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

Women are eight to 10 times more likely to suffer from sacroiliac pain than men, mostly because of structural and hormonal differences between the sexes. A woman's anatomy allows one less sacral segment to lock with the pelvis. It may sound minor, but this has a big influence on instability. Also, the hormonal changes of menstruation, pregnancy, and lactation can affect the integrity of the ligament support around the S-I joint, which is why women often find the days leading up to their period are when the pain is at its worst. Finally, women's wider hips influence stability during everyday activities; in walking, for example, as each hip joint alternately moves forward and backward with each step, every increase in hip width causes an increased torque across the S-I joint. Add the fact that women also make up two-thirds of exercise walkers, and it's easy to see why sacroiliac pain is found so much more commonly in women than it is in men.

Before turning to the mat for help, you first have to determine whether your lower back pain is in fact due to S-I dysfunction. There are a few telltale signs. The most common is pain that exists in an area about the size of a quarter over the S-I joint. This pain can be caused by the sacrum either slipping forward or backward in relationship to the ilium. It is commonly felt only on one side—and sometimes not on the side of the actual dysfunction. Another simple way to test whether your S-I joint is causing your pain is to observe your symptoms as you slowly stand and sit.

Other signs include pain radiating into the hip socket, or down the outside of the leg, or deep inside the belly over the anterior surface of the S-I joint. But pain is not an accurate indicator; there are other situations that mimic S-I dysfunction. It's important to have a health-care professional confirm your intuition—especially about which side and which way the dysfunction has manifested. Once you have been diagnosed, you can use yoga by practicing specific poses in a certain way. Remember, though, that while yoga can help strengthen around the joint, as well as provide the awareness necessary to help you prevent future problems, asanas in and of themselves may not be sufficient to cure all sufferers.

Proceed with Caution

The sacroiliac joint remains healthier if it is not stretched too much. In fact, focusing on creating stability is the key to preventing overstretching and thus remaining pain free in the sacroiliac joint. I have found that the best poses for sacroiliac pain are twists and asymmetrical forward bends, both of which help to diminish the torque through the joint. And strengthening the muscles around the S-I joint so as to prevent future problems can be accomplished by practicing simple backbends and standing poses. But while these poses can be beneficial, doing them incorrectly can put further stress on the area and end up causing more harm than good. If your sacroiliac is already out, then twists and forward bends can be especially problematic.

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