Entrapment or inflammation of the cluneal nerves is a fascinating topic with tons of clinical nuggets for the astute practitioner. Many clinicians overlook the possibility that hypersensitization of these superficial nerves is the cause of low back pain and or leg pain. Pain associated with these nerves is often mistaken for a disc, facet, sacroiliac or radicular issue. It’s an easy mistake to be made, especially when symptoms look so similar.
“LBP due to SCN-E is exacerbated by lumbar movement such as extension, bending, rotating, prolonged standing, sitting, walking, and rolling. It produces leg symptoms in 47%–84% of patients and mimics radiculopathy due to lumbar disorder. SCN-E also elicits intermittent claudication due to worsening LBP during walking. As these symptoms are similar to those of lumbar disease, a differential diagnosis is necessary.”
While this article focuses mainly on the medical approach to treatment (blocks and surgery), we’ve seen a great deal of success with soft tissue mobilization and targeted movement patterns. Much of this success is in large part to the information we’ve gained from our friends with FNOR (Functional Neuro-Orthopedic Rehabilitation).
Have you ever treated “sciatica” with soft tissue and it went away quickly? It probably wasn’t sciatica…
This gives yet another case for conservative intervention for LBP as a first line treatment.