Out of Joint

The sacroiliac joint—where the pelvis and sacrum meet—is where many yogis experience lower back pain. But you can resolve the discomfort in the same place it started: on the yoga mat.

By Judith Lasater

Years ago I was in the middle of my yoga practice, legs wide apart, bending deeply down over my right leg in Upavistha Konasana (Open Angle Pose) when I heard it—a popping sound in my left lower back, like a wine bottle being opened. Alarmed, I came up but only noticed a dull ache over my sacrum. I shrugged it off and finished my session relatively unfazed.

But it didn't go away. In fact, I was plagued with recurring bouts of pain. At the time I was in physical therapy school and had easy access to an orthopedist. His examination revealed little, and when I demonstrated the pose at his request, he smiled and expressed skepticism that I had lower back pain at all. Needless to say I felt somewhat hopeless about understanding what was causing this nagging pain. I continued to seek medical help over the next few years and even consulted with chiropractors and massage therapists. My chiropractor finally diagnosed my pain as being caused by my sacroiliac joint, but he had little success in treating it.

To my surprise, the pain was finally resolved at the place where it first occurred: my yoga mat. I noticed that when I began to take particular care with my pelvic alignment during yoga poses, especially in twists and forward bends, the pain and discomfort went away. That extra care and attention were the final piece that helped me understand the puzzle of my sacroiliac joint. Although my practice caused my sacroiliac pain, it was also the best medicine when it came to not only healing it but also preventing any future problems.

Casing the Joint

Lower back pain has been around as long as men and women have walked upright. In fact, approximately 80 percent of people experience some form of lower back pain, including sacroiliac pain, during their lifetime—although there are no definitive statistics on how many experience sacroiliac pain specifically. Part of the difficulty is there is no way to objectively measure the degree to which the sacroiliac joint is "out." In fact, there are some health professionals—like my orthopedist—who debate whether the S-I joint contributes significantly to lower back pain at all.

The sacroiliac is one of the joints in the pelvis, formed by two bones, the sacrum and the ilium. While there is a small amount of movement allowed at the S-I joint, its major function is stability, which is necessary to transfer the downward weight of standing and walking into the lower extremities. Held together by strong yet pliable ligaments, it is designed to lock in place when you stand; the sacrum bone wedges down into the pelvic joints due to the weight of the trunk—similar to the way a padlock closes. This tight sacrum-pelvis connection creates a firm base for the entire spinal column. However, when you sit, this stability is lost because the sacrum is no longer wedged into the pelvis—which is why S-I joint pain sufferers often prefer to stand.

Sacroiliac pain is a result of stress at the joint created by moving the pelvis and the sacrum in opposite directions. This can be caused by an accident or sudden movements, as well as poor standing, sitting, and sleeping habits. However, it has been my observation during 30 years of teaching and practicing that yoga students—particularly women—experience sacroiliac pain in higher percentages than the general population. This is mainly due to the unusual and consistent stresses put on the supporting ligaments around the S-I joint during asana practice, as well as poses that move the pelvis and sacrum in opposite directions.

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