Yoga Tips to Relieve Sacroiliac Joint Pain _ Yoga International

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Yoga Tips to Relieve Sacroiliac Joint PainBY Judith Lasater ON May 28, 2015

My great-aunt Hattie used to complain about her back. Sometimes when she

rose from sitting she would straighten up slowly, place a palm over the back

of her pelvis, and let out a slightly audible groan. “It’s my lumbago, honey,”

she would complain. “Auntie’s had it for years.

With the wisdom of hindsight as well as training in physical therapy, I now

guess that her “lumbago” was actually pain associated with the sacroiliac

joint. *is is the site where the ilium bone of the pelvis and the sacrum bone

of the vertebral column come together. Sacroiliac dysfunction is defined as a

slight mismatch between these joint surfaces, and it is not uncommon in

yoga students. To understand why, one first needs to understand the basic

anatomy of this specific area.

The Sacroiliac Joint

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Sacroiliac dysfunction is

defined as a slight

mismatch between these

joint surfaces, and it is

not uncommon in yoga

students.

*e word pelvis means “basin,” and

it serves as the container and

protector of the abdominal organs.

*e pelvis also creates support for

the base of the vertebral column as

well as provides the attachment for

the lower extremities. *e gently

curved sacrum consists of five

vertebrae which fuse together by the

age of 25, and form a single wedge-shaped bone which is connected to both

the last lumbar vertebrae and the ilium bone of the pelvis. When we stand,

the sacrum is designed to actually wedge down firmly into the pelvis, which

helps to create stability. During sitting this tight connection is lost and must

be reestablished as one returns to standing. If there is an existing positional

fault or misalignment between the sacrum and the pelvis this slight

movement is interfered with. *is was probably what caused the distress my

great-aunt felt as she tried to stand, and is termed “sacroiliac dysfunction.”

Additional stability in the area is

o0ered by a series of strong

ligaments which hold the sacrum

in place nestled against the pelvis.

But they can become overstretched

by habitual asymmetric standing,

sleeping, or sitting postures, as

well as by performing yoga asanas

in a manner which creates torque

across this joint (more on this

later). In addition to the ligaments

which hold bones together, most skeletal joints have the added benefit of

muscles around them which help to create stability (think, for example, of

the shoulder with the strong deltoid on the upper outer arm). *e sacroiliac

joint, however, has only one small muscle, the piriformis, which crosses the

joint and can thus lend stability to the area.


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As if this were not enough to predispose

the sacroiliac joint to instability, there

are additional factors in women which

can contribute to increased instability.

*e first is that only two bony segments

of the sacrum join with the pelvis

instead of the three which join together

in males. (*is di0erence, as well as all

the others, is directly related to

childbearing.) Second, in women the

joint surfaces at the sacroiliac joint are

more shallow than men’s. Also, the

sacrum bone itself is wider in women

and this width contributes to an increase

in the natural torque across the joint as

the legs move in an alternating pattern

during walking. Hormonal changes are part of the picture as well. *e

monthly hormonal shifts of menstruation as well as those of pregnancy and

lactation contribute to ligamentous laxity in the sacroiliac joint, and thus

increase the likelihood of misalignment between pelvis and sacrum.

Childbirth itself can be traumatic to the joint.

Asymmetrical Movements

During the practice of yoga asanas, as well as in some kinds of sports like golf

and tennis, we often find asymmetrical movements which can stress the

integrity of the sacroiliac joint. *e asymmetrical nature of a golf or tennis

swing, accompanied by great momentum, can move the sacrum and ilium in

opposite directions, and this is at the heart of what creates di6culty for this

joint. In yoga, we practice asymmetrical movements all the time, especially in

poses like forward bends and twists.

A common forward bend which can cause di6culty is janu shirshasana,

commonly known as the “runner’s stretch.” *is pose is practiced by sitting

on the floor, bending one knee, placing that foot near the groin of the


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opposite leg, and finally lowering the thigh and knee to the floor before

bending forward. Experienced students often point the bent knee backward

instead of directly out to the side.

*is pose can cause di6culty in part

because the sacroiliac joint is in a less

stable position when we are sitting.

(Remember that sitting releases the

self-locking mechanism between the

wedged-shaped sacrum and the pelvis

which is created during standing.) What

is more, the pose is by its very nature

asymmetrical, thus causing potential

rotational stress across the sacroiliac joint. When the right knee is bent, for

example, and we are stretching forward in the pose, the right side of the

pelvis is being held stationary, or in e0ect moving backward, while the spine

is moving forward. *is separation of pelvis and sacrum can contribute to

sacroiliac dysfunction and can exacerbate an existing imbalance.

If you su0er from diagnosed sacroiliac dysfunction on the right side, try this

variation in the pose. It may help to alleviate pain as well as prevent further

di6culty. Instead of placing the right foot so near the inside top of the left

thigh, place the right foot at the side of the left knee or even near the calf.

*en when you bend forward concentrate on moving the right side of the

pelvis forward just as you do the spine so that the spine and the pelvis move

together.

*is is the most important concept to

remember about the sacroiliac joint and

practicing yoga poses. In all movements,

pay attention to where the sacrum is

moving in relationship to the pelvis. One

way to think of it is this: *e sacrum has

an identity crisis. It wants to know, is it

vertebral or is it pelvic? Does it go with


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the spine or stay back with the pelvis? If you move in such a way that you

separate the sacrum from the vertebral column or from the pelvis there will

be stress on the joint. So focus on bending from the hip joints in all sitting

poses so that the pelvis, sacrum, and lumbar spines are moving forward and

together in harmony.

Some years ago I was experiencing sacroiliac pain,

and I decided to become a “detective” in my practice

in order to ascertain what was causing the problem.

On the second day of my “search,” I practiced seated

twists exclusively. *e next morning I could barely

get out of bed. I realized that I was practicing the

twists by a6xing or planting my pelvis to the floor

before twisting, and was then trying to twist my

spine by pressing my arm/elbow vigorously against

my opposite thigh as if it were a weapon to be used

against my spine in the hope of forcing a twist.

Now I have learned to let my pelvis twist the

maximal amount around the hip joints first in

preparation for the seated twist; by doing that I

practically get half the way around before I even

begin to “twist.” In addition, I now focus on

twisting from the organs in the front of the body

instead of from the bones (vertebral column) in

the back of the body. *is approach, coupled with

the movement of the pelvis first and slow natural

breathing, has alleviated about 90 percent of any

sacroiliac pain.

Therapeutic Movements

*ere are two basic simple therapeutic movements which can be of benefit if

your sacroiliac joint is “out.” *e first thing to do is to figure out if the sacrum

is rotated forward or backward in relationship to the pelvis. (Perhaps a


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chiropractor or physical therapist can tell you.) When you know for sure

which way the sacrum is tipped, you can try ONE of the following.

Remember that sacroiliac dysfunction is an asymmetrical pathology, so

unlike yoga asanas, you will perform these therapeutic movements only on

one side.

If your sacrum is rotated back on one side, go to the

wall and stand about three feet from it; lift the leg

backward on the side where the rotation is, and hold

onto the ankle with the hand on the same side. Place

the other hand against the wall for balance. In a

series of gentle pumping motions, slowly lift the

knee up behind you as high as is reasonable,

preferably about waist high. Keep the elbow straight,

and push outward with the ankle against the hand.

Pump the knee up and down about 12 times,

moving in approximately a six-inch range. Keep the

chest upright and the pelvis facing the wall. *en release the leg and DO

NOT do the other side. Walk a few steps around the room. Try to do a few

simple backbends (like the bow pose) in your practice for the next few days.

If you know that your sacrum is rotated forward, lie on your back with one

leg straight, and bend the knee on the involved side toward your chest. Hold

the leg between the calf and the thigh and pump gently down about 12 times

so that the knee moves down near the armpit. It is more helpful if you can

move the lower leg perpendicular to the floor so that the sole of the foot faces

the ceiling. Do this if your flexibility allows. After pumping, release the knee

and roll toward that side to stand up and walk around a few steps. For the

next few days, practice the “runner’s stretch” pose described earlier with that

same knee bent, but do this only on the side of the rotation.

It is important that you do the poses on one side only, and that you keep

your breath soft and moving freely. I like to exhale naturally several times on

the pumping motions. It is also helpful if you begin to pay attention to how

you are sitting, sleeping, and standing. It is asymmetrical and habitual


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movements which can

overstretch the ligaments

around the joint and lead to

increased instability.

Sacroiliac dysfunction is

usually related to posture, be

that standing, sitting,

sleeping, or in yoga practice. Learning to move the pelvis and sacrum

together is the key to preventing this. It is a simple solution to a complex

problem.

Illustrations: Georg *ieme Publishers/NY 2 and Littlefield, Adams & Co./NJ

Lead: © Bill Longore/Photo Researchers

ABOUT Judith Lasater (https://yogainternational.com/profile/125590) Judith Hanson

Lasater, Ph.D., Physical Therapist, has been teaching yoga since 1971. She trains

students and teachers throughout the United States as well as abroad, is one of the

founders of Yoga Journal magazine, and is president of the California Yoga Teachers

Association. She has written eight books.

Photography: Lyle Olson Model: Bill Boos#pelvic & abdominal

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Yoga Tips to Relieve Sacroiliac Joint Pain _ Yoga International

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