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

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 YogaLower 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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7 thoughts on “Understanding and Managing Sacroiliac Pain in Yoga Practice

  1. Hi Niki, I found your blog by searching neck pain from malignment from sacroiliac joint. For 19 years the medical profession diagnosed me with failed back surgery syndrome, when in actuality, the whole time was suffering from an unstable rt. sacroiliac joint. Before I go much further, I can see you understand a great deal about this problem. I’m not asking for your advise. I’m hoping you can lead me to a doctor or physical therapist who can help me. Last month I had a successful rt. sacroiliac joint fusion. Prior to surgery, I had secondary mid, upper back, neck and rt. shoulder blade pain/tension. Right after surgery, all the pain/tension was gone! Last week, after riding a recumbent bike for the first time, all the mid, upper back, neck & shoulder blade pain returned. I would be forever in your debt if you could recommend someone I could see that could help me. I live in Arizona, but it’s so bad, I would travel anywhere for help. One more bit of info, I had 2 whiplashes in the mid 80’s, which I always thought my pain/tension was coming from. I appreciate any advise or suggestions!

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    • Hi Jenny. Unfortunately, I don’t live in the USA, so I can’t make any recommendations about particular doctors.

      Please bear in mind that if you have had an unstable Sacroiliac joint for so long, your muscular system has learned to function in abnormal ways to accomodate this. Although you have had fusion of the joint, your muscular system will not simply function correctly of it’s own accord, your muscles need to be retrained in proper alignment to become pain-free.
      Basically, you’ve been resting since your fusion but now that you have exercised and there is tension in your muscles, the pain has returned. Referred pain in your upper body is a common consequence of hip misalignment and can improve with rehab-exercise, patience and commitment to the process

      My suggestion is that you look for both a Chiropractor and a Biokineticist or rehab specialist and work together with them and understand that this will be a long process

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  2. Thank to your article i could finally identify what’s wrong with my hips ! Rare and most useful Yoga information ever .
    I realized i got this pb for 9 months now.
    Pictures along the text to illustrate asanas to avoid or strenghtening exercices to do, would help a lot (For students who’re not fluent in english or sanskrit) .
    Developping about recommendable Core therapeutic exercices would be even great !

    Grateful thousands thanks for thoses explicit advices that none of my 14 yoga instructors nor my 3 chiropractors and physiotherapist could give me.
    It really helps, so keep it up!.

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  3. Thank you very much for your article! A lot of these symptoms seem to be associated with my pain, but I’m having trouble making sure.

    I’ve been experiencing very severe left-side body pain for the past three year. I’ve always had low back problems, and I was told when I was 12 then one hip was slightly higher. This new pain came during yoga teacher training and began as a knee injury. It has developed to cause intense pain behind my glute and sometimes behind my right shoulder blade and hand. It is very very intense and it has totally changed my life. I can no longer even take short walks. I spend much of my time in a bath. I have intense pain all day everyday.

    I have gone to every type of doctor. Some internal pelvic floor releases done by my physical therapist have helped temporarily, but it seems it is only getting worse. I just turned 24, and I really need to find a way to change things. I want to start to do something to help my body. I’ve interestingly, noticed lately that my sacro-illiac joint cracks a lot. I can do it voluntarily when I stabilize my legs and then externally rotate. There is so much tension on my left side. Do you have suggestions for where to begin with rehab? Maybe even some websites. I feel so desperate at this time, and I would appreciate any suggestion. Thank you, thank you.

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    • Hi Sophie

      That sounds really bad and I’m sorry to hear that you are in so much pain. I think you do have a body alignment problem of some kind: whether in your hips or spine (scoliosis), I couldn’t say. Have you ever had your back and hips x-rayed?
      I would try a chiropractor and sports practitioner for hip and sacroiliac problems. Googling sports rehabilitation and your city based on your IP location, I see a number of different listings and I think you should look at exercise therapy as a way of improving your pain.

      Continued yoga practice is a very bad idea if you do have issues in your sacroiliac area. The cracking sounds you describe are mostly caused by tension in the ligaments that connect the hips and lower back and a tailored exercise program to strengthen hips and core is your first type of treatment to consider. I’m not in the USA so I can’t recommend any doctors there but I’m sure there is someone competent in your area.

      I hope this helps
      Best wishes, Niki

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