Suryanamaskar and Sacroiliac Pain

A question from a reader:

There is a condition called sacroiliitis which I am told is common among women who have delivered babies.

I was enjoying my suryanamaskaar after such a long time and now it has been suspended on advice. I am not sure that is entirely correct.

Please tell me, can yoga stretches be detrimental now?

Sacroiliitis is an inflammation of the sacroiliac joint (SIJ) located just below the waist on each side of the lower back where you can find a small dimple. Its where the sacrum of the spine joins and interacts with the big pelvic bones. Unlike other joints which are flat and horizontal, the SIJ is almost vertical. All the weight of the body, all our twisting movements and other actions, must be supported by these strange vertical joints.

Because of their odd orientation and big job, the SIJs need powerful ligaments to hold them in proper position. During pregnancy ligaments soften, particularly those in the pelvis, to aid in childbirth. That can loosen the joint on one side or both and cause movement which leads to inflammation and pain.

The SIJs also contain numerous ridges and depressions, indicating their function for stability more than motion. Motion does occur, however, and because of the ridges partial dislocations and even locked positions can occur.

Many muscles interact with these ligaments and the SIJs, including the piriformis, biceps femoris, gluteus maximus and minimus, erector spinae, latissimus dorsi, thoracolumbar fascia, and iliacus. Any of these muscles can be involved with a painful SIJ.

In other words, the SIJs are complicated structures. Diagnosis of dysfunction is complicated, too, and tests are often inaccurate. Depending on the source of pain or the type of SIJ trouble, recommendations of what to do and what not to do vary. Sometimes instructions from various experts seem to contradict each other.

The best advice is to see a qualified physical therapist near you. They will evaluate for subtle differences in the length of the legs (it can change over time) which can be causing trouble. They will look for dislocated or locked joints, tight muscles, weakened muscles, scoliosis, and loose joints from softened and stretched ligaments. Knowing exactly what the problem is will help you to design an appropriate exercise regimen which can and should include Yoga – with proper attention to correct poses.

Although it depends on the particular pathology, a few things tend to increase pain in the SIJs. Anything that increases pain should be avoided as much as possible for at least three weeks to give the joint a chance to heal on its own.

  1. Hyper-extending the leg.
  2. Twisting or rotary motions.
  3. Forward bends, especially with the feet together.
  4. Standing with poor posture.
  5. Repetitive rising from a sitting to a standing position.
  6. Climbing stairs.
  7. Running.

Since suryanamaskar involves forward bends and leg extensions, their performance may aggravate SIJ inflammation and pain. Its reasonable advice to hold off on their practice for two to three weeks to see if the pain goes away. In addition, avoid any asanas that extend a leg out behind, bend the body forward, or twist the torso.

When you resume suryanamaskar, be sure to stand in the opening position with the feet hip-width apart rather than close together as is taught in many Yoga styles. Keep the core engaged with the belly button pulled in to the spine and the back and neck straight. Work into the forward bend taking care not to overstretch the back of the pelvis.

Basically, as with any musculoskeletal inflammation and pain, the best advice is to give the structure a break and let it heal. If it’s continually aggravated by the demands you place upon it, the energy can’t be used for repair.

Since the SIJ is a complicated structure with many adjacent potentially implicated ligaments and muscles, it’s important to determine what elicits pain in each individual. If you find something is aggravating, stop it for three weeks. Then go delicately when you resume.

There are many stretches in Yoga. Finding the right ones for you during different phases or your life and health is the key to a proper and beneficial practice.

Any physical therapists or Yoga therapists out there have anything to add or to disagree about? Any teachers or students have practical suggestions of what’s worked for them? This one isn’t easy, and I’d love to hear from you.

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