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.
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| 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.
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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.
