Why is it that there are yoga practitioners (including teachers) who pay so much attention to alignment and avoiding unnecessary injuries, still get one particular common injury, SI join pain, even after years of practice?
The answer, many reasons.
Among them, include hyper mobility in the hips; forcing the body beyond its range of “preferred” motion during practice; poor standing, sitting, and sleeping habits; or an injury sustained to the hips off the yoga mat.
What is the SI joint?
The sacroiliac joint or “SI joint” is the joint in the bony pelvis between the sacrum and the ilium which are joined by strong ligaments. The joint looks like two small puzzle pieces, which, when stretched too far can easily become displaced. The job of the sacrum is to bear the weight of the spine while the SI joints (one on each side of the hips where the sacrum meets the back of the pelvis) help to distribute weight amongst each hip and leg.
When the sacrum and pelvis move in opposite directions, say during an asymmetrical forward bend like janu sirsasana (head-to-knee pose), where the hips may be stretched or uneven, stress is put on the SI joint which may be painful and lead it to “pop” the puzzle pieces out of place and stretch the joint, causing pain.
How can SI joint pain be avoided?
The simple answer is to create and maintain stability during a pose.
But, if that’s what we’re trying to do to teach anyway, why does it still happen?
Baltimore area yoga teacher, Lucy Lomax, E-RYT-500, who focuses most of her classes on proper alignment, biomechanics and yoga as therapy, stated, “Women in general have wider hips and more fluid ligaments,” and gave a number of examples of causes of SI joint pain or misalignment seen in most women and some men:
1. Pelvic torsion, where the pelvis is tilted more to one side and therefore forces on the two sides are unequal (e.g., unstable twisting action, or shifting the hips to the side away from the direction the torso.)
2. Lordotic posture. posture (over-arched lower back) Caused by bending backwards too deeply from the lumbar region as in using the arms rather than the back muscles.
3. Curved back posture. Caused by bending forward from the lumbar region rather than the hip creases, which causes a curved, rather than a healthy flat back. This is seen mostly in forward bending poses.
4. Weak muscles of the hip girdle and/or abdomen.
5. Increase in female hormones which can promote more laxity in the joints, an issue during menstruation and pregnancy.
The fact is that yoga was originally created by men, who naturally have slim hips, which in turn created classical pose alignments for their physiological structure, and therefore, women are predisposed to more SI joint injuries.
How do you know if you have an SI joint injury?
The most common symptom of your pain being caused by the SI joint is an ache on one side of the rear-most point of the pelvic bone.
Trained physicians or physical therapists are able to assess a possible misalignment of the SI joint by pressing their hands around the hips and thumbs at each SI area on the pelvis. If one side is achy or tender, and the other feels normal with the same pressure, then it could be an SI injury. If the pain isn’t localized on the left or right, then it might not be the SI joint and, perhaps, a sciatica issue instead.
How can you avoid SI joint pain or injury?
Lomax also gave several tips on mindful alignment during yoga practice to avoid SI injury which include:
1. Ensure the pelvis is in an anatomical neutral position. What does that look like? Stand so that your side is facing a mirror. Look for a natural arch or inward curve in your low back. Then the front hip points (ASIS) should roughly line up horizontally with the “dimples” on either side of the sacrum in the back (PSIS). Further, the front hip points (ASIS) should line up vertically with the pubic bone (public symphysis).
2. Engage the sacral muscles. With the pelvis neutral, engage the sacral muscles by gently squeezing the hips towards the central axis of the spine while energetically drawing the TOPS of the buttocks downward. You can get a feel for this action by holding the sides of your pelvic rims in your hands, fingers forward, thumbs back – as if you were going to try to lift yourself up by the hips. Holding your pelvis firmly, gently press your hands towards each other as if you were giving your hips a hug while energetically lengthening the skin above the sacrum (below the back waist) towards the earth. This should feel as if there were a girdle around the hips, gently squeezing circumferentially around the upper area of the pelvis. You may also feel your pelvic floor and lower abs energetically lift.
3. Move the pelvis and sacrum as a unit. Maintaining pelvic neutrality while keeping muscle forces balanced is especially important in twists and asymmetrical poses.
How can you make the SI pain go away?
Using yoga practice to cure a yoga injury seems too easy, but is usually the most recommended course of action. Several of the recommendations mentioned above can also help to relieve the pain as well.
Consciously, “hugging the midline” of the hips and thighs and engaging the sacral muscles help to strengthen the muscles in the SI joint area.
Additionally, practicing easy backbends that don’t cause severe back compression (i.e., bujangasana/cobra, matsyasana/fish pose, salambasana/locus pose) and some standing poses, while being mindful of engaging the pelvis and sacrum properly to assist with strengthening the SI joint area.
There is also the possibility of being able to “pop” the joint properly into place – however, this should only be attempted with a properly trained practitioner, physician or physical therapist.
If you do have SI joint pain avoid side-bending poses that twist one side of the lower back; forward bending poses that extend the joint away from the pelvis and the joint; and hip opening poses. Typical poses to avoid include:
– Eka Pada Rajakapotasana (pigeon pose)
– Baddha Konasana (bound angle pose or butterfly)
– Upavistha Konasana (seated wide angle pose)
– Prasarita Padottanasana (standing wide angle pose)
– Utthita Trikonasana (extended triangle pose)
– Virabhadrasana II (warrior 2)
– Utthita Parsvakonasana (extended side angle pose)
– and Janu Sirsasana (head-to-knee pose).
Strengthening and realigning the SI joint may take some time and effort – and especially patience on the part of the yoga practitioner. Injuries are just one more way we learn about the capabilities of our bodies, as well as the true yogic practice of ahimsa.