End back pain: Align­ment tips that de­liver re­lief

Twist­ing poses are a top cause of SI-joint in­jury. Learn how to safely an­chor your­self be­fore mov­ing into your next twist.

Yoga Journal - - Contents - By Ju­dith Hanson Lasater

PAIN IN OR NEAR the sacroil­iac, or SI, joint—the spot at the base of the spine where the sacrum bone joins the ilium bones of the pelvis—is a grow­ing com­plaint among yo­gis. It’s es­pe­cially com­mon among women, who com­prise 8o per­cent of suf­fer­ers. That’s in part thanks to hor­mones re­lated to men­stru­a­tion, preg­nancy, and lac­ta­tion, which make women’s lig­a­ments more lax and prone to over­stretch­ing.

Struc­tural dif­fer­ences play a role, too. Of­ten in women, only two seg­ments of the sacrum ar­tic­u­late (or move) with the pelvis as com­pared to typ­i­cally three seg­ments in men, and less sur­face area touch­ing the joint trans­lates to less sta­bil­ity. The SI joint it­self is also shal­lower in women, fur­ther re­duc­ing sur­face con­tact be­tween bones. Fi­nally, fe­male SI joint sur­faces are fat­ter and not as deeply curved as men’s—they can’t ft to­gether as tightly, like two nest­ing bowls—and women’s two hip joints tend to be far­ther apart. Both lat­ter fac­tors neg­a­tively af­fect the biome­chan­ics of walk­ing, in which the hip joints alternate mov­ing for­ward one af­ter the other, caus­ing a torque­ing force across the pelvis and the SI joint. Though this is a nor­mal ac­tion, with an in­nate slight slip­page in the joint, in women the torquing force in the pelvis is greater, po­ten­tially stress­ing the sacral lig­a­ments.

Of course, men suf­fer SI joint pain too, of­ten as a re­sult of in­her­it­ing lax lig­a­ments from their par­ents, or through in­jury or over­stretch­ing in yoga. Re­gard­less of gen­der, an SI in­jury can se­ri­ously im­pact your prac­tice and your life. In stand­ing, the weight of the trunk, head, and up­per ex­trem­i­ties trans­lates lat­er­ally out through this joint to the greater pelvis, and then through the pelvis to the legs, and fnally to the feet and foor. This makes the SI joint crit­i­cal to stand­ing, and al­lows us to bear weight on our bones rather than let­ting the weight just hang and po­ten­tially in­jure soft tis­sue like the lig­a­ments. (Lig­a­ments need to have in­tegrity; they’re re­spon­si­ble for hold­ing bone to bone, and if they are over­stretched and stressed, the sur­round­ing tis­sue must work ex­tra hard

to help cre­ate the needed sta­bil­ity— putting it at risk of in­jury, too.)

On the yoga mat, twist­ing poses are the top cul­prit be­hind SI-joint in­jury. That’s be­cause many stu­dents are taught to hold the pelvis still dur­ing twists, es­pe­cially seated ones, and some­times they’re told to “an­chor” the pelvis to the floor dur­ing the twist and to keep the sit­ting bones level. But an­chor­ing the pelvis can lead to over­stretch­ing the lig­a­ments hold­ing pelvis to sacrum, and, even­tu­ally, chronic ach­i­ness and some­times de­bil­i­tat­ing pain in the whole SI area.

Con­sider a seated twist like Marichyasana III. When the pelvis is an­chored to the floor at the sit­ting bones, the twist­ing must come solely from the spine, which means the sacrum is be­ing dragged into the twist with the rest of the spine, while the pelvis is be­ing held back and thus moves in the op­po­site di­rec­tion. Add to this ef­fect the ex­tra torque and force that the arm ex­erts on the soft tis­sue around the SI joint when it levers against the out­side of the leg to cre­ate the twist, and the po­ten­tial for over­stretch­ing the sacral lig­a­ments in­creases many­fold.

Re­peat­edly prac­tic­ing in this way stretches the sacral lig­a­ments that are try­ing to hold the pelvis and sacrum to­gether, un­til pain re­sults. In fact, the very def­i­ni­tion of SI dys­func­tion and pain is a con­di­tion in which the SI joint is not in its neu­tral, stable po­si­tion, with the joint sur­faces be­tween pelvis and sacrum aligned.

While I agree that ev­ery asana needs an an­chor, in twist­ing poses the an­chor is not the pelvis—in­stead, it’s the thigh, and the foot on the floor. The most im­por­tant thing to re­mem­ber about the SI joint is that it is a joint of sta­bil­ity, not mo­bil­ity. If the pelvis is al­lowed or en­cour­aged to twist first, fol­lowed by the spine twist­ing sec­ond, the SI joint will be much hap­pier. The key to pro­tect­ing the SI joint, be it in stand­ing poses like Ut­thita Trikonasana (Ex­tended Tri­an­gle Pose) and Parivrtta Trikonasana (Re­volved Tri­an­gle Pose), for­ward bends like Marichyasana I, or seated twists like Marichyasana III, is this: Al­ways move the pelvis and sacrum to­gether. Story orig­i­nally pub­lished in Yoga Jour­nal, Septem­ber 2o15.


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