Protecting the Sacroiliac Joint in Yoga, Part II

It’s (usually) not the yoga pose, it’s how you do it.

Welcome to Part II of Protecting the Sacroiliac Joint in Yoga. If you missed Part I, get it here: https://gingergarner.com/protecting-the-sacroiliac-joint-in-yoga/

Easy Ways to Keep your Sacroiliac Joint Safe During Yoga

Let’s talk joint safety – specifically Sacroiliac Joint Safety in Yoga. Words matter. It’s not difficult to keep the sacroiliac joint safe in yoga once you know the “ABC’s” of biomechanics and “123’s” of physiology. But the catch is, I cannot teach you all of that in a blog post.

In fact, this post became so large (like a large book chapter) that I had to turn it into a DOWNLOADABLE GUIDE. Y’all (I am from the South), I had to make it easier for you to read & use!

This totally free 40 page guide includes:

• Recommendations on the most common problematic yoga postures.
• Safety Tips to get the most out of strength and stability building for the spine and sacroiliac joint.
• Expert Advice to avoid the mistakes I made when I started out.
• Wisdom from over 2 decades spent as a physical therapist, athletic trainer, women’s health therapist, and yoga educator.
• A *BONUS* Quick Reference Guide
• 2 dozen illustrations

But before download the Asana Evolution SIJ Guide, there is a little more prep work we need to do.

First, I’d like to discuss common problematic words and phrases that hinder progress. They hinder progress in pain management, they can create injury, or lead to dependence on “drive-through” medicine. What is that? Drive-through medicine is healthcare that teaches a person to be a passive recipient of repeated (often invasive) healthcare interventions that may not be effective, healthy, sustainable, or even appropriate.

With sacroiliac joint and back pain, drive-through medicine often consists of MRI’s, injections, surgeries, drugs, therapy and other care that may have little scientific support or proof (like repeated manipulations or use of modalities without addressing the major lifestyle changes or therapeutic exercise that are known to be effective for back and sacroiliac joint pain).

Words Matter

Problem Words = Flawed Solutions

If you have ever asked any of the following, then you may be a perfect reader for this post!

• What yoga postures are “good” or “bad” for the sacroiliac joint?
• What yoga postures will help “fix” my sacroiliac joint?
• What modifications can I do to allow me to do ____________________yoga pose?
• What should I avoid in class to prevent hurting my sacroiliac joint?
• Yoga hurt my sacroiliac joint/back. What can I do to fix it?
• Who should I see if I have sacroiliac joint/back pain?
• Can sacroiliac joint pain mimic hip pain, pelvic pain, or contribute to sexual or urological problems? (the short answer, yes)

I am SURE there are more questions, but these are the most common ones I have gotten teaching and using yoga therapeutically for the last 25 years. In order to answer them, we need to address the problematic words, or vernacular, folks use when talking about sacroiliac joint pain.

Top 5 Red Flags for Spotting Sacroiliac Joint “Malpractice”

I consider these little phrases Red Flags for spotting an egomaniac instructor in the yoga studio. These Red Flags also apply to spotting an egomaniac healthcare provider!

When you hear someone use these little harmless sounding phrases, more often than not it is indicative of a much bigger problem. That problem is ego. If your teacher, therapist, or doctor is using these words, chances are they are teaching from a place of ego and feigned authority rather than as a safety guide and compassionate coach and/or caregiver who listens and deeply cares about what is best for your health and well-being.

1. “I can fix your sacroiliac joint.”
   
   No, just no. No one can “fix” your sacroiliac joint, and anyone who says they can is lying. The reason is the sacroiliac joint is a complex joint that rarely acts alone. It usually has accomplices in creating impairment or pain. The other reason is – a therapist or teacher’s job is not to “fix” you. The same teacher,  therapist, or doctor who says this phrase to you is also the same person who will tell you “You can’t return to running.” or “You can’t weight lift.” or “You can’t go hiking.” because it will “hurt your sacroiliac joint” or whatever other excuse they give you. This phrase is a classic dominator language vernacular that puts the therapist in the control seat and “god” position. I don’t believe in the “doctor is god” or “guru as god” fallacy. No person knows you better than you. So, if a teacher or therapist or doctor tells you “they can fix you,” run the other way. Because in the next breath that same attitude will tell you “You are broken., You aren’t listening., You hurt yourself., I can’t fix you.” Both extremes are born of the same patriarchally-driven control complex and ego. Avoid folks who use this phrase like the plague. 
   
   
2. “Your sacroiliac joint is hypermobile.”
   
   How do they know that?Quite simply, they don’t. They can’t. I’ve been helping folks with sacroiliac joint pain for over 2 decades, and unless they have Ehlers-Danlos syndrome or hip dysplasia or other serious hypermobility syndrome, tossing around “you have a hypermobile sacroiliac joint” is careless and inappropriate. It’s just not helpful to use or hear this phrase. 
   
   
3. “Your sacroiliac joint is hypomobile.”
   
   Nope, sorry. The same story applies here. We can’t make that claim and maintain a straight face. We don’t know that unless the joint is actually fused (congenital or via osteoarthritis or some other pathophysiology). And even then, how can we be sure there isn’t movement of some type happening? What we DO know is that through a battery of tests (that only a licensed physical therapist, orthopaedist, chiropractor, osteopath or other similarly licensed healthcare pro can do) we can determine if sacroiliac joint mobility or movement is not balanced or roughly symmetrical to the opposite side in the SAME PERSON. We cannot make deductions about normal movement BETWEEN PEOPLE. So, when I evaluate someone’s sacroiliac joint, all I can do is compare their amplitude of movement and quality of movement on one side of the joint versus the other. Now I AM able to compare performance of pelvic floor, trunk, and hip musculature strength, quality, and amplitude of movement person-to-person, however; that is part of the reason why addressing sacroiliac joint pain and preventing it are so complex. There are a lot of variables at play that must be measured. So again, hearing or using this phrase just isn’t helpful either. 
   
   
4. “Sacroiliac joints cannot move. They are fused. They don’t move enough to matter.”
   
   I think the last post verified that these statements are false. The sacroiliac joint may be fused in some folks, either congenital (the person was born that way) or due to a condition, age or gender (osteoarthritis, being male, surgical fusion, or inherited fusion condition) but not all. And it does move. Before I was pregnant with my third child, for example, I had pregnancy-induced sacroiliac joint pain, but I wouldn’t have believed the joint could sublux or dislocate. However, my third pregnancy changed that. I often had to walk with a cane because of the lack of reliability in the sacroiliac joint (due to the hormone relaxin, which softens ligamentous support in joints). And I’d have to coach my husband through manipulating my sacroiliac joint when it did decide to “relocate.” After pregnancy, it never happened again, but I have a new respect for pregnant women with severe sacroiliac joint dysfunction and pain, as I had. I also take care to counsel pregnant women on how to minimize the secondary effects of relaxin through working on foundational yoga-based joint stabilization techniques that I discuss in my book, Medical Therapeutic Yoga.  Buy the book here
   
   
5. “Oh the problem isn’t the yoga pose. (Another way of saying the problem is you.) You just need to increase your flexibility or range of motion. You just need to do ____________to do the pose.”
   
   A pose should NOT be something you put on and take off like a piece of ill-fitting clothing. A good teacher, therapist, or doctor will know HOW the pose may or may not fit your body, NOT how your body can fit the pose. The problem is RARELY with the yoga pose itself. The problem is typically how the pose is being done. Notice I said rarely. There are cases where the yoga pose is just ridiculous and unnecessary and would cause pain to anyone doing it, if they do it long enough. Like drop-back backbends or full splits for example. No one needs that kind of extreme and volatile motion in their daily lives unless they are an elite athlete, and even then, it’s unsustainable. So, there are always exceptions to almost any rule. My point is – the pose isn’t usually the problem, it’s how the pose is done. I will discuss a concept I call “Posture Scaffolding” in the handout, which will help get you safely into and out of some of the most problematic postures.

Ok, now that we’ve tackled the 5 Red Flags for Sacroiliac Joint Malpractice, let’s move on to the nitty gritty of this post.

---

Let’s discuss:

• the most common nemesis or red flag postures for sacroiliac joint dysfunction
• how to recalibrate those postures
• how to prevent sacroiliac joint pain if you are currently doing just fine

So here we go! 

Asana Evolution & the Sacroiliac Joint

FIRST! A Word about the SIJ Asana Guide – We will discuss the postures that are perhaps the most common, problematic postures for the sacroiliac joint. These are the troublesome poses you can recalibrate to better fit the sacroiliac joint now. I have grouped the postures together according to their similarities with regard to biomechanical alignment for protecting the sacroiliac joint. To get the most out of the guide, display it on a tablet to use during your practice.

---

READ THIS FIRST BEFORE DOWNLOADING 

There are two things you need to know before you dive into Safety for the SIJ in Yoga.  

Point 1. Yes, we all know yoga is more than asana.

To all the yogis who think that those of us who talk about biomechanics in asana aren’t spiritual, I need to say to you – Stop the judgement. Please. You don’t know me. You don’t know my spiritual belief system. You don’t know how wholeheartedly I support and teach Yoga Philosophy. So please do not assume that anyone who talks about yoga posture biomechanics is neglecting Yoga’s philosophy. It makes the yoga community look like condescending know-it-alls on their spiritual high horses; and it isn’t helpful for our already fractured community. Yoga is about oneness, balance, inclusion, and compassion. It is about improving ourselves, not judging others around us as lesser. Let’s work together to make yoga safer for every body and every one.

Now we can get on with discussing how so many people get hurt in yoga. They don’t get hurt reading philosophy. They get hurt practicing asana. They get hurt because students look to yoga teachers as movement experts, when they can’t be. They get hurt when yoga teachers don’t know their boundaries in teaching. They get hurt when yoga teachers present themselves as movement experts or claim that yoga can fix or cure (almost) anything. (Hint: Yoga can’t fix everything. Not even close.)

 

That brings me to Point 2: 

Any actual expert in movement science or biomechanics will be the FIRST to tell you that EVEN if you DO have a masters or doctorate degree in physical therapy, biomechanics, exercise physiology or kinesiology – We don’t know everything there is to know about movement.

We don’t even know a fraction of what is yet to be discovered. Experts in movement sciences do realize the old cliche’ is true – The more we know, the more we realize we don’t know. I’ve been in orthopaedics for 25 years (and practicing yoga for longer), and everyday there’s something new I need to learn and more research to read to improve my skills as a therapist and doctor of physical therapy.

In light of these two points, I’d like you to consider these three things: 

1. Question everything you have been told about asana or taught about movement. Search for the science. 
2. Keep asking questions. Don’t stop learning. 
3. Do not blindly follow a lineage, a guru, a teacher, or a healthcare provider. Ask for their educational background and the scientific evidence to back up their claims. 

Not doing these three things has made yoga dangerous, hurt people, has made healthcare unhealthy, and has hurt yoga. We have a chance to heal the hurt by considering the 2 points and 3 action items above. 

Even if you are feeling hunky dory in yoga posture practice right now, if you are a woman, or if you have a risk of back pain, you can still benefit from practicing postures in this way. In other words, there isn’t a population that wouldn’t benefit from using the Posture Scaffolding neuromuscular and motor patterning principles, as well as alignment suggestions, that I’ve made in the guide. 

One final reminder – I cannot explain every detail of what I look for when I use yoga postures to diagnosis and treat sacroiliac joint pain, but I do explain more of it in my textbook and of extensively in course trainings and workshops.  

A Word about When and Who to Refer To 

First, I cannot teach a full sacroiliac joint examination on a blog. So this 2-part blog series just scratches the surface of what there is to know. Plus, it’s not legal for anyone to perform a sacroiliac joint examination unless they are a licensed physical therapist, doctor, or other similar healthcare provider. The SIJ exam gives me the information I need to make a physical therapy diagnosis and create a plan of care to address a person’s pain and impairment. And, that exam informs my medical therapeutic yoga prescription.

A few pointers on when and how to refer:

• Know that you can refer to a spine-trained physical therapist at any time to best help your students or clients.
• Try to establish a good working dialogue with a local physical therapist or osteopath who can dig in deep to evaluation and treatment of the sacroiliac joint.
• Also important to note – orthopaedic surgeons are not the first line practitioner of choice for evaluating or rehabilitating the sacroiliac joint. Orthopaedic surgeons are experts trained in surgery. Osteopaths and physical therapists are the experts in evaluation and rehabilitation of the joint. It’s important to know the difference so you can refer appropriately. Surgeons can only prescribe surgery, drugs, injections, or send you right back to the therapist.
• Look here for a therapist or doctor who specializes in yoga.

Tips to get the MOST from the Guide

1. The postures in the GUIDE are not a comprehensive list.
2. I also haven’t discussed restorative postures, which can be a nightmare for the sacroiliac joint.
3. Many poses that are erroneously deemed “Hip Openers” (see my post on Stop the Madness of Hip Opening) are actually hurtful for the sacroiliac joint, especially those with who asymmetrical movement or torsion. Commonly offensive postures to the sacroiliac joint include Reclined Cobbler’s Pose, Prone Tree Pose, Reclined Tree Pose, Frog Pose, and anything that puts the hip in a FABER (hip flexion, abduction, and external rotation position). I’ll have to save a discussion of these poses for another post! 
4. I highly recommend using a tablet or iPad to read the Guide. 

Questions? Want to learn more? Please reach out via my contact page! I’d love to chat or teach workshops on Asana Evolution & Safety in Yoga Practice! The SIJ is one of my favorite topics to chat about and teach!

---

 

This and all blog posts related to yoga and/or physical therapy on www.gingergarner.com are not a substitute for medical advice and are not a prescription or program for individualized physical therapy. You must seek the advice of your health care provider and, only after a thorough physical examination and clearance, participate in any movement or exercise program.