The Hidden Cause of Lower Back Pain (Updated 2026)
Principal Chiropractor - Southside Spine and Sport, Bicton WA
AHPRA Registration: CHI0001927257 Practising chiropractor since 2015.
Trained in Integrative Diagnosis (USA).
Special interest in nerve entrapment conditions including cluneal nerve pain, sciatica, and piriformis syndrome.
Lower back pain that won't go away - could it be your cluneal nerves?
If you've had lower back pain that adjustments, massage, and rest haven't been able to shift, or pain that keeps coming back no matter what you try, there's a commonly overlooked cause worth knowing about.
The cluneal nerves are small sensory nerve branches that cross over the top of the pelvis and supply sensation to your lower back, glutes, and hips. When they're compressed or irritated, they produce pain that closely mimics sacroiliac joint (SIJ) dysfunction and disc problems, which is exactly why they're so often missed.
In this article I'll explain what cluneal nerve pain is, what it feels like, why it gets misdiagnosed, and how we treat it at Southside Spine and Sport.
What are the cluneal nerves?
The cluneal nerves are purely sensory, they carry pain and touch signals, but don't control muscle movement. There are three groups: superior, middle, and inferior. The superior cluneal nerves are the most clinically significant. They exit your the upper lumbar spine and pass through a narrow fibro-osseous tunnel at the iliac crest (the bony rim at the top of your pelvis) before fanning out over the lower back and glutes.
This tunnel is the problem site. It's narrow by design, and when the nerve gets inflammed or fibrous adhesions develop, or when chronic muscular tension compresses the area, the nerve gets ‘caught’. And because it's a sensory nerve, the result is pain.
What does cluneal nerve pain feel like?
“Cluneal nerve pain typically presents as a sharp, burning, stabbing, or grabbing sensation directly over the top of the hip bones (iliac crest), the side of the tailbone (sacrum), or the upper gluteal region. It often feels shallow with moments of electric sharpness. Many patients describe it as a nagging toothache in the hip that flares with sitting, twisting, bending, or even the pressure of a belt or waistband.”
Unlike sciatica from a disc injury, which typically travels the full length of the leg to the foot, cluneal nerve pain usually stays localised to the glute and upper thigh. It rarely crosses the knee. The pain can shift between a dull, constant throb and a sharp grab with certain movements, and that variability is part of what makes it difficult to diagnose.
In my clinical experience, the most common pattern is a patient who can pinpoint the painful spot with one finger, right on the back of the hip bone, and who gets a brief flare when that spot is pressed. That precise, point-specific tenderness is a strong clinical indicator.
Does this sound like you? A quick self-assessment
This isn't a clinical diagnosis, but if several of these apply, cluneal nerve irritation is worth investigating properly.
Sharp or grabbing pain directly over the back of the hip bone or upper glute
Pain that worsens when sitting, especially on hard surfaces or with a waistband pressing on the hip
A toothache-like sensation in the lower back that stretching and massage don't resolve
Pain that flares with twisting, bending, or reaching (e.g. into the back seat of a car)
You've had repeated pelvic or SIJ adjustments with only short-term relief
Your back feels more sensitive after repeated manual adjustments
No disc or nerve root pathology found on imaging, but the pain persists
Discomfort that stays mostly in the glute and upper thigh, rarely below the knee
Ticking three or more warrants a clinical assessment. Ticking five or more makes cluneal nerve irritation a strong probability.
“If several of those apply to you, you are not imagining it and you are not stuck with it. Book a Cluneal Nerve Assessment at Southside Spine and Sport and we will tell you exactly what is going on.”
Or call us: 08 6317 9897
Why does it get misdiagnosed so often?
The superior cluneal nerves run directly across the region of the sacroiliac joint. When they're irritated, the area of pain maps almost exactly to what clinicians associate with SIJ dysfunction. Without specifically palpating for nerve tenderness at the iliac crest, it's straightforward to attribute the pain to the joint rather than the nerve.
Standard MRI and X-ray imaging doesn't reliably show cluneal nerve problems. The diagnosis is clinical and made through careful history-taking, reproduction of pain with specific nerve palpation at the right location, and response to targeted treatment. This is another reason it gets missed: the diagnostic tools most clinicians reach for first simply won't find it.
The most telling pattern I see in clinic is this: a patient has had their pelvis adjusted repeatedly, feels better immediately after each session, but the relief lasts a shorter and shorter time with each visit. Eventually the area becomes so sensitised that even low-force treatment is uncomfortable.
This escalating sensitivity is a hallmark of nerve irritation, not a joint problem in my clinical experience.
The chronic bracing trap
A number of patients I see who have been struggling for months are still following advice from the acute phase of their injury: ‘engage your core’, never bend from the spine, protect the back with every movement.
In the first couple of weeks after a flare, this guidance has merit. But sustained, chronic core over-bracing creates constant compression of the cluneal nerves against the pelvic rim. The nerves sit at that crossing point, continuous muscular tension squeezes them further and maintains the very irritation the bracing was meant to prevent.
True recovery requires re-learning how to move with ease and confidence, not living in a permanent state of muscular guarding. This is a significant reason some people plateau: the management strategy that helped initially is now actively perpetuating the problem.
When to seek urgent care
“Cluneal nerve pain does not cause the following symptoms. If you experience any of these alongside your back and hip pain, see a doctor promptly, they may indicate a more serious spinal condition”
Loss of bladder or bowel control
Numbness or tingling in the groin or inner thigh (saddle anaesthesia)
Progressive leg weakness — not just pain, but genuine inability to lift the leg or foot
Unexplained weight loss alongside back pain
Back pain that began after a significant trauma such as a fall, accident, or collision
How we treat cluneal nerve pain at Southside Spine and Sport
Because the underlying problem is typically mechanical compression or adhesion formation around the nerve at the iliac crest, we use a targeted two-pronged approach.
1. Manual soft tissue therapy
We apply specific pressure and movement to the tissues surrounding the nerve where it crosses the pelvic rim, working to break down fibrous adhesions and restore normal nerve mobility. This is distinct from general massage, we are working specifically on the nerve not the surrounding musculature in general.
This is the same precision approach we apply to other nerve entrapment conditions, including piriformis syndrome and thoracic outlet syndrome. Learn more about our soft tissue therapy and adhesion release techniques.
2. Shockwave therapy
Acoustic shockwaves reduces nerve hypersensitivity and stimulates a healing response in the connective tissue around the compression site. It's particularly useful in cases where the nerve has been chronically inflammed where manual work alone isn't enough to settle the sensitisation.
“Did you know? At most clinics, shockwave therapy is charged as an additional fee (typically $50-$80 extra per session). At Southside Spine and Sport, Radial Shockwave is included in our standard consultation fee at no extra cost! We include it because it should be available to every patient who can benefit, not just those who can absorb the premium.”
Learn more about our shockwave therapy service.
A note on adjustments
I am a chiropractor, and spinal and pelvic adjustments are part of my toolkit. But when cluneal nerve irritation is the primary driver of pain, traditional adjustments will not provide lasting relief and in sensitised cases, they can increase pain.
How long does recovery take?
When we identify cluneal nerve irritation early most patients see meaningful improvement within 2-4 sessions. Releasing nerves can be uncomfortable and sometimes flare up for a day or so. When this happens it is best to rest for 1 or 2 days until it feels normal again. Most patients experience substantial relief when it subsides.
Longer-standing cases, particularly those where the nerve has been repeatedly provoked by unsuitable treatment, take longer. The nerve needs time to uninflame and the time your body takes to recover is different for everyone. In these cases we adjust the pace and approach accordingly.
Once symptoms have settled, we move into rehabilitation, specifically, re-training movement patterns that load the lumbar spine and pelvis progressively and confidently. The goal is not a fragile back that needs permanent protection. It's a resilient one that can handle whatever your life asks of it.
See our lower back pain page and rehabilitative exercises page for more on how we approach this phase.
Frequently asked questions
What is cluneal nerve pain?
Cluneal nerve pain is irritation or compression of the cluneal nerves. They are small sensory branches that cross over the top of the pelvis (iliac crest) supplying sensation to the lower back, glutes, and hips. When compressed or adhered at the pelvic rim, they produce sharp, burning, or grabbing pain in the lower back, sacrum, or upper glute.
How do I tell the difference between cluneal nerve pain and sciatica?
Cluneal nerve pain usually stays localised to lower back, glute, upper thigh and rarely crosses the knee. Sciatica from disc herniation typically travels the full length of the leg, often to the foot. A clinical examination is needed to confirm.
Why does cluneal nerve pain get misdiagnosed?
Some of the nerves run directly over the sacroiliac joint, so their symptoms closely mimic SIJ dysfunction. Without specific nerve palpation of the ilium and sacrum during examination, the nerves are easily overlooked. Standard imaging (MRI, X-ray) does not reliably show cluneal nerve problems, the diagnosis must be made clinically.
What treatments work for cluneal nerve pain?
We use manual soft tissue therapy to release adhesions around the nerve, combined with shockwave therapy to reduce nerve sensitivity and stimulate healing. Traditional spinal adjustments alone do not provide lasting relief when the cluneal nerve is the primary driver.
How long does cluneal nerve pain take to resolve?
Most patients see significant improvement within 1-2 sessions when identified early. Chronic or sensitised cases may take longer. Rehabilitation to retrain movement patterns is an important part of preventing recurrence.
If the pattern described in this article sounds familiar, persistent lower back or glute pain that hasn't responded to adjustments or massage, or keeps coming back, we'd be happy to assess you and give you a clear answer.
Book an appointment online or send us a message if you'd prefer to ask a question first.
We're based in Bicton and see patients from across Perth's southern suburbs, including Fremantle, Melville, East Fremantle, Cockburn, and surrounding areas.
Reviewed and updated by Dr Russell Jensen, Principal Chiropractor (AHPRA: CHI0001927257)
Southside Spine and Sport - May 2026. Originally published July 2025.
This article is for general information only and does not constitute medical advice. Always consult a qualified health professional for diagnosis and treatment.
