Yoga

SI joint pain is like malaria…

Articulations of pelvis. Anterior view.

If you’re unlucky enough to catch malaria, doctors will tell you that even though it’s been treated, “recrudescence is possible”. You know what they’re like, these quacks – what they tell you doesn’t sound that bad until you grasp its full meaning, which is:

It’s in your body. It might come back.

It’s even likely to come back.

SI joint pain is a bit the same. Once the pain is there (we discussed what it feels like and the reasons for it here), we’re not talking about curing it. We’re merely talking about managing it. That doesn’t mean you won’t be pain-free. But it does mean that if you don’t practise mindfully, it will come back. Or worse: never go away.

Why? Because all the reasons why you’ve got it in the first place are still there: hyper-mobile joints, for example. The tendency to push (force?) too much. Or both. You’re kind of unlucky if nature permitted you a range of movement that’s out of reach for others. In addition to the image in the previous post, I inserted another one to clarify. What looks like white fibres (fibrous ligaments, in fact) is where the pain comes from if you overstretch them. This is where the healing needs to take place.

No, it’s not fair that this is mainly affecting hyper-mobile people, but there’s something you can do about it. Something you must do about it. Because if you don’t, at one point you won’t even be able to turn around in bed because it’s too painful. This is not an exaggeration, promise.

Because you won’t print this page and read through paragraph after paragraph while twisting and turning on your mat, I kept it to short, easy to read bullet-points.

What to do (and NOT to do) if you have SI joint pain:

1) Practise mindfully. Whichever posture you’re in, you have to have this “snug” feeling in the area of the pelvis. Any sort of pinching or twitching sensation is a big STOP sign.

2) The SI joint works like a hub that transmits force. Get used to thinking of sacrum and pelvis as ONE entity rather than separate joints helps to maintain stability. We’re all about stabilizing hyper-mobile structures here!

3) Forget about certain postures for a while – namely e-v-e-r-y-thing that opens the hip joints using the SI joints as leverage (people do this because the hip joints won’t allow them to go further). Everything that prompts to move the sacrum and ilium in opposite directions. Forget these deep, one-sided forward bends. At least for the moment.

4) Get used to the idea that you will need to adapt your practice, no matter what. (I know, Ashtangis won’t like that.)

5) Women need to be careful because hormonal changes during the cycle can cause laxity in the ligaments – so watch yourself carefully. The alarm bells should ring if you’re suddenly able to do something that’s not normally available to you.

6) Accept your physical limitations. We don’t all run the 100 metres in under ten seconds. Why should we all have to be able to sit in Padmasana?

And, most importantly: ENJOY your practice, listen to your body, and give it time to heal itself. :)

Namaste!

 

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12 replies »

  1. I’m so glad to find this post! I have the beginnings of degeneration in my right SI and have been struggling to identify all the potential trouble spots in my Ashtanga practice that aggravate the joint. I hadn’t even thought of the asymmetrical forward folds (read: most of Primary)!

    After being told by my chiropractor to avoid deep twists, I laid off Marichi D and pasasana, but it took me a long time to realize the worst offender was plain old revolved parsvakonasana. Lifting the back heel in that pose has made a huge difference in managing my SI pain!

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    • Thanks for your comment! I’m glad you found the post useful. One the upside – SI trouble really cultivates awareness during the practice. I realised that most of my deep twists were happening from the hip due to stiffness in the thoracic spine, something that I have been focusing on since and which has improved things so much for me! Hope you can go back to your normal practice very soon!

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  2. Thank you so much for this post! I recently started Yoga and I have been struggling with SI issues since a sports accident in high school. Question for you as a teacher- Should I inform my teacher of the SI issues as well or just pay more attention to my body when doing poses that are stressful on the hips? Great site and thank you for the visit to mine as well! Happy New Year!

    -Jess

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    • By all means, let your teacher know! He or she might have your best interests at heart, but cannot read your mind. Some teachers ask about injuries before class, but if you don’t feel like discussing in front of everybody, just go and see her/him separately so they know they need to watch your practice – why paying for a teacher otherwise? A good teacher should be able to give you options for all postures you shouldn’t do so that you don’t injure yourself and are not just sitting there, waiting for the class to move on. A really (!) good teacher would remember you next time, ask about your progress and pain level and come up with ever new postures you could incorporate into your daily routine. Keep on looking until you find that teacher, they’re out there :)

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  3. Hi Andrea! Great topic! And great suggestion, to treat the whole pelvis/SI as one unit (like a box).

    If someone has SI problems on one side of the back, they might also want to observe the *other* side of the body. They can observe their habits. For example, if the problem is in the left lower back, one of the usual suspects is their right front hip joint (the opposite corner of the “box”). Is it tight? Or might they be leaning on their right elbow, compressing their right side, as they work, squishing the “box” on the right front top?

    If someone’s muscles are not acutely in spasm, they can cautiously try 1) very gentle extension of the whole back and 2) loving attention (maybe massage) to the opposite side, front of body. They can also check their desk chair and make sure it’s a good height for them, and symmetrical with their work area. If they’re acutely in spasm, your advice (rest and don’t force) is great… especially if they take this time to observe the root cause of their pain.

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  4. Another well-written and informative article. Thank you so much. And speaking from experience, it is very much a here again – gone again pain. With rest and asana in moderation, the pain goes away. Jump back in too fast and ouch, there it is again. Speaking of jump-back – on the Ashtanga front, I think one of the most damaging things is the jump back, especially as we get tired. It is pretty easy to throw yourself to the back of the mat without using the core, but in doing so, you land heavily, thereby jarring the SI. If you are tired, skip a few of the vinyassas between sides on the poses, until you are sure your can jump back and lift up with the core fully engaged. Your SI will thank you.

    Namaste,
    Diana Bonyhadi

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  5. LOVE and appreciate posts about the SI joint, especially reinforcing the ‘listening’ and ‘resting’. Would love to hear your ideas on adapting the Ashtanga practice for older students. It’s a practice I keep going back to, or using as a springboard, yet the challenge with students is often just those pieces… listening, waiting, resting, honoring our starting point and not barreling through and ending up injured.

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    • Hi, thanks for your comment! I think Ashtanga is a bit what we make of it. It’s permitted to take more than five breaths in each posture (though this makes the practice much longer), take your time, adjust, instead of rushing through. Catch your breath :)
      If someone has SI joint pain I would also suggest that they bend the knees before and after every surya namaskar, this will take some pressure off the hip joints.
      I believe the problem with fast flowing practices is that there’s simply no time to reflect on “does this feel OK?”. Probably only very advanced practitioners managed over the years to develop this sort of instant body awareness that works within seconds. The rest of us, well, we need to take our time :)

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  6. Hello Andrea aka SavasanaAddict -

    nice addiction! love to addict myself too!! in pune we have this very unique style of yoga for pain relief, where we use a physiotherapy based, Traction Medical Yoga. I will try to upload am image asap. It is quite popular for pain relief here .. regards Dipankar, India

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