Sacroiliac Joint
The skeleton is a kinetic chain held together by ligaments and held erect by muscles. Correct skeletal alignment is dependent on muscle tone and elasticity. When muscle tension becomes unbalanced, the joints are compromised. Misalignment of one joint can impact other joints in the body by shifting the centre of gravity, forcing the body to compensate to achieve balance. For example, when the Sacroiliac joints become misaligned, body alignment shifts to compensate and can be the cause pain of anywhere from the head to the feet. The sacroiliac is one of the joints in the pelvis, formed by two bones, the sacrum and the ilium. There is a small amount of movement allowed at the S-I joint, its major function is stability. Held together by strong yet pliable ligaments, it is designed to lock in place when we stand. The sacrum-pelvis connection creates a firm base for the entire spinal column. This dysfunction refers to either hypo or hyper mobility (low or high respectively). In other words, the joint can become ‘locked’ or be too mobile. This can then lead to problems with surrounding structures such as ligaments (e.g. Iliolumbar ligament) and muscles, which means SIJ problems can cause a wide range of symptoms throughout the lower back and buttocks, or even the thigh or groin.
What yoga poses should be avoided?
As a physiotherapist and yoga teacher, the most important thing from point of my view is to work with a diagnosed injury. If a students practice yoga with undiagnosed injury, it may result in crucial injuries in a yoga class. Once you injure the area, you are likely to reinjure it again, especially if you ignore your body’s pain signals.
Once an injury occurs, forward bends are most likely to aggravate the symptoms. Forward bends or lumbo-sacral flexion make the SI joints more vulnerable to injury because there is less stability. Sitting in and of itself “unlocks” the sacrum and the ilium. If additional stress is then placed on the joint, discomfort and/or injury could occur. In a flexed posture or with the tailbone ‘tucked’, the stability of the joint is entirely dependent on the ligaments around it. Therefore, Janu Sirsasana or Head-to-Knee Forward Bend and Paschimottanasana or Seated Forward Bend can aggravate the pain by stretching the muscles at the back of the leg putting additional pressure on the joint.
Supported Seated Forward Fold may be tolerable for those with chronic conditions worsened by spinal flexion (HNP, osteoporosis, SI joint instability) if approached slowly and modified to limit the degree of spinal flexion. Paschimotanasana can be practised with the knees raised using a bolster or rolled up blankets or a bolster under the torso. If it is still painful supported janu sirsasana or Balasana with trunk supported on a bolster can be performed. Over time forward bends may become easier and more beneficial.
Yoga is definitely a useful tool for incorporating prevention strategies and I strongly believe that yoga teachers have a great responsibility to understand and manage a sacroiliac injury in yoga class.