How To Prevent SI (Sacroiliac) Joint Pain During Yoga

I gotta say: I had never heard of sacrum problems before I began my Viniyoga instructor training course. Yeah, I knew what a sacrum was, however my very first instructor training course had never discussed it, and my students had never raised any complaints regarding the matter. I had never had any trouble myself with it. There I went through life just completely ignorant of the matter. Then… I began my Viniyoga instructor training course. Out of nowhere, the sacrum had come to be something of vital importance. I began to hear things like “don’t do this pose if you have sacrum issues,” “to take care of your sacrum, make sure to do this,” “don’t let yourself feel any discomfort in your sacrum,” and so forth.

The sacrum

It’s kind of like when you buy a car in a certain color and then you start to notice it everywhere. Well it was the same way with the sacrum and how many people had issues with it.

So, in order to be a bit more specific, it isn’t actually the sacrum we may have have problems with, but rather the SI, or sacroiliac joints (unless you experience back or hip pain).

Just to remind you of where it is located, the sacrum is right at the bottom of the spine. It happens to be made up of the five vertebrae bones which together are about the size of your hand and are fused together to form one solid base for your spine. The sacrum fits snugly in the middle of your right and left pelvic bones and is joined to them through the SI, or sacroiliac joints.

Sacroiliac Joint Pain Relief During Yoga

Sacroiliac joints happen to be weight-bearing. This is because the sacrum holds the load of your upper body and the forces are transferred through these joints to the pelvic bones. Your weight is then further carried by your legs from there. As with any load-bearing joint, stability is key to being pain free. Hence several ligaments are in place to bind the pelvis to the sacrum to restrict any over-extended movements.

Over extending the abdominal stretch

A certain number of us may have a bit more flexibility in our sacroiliac joints than other people. This is what can potentially cause problems. The sacrum itself may have a tendency to lean forward a bit with respect to our pelvis (which we refer to as nutation) or perhaps a bit back (which we refer to as counternutation). It may lean 5-10% at the very most. However, even this amount of offset can result in a sense of our pelvic area not being stable.

Who may be at risk for such an injury? Well, just about anybody has the potential to suffer sacroiliac joint problems. However, people that fall into the following categories are at higher risk.

Women coming of reproductive age – Essentially the flexibility of their sacrum is to allow the passing of a baby through the pelvic opening. Counternutation is first to provide an opening for the baby’s head to come into the pelvis while nutation then allow tailbone to move out of the way. The fact is that in pregnant women, relaxin is released, which is a hormone that provides more flexibility for the ligaments so that it can accommodate the process of birthing. If your students have given birth before, are of reproductive age, or are pregnant, they may have more flexibility in their sacroiliac joints.

There are some of use that may have more flexible ligaments than others. This is because some of us happened to be born with more flexible ligaments that allow us to enact more advanced yoga poses. However, this also provides more risk to injury to our sacroiliac joints as the extra mobility in our sacrum is a given.

Feet behind the headSo the problem may be that when you’re a young girl, you’re trying to put your foot behind your head. When you do this, your sacrum has a great tendency to move out of place, and this is usually on just one side. When it is actually forced out of place, it will tend to pull on ligaments which are meant to maintain its positional integrity. This could cause a sharp pain to arise above one of her hips on one side of her spine. When this happens, it could take a long time for the pain to go away and for this injury to heal because ligaments, like cartilage, are avascular. This means that they get very poor circulation. When parts of the body do not get ample blood flow, they do not get a regular supply of nutrition that provides for the building blocks of healing.

Once you unfortunately injury the area, you may just be prone to injure it again. This is especially true if you are practicing yoga that focuses on some extreme poses while you are ignoring the pain signals that your body is sending you. A student may have a “hot sacrum” if it is prone to injury. Women that are suffering from this will need to change their yoga routines as they remain in the healing stage. It is important to practice healing yoga after you are injured to minimize the chances of injuring yourself again.

What Are Ways We Can Minimize Injuries To The Sacrum?

Do not teach asymmetric poses to these students. This is especially true for those where one of their hips is in a raised position curving the spine towards their other hip. However, take a look at Janu Sirsasana which is generally not an advanced pose yet does aggravate sensitive sacrum.

Pulling The Sacroiliac Joint

You may take great care when teaching the advanced asymmetrical pose:

Don’t utilize the leverage from your arms to put yourself into this pose when you feel pain in your sacroiliac joints.

Be sure that the bodies of your students are amply trained preceding any attempt to make these advanced poses especially if they cannot yet touch their toes.

Be absolutely sure not to demonstrate advanced yoga poses to your class if you are not properly warmed up yourself. This is the leading cause for injuries to yoga instructors.

Be sure to let your students, as well as yourself, to stop if it hurts.

Don’t show your class too many asymmetrical poses that only involve one side. This can cause accumulating tension on the sacroiliac joints. Let’s take a look at some of the poses I was presented in one of my most recent classes:

Asymmetrical yoga poses

We actually did this entire sequence on just one side first while we were holding each pose for 4-6 breaths. We never asked about moving over to the other side or changing the position of our feet and utilizing abdominal contraction to support us.

Can you begin to see issues here? Our left leg remains in a fixed position and means our left side of our pelvis will stay in mostly a forward-facing pose. When you take your spine through a forward bend, side bend, and forward bend, then twist your sacrum tends to follow the motion of your spine. This causes twisting, torquing, and tugging the left sacroiliac joint.

This certain motion happens to remind me of attempting to remove the top part of a plastic bottle. I mean to break the little piece of plastic you would have to keep bending back and forth until it finally came free. This is a similar motion you are doing to your sacroiliac joint. Sure the sacroiliac joint wouldn’t just break off, however it may destabilize and become more susceptible and vulnerable to injury.

How do we fix this? Change sides more frequently and swap symmetrical poses with asymmetrical poses when it comes to forward bends.

Don’t force them to keep their legs straight during forward bends because it creates what is known as shear stress on their sacrum.

When you create the curriculum of your classes, ensure you don’t forget to include certain poses that will help to stabilize their sacrum.

Now, if you are looking for other ways to help people cure their joint pain, they may want to check out Joint Pain Relief codes by Jonathan Bender, and the can find them here.

Can Yoga Prevent Or Relieve Back Pain?

Woman with pain in backBack pain can be quite tricky. The large majority of Americans will suffer from issues regarding their back at some stage during their lives. Moreover, for a third of them, therapy and treatments simply won’t resolve the issue. This is when back problems will generally become chronic. Is there a real remedy out there like yoga for back pain or Pilates that can permanently get rid of back pain?

S shaped spine on Left. J shaped spine on right

S shaped spine on Left. J shaped spine on right

Unbeknownst to most who live in the western world, there are several cultures around the globe where the problem of back pain barely exists (if at all). There is such a tribe in the center of India where they reported basically none at all. The discs of their spines regarded few signs of degeneration as people grew older.

Many statues that you may see when looking at ancient Greek cultures display a J-shaped spine as opposed to the S-shaped spine we see in modern western cultures. The statues’ backs are almost completely flat until the very bottom, where it bows out so the buttocks are behind the spine.

A well-known acupuncturist from Palo Alto, California believes that she may have discovered why they report significantly less instances of back pain. She’s trekked around the globe studying cultures with few accounts of reported back pain. She studied how they sit, stand, and walk. Today, she is sharing her conclusions with back pain sufferers in efforts to help people across the United States.

Around 20 years earlier, Esther Gokhale began to have issues with her back after she’d been pregnant with her first child. “It was an excruciating pain. I could not sleep at night,” she claimed. “I was going for walks around the block every two hours. I was completely crippled.”

Surgery on spine - actual operation

Esther had what is known as a herniated disc (A condition which refers to a problem with a rubbery disk between the spinal bones). Eventually she needed to have a surgical operation to rectify it. However, after about a year, she had another herniated disc. “They wanted to conduct another another surgery on my back. You do not want to make a habit out of back surgery,” she says.

Being fed up with the pain and surgeries, Esther needed a permanent remedy for her back pain. She was not swayed Western medicine could provide it. Esther began to think outside of the box. An idea came to her: “Visit cultures where they aren’t experiencing these crippling problems and find out what they are doing differently.”

So Esther researched discoveries from anthropologists, like Noelle Perez-Christiaens, which assessed postures of these indigenous cultures. Likewise, she researched physical therapy techniques, like the Feldenkrais Method and the Alexander Technique.

During the following ten years, Esther traveled to populations around the globe that are distant from modern, Western life. Esther traveled to Aboriginal tribes in Australia, small fishing villages in Portugal, the mountains of Ecuador, and remote tribes in West Africa.

Aboriginal tribe Australia

“I visited villages where every child under age four was crying because they were scared to see somebody with white skin — they had never seen a white person before,” Esther says.

Esther had taken video and photo of people that sat on the ground weaving, walked with buckets of water on their heads, or collected firewood for hours.

“I have pictures in my book of two women who worked seven to nine hours everyday, bent over, gathering water chestnuts,” Esther said. “They’re actually quite old, but the truth of the matter is they don’t have any back pain.”

Esther attempted to find out what all of these different peoples had in common. The very first thing that arose was the curvature of their spines. They have a regal-like posture that it is quite compelling, and it is very different from American’s spines.

When you view the shape of an American’s spine from the side, it is shaped like the letter S. It bows outwards at the top and inward towards the pelvis.

However, Esther did not see the S-shaped spine in people who do not have pain in their back.

“That S shape isn’t natural,” Esther says. “It is a spine with a J-shaped that you want.”

Da Vinci Anatomy DrawingAs a matter of fact, if you take a look at depictions from the works of da Vinci, or even a book from Gray’s Anatomy circa 1901, the spinal column is not at all like a deeply curved S. It is quite a bit flatter down to the pelvic area.Near the pelvis, it bends outward to push the buttocks out. Again, so that the spinal column appears more like a J than an S.

So Esther conducted several exercises (as we discuss toward the end) to force her spinal column into the ideal J shape. Over the course of doing these simple exercises and maintaining proper postures as much as possible, he back pain actually subsided completely.

Then Esther also realized she had the potential help others as well. She developed this set of exercises into a routine anyone could follow, wrote an entire book about it, and even started a studio in the downtown Palo Alto area to teach classes.

Moreover, she has helped Matt Drudge from the Drudge Report and YouTube CEO Susan Wojcicki. She has even taught classes at Facebook, Google, and companies around the US. In Silicon Valley, she is referred to as the “posture guru.”

Every year, doctors from around the Bay Area refer numerous patients to Esther. Dr. Neeta Jain is one of them, an internist working at the Palo Alto Medical Foundation.

Yoga For Back Pain?

She puts Esther’s techniques in the same category as Pilates and yoga for back pain. The fact that her techniques haven’t been testing in a clinical trial doesn’t bother her at all.

“If people are discovering things that are helpful to them like yoga for back pain, and it isn’t doing any harm, then why should we have to wait for a trial?” Jain asked.

“The J-shaped spine is what you will see in statues of Greek gods and goddesses. It is also what you see in young children. It is good design,” Esther says.

However there still is a big looming question here: Is Esther right? Do people in Western cultures just don’t know how to stand properly anymore?

Scientists just do not know yet, says Dr. Mummaneni, a neurosurgeon at the University of California, San Francisco’s Spine Center. There is yet to be a conclusive medical study on traditional cultures to understand why some report lower numbers of back pain cases, he says. The fact is, science has yet to document the shapes of their spines.

“I would love to go and take X-rays of indigenous peoples and compare it to those of the Western world,” Mummaneni said. “I believe that it would be quite helpful.”

However there are a many reasons why postures of Americans, along with the shape of their spinal column, might might vary from those of indigenous cultures, says Dr. Mummaneni. To start, Americans tend to be much taller and heavier.

“Lets say you have a quite a bit of fat built up in the belly. That would likely pull the weight forward around the lower lumbar or bottom of your spine,” Dr. Mummaneni said (read here how to correct this). “This would force the spine to bend, so people that are thinner in physique most likely have less of a curvature” hence they are more likely to have a spinal column that resembles a J rather than an S.

Westerners, especially Americans, are also not quite as active as those in traditional cultures. “I think especially the sitting down and sedentary lifestyle leads to a lack of muscle endurance and tone. This furthermore leads to a lack of postural stability due to the muscles tending to get weaker” says Mummaneni.

abdominal-strengthMost people know that having weakness in the ab muscles can quickly lead to back pain. In fact, Mummaneni claims that strengthening the core muscles may just be the very secret to Esther’s and all indigenous cultures’ resolution of back pain.

To put it another way, it is not specifically that the spine shaped like a J is the ideal spinal shape or even the healthiest. It is what actually goes into that J shape of the spine that makes the difference. “You must make use of abdominal and back muscle strength to get your spinal column to resemble this J shape,” Say Dr. Mummaneni.

So Gokhale may have somehow discovered a method to teach people to reinforce their core strength building routines without them ever even knowing it.

“Yes I certain believe think you’re correct,” say Mummaneni. “You are absolutely not going to go from the S shaped to the J shaped spinal column without presenting solid muscular strength in your core, and I believe that is the very key here.”

So traditional peoples around the globe do not have some sort of cure-all for preventing or relieving back pain. They just have strong abdominal muscles. Likewise, their lifestyle forces them keep them strong even as they grow older.

Esther’s Five Techniques For Improved Posture And Reduced Back Pain

Try these exercises while you are sitting at the dinner table, working at your desk, or walking around (or watch the videos from the Yoga Burn system).

  1. Shoulder roll: Americans tend hunch forward letting their shoulders droop where our arms are in front of us. This is not how indigenous populations carry their arms, says Esther. To remedy this, slowly pull the shoulders up, push them back and then let them drop like a shoulder roll. You should feel a bit of a stretch in your collar bones. Now your arms should hang by your side with your thumbs pointing outward. “This is the way all your ancestors parked their shoulders,” Esther says. “This is the natural architecture for our species.”
  2. Lengthen the spine: Adding more length to our spines is quite simple, Esther says. Careful not to arch your back, take deep breaths in and feel your self growing tall. Keep this height as you exhale. Breathe in and keep repeating this to grow even taller and keep that new height as you exhale. “It takes some effort, but it really strengthens your abdominal muscles,” Esther says. An inversion table is another way to stretch out your spine.Gluteus Medius muscles and surrounding anatomy
  3. In several indigenous cultures they squeeze their gluteus medius muscles every single time they take a step. That is one reason why they have such prominent buttock muscles that help to support their lower backs. Esther claims you can start developing the same type of butt by contracting the buttocks with every step you take. “The gluteus medius is the one you’re after here. It’s the one high up on your bum,” Esther says. “It is the muscle that keeps you perky, at any age.”
  4. Don’t put your chin up: Instead, add length to your neck by taking a lightweight object, like a bean bag or folded washcloth, and balance it on the top of your crown. Try to push your head against the object. “This will stretch the rear of your neck and allow your chin to angle down in a relaxed manner and not in an exaggerated way” Esther says.
  5. Do not sit up straight: “That’s just arching your back and getting you into all sorts of trouble,” Gokhale says. Instead do a shoulder roll to open up the chest and take a deep breath to stretch your spine.