The Silent Epidemic in Yoga

The SI Joint Pain Yogi Club

In case you don’t know (I didn’t before joining the club) where exactly is the Sacroiliac Joint (SI Joint): it is located at the lower back, where the sacrum meets the iliac bones of the pelvis. You have two of them, one on each side of the sacrum.

SI Joint dysfunction is said to be one of the most common injuries for yoga practitioners, especially those with more years of practice. That’s understandable as joints are susceptible to repetitive stress. 

I don’t have the statistics on hand - but you just knew it’s an epidemic when more and more teachers and students you encounter are either educating, or sharing their own stories about it.

Below recounts my journey of managing my own SI Joint pain and does not serve as medical advice of any kind.

What happened to me:

I would have never imagined I could do front split (Hanumanasana) before I started yoga. Just one or two years into the asana practice, my body opened up rapidly, providing the conditions of achieving the pose. I still remember the thrill and excitement of nearly achieving the pose for the first time—I was completely hooked. “Sensational junkie” as they said.

Since then, there was about one two two years when I practiced Hanumanasana almost daily, together with “deeper” postures like one-legged king pigeon (Eka Pada Rajakapotasana), without much attention to pelvis anatomy & health.

When the pain first emerged I thought it was just fatigue, and it will go away in a couple days. I didn't even have the idea what SI Joint was and I said, "low back". 

Of course it didn’t just go away, and developed into even worse pain affecting a lot of movements during the day (even like getting out of the bed). It took me a while to find out it could be SI Joint dysfunction.

Anatomical points-to-note:

• SI Joint is a shock absorber between the spine and the legs and has very limited movement (this is arguable but most researches I saw confirmed so - about several millimetres)
• A gynecoid (or typically the female pelvis Note 1) is less stable by default, creating the conditions for pregnancy
• A gynecoid has shorter vertical attachment to the spinal column compared to an android (typically the male pelvis), possibly contributing to more flexibility than stability
• Hormonal change during the menstrual cycle and pregnancy, notably relaxin, further destabilizes the pelvis as our fascia are more lax
• SI Joint, together with other micro-joints within the pelvis, can become over-mobile over repetitive and excessive stress
• I also noticed it gets worse premenstrual, making me infer that it can be hormonal or vascular related

Why it happened to me - some possibilities:

• Lack of treatment of the pelvis as a whole unit in asymmetrical poses (which is frankly, the majority of standing and crouching postures). Think of Virabhadrasana I and II (Warrior I and II family). The classical cues of asking us to align heel to heel (for I) or heel to arch (for II) put bodies into a cookie cutter and overlook the pressure this could have for the low back and pelvis.
• Not-so-mindful transition from external rotation of hips to neutral standing postures. Think of going from Virabhadrasana II to I. Such sequencing easily compromise SI stability and neglect the cohesiveness of the pelvis as whole unit.

Management:

At time of writing I have not fully recovered, but much better.

I have listed below some of the more effective remedies and measures I went through -

• Acupuncture
• Self-massage with lacrosse ball
• Widening the stance in all asymmetrical poses
• Think of moving the pelvis as a whole unit in all asana practice, and minimize the application of pressure on a particular joint in all postures
• Think of balanced sensation on the whole spinal column, and any demand from a given posture is well distributed from bottom to top
• Minimize backbend in asymmetrical poses
• Strengthen hamstring and low back, especially quadratus lumborum (QL). My barre and reformer classes helped a whole lot by isolating these areas and strengthen them.
• Apply a thermal blanket – heat therapy does help relax tight muscles and improve circulation

Remember there’s not much we can do on the joint itself once it has become dysfunctional. So strengthening the muscles for better stability and support around it is the key.

If you've read this far, I sincerely hope you're not part of the SI joint pain club. But if you are, here’s my best advice: break free from repetitive sequences, rethink your movement modalities, explore movements that feel intuitively good to you that don’t necessarily have a Sanskrit name, and introduce variety and fluidity into your practice. 

This partly led me to revamping my own way of movement into today’s fascia focused sequence, which I will talk about in other posts.

Above all, give yourself permission to rest.

Sending you lots of healing vibes.

Source:

Picture of female pelvis -

https://www.hopkinsmedicine.org/health/conditions-and-diseases/pelvis-problems

Comparison of Female and Male Pelves -

https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_%28Boundless%29/7%3A_Skeletal_System_-_Parts_of_the_Skeleton/7.7%3A_The_Hip/7.7E%3A_Comparison_of_Female_and_Male_Pelves

Recommended podcast:

https://jasonyoga.com/podcast/episode43/

Note 1: Researchers estimate that about 50% of all females have a gynecoid pelvis. It’s uncommon in males. Female and male here refer to biological sex assigned at birth only.