On August 23rd I offered my first Yoga Lab workshop exploring the sacroiliac joint. The Yoga Lab is a place to explore, ask questions, and delve deeply into specific areas of interest relating to the practice of yoga. This blog is an attempt to share some of the many things we talked about as well as the basic structure of the sequence we worked with. I hope you enjoy it and can make it to the Yoga Lab in person some day!
The sacroiliac joint, often referred to simply as the SI joint, marks the intersection between the spine and the pelvis, the juncture through which the force of gravity is transferred from the torso, head and upper limbs to the hips and legs. The spine rests on the hips via this joint. The sacrum, a group of five fused vertebrae beneath the lumbar spine, articulated with the iliac bones of the pelvis at the SI joint, which is ligamentous and has rough, bumpy articular surfaces that fit together in a lego-like manner. There is disagreement within the medical community about how much movement is meant to occur within this joint, but there is consensus that the range is somewhere from none to very little. ‘Sacroiliac dysfunction’ is the broad term for any pain arising from the sacroiliac joint and is a common form of back pain. 98% of all ‘sacroiliac dysfunction’ arises from hypermobility (too much movement) within the SI joint.
Because almost all pain arising from the sacroiliac joint is due to weak muscles that allow for too much movement within the joint, our exploration in this Yoga Lab focused on the question: how can we create strength and stability in this region? Our class focused on strengthening exercises for three groups of muscles commonly understood to stabilize the SI joint; the abdominals (rectus abdominis, transverse abdominis, internal and external obliques, the hamstrings and glutes (hip extensors), and the outer hip rotators (muscles such as piriformis)
---> indicates a place where there is a ‘flow’ or fluid movement between 2 different shapes
s indicates poses that are safe to do even if you have acute SI pain
- Core awareness exercise s
Lying on your back bend your knees and place your feet on the floor. As you exhale ENGAGE your abdominal muscles via a 3 STEP PROCESS that activates ALL of the core muscles together; the muscles of the pelvic floor, the rectus abdominis, transverse abdominis and both sets of obliques (internal and internal):
1. tone your pelvic floor (think of stopping the flow of pee, squeezing your butt hole shut – no that is not the scientific phrase for it – and drawing your sit bones toward each other)
2. draw your navel back (like you are making the sound of the letter ‘Sssssss’)
3. draw the base of your ribcage back
These muscles are often not used to working as a single, synchronized unit, which can be one cause of instability in the core and thus in the pelvis. For this reason it may not be feasible to engage them all together over the course of one exhale to start. See if you can get them all engaged and hold that for a few breaths, then see if you can relax all of the muscles completely for a few breaths, repeat until the action begins to feel more fluid or until you become fatigued.
- Supine leg spirals
Lying on your back bend one knee and place your foot on the floor. ENGAGE your abdominal muscles via a 3 STEP PROCESS described above. Now your pelvis and lower back should be very stable. Bend your knee all the way in to your chest and hold it. Begin to make small circles with the knee making sure to keep you core engaged so you back and hips do not move all around. Make circles in both directions and then repeat entire procedure on the second side.
- Cat ---> cow with leg lifts
On an inhale look forward and extend your spine while you simultaneously lift your right leg up behind you, on the exhale round your back and look toward your navel while pulling your right knee in toward your nose. Repeat 3x and switch sides. This pose strengthens the glutes and the hamstrings (both important pelvic stabilizers)
- Plank / Phalakasana (knees down) s
This one’s for the core! Come to the top of a pushup position and drop both knees onto the floor. Follow the 3 STEP PROCESS for engaging the core (pelvic floor, navel, base of ribs) detailed above. In addition, tone your glutes and make a ‘tail tucking’ action. Keeping all of that exhale and lower down slowly to the floor (do not pitch shoulders forward as you go)
- Cobra / Bhujangasana (no hands version) with legs lifted s
Without using your arms to help you lift the head, shoulders and chest up into a ‘cobra pose’ at the same time that you engage your glutes to lift your legs up off of the floor. Hold for several breaths making sure that the legs are engages and the feet point straight back. Great glute and hamstring strengthener.
- Downward Facing Dog / Adho Mukha Svanasana s
Bend knees and lift sitbones just enough to gain an inward (lordotic) curve in the lower back, then (without rounding your back and loosing the curve you have created) practice lifting your navel back and rooting your sit bones down toward the floor.
- Standing forward bend / Uttanasana s
Extend the spine, lift the navel back toward the spine and root the sit bones down without rounding your low back (just like you just did in down dog). On the inhale, keep the core engaged and root the sit bones down as you take hands to hips and stand up with a long spine. When performed this way, standing up from uttanasana strengthens the hamstrings.
- Standing sequence:
*NOTE: when sacroiliac dysfunction/pain is severe asymmetrical poses (those where the two legs are not doing the same thing together) are very risky. If SI pain is acute, I would suggest sticking to the SYMMETRICAL poses in the sequence (I have marked them with an s to indicate symmetry)
- Warrior / Virahabdrasana II
Engage the core via the 3 STEP PROCESS above. Root down through outer edge of front heel to engage the butt muscles more. Begin with hands on top of pelvic bones and make sure that they remain level.
- Triangle / Trikonasana
Engage the core via the 3 STEP PROCESS above. When coming into this pose RESIST the temptation to throw the hips to one side. If you hear a popping in the tissue of the front leg engage the core more fully.
- Side Angle / Parsvakonasana
Do this pose with your forearm on your front leg. Follow instructions for Triangle pose above.
- Standing / Tadasana Uttanasana (with block) s
Place block between inner upper thighs, engage the core using the 3 step process, with soft (not locked) knees firm all of the leg muscles (including your butt) and squeeze your block, exhale to fold into
---> Forward fold / Uttanasana (with block) s
Inhale to extand the spine exhale to hop or shuffle to
---> Plank / Phalakasana (with block between upper thighs) s
Make sure to ‘tuck the tail’ and exhale and lower down slowly to the floor. Release the block and rest.
- Side plank / Vasistasana (variation) s
Come onto your right elbow and the outer edge of your right foot. Make your legs very strong and lift the hips up away from the ground strongly. The top hand can extend up in the air or rest on your hip. Repeat on second side. This pose is a top notch strengthener for all of the muscles of the outer hip.
- Cobra / Bhujangasana (no hands variation) s
On your belly find a way to get the block between your shins. Squeeze the block firmly, engage your glutes and lift your shoulders, chest, head and feet up off the floor. Hold for several breaths, repeat 2x
- Quad stretch / Eka Pada Bhekasana (‘one legged frog pose’)
Make sure to lift the bottom edge of your ribcage away from the floor as you do this pose. Also, be aware of where the front of your hips are in relation to the floor, if they are on the floor make sure the hip bones carry even weight side to side, if they are off the floor attempt to make them level. Quad stretching is important for SI joint stability when the quadriceps are short, however, as with standing poses, these poses are asymetical and may be too much if SI pain is acute.
- Leg lifts / Shalabasana s
Lying on your belly with your head in a comfortable position (forehead or chin rest on the floor), keep your pelvis level, and lift one leg off the floor while toning your glute on that side, hold for a few breaths then switch legs. Repeat until fatigue sets in. This is a hamstring/ glute strengthener straight out of the Buns of Steel video.
- Pigeon / Eka Pada Rajakapotasana (quad stretch version)
Engage core (3 step process described above).
- Down Dog / Adho Mukha Svanasana s
---> Side Plank /Vasistasana s
Focus on lifting the hips high away from the floor. To add even more strengthening for the muscles of the outer hip (the bottom one), lift the top foot a foot or two above the bottom foot instead of having them stacked.
- Standing one legged / Padangusthasana
Stand tall on 2 feet. Engage the core using the 3 step process, try to maintain the pelvis in as level a position as possible as you bend one knee in and hold it. Hold. Repeat on second side. Standing on one leg is very strengthening for the piriformis and other stabilizers of the SI joint. However, these positions can also be VERY risky for the SI if these muscles are not strong enough to stabilize the pelvis. Proceed with caution if you have acute SI pain.
- Tree / Vrksasana
Stand tall on 2 feet. Engage the core using the 3 step process, try to maintain the pelvis in as level a position as possible as you bend one knee and place the foot on the inner edge of the opposite shin or thigh.
- Standing quad stretch
(using same allignement as in other one legged balance poses above)
- Abdominal exercises: s
1. Lying on your back bend your knees and place your feet on the floor. As you exhale ENGAGE your abdominal muscles via a 3 STEP PROCESS that activates ALL of the core muscles together (tone your pelvic floor, drawing your sit bones toward each other, draw your navel back, draw the base of your ribcage back), your back should now be pressed flat to the floor. Come up on your tippy toes, slowly lift your right foot a few inches off the ground and slowly put it back down without changing the integrity of your core, repeat with the left foot. Move as slowly as you possibly can. Go back and forth like this until you start to feel tired.
2. Lying on your back bend your knees in toward your chest and put a block between them. Squeeze the block firmly with your legs and roll slightly to the right so you are balanced on your right hip, interlace your hands behind your head and crunch in like you are trying to take your nose to your outer left hip. Do 5 on this side then switch and do 5 on the second. Move slowly to increase resistance.
- Quad stretch of Death / Eka Pada Rajakapotasana variation
Quad stretch against the wall.. repeat x2
- Bridge / Setu Bandha Sarvangasana s
Use a block between the legs to increase muscular engagement in this area, focus on engaging the glutes evenly and steadily as well as maintaining core tone.
- Jathara Parivartanasana s
Lying on your back bend your knees in toward your chest and put a block between them. Squeeze the block firmly with your legs and flex your feel. Open the arms out to either side on the floor. Exhale to bring the block over toward the right, inhale keep SQUEEZing with your legs and bring the block back to center. Repeat until you start to feel your obliques and outer hips starting to get exhausted.
- Supine hips stretch / Supta gomukasana
Lying on your back cross your right thigh oer your left and hold your knees, shins, or ankles. Breath. Repeat on the second side.
- Time to rest! / Savasana