Understanding and Managing Sacroiliac Pain in Yoga Practice

It is common for yogis to develop painful sacroiliac joints, with serious consequences: dysfunction at the sacroiliac joint inhibits the hip muscles and starts a vicious cycle of hip instability and body misalignment. Painful sacroiliac joints must be treated and stabilised to avoid chronic pain and it is not advisable to continue with any yoga practice that causes sacroiliac pain. Successful treatment by a specialised therapist is life-altering for yogis suffering from sacroiliac dysfunction.

It is very important to get sacroiliac pain diagnosed and treated promptly because hip alignment affects the entire body. When one hip is weak, the pelvis twists – one hip goes forward and the other backwards, causing

• rotation in the upper body: shoulder imbalances, chest or neck pain
• Lateral pelvic tilt affecting the knees and feet

It’s complex to balance body alignment after long-term hip misalignment. The body is stabilised in spiral patterns and there are often alternating zones of weak and tight muscles in the torso, shoulders and legs. If these aren’t addressed, sacroiliac joint problems return.

When one joint in the body doesn’t move, hypermobility occurs in the surrounding joints. This also happens between the left and right sides of the sacroiliac joint, or at the upper and lower part of the joint (the sacroiliac joint is roughly banana-shaped): if parts of the sacroiliac joint are hypermobile, the Gluteal muscles weaken and the hips easily become misaligned. The non-moving part of the joint can become fused (ankylosed) over time– a natural ageing process starting around the age of 40, commonly in men, but less so in women, according to studies.  Stiffness in the sacroiliac joint causes hypermobility in the lumbar spine and lower back pain.

Muscle release and massage generally gives temporary relief to sacroiliac pain and symptoms. Chiropractic treatment works if sacroiliac pain is caused by physical trauma, like a bad fall or pregnancy.

Sacroiliac dysfunction can be caused by injury, but also by muscle imbalances or differences between the left and right sides of the body. This type of sacroiliac dysfunction is common from yoga and is treated by

1. rehab exercises focused on pelvic stability
2. identifying and strengthening weak hip and core muscles
3. stretching muscles that have shortened because of changes in body alignment
4. changing muscle-recruitment patterns and movement habits

Asymmetrical positions of the hips such as Virabhadrasana 1 & 2, Hanumanasana, Parsvakonasana and Trikonasana variations, Chandrasana with the back knee off the ground and standing back-bending are well known causes of sacroiliac joint pain in yoga but there are some other factors:

1. Reciprocal inhibition of hip muscles from unbalanced leg strengthening makes the sacroiliac joint vulnerable
2. Core stabiliser muscles don’t function automatically and it is completely possible to move without them. Stabiliser muscles respond to intention so conscious activation of the Bandhas, hips and deep spinal muscles must be constantly reinforced.

The core-muscle stabilisers of the sacroiliac joint are the pelvic floor muscles – Mula Bandha, lower Transverse Abdominis – Uddiyana Bandha and the Multifidis (deep stabiliser muscles of the spine), but

• Mula Bandha is often treated as something to think about as a yoga practice progresses, or ignored.
• Many teachers give the instruction to ‘pull the bellybutton to the spine’. Ashtanga teachers David Swenson and Richard Freeman correctly identify the point of focus to be lower: between the hip-bones. Hollowing the lower Transverse Abdominis between the hips supports the pelvis – hollowing the stomach at the bellybutton doesn’t.
• Lower back pain causes deep Multifidis muscles to atrophy and they need rehabilitation exercise – a dysfunctional Multifidis inhibits the Gluteus Medius. People can develop sacroiliac instability after an episode of lower back pain if they are unaware of this fact.

During yoga practice, the deep spinal stabilisers are activated by visualising the top of the head being pulled up to the ceiling by piece of string and the legs being pulled deeper into the hips by cords, creating a lifted sensation in the spine and flatter firmness in the back muscles, not bulging Erector Spinae muscles

It helps to practice yoga with the hands on the hips to monitor pelvic position, ensuring that the pelvis is stable and in good alignment. Self-observation is important:

1. hip-bones should move as a unit – the two halves of the pelvis should move together, not rotate in opposite directions
2. hips are level horizontally

When the pelvis is adequately stabilised by the core muscles in standing poses and bridging poses it is possible to move the legs and arms without clenching the hip muscles or the hipbones moving.

Yoga teachers have a great responsibility to avoid causing Sacroiliac problems in students:

• don’t teach asana sequences with a high proportion of poses that irritate the sacroiliac joint
• know and reinforce correct Bandha use and movement habits.

Related topics on this site:   Sacroiliac Joints and Yoga,  Lower Back Pain and the Sacroiliac Joint

Sacroiliac joints & women:   Menstruation and Yoga,   Pregnancy Yoga

Reading Sources:
De Franca, 1996, Pelvic Locomotor Dysfunction
Lee, 1999, The Pelvic Girdle

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