Yoga Shouldn't Hurt Part III: Sacroiliac Joint

Avoid injuries on the mat with this practical guide to caring for your knees, hamstrings, and sacrum ~ by Roger Cole

Sacroiliac Joint

The Road to Injury

Suppose you're one of those people who finds that yoga comes easily to you. You can bend into most poses without stress or strain. One day, while coming out of Janu Sirsasana, you notice that something feels a little off down where your lower back joins your pelvis. From that day on, you frequently have a nagging ache in that area. It's usually more annoying than disabling, and periodically it goes away altogether, only to mysteriously reappear days or even weeks later. These are some of the symptoms of an unstable sacroiliac joint alternately moving out of alignment and back in again.

The sacrum is the bone that is shaped like an upside-down triangle at the base of the spine. On each side of the sacrum, a roughened surface makes contact with the corresponding surface of the left and right ilium bones, or the "wings" of the pelvis. These are the left and right sacroiliac (SI) joints. Strong ligaments hold the SI joints together to prevent the sacrum from tipping forward between the ilium bones. To get an idea of where your SI joints are, trace your thumb over the top rim of your pelvis on one side, moving backward until you find the rearmost bony prominence of the ilium (this is called the posterior superior iliac spine or PSIS). If it were possible to press your thumb forward an inch or two, deep into your body, you would be touching one of your SI joints.

Yoga students frequently develop a specific pain pattern that's characterized by a dull ache over an area about the size of a quarter and is centered on the PSIS on one side of the body only. Sitting, forward bending, and twisting movements often make it worse, and back and sidebending can also be painful. Although not all experts agree and other injuries must be ruled out, many yoga teachers and health professionals believe that this pain pattern is caused by the misalignment of one of the sacroiliac joints.

According to one theory, yoga practice (especially if it emphasizes forward bends, twists, and poses that stretch the inner thighs) can loosen the supporting ligaments of the SI joints over time, until one side of the upper sacrum slips forward relative to the ilium on that side. Because the two irregular surfaces no longer sit properly on one another, pressing them together tightly (as occurs strongly while sitting) causes pain.

Prevent and Prepare

To prevent this problem from happening, be mindful of your alignment in different types of poses. In forward bends, be careful to move your sacrum and ilium forward as a unit. For example, in Janu Sirsasana, move into the pose by tilting the iliac crest (pelvic rim) of the bent leg forward toward the foot of the straight leg. This makes the ilium push the sacrum along so that the two bones move as one. When your ilium stops moving, don't tilt your sacrum any deeper into the pose. Likewise, in twists, experiment with letting the pelvis turn along with the spine instead of keeping it fixed, so the sacrum and ilium move as a unit.

In forward bends, twists, and any pose that stretches your inner thighs, try contracting the pelvic-floor muscles. These muscles help hold the sacrum in place by pulling the sitting bones toward one another, thereby squeezing the ilium bones inward against the sacrum. Finally, strengthening muscles of the back with poses such as Salabhasana, and strengthening the deepest abdominal muscle (transversus abdominis) with pranayama practices such as Kapalabhati (Skull Shining Breath), help stabilize the SI joints.

The Path to Healing

If you already have a sacroiliac misalignment, the key is to adjust the joint back into its proper position and keep it there. Some health professionals know how to manually manipulate the SI joint back into place, but it often pops back out soon afterward. Therefore, it's helpful to learn how to reset your own SI joint using asana techniques, but it's best to learn these techniques from a qualified instructor.

The golden rule for SI-adjusting postures is that a correct pose should immediately feel good on the injured area while you practice it. Enter each pose slowly, and if it causes any discomfort near the PSIS, come out of it right away. Not all poses work for all people, but you need only a single one that works for you. Two examples of poses that help some people are the Salabhasana and Virabhadrasana I (Warrior Pose I) variations shown here. Either side of the Virabhadrasana I variation may be helpful.

Once you have learned to put your SI joint back into place, make sure it is properly located before each yoga practice and follow the preventive steps above to keep it there. At the end of practice, use your technique again, if needed, to firmly reset the joint. Some teachers find that taking special care to keep the SI joint in place at all times over a period of months or even years can make it more stable.

Salabhasana (Locust Pose), modification This pose may help stabilize the sacroiliac joints. Strap your ankles 8 to 12 inches apart. Lie on your belly with your arms alongside your body, palms facing up. As you inhale, lift your arms, legs, and chest up. Pulling the legs strongly outward against the strap may relieve sacroiliac symptoms; it contracts outer hip muscles (gluteus medius and minimus) that pull the ilium bones apart, temporarily creating a gap between the sacrum and ilium to give the sacrum the freedom to move back into place. Introduce this pose gradually and back off immediately if it causes discomfort.

Virabhadrasana I (warrior pose I), variation This pose may relieve sacroiliac symptoms by putting asymmetrical forces on the joint. Move into it slowly to make sure it feels OK; avoid it if it hurts. Take a wide stride, bend your front knee, and place a block between your knee and the wall. Keep your front shin vertical, back knee straight, back heel lifted, and chest lifted. Shift your body weight and adjust the angle of your pelvis to find the position that feels best in your sacroiliac area.

Roger Cole, PhD, has practiced yoga since 1975 and taught since 1980. He is a certified Iyengar Yoga teacher trained at the Iyengar Yoga Institutes in San Francisco and Pune, India. He teaches at Yoga Del Mar in Del Mar, California. For more information, visit http://www.rogercoleyoga.com.