I first experienced sacroiliac joint dysfunction (more commonly referred to as SI joint dysfunction or SI pain) when my third child was a few days old. I picked up one of my then two-year-old twins when she was crying, and with all the hormone relaxin in my postpartum body, it threw everything out of whack. And, wow, did it hurt! I could barely walk when it first happened.
Thankfully, I was able to connect with Dr. Monica Saliu, Co-Founder and Clinical Director of Tribeca Physical Therapy, PT extraordinaire and postpartum expert, who taught me how to heal and keep this joint as stable as possible once the inflammation and acute period had passed. With her help, I was able to create yoga flows for myself, and many of my postpartum patients, that helped give this joint stability, space and strength.
While I had learned about it in my prenatal yoga teacher training, I had no idea just how common SIJ dysfunction is. According to Dr. Saliu, this condition affects mostly young adults, with more prevalence in women, and increased incidence in postpartum women. SI Joint Dysfunction presents with pain, instability or restriction at the joint that connects the pelvis to the lower back. It can be quite debilitating (as I can attest) and can result in movement dysfunctions and long-term low back pain and/or nerve damage, if not treated appropriately.
During the acute phase, Dr. Saliu typically prescribes:
- Anti-inflammatory medication
- Bracing and therapeutic exercises
Unfortunately, after the pain subsides, the dysfunction can continue if not corrected properly.
If SI joint dysfunction is something that you struggle with, areas to focus on strengthening include your:
- Lateral hip (Gluteus Medius, Piriformis)
- Posterior hip (Gluteus Maximus)
- Core (Transversus Abdominus, Internal and External Obliques, Multifidi, and pelvic floor)
- And sometimes your anterior hip (Iliopsoas muscle if weak).
Areas to focus on lengthening (stretching and opening) include your:
- Back muscles and lateral trunk (Erector Spinae and Latissimus Dorsi)
- Hip muscles (TFL, Gluteus Medius and Minimus)
- Anterior hip and thigh (Psoas, Iliacus, Rectus Femoris and the Adductor group)
The following yoga moves work well to achieve these results:
1. Sukhasana, variation (Easy Pose)
Begin seated and cross one shin in front of the other, knees wide, heels underneath opposite knees. Allow your arms to relax by your sides, with your fingertips or hands on ground on either side of your hips. Reach your left arm long to the ceiling, alongside your face. Take your right hand to the ground and crawl it over to the right, allowing your right forearm to move towards the ground. Lean your torso to the right. Reach your left arm to the right as well, and revolve your chest open towards the ceiling. Keep rooting both sitting bones down into the ground. Use each inhale to lengthen your side waist, and each exhale to gently open your chest. Hold for 3-5 breaths. Repeat on the other side.
Focus: Lengthening of the lateral torso and back muscles with breathing while being mindful of the possible restrictions between the two hips.
2. Seated Sufi Circles
Begin in Easy Seat by crossing one shin in front of the other, knees wide, heels underneath opposite knees. Place your hands gently on your knees, cupping them lightly. Begin to make circles with your torso: leaning to the left, rounding your spine backwards, leaning to the right, then arching your spine forward. Take several of those with deep breaths, and then repeat in the opposite direction.
Focus: Promoting pelvis and spinal controlled mobility coordinated with breathing.
3. Forearm Plank
Begin on all fours. Lower your forearms to the ground so that your elbows are align with your shoulders. Your forearms can be parallel to one another with your palms facing down, or you can clasp your hands together. Tuck your toes, lift your knees off the ground and step your feet back so that your legs are long. Reach back through your heels and forward through the crown of your head, keeping a long spine. Engage your navel to your spine and breathe here for at least 3 deep breaths, working your way up to one minute.
Focus: Spinal stability, core strengthening and pelvis stability.
4. Adho Mukha Svanasana, variation (Downward-Facing Dog Pose)
Begin on all fours. Tuck your toes and lift your hips high, reaching your sitting bones towards the ceiling. Reach your heels back toward the mat, but not touching. Drop your head so that your neck is long. Keep your wrist creases parallel to the front edge of the mat. Press into the knuckles of your forefinger and thumbs to alleviate pressure from your wrists. This is Down Dog.
From Down Dog, on your inhales: bend both of your knees so that your thighs get closer to your torso, then, on your exhales: lengthen both legs, reaching your heels in the direction of the ground at the same time, once more. Repeat this for 5-10 breaths.
Focus: Dynamic lengthening of the posterior chain muscles of legs and back, most importantly the hamstrings, gluteus and latissimus dorsi. Moving both heels together (as opposed to pedaling through your feet one at a time) minimizes pelvic rotation and decreases the sheer force at the Sacroiliac joint preventing irritation/inflammatory response.
5. Supta Virasana (Reclining Hero Pose)
Begin in a kneeling position. Separate your feet so that your sits bones can come to the ground or to yoga props (such as a bolster or blankets) between your heels. Keeping your knees relatively close together, neither touching nor widening, slowly crawl your hands back until your forearms are on the ground. Walk your elbows down until you are lying down on the mat or props. Tuck your tailbone underneath you to mitigate the arch in your back. Breathe here. Reach your arms overhead, take a hold of opposite elbows, and allow them to rest on the ground. Hold for 5-10 breaths. Then, come up slowly and evenly, using your forearms as you did when you came into the pose.
Focus: Lengthening of the anterior hip/thigh muscles to improve hip mobility and minimize the anterior pelvic tilt.
6. Bridge Pose (Setu Bandha Sarvangasana)
Begin lying on your back. Bend your knees and place your feet on the ground at hip-width apart. Keep the outer edges of your feet parallel. Take a block on the medium width, and place it between your thighs, just below your knees, then relax your arms to either side of you. Press into your feet (especially into your big toe mound), lengthen through your tailbone and lift your hips. Interlace your hands together underneath you, and, if it feels good, wiggle your shoulders closer together one at a time. Keep ahold of the block in between your thighs. Hold for 5-10 breaths.
Focus: Hip and pelvis stability and strengthening of the posterior chain muscles with core control.
7. Supta Gomukhasana (Reclining Cow Face Pose)
Begin lying on your back. Cross your right knee over left, winging your feet out to the sides slightly. Take hold of the outer edge of your right foot with your left hand and the outer edge of your left foot with your right hand. You can also hold onto your shins. Keep your knees stacked, and direct your feet with your hands, moving in the direction of getting your shins into one long line. Bend your elbows and flex your feet. Hold for 5-10 breaths. Repeat on the other side.
Focus: Lengthening of bilateral piriformis, tensor fasciae latae and gluteus muscles to improve hip rotation.
8. Supta Baddha Konasana (Reclining Bound Angle Pose)
Begin lying on your back. Take your feet together, knees apart, and allow your arms to relax long on either side of you, palms face down, around your bum. Take a deep breath in, and on your exhale, lift your hips off the ground. From here, slowly lower and lift with control, focusing on contracting your glutes, 10-20 times. Your exhales coincide with the lifting, and the inhales with the lowering.
Focus: Strengthening of the pelvic floor coordinated with breathing to increase pelvic stability.