How the Lumbosacral Plexus and Hips Can Contribute to Pain in the Lower Abdomen and Testicle
Pain or sensitivity in the lower abdomen and testicle can feel confusing, even alarming. Many men first assume the issue must be in the scrotum, bladder, or prostate. While those areas can certainly be involved, what is often overlooked is how nerves from the back, hips, and pelvis, particularly the lumbosacral plexus, can cause pain that radiates or refers into these regions.
A Quick Anatomy Review: The Lumbosacral Plexus
The lumbosacral plexus is a network of nerves formed by spinal nerve roots from L1 to S4. It sits deep in the pelvis, weaving around muscles and connective tissues before branching into nerves that supply the abdomen, hips, pelvis, and legs.
The lumbar plexus (L1 to L4) provides nerves to the abdominal wall, groin, upper thigh, and genital area.
The sacral plexus (L4 to S4) provides nerves to the hips, buttocks, pelvic floor, and legs.
This web of nerves is responsible for both motor control (muscle activation) and sensory input (pain, temperature, touch) in the trunk, pelvis, and lower limbs.
Dermatomes and Pain Referral
Each spinal nerve supplies a specific skin region called a dermatome. If a nerve root is irritated at the spine, or compressed by tight muscles, ligaments, or fascia, the brain may interpret the pain as coming from the dermatome rather than the original site.
Relevant dermatomes for abdominal and testicular pain include:
T12 to L1 (iliohypogastric and ilioinguinal nerves): lower abdomen, groin, and scrotum
L1 to L2 (genitofemoral nerve): front of the thigh, inguinal canal, and testicle
L2 to L3 (obturator nerve): inner thigh and pelvic floor
S2 to S4 (pudendal nerve and pelvic branches): perineum, penis, and scrotum
Because of this overlap, irritation in the back or hip can feel like sharp, achy, or burning pain in the lower abdomen, groin, or testicle.
What Nerves Can Be Involved
Several specific nerves commonly play a role in referred abdominal or testicular pain.
The ilioinguinal nerve (L1) passes through abdominal muscles and supplies the scrotum. Entrapment can cause burning pain in the groin and testicle.
The genitofemoral nerve (L1 to L2) runs along the psoas muscle and splits into genital and femoral branches. Compression here can mimic testicular pain or hypersensitivity.
The obturator nerve (L2 to L4) runs through the pelvis and hip muscles. Dysfunction may cause deep pelvic or inner thigh pain that radiates forward.
The pudendal nerve (S2 to S4) supplies the pelvic floor and perineum. Irritation can cause aching, burning, or sensitivity in the genitals.
How the Hips Come Into Play
The hip joint and its surrounding muscles have a powerful influence on the lumbosacral plexus.
The psoas muscle, which helps flex the hip, lies directly over the lumbar plexus. Chronic tightness can compress the ilioinguinal and genitofemoral nerves.
The piriformis muscle, in the buttock, crosses the sacral plexus. Irritation here can lead to radiating pelvic or scrotal pain.
Hip instability, labral tears, or joint degeneration can cause altered movement patterns, pulling on surrounding fascia and irritating nerves.
Structural Failure: When Posture and Repetition Break the System
Pain often does not come from one sudden injury. It builds up slowly as posture, movement, and mechanics break down over time. This is what can be called structural failure.
Prolonged sitting shortens the psoas, compresses the lumbar plexus, and weakens the glutes. This imbalance makes the nerves of the lower abdomen and groin more vulnerable.
Repetitive poor posture such as standing with sway-back posture, sitting cross-legged, or carrying weight unevenly shifts the pelvis and lumbar spine. Over time this strains ligaments, fascia, and muscles, gradually compressing nerves.
Hip instability occurs when stabilizing muscles like the glute medius or deep rotators are weak. The pelvis rocks and twists with every step. The nerves of the lumbosacral plexus travel through this shifting tunnel, creating friction and irritation.
Core weakness leaves the lumbar spine and pelvis unsupported. The abdominal wall may bulge, scar tissue from old surgeries may tug, and tension builds across the ilioinguinal or genitofemoral nerves.
Cumulative load is another factor. Small imbalances such as sitting crooked, leaning into one hip, or shallow breathing repeat day after day. Over years these micro-strains add up to nerve irritation that shows up as pain in the testicle, groin, or lower abdomen.
In other words, it is not just one bad day at the gym. It is the daily, unconscious habits of posture and movement that slowly erode structural integrity until the nervous system finally signals pain.
The Bigger Picture
If you are experiencing unexplained pain or sensitivity in the lower abdomen or testicle, it is worth considering the whole system—spine, nerves, fascia, hips, and pelvic floor—not just the local structures. A physical therapist trained in pelvic floor health can help assess movement patterns, release irritated nerves, and restore balance between the hips, back, and pelvis.
Looking to optimize your well being with pelvic floor physical therapy? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.