The SI Joint
After learning all the ways that asanas can stress the sacroiliac area in Protect the Sacroiliac Joints in Forward Bends, Twists, and Wide-Legged Poses, you may be thinking, “Maybe Ill just advise my students to give up yoga, go home and sit on the couch watching reruns of Sex and the City until their SI joints fuse . . . and Ill ask them to save me a seat.” Luckily, you can do better than that (and not just by picking a better TV show).
To help your students prevent sacroiliac joint (SI) problems, or avoid making existing ones worse, follow these three suggestions: put it in place, stabilize it and move it with care.
I. Put it in place
If your student does not have an existing SI problem, or if she has had SI problems but her joints are currently in good alignment (pain-free), you can skip to suggestion 2, “Stabilize it.” If your students SI joint is currently out of place, advise her to try to get it back into place before practicing asanas. This is easier said than done, and it doesnt mean she cant ever practice if her SI joint is a little out of place, but its much better to practice with the SI joints where they belong.
One way to get a misaligned SI joint into place is to have a qualified health professional, such as a physical therapist, chiropractor, or osteopath, physically manipulate it. As a yoga teacher, you dont have license to do this yourself, so dont try unless you have additional qualifications. Also, despite their training and licensing, most health professionals really dont understand how to manipulate the SI joints effectively, so advise your student to be careful to choose a caregiver who has a track record of helping with this specific problem.
A second way your student might get her wayward SI joint back into place is by practicing specialized asanas to put it there. There is not room in this article to go into the details, but here is a general framework for understanding these poses. There are lots to choose from, and each health professional or yoga teacher seems to have her favorite. Despite the wide variety, postures that help realign the SI fall into just four simple categories.
Backbends, like Supta Virasana (Reclining Hero Pose), may help by directly pushing the top of the sacrum backward into place.
Modified twists can sometimes help by rotating one side of the sacrum backward and the other forward; however, these poses tend to be complicated and tricky to perform, and the wrong twist can easily make matters worse, so your student needs to learn them from a specialist.
One-sided pelvic tilts, such as reclining and drawing one bent knee toward the armpit on the same side, may help by focusing the adjustment specifically on the joint that is out of place, so that the ilium shifts in the right direction relative to the sacrum.
Exercises that pull the ilium bones apart, such as certain variations of Padmasana (Lotus Pose), or specialized poses that use props or muscle actions to apply lateral pressure to the upper thighbones, may help by opening the top part of the SI joint space. This seems to give the upper sacrum room to slide back into place without grating its rough auricular surface across the auricular surface of the ilium.
Many of the most successful SI-adjusting exercises combine elements from more than one category, and some add another factor: muscular resistance. For example, practicing Salabhasana (Locust Pose) variations with just one leg lifted combines backward bending with one-sided pelvic tilting and works muscles against the resistance of gravity. Combining a Padmasana action with a backbend (as in some forms of Matsyasana, or Fish Pose) can often create both the space and the movement needed to put the sacrum back where it belongs.
There are a few crucial things to tell your student about adjusting her SI joint, whether she does it herself or has someone else do it. First, tell her that a good SI adjustment should feel good, both during the adjustment and afterward. If the adjustment feels at all painful, or even neutral, it is probably not helpful and may even be harmful. Second, tell her that the appropriate adjustment or pose for her SI may be one-sided. An asymmetrical adjustment or posture that helps the SI when practiced on one side may well make it worse when practiced on the other. Advise her to only practice the posture on the side that feels relieved by it. Third, tell her that not all adjustments are appropriate for her. A posture or manipulation that works wonders for her friend may do nothing at all for her. Advise her to find just one or a few postures or adjustments that work well and to abandon those that dont work. Fourth, tell her that immediately after she gets her SI adjusted into place, she is best off leaving it alone overnight (or longer) before practicing any asanas. When she does practice, she should begin with stabilization.
II. Stabilize it
Certain yoga postures and practices can help stabilize the sacroiliac region by strengthening the muscles that cross the joint or holding the pelvic bones in place.
Backbends against the resistance of gravity, such as Salabhasana, Setu Bandha Sarvangasana (Bridge Pose), and Urdhva Dhanurasana (Upward Bow Pose) all strengthen the erector spinae muscles that run vertically from the sacrum or ilium up the back. They also strengthen the gluteus maximus (buttock) muscles. Note that practicing one-legged variations of these poses (like Eka Pada Setu Bandha Sarvangasana, Bridge Pose with one leg lifted) doubles the strength demands on one side of the body and puts asymmetrical stress on the SI joints. This means that these poses can be especially effective strengthening exercises, making them therapeutic for people who have an existing SI imbalance; however, the asymmetry also has the potential to worsen an existing imbalance.
Mula Bandha (the Root Lock, performed by contracting and lifting the area bounded by the tailbone, pubic bones, and sitting bones) strengthens the pelvic floor muscles (pubococcygeus, iliococcygeus, and coccygeus) that help keep the lower end of the sacrum from lifting and the lower pelvic bones from spreading apart.
Virabhadrasana III (Warrior III) powerfully strengthens a host of muscles that either cross or affect the SI joints, including the piriformis (which runs from the front of the sacrum to the outer upper thighbone), erector spinae, gluteus maximus, and gluteus medius (which runs from the outer ilium to the outer upper thighbone). However, this pose is an asymmetrical forward bend that can irritate the sacroiliac of the standing leg, so it is best reserved for students whose SI joints are already in place and stable.
Pranayama (Breathwork) includes certain actions that cinch the waist to a narrow shape without contracting the outer layers of the abdominal muscles. These actions help selectively contract the innermost abdominal muscle layer, the transversus abdominis. Strengthening this muscle helps stabilize the SI joints by holding the fronts of the ilium bones together horizontally.
III. Move it with care
Teach your students to avoid SI injury by moving with special care in the poses that put the most strain on the sacroiliac joints, especially seated forward bends, twists, and wide-legged poses. The most important instructions are to move the sacrum and the two ilium bones as a unit, keep the pubic bones together, and roll to one side before sitting.
Move the sacrum and the two ilium bones as a unit. In forward bends, instruct your students to “lift the sitting bones” or to “lift the sitting bones and tailbone together,” not “lift the tailbone” alone, because lifting the tailbone faster than the sitting bones tilts the top of the sacrum forward relative to the ilium. Instructions to lift the sitting bones (and to “tilt the top of the pelvis forward”) are intended to activate the iliocostalis muscles that run vertically from the back of the ilium to the rib cage. These muscles drive the pelvic tilt by moving the ilium bones forward, and these, in turn, push the sacrum ahead of them. This is less likely to cause SI trouble than actions that attempt to drag the ilium bones forward by pulling on them with the sacrum.
Teach your students that when the pelvis stops tilting forward in a forward bend, they should also stop moving the sacrum forward. They can continue bending the spine forward a little after the pelvis stops, but they should avoid bending it too far or pulling too hard, because this can draw the sacrum out from between the fronts of the ilium bones.
Protecting the SI goes hand-in-hand with protecting the disks of the lower back (lumbar) in forward bends (see Protect the Disks in Forward Bends and Twists). Both require that your student bend gently, rather than forcibly pulling her spine forward (or allowing someone else to push it). However, to protect her disks your student has to limit the amount of forward bend in her lumbar spine. In doing so, she runs the risk of inadvertently transferring the forward-bending force that would have gone into her lumbar directly into her sacroiliac joints. To avoid this, teach your student (1) to reduce the total amount of forward-pulling force in forward bends–advise her, in particular, not to pull too hard with the arms–and, (2) to bend cleanly at the hip joints, rather than letting the body bend half way between the lumbar spine and the hips.
Moving the sacrum and the two ilium bones as a unit is also important in twists. Instruct your students not to rotate the sacrum faster than the pelvis. Rather than insisting that they hold the pelvis rigidly in place, allow them to let it turn a little along with the twist. Teach them that when the pelvis stops turning, the remaining twist should come not from the SI joints but from rotation higher up on the spine and trunk (that is, from joint movement of the thoracic vertebrae and ribs, facilitated by release and stretch of surrounding muscles).
Keep the pubic bones together. In poses that spread the thighs apart, like Baddha Konasana (Bound Angle Pose), Upavistha Konasana (Wide-Angle Seated Forward Bend), Prasarita Padottanasana (Wide-Legged Forward Bend), and Virabhadrasana II (Warrior II Pose), teach your students to release the inner thigh (adductor) muscles while keeping the pubic bones together by stabilizing them with other muscles. Although students without SI problems may need to learn to relax the pelvic floor and spread the sitting bones in these poses, those with SI instability may benefit instead from instructions to contract the pelvic floor muscles, pulling the sitting bones and pubic bones toward one another. (Using the pelvic floor muscles to pull the tailbone toward the pubic bones can also help, especially if bending forward). Also instruct your students to narrow the waist in wide-legged poses. This selectively activates the transversus abdominis muscle, which helps hold the front of the pelvis together left to right.
For many students (especially more flexible ones and those with existing SI problems), all this muscular stabilization may not be enough in Baddha Konasana. It may also be necessary to place supporting blankets under each thigh to prevent the legs (and therefore the pelvis) from spreading too far. This is even more important in Supta Baddha Konasana (Reclining Bound Angle Pose), because the alignment and relaxed muscles of this pose make it especially hard on the SI joints.
Roll to one side before sitting. After Savasana (Corpse Pose) or other reclining poses, instruct your students to roll to one side. Tell those with SI instability to move the pelvis and spine as one unit. Sitting straight up from the supine position can force the psoas and iliacus muscles to put excess forward pull on the spine and pelvis. Rolling as a unit prevents excess twisting at the SI joints.
Following these suggestions can help you and your students maintain healthy SI joints as you increase your body’s mobility and advance in your practice.
ABOUT OUR EXPERT
Roger Cole, Ph.D. is an Iyengar-certified yoga teacher and Stanford-trained scientist. He specializes in human anatomy and in the physiology of relaxation, sleep, and biological rhythms. Find him at rogercoleyoga.com.