Keeping Your Sacrum and SI Joints Happy and Healthy

by Shari

Keeping His Sacrum Happy and Healthy

Now that I’ve described how the sacrum moves (see Yoga and the Sacrum), let’s look at how the sacrum and sacroiliac joints work in some of the typical yoga poses we encounter in a class, and how to keep your SI joint healthy and happy while you do them. Hopefully this will provide help for people who are already suffering from sacroiliac joint problems as well as for people who would like to avoid developing problems.

Note that if you think you might be having sacroiliac join problems but are not sure, I would recommend that you should not try to diagnose yourself. Instead, please try to consult a health care professional for a diagnosis. And although this injury is more common in women, it definitely occurs in men as well, so you guys should also get yourself checked out. Finally, for any of you pregnant yoga practitioners or teachers who teach pregnant women, all of these suggestions that follow are beneficial for pregnant women.

Now let’s get started at the beginning of a typical class. Warm ups are often asymmetrical because we work first with one leg and then the other. A typical warm-up series might include hip openers, reclined leg stretches (Supta Padangusthasana), Figure Four pose, and so on. Any type of hip opener that is asymmetrical will put different stresses on your SI joints. So for our Figure Four pose, when we stretch the piriformis on the right, the sacrum will be turned to the side that is being stretched, the right side. And conversely the sacrum will be turned to the left when we stretch the left piriformis. That’s all well and good, except if you have a piriformis that is already in spasm. Stretching it more only inflames that poor little muscle, so avoid this asymmetrical position if it hurts (or if starts to hurt while you’re in the pose, come out).

Leg stretches are also poses you may need to approach with care. If you are really tight, when you stretch your hamstrings, the hamstrings pull on your ischial tuberosities ( the sitting bones of the ilia), which flattens your lumbar spine and pulls your sacrum into a flexed position. This may cause you pain because as your sacrum is pulled down into the ilia, the two sides may not be moving equally (one side will be moving more than the other side).

When you take your leg out to the side and are stretching your adductors, try not to roll onto the SI joint of the raised leg and have the opposite side of the pelvis roll forward. Learn to move from your hip joint and limit the stress through your sacrum. If one side is tighter than the other, this may also create an asymmetry in the sacrum that will cause pain. In this case, less stretch is better (use a wall to stop the stretch on the raised leg, or use a block, chair, or bolster to limit the stretch).

For standing poses, if you are having SI problems, focus on symmetrical poses and using props. Also, be kind to yourself—think I am going to do 50% not 125%. Standing poses which are done with wide legs and an asymmetrical pelvis position may strain the ligaments holding the sacrum in place, which can then cause subsequent pain. Try firmly contracting the back leg to give some stability to the sides of the sacrum. Although Wide Legged Standing Forward Bend (Prasarita Padottanasana) is a symmetrical pose, how deep you go into the pose and what position your spine is in will all contribute different problems to the sacrum. So, when in doubt, try to keep your spinal curves in neutral and use a chair to take the torso’s weight and do less stretch than more.

In seated poses, spinal position is paramount. You want to keep your spinal curves in neutral and have enough height under your ischial tuberosities (sitting bones) to encourage your ilium to rotate over the femoral heads (hip joints). And never use your arms to pull yourself into pose, but instead rely on your abdominal muscles and spinal stabilizers. This applies to all practitioners, as both a preventative approach for those of you with no current problems as well as a therapeutic approach for those of your with SI problems. As Baxter mentioned, you want your sacrum to move with the ilia, not to be “held back.” If you are currently having symptoms, I would avoid revolved seated poses for quite a while until the symptoms are gone and you understand your vulnerabilities.

Backbends will either feel great or terrible, depending on your issues. Backbends and forward bends position the sacrum into very different positions. In forward bends the sacrum is less stable. In backbends the sacrum is more stable. But stability doesn’t mean it is going to feel good if the inherent alignment of the bones is not congruent.

If backbends feel good, pay attention to symmetry in how you go into and out of a pose. And be careful not to tuck the bottom of your spine—you lumbar spine needs to be in lordosis (curved) when you do backbends, which then puts the sacrum into a more optimum position. And less is better than more as you are healing.

However, if backbends feel terrible, don’t do them. Rather than putting a block under your sacrum in an easy Bridge pose, try an active Bridge pose and slowly evaluate how you feel afterwards. Less lifting is also crucial.

I hope this advice is helps you keep your sacrum happy and healthy!