Pain Condition
Cluneal Nerve Entrapment
By Dr. Anthony J. Gordon, Doctor of Acupuncture | Last reviewed September 2026
The pain sits along the top of your pelvis and upper buttock, often on one side, and it is worse when you bend, twist, stand up or sit for long. It may have been called SI joint pain or back pain, but treatments aimed at the joint or spine have not helped. Small nerves called the cluneal nerves pass right through this area, and when they are pinched, they produce exactly this kind of pain.
Prefer to talk it through? Call (516) 597-5400. Most new patients are seen within one to two weeks.
Overview
Understanding Cluneal Nerve Entrapment
The cluneal nerves are small sensory nerves that supply the skin of the buttocks. The superior cluneal nerves travel over the top of the pelvis, called the iliac crest, where they pass through tight openings in the fascia. The middle cluneal nerves run near the sacroiliac joint.
When these nerves are compressed, they cause pain along the top of the pelvis and into the upper buttock, sometimes spreading down the leg. The pain often mimics SI joint pain, lumbar disc pain or sciatica, and it is frequently missed. It tends to worsen with bending, twisting, sitting and standing up, and there is usually a very tender spot along the top of the pelvis.
Dr. Gordon locates the entrapment point by tracing the nerve and treats the fascia and muscles compressing it, along with the nerve sensitivity that has developed.
Cluneal Nerve Entrapment at a Glance
Also called
Superior or middle cluneal nerve entrapment, cluneal neuralgia
Where it is felt
Along the top of the pelvis, upper buttock, sometimes down the leg
Often mistaken for
SI joint pain, lumbar disc pain, sciatica
Telltale sign
A very tender spot along the top of the pelvis that reproduces the pain
Common aggravators
Bending, twisting, long sitting, standing up
The Gap in Care
What Tests Check, and What They Can Miss
Cluneal nerve entrapment is rarely considered. Imaging of the spine and SI joint is often normal or shows unrelated changes.
What routine testing is looking for
- Disc herniation
- SI joint arthritis
- Spinal stenosis
- Hip joint problems
What often keeps symptoms going
- Superior cluneal nerve compression at the iliac crest
- Middle cluneal nerve irritation near the SI joint
- Tight fascia and back muscles over the nerve
- Gluteal tension around the nerve's path
- Sensitized nerve after long-standing pain
The entrapment point is found by careful palpation along the top of the pelvis, which is part of Dr. Gordon's evaluation.
Signs & Symptoms
Does This Sound Like You?
Symptoms vary from person to person. These are the patterns Dr. Gordon sees most often.
Pain along the top of the pelvis
Pain at the iliac crest, usually on one side.
Upper buttock pain
Pain in the upper part of the buttock.
Pain with bending or twisting
Sharp pain when bending forward or rotating.
Pain standing up
Pain as you rise from sitting.
A very tender spot
One spot that reproduces your pain when pressed.
Pain spreading down the leg
Sometimes pain travels into the thigh.
Root Causes
The Four Drivers Dr. Gordon Looks For
Most people have more than one of these in play. Finding which one leads makes treatment more efficient.
Fascial compression
The nerve passes through tight fascia at the top of the pelvis.
Back muscle tension
Tight low back muscles increase pressure on the nerve's path.
Gluteal tension
Tight gluteals affect the tissue around the nerve.
Nerve sensitization
Long-standing compression makes the nerve more reactive.
Your First Visit
How Dr. Gordon Evaluates Cluneal Nerve Entrapment
The initial evaluation runs 60 to 75 minutes. You leave with a clear picture of what is driving your symptoms, a written plan, a realistic timeline, and in most cases your first treatment.
- 1
Records and history review
Dr. Gordon reviews your imaging, physician or physical therapy notes, medications and past treatments so he knows what has been ruled out and what has already been tried.
- 2
Nerve palpation along the pelvis
Careful palpation along the iliac crest to find the tender entrapment point.
- 3
Spine and SI joint screen
Tests to separate cluneal pain from disc, SI joint and hip sources.
- 4
Movement testing
Dr. Gordon checks bending, twisting and sit-to-stand movements.
- 5
Plan and coordination
A clear plan, plus communication with your physician, orthopedist or physical therapist when that helps your care.
When to see a physician first
- New weakness, numbness or tingling that is spreading or getting worse
- Numbness in the saddle area or loss of bladder or bowel control
- Back pain with fever, chills or unexplained weight loss
- Pain after a significant fall or accident
- Back pain with a history of cancer
- Severe pain at night that does not change with position
If you have any of these, contact your doctor or go to the nearest emergency department.
Bring to your first visit
Records
Recent lab results, imaging reports and specialist notes. These can also be faxed ahead.
Treatment history
A short list of what you have tried and what did or did not help.
Clothing
Something comfortable and loose fitting.
Treatment
How Dr. Gordon Treats It
These are the tools Dr. Gordon uses most often for cluneal nerve entrapment, chosen from your exam findings.
Orthopedic Dry Needling
Dr. Gordon has used dry needling for more than 18 years. Treatment releases the fascia and low back and gluteal muscles around the cluneal nerve entrapment point.
See all servicesNeuro-Functional Acupuncture
Electro-acupuncture along the nerve pathway to calm irritation.
See all servicesMovement Plan & Team Coordination
Guidance on bending, sitting and belts or waistbands that press on the area, coordinated with your physician.
Referring provider? Contact the clinicWhat to Expect
A Typical Recovery Arc
Find the main driver
Dr. Gordon confirms which muscles and nerves are behind your symptoms and starts calming the most reactive areas. Many people notice early changes between visits.
Lower the baseline
Day-to-day symptoms ease, flares become shorter and less frequent, and normal routines start to feel more manageable.
Build resilience
Visits are spaced out as improvement holds. You leave with a maintenance and early-flare plan.
Most patients are seen weekly or every other week during active care. Individual results vary with how long symptoms have been present and how reactive they are. Progress is reassessed at every visit.
Not sure how to describe it? Put your pain or discomfort into words before your visit
Dr. Gordon is a master of his craft...always listening to our symptoms and concerns and developing a customized and comprehensive plan to address the symptoms and the body as a whole so that it can work toward healing itself. Dr. Gordon is caring, compassionate and knowledgeable and truly has the best interest of his clients at heart.Mo Dee, Google Review
Cluneal Nerve Entrapment Questions
Answers About Cluneal Nerve Entrapment
Still unsure whether this is the right fit? Reach out before you book and Dr. Gordon will talk through your history with you.
Before You Book
General Questions
About Dr. Anthony J. Gordon
Dr. Anthony J. Gordon is a Doctor of Acupuncture licensed in New York and board certified. He holds ASE certification in intrapelvic and extrapelvic dry needling, along with advanced certifications in Functional Dry Needling and Neuro-Functional Acupuncture. With more than 18 years of clinical experience and over 3,000 complex cases treated, he focuses on pelvic, spinal and orthopedic conditions that have not responded to standard care, and works closely with each patient's physicians and physical therapists.
Read Dr. Gordon's full bioBook an Evaluation for Cluneal Nerve Entrapment
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