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Yoga Tips to Relieve Sacroiliac Joint Pain | Yoga International

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Yoga > Yoga Therapy

Yoga Tips to Relieve Sacroiliac Joint Pain

BY 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. Its my lumbago, honey,
she would complain. Aunties 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 dened as a
slight mismatch between these joint surfaces, and it is not uncommon in
yoga students. To understand why, one rst needs to understand the basic
anatomy of this specic area.

The Sacroiliac Joint

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*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


Sacroiliac dysfunction is
dened as a slight
mismatch between these

well as provides the attachment for

joint surfaces, and it is

the lower extremities. *e gently

not uncommon in yoga

curved sacrum consists of ve


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 rmly 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 benet 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 rst 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 mens. 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 nd 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 runners stretch. *is pose is practiced by sitting
on the oor, bending one knee, placing that foot near the groin of the
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opposite leg, and nally lowering the thigh and knee to the oor 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
*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 oor
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 rst 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 rst 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 benet if
your sacroiliac joint is out. *e rst thing to do is to gure 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 oor so that the sole of the foot faces
the ceiling. Do this if your exibility 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 runners 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

Illustrations: Georg *ieme Publishers/NY 2 and Littleeld, 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.
#pelvic & abdominal

Photography: Lyle Olson Model: Bill Boos

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