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.
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.
SPINE SI JOINT SACRUM