Q: What are good poses for people with sacroiliac pain? Which poses should one avoid? —Natalie
Esther Myers’ reply:
Before I suggest ways to work in your yoga practice, I recommend an accurate assessment and diagnosis of the cause of your pain by a qualified professional such as an osteopathic physician, chiropractor, or physical therapist. It may be challenging to diagnose since the symptoms of sacroiliac problems are often similar to those of other lower-back problems.
A qualified professional will try to determine if your discomfort is caused by a misalignment of your pelvis, tension in the large muscles of the hips and pelvis (which may cause the joint to jam or stiffen), or a strain (which is often due to looseness or hyper-mobility in the joints). Very often one sacroiliac joint is stiff and the other is hyper-mobile, creating an imbalance that can cause discomfort in either side. The discomfort itself may not correspond to the cause.
In her article, Judith Lasater notes that a higher percentage of women experience sacroiliac pain than men. She attributes this to “the hormonal changes of menstruation, pregnancy, and lactation [which] can affect the integrity of the ligament support around the S-I [sacroiliac] joint.”
Another potential risk factor for women is that yoga poses were developed by and for men. The pelvis is narrower in men than in women, which makes it more natural for men to stand with the inner edges of their feet together in standing poses. Although I was taught to do Tadasana (Mountain Pose) and other standing poses with the feet together, I now practice and teach with the feet hip-width apart. Widening the stance creates more space in the pelvis and provides a wider base of support.
Finally, stiffness in the hip joints in combination with the unusual stresses placed on the joints through asana practice can strain the sacroiliac. If you push yourself beyond the natural range of movement in forward bends or twists, you may strain your sacroiliac joints, lower back, or knees. It can be very frustrating to hold back in class when you want to do all of the poses, but it is essential that you respect your body’s limits.
If your sacroiliac joints are hyper-mobile, your first task is to strengthen and stabilize the back of your pelvis. Backbends lying on the stomach such as Bhujangasana (Cobra Pose), Salabhasana (Locust Pose), and Dhanurasana (Bow Pose) are particularly effective, although you have to be careful not to compress your lower back. If your back feels tight or achy after you’ve performed the poses, you’ve gone too far.
When the joint has been stabilized and you are pain-free, begin to gradually reintroduce forward bends, being careful not to overstretch the back of your pelvis. Interspersing forward bends with small backbends (listed above) may help prevent overstretching in one direction or the other. I recommend introducing twists and Trikonasana (Triangle Pose) last.
If the pain is caused by muscle tension in the back of your pelvis or by compression on the joints, then forward bends and seated poses that stretch the back of the pelvis will be beneficial. Eka Pada Rajakapotasana (King Pigeon Pose) forward bend, Gomukhasana (Cow Face Pose), and Ardha Matsyendrasana (Half Lord of the Fishes Pose) are very effective. Remember that you may find that you need to strengthen one side and stretch the other, which will make for an imbalanced practice while you are healing.
Although the recommendations sound quite straightforward, you will have to be patient and experiment for a while to find the balance of strengthening and stretching that is right for your body.