Back? Sacroiliac!

Even before the micro-discectomy I had last year (which very successfully released my sciatic nerve & resolved all that nasty leg/foot pain/tingling/numbness) my pain doctor was talking about my sacroiliac (SI) joint.  I was so utterly distracted by the sciatic pain that the distinction didn’t really sink in. It did not occur to me at that time, the sensations were coming from two different places.

At my last doctor visit, she started talking to me in detail about the SI joint, treatments and alternative treatments.  It finally occurred to me:  these are two separate and distinct issues.  My disc problems are pretty much resolved.  The SI joint is angry.

So I did what I always do when a doctor talks to me about an issue.  I started reading.  We all know that a joint is formed where two bones come together, so the sacroiliac joint is formed where the sacrum and ilium bones join one another.  The sacrum is the base of your spine and formed by five vertebrae that are fused together, with the coccyx (tailbone) protruding from the bottom of the sacrum. The sacrum is roughly triangle shaped with the peak pointing down (where the coccyx protrudes).  So the sacrum has a “wing” to the left and the right where it meets the ilium.

The ilium is one of three bones that makes up the pelvis.  Two of the three bones (pubic bone and ischium) fuse together during our development.  The ilium is the top bone and it flanks the sacrum.  The sacrum is more or less lodged between the left and right ilium bones.

The SI joint has limited range of movement.  While you are standing, try to swing your leg out to the side and back.  That place where it stops going back?  SI joint.  So knowing that, you can imagine that anything that takes the legs or the joint wide (wide legged forward bends, bound angle pose, revolved head to knee pose) is going to aggravate the SI joint.

Unless it doesn’t.

Here’s the thing.  If the past two years of medical treatment, including conservative, holistic, Eastern, Western, supplements, massages, physical therapy and medications have taught me anything, its that there are not any one-size-fits-all treatment.  Since I’m a big proponent that there is no one-size-fits-all yoga, I don’t know why this would surprise me.   I’m pretty good about widening back in a seated position and overall, making space there feels good for me.  Janu Sirsasana (revolved head to knee pose)?  Feels amazing, especially when I take my far arm to the outer edge of my foot and take that little twist before I settle in.   This is very much not true for everyone.

Even if you have pain or discomfort at the SI joint you cannot tell on your own if your SI joint is out of alignment, you do need a trained medical professional to diagnose.  If you are a yoga teacher, unless you are also a physician or physical therapist or otherwise a licensed professional, you do not have the training or qualifications to diagnose SI instability.  As we should anytime a student or friend asks us to diagnose a problem, we properly demure and refer to the appropriate health care professional.

What we can do is try to stabilize the SI joint, in ourselves and our students.  Backbends, particularly those like supta virasana (reclined hero pose) that gently release the sacrum back into place can be helpful.  That being said, bridge may prove difficult because so many students clench their buttocks so strongly that they lose some of the benefit of the pose.  If you are going to do bridge, work slowly and perhaps try a supported bridge.  Encourage students (and yourself!) to lift from the top hamstring insertions for more of a “float” and less of a “choking” with the buttocks.  Importantly:  increased pain means stop.  Do not move past go if pain occurs.

One sided pelvic tilts, such as lying reclined and alternating drawing knee in towards same shoulder, will shift the ilium in the correct manner towards the sacrum.  Modified Locust pose, lifting one leg and then the other, will combine more than one element of realigning the SI joint by both back bending and shifting the ilium.

I’ve seen information that suggests twists, rejects twists and suggests modified twists taught by a medical professional.  Any disc involvement whatsoever, do not do twists.  If the student is experienced and body conscious, maybe, with modifications.  Reclined twists may be preferable because many students find it easier to modify.  Alternatively, one of the frequent symptoms with SI problems is soft tissue discomfort in the outer hip and leg (differentiated from sciatic pain; if you can’t tell the difference, don’t twist) and a good reclined twist feels so helpful.  I would approach twists with extreme caution.

Be kind to yourself in forward bends, especially standing.  Keep the knees soft and hug the thighs in towards the belly.  In a seated forward bend as soon as your pelvis stops tilting forward, stop moving.  Modify as needed.  Again, if there is a disc diagnosis, do not forward bend.  For SI joints, it depends upon the student but approach with caution.

I’m going to digress at this point.  I’ve been lucky enough to have more than one Viniyoga teacher and Gary Krafstow’s book, Yoga for Wellness, was a part of our training.  In reviewing the Viniyoga website and my dog-eared copy of Yoga for Wellness, I can’t help but notice how many of the modifications and sequences  speak to the SI issue.   If you want a specific practice or sequence, check out his DVD’s and books.  If you can find a Viniyoga practitioner, all the better.

More stabilization:  mula bandha.  Mula bandha is incredibly difficult to explain but the first thing women generally relate to are kegels, the exercise wherein we contract and relax the pelvic floor muscles.  Mula bandha is literally the “root base” and is contracted at the perineum, the “root floor” and draws up into the pelvic floor.  It is not a contraction of the sphincter.  It is an exercise of the PC muscle at the pelvic floor as are kegels, the approach and purpose are just somewhat different.  Mula bandha is an energy lock, a drawing up of energy into the central channel.

And its a great exercise to help stabilize the SI joint.  There are many benefits to exercising the pelvic floor.

In summary, I don’t like the shots and the shots don’t like me.  Doctors are so quick with the needle these days that I know a lot of people who have had shots and epidurals.  Unfortunately, like me, a large percentage of them have had no relief with the shots and another percentage have elevated pain from these shots.

There is much, much more to this issue.  The treatment can literally be 180 degrees from person to person.  Give that SI options seem to lead back to shots or even worse, stabilization surgery, this is a topic which will likely be revisited in this blog in the future.  Now I have a path to follow.