Common Reasons for Sacroiliac Joint Pain in Yoga
Sacroiliac joint pain is quite common amongst yoga practitioners. The most common symptoms are aching or pain in the joints themselves that can radiate to the lower back, buttocks, legs and even the groin. For the majority of people the symptoms are only on one side. To find the location of your sacroiliac joints follow the curve of your lower back down to your sacrum - your sacroiliac joints are located a few centimetres from the centre to the left and right sides. If you have your thumbs on those points on the left and right, pain is usually felt a few centimetres deep below the skin underneath your thumbs.
The reasons for pain in these joints are usually put into 3 categories: too little movement of the joints, too much movement and inflammation.
TOO MUCH MOVEMENT
This occurs when the ligaments holding the joints together have become overstretched allowing to joint surfaces to move or separate too much. This is really common during pregnancy due to the hormone relaxin, as well as after giving birth due to the stretching of the ligaments that happens during childbirth. Another cause of ligaments becoming overstretched can occur with trauma to the area such as a fall or a car accident.
If this happens, it’s important to build up strength (whilst maintaining a healthy range of motion) in the lower abdomen, lower back and the muscles of the pelvis and hips.
TOO LITTLE MOVEMENT
When the muscles that surround the pelvis and attach to the sacrum become too tight they can limit the movement of the joints. This is another cause of pain. An example of this is when your piriformis muscle (and the other deep hip rotator muscles) on one side become tight, they will “jam” the joint (preventing it from moving properly) and cause pain.
If this happens, it’s important to release tension from the excessively tight muscles. It depends on each individual which muscles may be tight, but common muscles are the deep hip rotators, hip adductors and the outer hip muscles (tensor fascia latae, gluteus medius and gluteus minimus)
Piriformis and other deep hip rotators
Gluteus medius and minimus
Hip adductors
INFLAMMATION OF THE JOINT
Inflammation of the joint can occur due to many factors such as hormonal changes (such as pregnancy and menopause), arthritis, auto-immune conditions, infections and even mechanical pressure from tight muscles.
WHICH YOGA POSTURES CAN CAUSE A SACROILIAC INJURY?
Usually it is the more extreme poses where the hip joints are taken into very deep ranges of motion that can cause sacroiliac joint injury. If your deep hip rotator muscles and hamstrings are not flexible enough and you attempt foot behind the head poses - instead of the hips joints moving, the sacroiliac ligaments can be overstretched and cause injury.
Practicing deep backbends without lower abdominal strength can also cause sacroiliac joint injures due to excessive pressure on the joints, especially when combined with tight hip flexor muscles.
WHICH POSES SHOULD YOU AVOID IF YOU HAVE SACROILIAC PAIN?
Some people feel discomfort during backbends, some during forwards bends. It will depend on the location of the injury and which movements may have caused it. Standing on one leg can also be uncomfortable as well as Trikonasana (triangle pose). If the injury is recent, you need to give the joints, ligaments, tendons and muscles time to heal. Avoid any poses that hurt until the pain and inflammation have gone down.
HOW TO PRACTICE IF YOU HAVE SACROILIAC PAIN
If you feel pain during backbends, it’s best to give the joint a rest for a while by removing any poses that hurt from your practice for a period of time (eg. 7-14 days or more depending on the injury). Then gradually reintroducing easy backbends such as Eka pada shalabhasana (locust lifting only one leg at a time) and Shalabhasana (locust with both legs lifting) making sure that you engage your lower abdominals and pelvic floor muscles before you go into the pose. Only lift your legs as high as you can go with out any pain.
Shalabhasana (locust) - do the one leg at a time version first before you move on to this one.
If you feel pain during forwards bends, again, it’s best to give the joint a rest for by removing any poses that hurt from your practice for a period of time (eg. 7-14 days or more depending on the injury). Then gradually reintroduce gentle stretches for the hamstrings and hip muscles such as Supta padangusthasana (lying down big toe stretch). Keep your lower back muscles engaged to protect the lower back and sacroiliac joint area. Once you are ready to re-attempt forward bends again, only tilt forward to the degree where there is no pain.
Pull up through your lower back, lower abdomen and pelvic floor to stabilise the sacroiliac joints and pelvis before tilting forward into a seated forward bend. As you tilt forward, it’s better to bend your knees than allow the sacral area to stretch (if you have an injury there).
Only go as far into poses such as Uttanasana (forward stretch) as feels comfortable for your sacroiliac joint. Keep your back straight and bend your knees as much as you need to keep your back straight.
written by Jean Campbell