sign that the issue isn't a "stuck" joint, but a sensitized nerve.
What Are Cluneal Nerves?
The cluneal nerves are small sensory branches that exit your spine and travel over the top of your pelvis (the iliac crest). They supply feeling to the skin over your lower back, glutes, and hips.
The Superior Cluneal Nerves are the most common troublemakers. When they become irritated or compressed, often right where they cross the pelvic bone, they cause specific, localized pain near the Sacroiliac Joint (SIJ). The pain from these nerves can be surprisingly specific when you find them during an examination.
Symptoms: Does it Feel Like Sciatica?
Because these nerves supply the skin of the gluteal region, irritation can feel remarkably like a disc problem. Common symptoms include:
A "zappy" or electric sensation shooting into the buttock or upper thigh.
A constant, nagging "tight spot" that flares up when sitting or twisting.
Pain that increases when bending forward or lifting.
Worse with manual adjustments to the pelvis.
Why It Gets Missed
This pain is frequently misdiagnosed as an SIJ issue or a simple muscle strain. If you’ve had adjustments or rehab that provided only short-lived relief, the "stuck" feeling you are experiencing likely isn't your pelvis, it's likely these nerves.
The "Over-Bracing" Trap: Why Core Tension Can Hurt
I often see patients who are months into recovery but still in pain because they are following the old advice: "Engage your core" and "Keep your spine straight."
While helpful in the acute phase, over-bracing the core can actually compress the cluneal nerves against the pelvic bone. Constant tension and contraction irritates the nerves further. True recovery requires re-learning how to move with ease and control, rather than living in a state of permanent muscular contraction.
How I Treat It
Because the issue is often mechanical compression or "stickiness," we use a two-pronged approach:
Manual Soft Tissue Therapy: To address adhesions around the nerves and adjacent structures and promote movement.
Shockwave Therapy: To reduce nerve sensitivity and stimulate healing in the surrounding connective tissue.
Note on Adjustments: While I am a Chiropractor, I find that if cluneal nerve irritation is the primary driver, traditional spinal adjustments won't provide lasting relief. We have to target the nerve specifically.
Preventing It From Coming Back
Once the pain settles, we focus on re-education. One of my go-to tools is the Jefferson Curl. It teaches your body that bending isn't "dangerous."
"You could learn to avoid bending forever, and you might feel OK... until a toddler jumps on your back or you reach for a shopping bag deep in the boot of your car. Teaching your spine to move with control is a much better long-term strategy."
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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