Yoga therapy for the Sacroiliac Joint
Sacro iliac joint anatomy and function
The sacrum is part of the pelvis and is composed of five fused vertebrae. It is attached by ligaments to the ilium. The space in between these two parts of the pelvis is called the sacroiliac joint.
While there is a small amount of movement allowed at the SI joint, its major function is stability, which is necessary to transfer the downward weight of standing and walking into the lower extremities. Held together by strong yet pliable ligaments, it is designed to lock in place when you stand; the sacrum bone wedges down into the pelvic joints due to the weight of the trunk—similar to the way a padlock closes.
This tight sacrum-pelvis connection creates a firm base for the entire spinal column. However, when you sit, this stability is lost because the sacrum is no longer wedged into the pelvis—which is why SI joint pain sufferers often prefer to stand.
Cause of pain
Sacroiliac pain can be a result of stress at the joint created by moving the pelvis and the sacrum in opposite directions. This can be caused by an accident or sudden movements, as well as poor standing, sitting, and sleeping habits.
Women are eight to 10 times more likely to suffer from sacroiliac pain than men, mostly because of structural and hormonal differences between the sexes. A woman’s anatomy allows one less sacral segment to lock with the pelvis. It may sound minor, but this has a big influence on instability. Also, the hormonal changes of menstruation, pregnancy, and lactation can affect the integrity of the ligament support around the SI joint.
Advance yoga students also tend to put an unusual and consistent stress on the supporting ligaments around the SI joint during asana practice, as well as poses that move the pelvis and sacrum in opposite directions.
Strenghtening vs streching
The sacroiliac joint remains healthier if it is not stretched too much. In fact, focusing on creating stability is the key to preventing overstretching and thus remaining pain free in the sacroiliac joint.
Yoga not only can help strengthen around the joint, as well as provide the awareness necessary to help you prevent future problems.
Backbends and Standing poses
Strengthening the muscles around the SI joint so as to prevent future problems can be accomplished by practicing simple backbends and standing poses. Backbends, such as Dhanurasana (Bow Pose), in which the pelvis moves forward and contracts the posterior muscles. This helps move the sacroiliac into place and also strengthens the muscles of the lower back and hip, which can then help to hold it there.
Standing poses can help strengthen the area around the sacroiliac joint. Focus on Trikonasana (Triangle Pose) and Utthita Parsvakonasana (Extended Side Angle Pose), as these poses strengthen the rotator and gluteal muscles that help to stabilize the area of the SI joint. Remember that you want the area to be strong and supported by contraction of the powerful muscle groups of the pelvis and hip, like the gluteals and rotators.
Other asanas which can help to stabilise and protect the Sacroiliac joint are Vasistasana, Anantasana, Purvottanasana, Navasana (especially Parvritta Navasana), Astavakrasana, Parsvabakasana, as well as abdominal strengthening. It is important to do these in ratios balanced between the front, back and sides of the body.
Core body strength should always be greater than leg strength and if your yoga practice consists mainly of leg strengthening postures, you are creating strength imbalance between the legs and the core which may come back to haunt you in the form of Sacroiliac dysfunction.
When it comes to twists, the only way to prevent further injury and discomfort is to meticulously move the pelvis and sacrum together preventing the separation between them.
Popular forward bending poses—such as Janu Sirsasana (Head-to-Knee Pose), Baddha Konasana (Bound Angle Pose), and Upavistha Konasana (Wide-Angle Seated Forward Bend)—also can be tricky. Remember that sitting in and of itself “unlocks” the sacrum and the ilium. If additional stress is then placed on the joint, discomfort and/or injury could occur. To avoid this, you need to be mindful of a few minor details while doing the poses. For example, in Janu Sirsasana, the critical side of the asana is the one with the bent knee. As you begin to bend forward, the spine moves while the pelvis and sacrum tend to remain behind, especially on the side with the knee drawn back. This kind of separation is, by definition, sacroiliac dysfunction.
When you practice Janu Sirsasana, be sure the pelvis moves forward with the spine. If you strongly bring the bent-knee side of the pelvis forward, it will help to unite the joint and heal the problem. During a therapeutic period, you may want to practice the pose with the foot touching the opposite knee instead of the inner thigh to further reduce the torque .
Both Baddha Konasana and Upavistha Konasana unlock the sacroiliac joint and potentially strain the transverse ligaments of the sacrum, particularly if you bend forward. If you have SI problems, it’s wise to skip these poses during acute flare-ups of pain. At other times, place a firm, rolled blanket under the outer thighs in Baddha Konasana, especially if you are supple. The blanket reduces the stress that the weight of the thighs places on the SI joint.
Lets see an example how muscles and fascia also confer stability to the joint. The figures below illustrates the relationship between the erector spinae muscles of the back and the muscles of the pelvic floor. You can see that the erector spinae muscles draw the sacrum into flexion (nutation) and the muscles of the pelvic floor (especially the pubococcygeus) draw the bone into extension (counter-nutation). Simultaneously engaging these muscles creates opposing forces that stabilize the joint.