Body and Soul

Sacroiliac joint injury

Virabhadrasana (Warrior). JP/P.J.LEO

An injury on the sacroiliac (SI) joints ironically often afflicts very flexible people who can bend into most yoga poses without great strain. Often they start feeling something off on their sacrum, where the lower back joins the pelvis, when they come out of a pose such as a seated forward bend.

The injury causes nagging aches in the area, not so much crippling as irritating. They can go for days without feeling it, but some days the pain resurfaces. This condition is most likely caused by an unstable sacroiliac joint that moves in and out of alignment.

The sacrum is the bone that is shaped like an upside down triangle at the base of the spine. On each side of the sacrum, there are SI joints, which are connected to the left and right ilium bones, or the wings of the pelvis.

The SI joints are hold together by strong ligaments to prevent the sacrum from tipping forward between ilium bones.

If you trace your thumb over the top rim of your pelvis on one side and move backward until you find the rearmost bony prominence of the ilium, you will find the posterior superiori iliac spine or PSIS.

The pain related to this is characterized by a dull ache over an area about the size of a coin and is centered on the PSIS on one side of the body only. Sitting, forward bending and twisting movements often make it worse and back and side bending can also be painful.

There are still some differing opinions on this, but according to one theory, the practice of that are heavy on forward bends, twists and poses that stretch the inner thighs can loosen the supporting ligaments of the SI joints over time.

Eventually one side of the sacrum slips forward relative to ilium on that side, and pressing them together tightly, which happens when we’re sitting, triggers the pain.

Preventing and Healing.

As in all injuries, the first step to prevent it is to be mindful of your alignment in all types of poses.

In forward bends, always move your sacrum and ilium forward as a unit. Move into the pose by tilting the pelvic rim of the bent leg (or legs) forward toward the foot of the straight leg.

As the ilium pushes the sacrum along, the two bones move as one, but once your ilium stops moving, don’t tilt your sacrum any deeper into the pose.

In twists, experiment with letting the pelvis turn along with the spine – moving the sacrum and Ilium as one unit – instead of keeping it fixed.

As you bend forward, twist or stretch your inner thighs, try contracting the pelvic-floor muscles. By pulling the sitting bones toward one another, these muscles help hold the sacrum in place.

Finally, you can stabilize the SI joints by strengthening muscles of the back with poses such as salabhasana and strengthening the deepest abdominal muscles, the transversus abdominis, with pranayama practices such as kapalabhati (skull shining breath).

The key is to adjust your misaligned SI joint back into its proper position and keep it there. Although the SI joint can be popped back into place by some physical therapist, it often pops back out soon afterward.

Learn to reset your own SI joint using yoga asana techniques, but it’s best to learn these techniques from a qualified instructor.

A correct pose should immediately feel good on the injured area while you practice it. If you enter a pose and feel discomfort near the PSIS, come out of it right away.

Not all poses work for everyone, but all you need is one that works for you.

These two examples of poses might be helpful for you:

Salabhasana (locust Pose) modification
This pose may help stabilize the SI joints. Strap your ankles 20-to 30 centimeter apart. Lie on your belly with your arms alongside your body, palms facing up or out.
Inhale and lift your arms, legs and chest up. Pulling the legs strongly outward against the strap may relieve sacroiliac symptoms.

Go into this pose gradually and back off immediately if it causes discomfort.

Virabhadrasana I, variation
This pose put asymmetrical forces on the joint and may relieve sacroiliac symptoms.

Move into the pose slowly to make sure it feels OK and stop if it hurts. Step your feet wide and bend your front knee, placing a block between your knee and the wall.

Keep your front shin vertical, back knee straight, back heel lifted and chest lifted.

Shift your body weight and adjust the angle of your pelvis to find the position that feels best in your sacroiliac area.

Now once you know how to put your SI joint back into place, always make sure it is properly located before each yoga practice and follow these preventive steps to keep it there.

With special care to keep the SI joint in place, over a period of months or even years, hopefully it will become stable again. Namaste.

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