Massage & Bodywork

NOVEMBER | DECEMBER 2021

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82 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 1 Back pain is one of the main reasons clients see massage therapists. Trigger points, hypertonicity, strains, sprains, and a host of other complaints are all common causes of low-back pain. We look to these causes first when examining the source of our client's pain. Yet, sometimes their complaint doesn't fit the pattern of these conditions, or they do not respond to treatment. In these cases, it's helpful to think outside the box. In this column, we'll look at cluneal nerve entrapment in the gluteal region. The cluneal nerves are susceptible to compression and may be the source of pain complaints in the lumbopelvic region or lower extremity. Let's explore where they are, how they are injured, and a few key treatment strategies. ANATOMY The cluneal nerves are a group of cutaneous sensory nerves in the gluteal region. They are divided into three groups: superior, middle, and inferior. There are several branches within each of these three groups, but for the sake of simplicity, I'll address the smaller branches as components of the three primary groups. Superior Cluneal Nerves The superior cluneal nerves are composed of three branches and originate from the dorsal rami of the lower thoracic and upper lumbar spinal nerve roots, usually from T11 to L3 (Image 1). The dorsal rami are small nerve branches that depart from the main nerve root and go immediately in a posterior direction. These small and sensitive nerves must pass through several soft-tissue channels and directly through several muscles. It is easy to see why they are susceptible to pathological compression. After they exit the spinal region, the superior cluneal nerves pass lateral to the multifidus muscle and then pierce the erector spinae muscle group. They then pass directly through the latissimus dorsi muscle and over the top of the iliac crest before terminating in the upper gluteal region. The superior cluneal nerves provide sensory innervation to the upper iliac crest and the skin overlying the superior- medial portions of the gluteus maximus. technique | CLINICAL EXPLORATIONS Pain in the Rear Cluneal Nerve Entrapment By Whitney Lowe Branches of the superior gluteal nerves. Image from 3D4Medical's Complete Anatomy application. 1 The cluneal nerves are susceptible to compression and may be the source of pain complaints in the lumbopelvic region or lower extremity. Superior gluteal nerves

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