Massage & Bodywork

NOVEMBER | DECEMBER 2021

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84 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 PATHOPHYSIOLOGY The most common cause of pathology with the cluneal nerves is entrapment by adjacent anatomical structures. The superior cluneal nerves are most vulnerable to compression by the quadratus lumborum and the thoracolumbar fascia, or entrapment against the iliac crest as the nerves pass over the top of it. There is a strong fascial connection between the thoracolumbar fascia on one side of the body and the gluteus maximus on the opposite side (Image 4). Consequently, myofascial tension on one side may also play a role in cluneal nerve entrapment on the opposite side. The middle cluneal nerves are most commonly entrapped by the long posterior sacroiliac ligament. As noted earlier, they sometimes go underneath this ligament and sometimes over the top of it. Entrapment is most common when the nerves are under the ligament. The inferior cluneal nerves are not as vulnerable to compression as the middle and superior cluneal nerves. However, they may be somewhat susceptible to compression near the ischial tuberosities, depending on the individual's anatomical structure. Inferior cluneal nerve entrapment is likely to produce groin pain and may often be mistaken for other problems such as pudendal nerve injury. External compression, such as pressure from sitting, can add to the problem in any of these locations. Several other factors can also contribute to cluneal nerve compression, such as local trauma, intervertebral disc herniation, muscle spasms, lumbar stenosis, scoliosis, and vertebral fractures. Interestingly, Parkinson's disease can play a role due to abnormal muscle tone as well as altered postures and gait mechanics. ASSESSMENT For all three cluneal nerve groups (superior, middle, and inferior), pain in the lower back or buttock region is the most common complaint. Reports of aching or prickly sensations in the gluteal region are most common, but the location may not be highly specific. There may be some muscle weakness in the area if other motor nerves are affected. However, cluneal nerves are purely sensory, so their compression would not cause muscle weakness or atrophy. The symptoms of cluneal nerve entrapment often mimic those of sciatic nerve irritation. There are no specific physical examination tests that accurately pinpoint the entrapment, however. It is also hard to isolate these regions during basic active, passive, or resisted evaluation movements. Therefore, a thorough client history along with a detailed palpatory exam is essential. During motion evaluations, superior cluneal nerve compression may cause increased discomfort or additional Fascial connections in the lumbo-pelvic region. Image from 3D4Medical's Complete Anatomy application. 4

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