Yoga for Your Lower Back

The Sacroiliac Joint or SI Joint is the cause of much confusion, often misdiagnosed and for some, a nagging pain in the butt. In this article we explore the SI Joint both from an anatomical view as well as its relationship to yoga.

SYMPTOMS
Figuring out if you have SI Joint dysfunction is often a case of following the pain.

First it is important to differentiate sacroiliac pain from sciatic pain. Sciatic nerve pain begins deep in the buttock and travels down the back of the thigh, through the calf and into the ankle and inner foot.

Whereas SI Joint pain generally is in one buttock near the posterior superior iliac spine (PSIS). However, pain can radiate to the hip, down the side of the thigh, the calf, and even to the outer edge of the foot or heel. It often gets worse when sitting for long periods or is aggravated by wide-legged (abducted) poses, twisting and forward bends.

CAUSES
SI Joint dysfunction can be the result of pelvic misalignment, poor posture or excessive movement that causes a strain in the joint. And sometimes, doing certain yoga poses can be the cause of sacroiliac pain caused by the stress of moving the sacrum and pelvis in two opposite directions.

Additionally, SI joint pain is more common in women, due to wider angle of the hips and hormonal affect on ligaments making them more flexible.

DIAGNOSIS
It may be challenging to diagnose SI Joint dysfunction since the symptoms of sacroiliac problems are often similar to those of other lower-back problems. I recommend seeking a trained professional for diagnosing such as a physiatrist, osteopathic physician, chiropractor, or physical therapist.

ANATOMY
The Sacroiliac Joint or SI Joint is made up of three bones: the sacrum and the two ilium of the pelvis. The sacrum is a triangle shaped bone with one point facing down. It is created from five vertebrae that have fused together. From the side the sacrum is a C shaped bone tilted with the top more forward than the bottom. At the very tip of the sacrum is the coccyx. Each side of the pelvis is created from three bones fused together during in utero development: the ilium, ischium and pubic bone. The sacrum is wedged between the two sides of the ilium. The connection between the sacrum and ilium is the Sacroiliac Joint or SI Joint.

We begin life with pliable and smooth Sacroiliac Joints. As we age the SI Joint becomes more unique, developing an elevated ridge along the ilial surface and a depression along the sacral surface, this unique ridging helps to create more stability in the joint. Weight from above comes down onto the sacrum and is then dispersed to the sides of the ilium, into the pelvis and finally down the thighbones. The SI Joint is also a shock absorber providing a "self-locking" (or close packed position) mechanism that helps with stability during the push-off phase of walking.  When the leg comes forward the SI Joint “unlocks” and when the leg comes directly below the pelvis and back to push off it “locks.” The “locking” and “unlocking” of the SI Joint is very subtle with an average of 1-3 mm up and down.

The limited movement of the SI Joint is due to the wedging of the sacrum in relation to the ilium and the resistance of the ligaments. The SI Joint is a synovial joint stabilized by a system of ligaments with surfaces of the ilium and sacrum lined with cartilage. The ilium side has fibrocartilage and the sacral side has thicker smooth hyaline cartilage. There are 5 ligaments which stabilize the SI Joint and they are some of the strongest in the body. Two ligaments in particular are commonly the source of pain, the Anterior Sacroiliac Ligament and the Posterior Sacroiliac Ligament. The Anterior Sacroiliac Ligament is weak and thin compared to the others and connects the inside top of the sacrum to the ilium. The Posterior Sacroiliac Ligament on the other hand is strong and tough to connect the Posterior superior iliac spine or PSIS to the sacrum; it can be felt below the PSIS from S1-S3 and is the main bond between the bones.

In addition to the “locking” and “unlocking” the sacrum also rocks front to back in what is called nutation and counter nutation. Nutation occurs when the ilium stays in a fixed position and the top of the sacrum moves forward as in back bending. Counter nutation is when the top of the sacrum moves back in relation to the fixed position of the pelvis, as in forward bends.  This again is a very subtle movement with only 1-4 degrees on average.

Often it is a combination of counter nutation and “locking” of the SI Joint that causes a problem. A helpful metaphor used for the SI Joint is two pieces of a broken cup; if you glued it together all you would see was a hairline where the break was. However, if you misaligned the pieces in any direction, there would be a clash between the two sides. This misalignment is what commonly happens with SI Joint dysfunction; the top of the sacrum tilts too far forward on one side of the body relative to the ilium, which then over stretches the ligaments. The opposite SI Joint becomes wedged or “locked” into place and resists nutation while the other side becomes “unlocked” and moves double time, which inevitably starts to wear down the stabilizing ligaments because of the hypermobility.

YOGA FIX
The first line of action in helping SI Joint dysfunction is to learn how to recruit the muscles of the core to stabilize the SI Joint and lower back. This is important to reduce pain and inflammation in the joint that is hypermobile by muscularly providing stability to the joint.
-Hollowing the Abdomen
-Bridge Pose with feet raises to mimic walking
-Plank Pose to further tone the core

POSES TO THAT WILL POTENTIALLY AGGREVATE THE SI JOINT
Wide-Legged (abducted) Poses
Baddha Konasana (Bound Angle Pose)
Upavistha Konasana (Wide-Angle Seated Forward Bend)

Virabhadrasana II (Warrior II Pose)
Utthita Parsvakonasana (Extended Side Angle Pose)

Seated Twists
Marichyasana III (Pose Dedicated to the Sage Marichi III)

Twisting, Abduction, and Forward Bending
Parivrtta Janu Sirsasana (Revolved Head-to-Knee Pose)
Janu Sirsasana (Head-to-Knee Pose)
Paschimottanasana (Seated Forward Bend)
Prasarita Padottanasana (Wide-Legged Forward Bend)
Utthita Trikonasana (Extended Triangle Pose)