The sacro-iliac joint and why it is vulnerable in yoga

Recently I taught a workshop on the sacro-iliac joint but a number of folk have told me that they were disappointed to miss it, so this month I am putting down a few thoughts about it. I must begin with a disclaimer, I am not a physiologist nor an anatomist, just a humble yoga teacher. I am presenting my understanding as simply as I can. So where is this sacro-iliac joint?

Photo credit: Wikipedia

Location: the Sacro-iliac joint is the junction between the spine and the pelvis.

Photo credit: One Health Osteopathy 

It is not meant to move much - the above picture shows the ligaments that bind the joint front and back. They form a dense webbing, intended to keep this joint very stable.

So why is it a joint? Why are the bones simply not fused together like the vertebral bodies of the scrum itself?
Please take a moment to look at this video. It is very short but it illustrates why.



Some movement is required in the joint for the normal functioning of walking and other movements of the body. This little animation is an exaggeration however. The degree of movement is actually very small, around 2 degrees. If you have as little as 4 to 6 degrees you will be experiencing pain.

So the next logical question is, how on earth do you get into the situation where you have instability in one of the sacroiliac joints.

How does a sacroiliac joint become unstable?

As with any joint it can be injured due to the immense pressure brought on it by an accident such as a severe fall or car accident. Falling onto the buttocks, perhaps when falling off a horse or motorcycle, is a common cause.

Repetitive strain is another way. When an action that is asymmetric is repetitively applied it can gradually loosen the bonds of the ligaments. The repetitive rotation of a golfer, batsman or bowler would be the kind of action that could gradually lessen the integrity of the ligaments.

Force through one leg can place a tremendous asymetric strain on the joint. This could be one major trauma as in a motor accident. But when an athlete repetitively lands on the same leg, perhaps a figure skater, ballet dancer, or hurdler, this again will lessen the integrity of the ligaments.

Women are more prone to sacro-iliac joint injury than men

Notably during pregnancy, but also during the menstrual cycle, and during lactation, a women's body has elevated levels of hormones that cause the ligaments to become prone to overstretching.

Can yoga practice contribute to sacro-iliac joint instability?

I believe so, especially if we attempt to force the body into positions its structure will not allow. Here are some examples.

Seated twists while trying to keep the pelvis anchored

House photo - Yoga Spirit Studios

Many people are taught to anchor the pelvis in a seated twist. Unfortunately this sets up precisely the conditions which can lead to over-stretching of the ligaments which bind the joint, and down the track might lead to the debilitating pain of sacro-iliac instability.

When twisting in a seated position, allow the pelvis to turn slightly in the direction of the twist and then direct the movement into the thoracic spine, not the lumbar, in order to keep both the lumbar spine and the sacro-iliac joint safe.

Forcing external rotation of the hip

This can happen in attempts to do open kneed seated postures, from simple cross legged, to lotus pose. But even being over zealous in padagusthasana could create a problem.

It has to do with the shape of your hip socket in relation to the shape of the top of your thigh bone. There is a tremendous variation in the way we are built and no two hip joints are really the same. This picture illustrates that.

If your head of your femur (thigh bone) runs into the rim of your acetabulum (hips socket) in external rotation (turning the leg so the toes point outwards) and abduction (leg going out to side) and you try and force this, it is like using your thigh bone as a tyre lever to prise open the sacroiliac joint.

So how do you know if you run into such a bony constraint? You will feel a jamming sensation on the leading edge, that is, in the hip in the direction of the movement.

It is not a case of needing to become more flexible. No amount of flexibility is going to change the shape of your hip socket. In such a situation the yoga lesson is contentment, Santosha, with what you have, Satya, honouring the truth of your body, and Ahimsa, doing no harm to your body. Take the sitting posture that is right and comfortable for you.

What to do if you have sacroiliac pain?

Cease all the postures that aggravate it. This will include:

• Forward bends
• Asymetric poses, such as warrior poses
• Anything that twists, including triangle pose, reverse triangle and so on, which are also asymetric, so double reason there.

The job now is to begin to train the surrounding muscles to take up the work of the overstretched ligaments in order to provide stability in the pelvic region. Now that is your core muscles, and I include in the core group the following, some of which are often not counted as core:

• transverse abdominus
• miltifidus
• spinae erectus
• iliopsoas
• pelvic floor
• quadratus lumborum
• internal and external obliques

Here are some pictures to help you identify those.

There are many ways for you to proceed with this core training, and many lovely yoga practices to help as well. Just do 70% of what you think you can do in any one session, and only begin to reintroduce the full range of postures when you are pain free. And when you do, practice with a new awareness of pelvic stability.

Your well trained yoga teacher can help you to identify practices that will help you and which ones to avoid.

Finally, listen to your body. It is immensely wise.

Trikonasana

1. Spot the triangles
Photo credit http://up4yoga.com/trikonasana/

Tri = three
kona = angle (think cone or corner)
asana = posture

TRIANGLE POSE

Often called Utthita Trikonasana

Utthita = striving, exerting, extended

EXTENDED TRIANGLE POSE

While we teach it to beginners, Trikonasana is a difficult pose, especially to practice in its extended form. In fact you would be forgiven for thinking it is trickinasana, the Tricky pose!

In the picture to the right is a man practising a well aligned Utthita Trikonasana and the picture is overlaid with triangles to demonstrate how it gets its name.You could also find another triangle from his hand to hand to crown of head.

Utthita trikonasana requires flexibility in the hips, external rotation in the thighs and exceptional alignment through the spine.

One of the biggest traps for many is to try and immediately emulate the way the chap in the picture is doing it, hand all the way down to the foot. Without the prerequisite opening of the body and alignment some very unfortunate things result. In the pictures below the one on the left shows what immediately happens when it is attempted to take the hand lower before the body is ready (and it may never be, by the way, more on that later.) See how the body has dragged forwards? Our colourful triangle man above would look more like the picture below right if we viewed him from the correct angle.

2. Photo credit http://www.fitnessnetwork.com.au/resources-library/the-art-of-alignment

Going back to our colourful man of the triangles above, do you notice how the sides of his torso are the same length. All too often the attempt to "make the shape" results in a student actually doing a side bend, contracting the waist on the lower side of the body, like this:

3. Photo credit: www.spfitnation.com 

Notice that this model has her back foot turned out at 90 degrees to the front foot and that her stance is not very wide.  Both of these factors might be contributing to her difficulties.

There are many ways to improve your alignment and expression in the pose, and the effort to gain better alignment will give you a more authentic Trikonasana perfect for you. No doubt you have heard these solutions form your teacher.

4. You can still make triangles when you modify the pose 
Photo credit http://up4yoga.com/trikonasana/

Start at the foundations. An ideal distance lengthwise down the mat for your feet to be is about a leg length. however you must be stable and comfortable in the distance you choose.  What that is will however impact upon your finished pose.

Then have your front foot pointing straight forwards and allow the back foot to angle in, maybe 45 degrees, with the toes pointing more towards the front than out to the side.  This will allow you to compensate for an inability to find external rotation in the hips and prevent you from putting undue pressure on your sacroiliac joint in a quest for ... what?

The one thing that the model above who is doing a side bend is doing correct is to not try to come down too far. Let go of the ambition to get the hand on the floor.  one day, after many moons of practice, that might happen. But who cares?  A comfortable and beautifully aligned Trikonasana is surely more important.

Your teacher will offer many suggestions and practices that will work towards your inner discovery of alignment.

What is it that makes it so very tricky?

Trikonasana challenges us even to the structure of our body! In this article I will just address hips on this subject.  It is very likely that not all of your constraints are muscular.  If you encounter a bony constraint, there may not be any further you will ever go, short of surgery to knock off a bit of bone and I really hope that no-one would ever seriously contemplate that!

5. Bone on bone - the greater trocanter meets the rim of the acetebulum
Photo credit: iynaus.org/book/export/html/248

Consider the illustration to the right. As the leg is taken out the knobbly bit at the top of the femur, the greater trocanter, is bumping up against the rim of the hip socket, or acetebulum. There is nowhere else to go.

In the next picture, bleow, you can see that when the thigh is rotated outwardly it may free the constraint and more outward movement is possible in the thigh. - Maybe. The ability to draw the thigh into such external rotation is also dependent on your unique structure and some very strong muscles to make it possible. Another scenario is that instead of rotating the thigh externally, the temptation is to tilt the pelvis forward which will tend to bring the whole torso forward and you finish up with the alignment flaw we saw in figure 2 above. At some point or other we may have to accept that this is as far as we go, in this body we are blessed to have.

6. Photo credit: iynaus.org/book/export/html/248

Why do we do Trikonasana, what are its benefits?

The pose strengthens parts of the knees, spine, core muscles and shoulders and stimulates abdominal organs. It stretches the thighs, knees and ankles, hips, groins, calves, shoulders, chest and spine. It builds better posture through an inner discovery of the connection between the head and the tail.

But these are but physical benefits. Perhaps its most profound lessons for us lay elsewhere. Tricky trikonasana gives us opportunities to explore some of the trickiest yamas and niyamas of the Yoga Sutras.

Santosha - contentment - can you be content with where you are and give up wanting to be like the chap in the colourful triangle picture at the top?

Satya - truthfulness - can you really honour and discover your own truth in this pose?

Ahimsa - non-violence - can you kindly meet yourself where you are and not violently try to push into something that you are not?

Brahmacharya - conservation of the life-force - can you find a place of ease and not over strive and exhaust yourself in the practice of Trikonasana?

Svadhyaya - self study - what can you learn about yourself as you meet and greet all of the nuances of your, perfect-for-you Trikonasana.