Sacroiliac (SI) Joint Instability
Several years ago, I noticed an anomaly in my own body that I began to observe in the bodies of many of my students. And I wasn’t the only one who took notice. I would often have students ask me after class, why it was that they could perform an asana so well on one side and yet struggle with it immensely on the other side. While there are many factors that can contribute to this occurrence, for the purposes of this article, I would like to focus on the sacroiliac joint and the importance of mindfulness within asymmetrical postures.
A Quick Assessment of the Pelvis
Too often within a yoga class setting, we teachers can be overwhelmed by the number of students. It can be daunting to familiarize yourself with every student’s compensation patterns, misalignments and injuries! Something that I have started offering in my group classes, is the opportunity for students to become aware of these patterns themselves. This can be implemented at the very beginning of the practice in a non-invasive way that integrates into a peaceful breathwork practice.
Invite students to lie on their mats in a gentle posture with their knees bent and thighs rolled medially toward one another. Beginning with a gentle and easy breath, I encourage students to invite ease into their abdomen as they inhale, allowing the navel to float away from the spine. On their exhale, students are invited to gently allow their navel to settle back toward their spine. I use this opportunity to walk around the room so that I can look for 2 things, the position of their navel and the position of their anterior superior iliac spine (ASIS).
What direction is the navel pointing? In a balanced pelvis, the navel should point straight ahead. If imbalance is present, the navel may point more to the left or the right. The direction that the navel points, can indicate the direction to which the pelvis is ‘twisting’. For example, in my own pelvis, there is a slight pointing of the navel to the right-hand side. This coincides with a posterior tilting of my right ilium and an anterior tilting of my left ilium.
Can you see the ASIS on both the left and right-hand sides? (On your own body, you can easily palpate the ASIS by sliding your hands down from your waist until you feel the upper rim of the ilium on either side. From here, slide your hands smoothly down along the front of your pelvis, maintaining contact with the pelvic rim. You will reach a bony protrusion along the front (anterior) and in the upper section (superior) of the pelvis. This is your anterior superior iliac spine.) Is one ASIS more prominent than the other or higher than the other? A lower ASIS indicates an ilium that is rotated more toward the anterior (front of the body) and a higher ASIS indicates an ilium that may be rotated more toward the posterior (back of the body).
What do you See?
If you feel unclear while students are lying down, another strong indicator of imbalance is what you see when students are simply seated with legs crossed on their mats. Is one leg higher than the other? Do they tend to favour one side more than the other? Have they expressed to you that certain asymmetrical poses (postures where the body is not doing the same thing on both sides; such as triangle pose) are easier on one side more so than the other? You can easily peak at students while they are in seated or standing postures to look at the navel and the ASIS throughout the practice.
Self Awareness – What do they Feel?
As students are practicing gentle breath work on the floor, you can invite them to roll the pelvis from side to side and to gently circle the pelvis along the edges of the sacrum. Invite them to place their hands on their navel and on the ASIS. You can still encourage breath work, please do, but use this time to draw awareness of the alignment of their body. This can be shared in a positive way that helps students to more deeply connect with their bodies through the process of ‘embodiment’ rather than making someone feel badly that there is something ‘wrong’ with them. Be mindful of the language that you employ. Ask questions around what students feel? As they rock the pelvis back and forth along the floor, do the two sides of the pelvis roll smoothly together? Does it feel like one side is more prominent? You can invite this awareness into the practice, especially as they explore any postures that are asymmetrical in nature. Start the conversation with them around the experience of the pose from side to side. Does one side feel stronger or more flexible? Is it easier to perform certain asana on one side more so than the other?
Modifying the Practice and Self Care
If you, or a student, become aware of a misalignment, how does that change the practice? What should they do, and more importantly, what should they avoid? I would like to give 3 suggestions here regarding movement within all asana, asana to avoid and asana to focus on.
Movement within Asana
If a misalignment becomes apparent, rather than suggesting that students always start on the right-hand side, give the option for students to start practicing on the side they find most difficult. Slow down. Focus on mindful and smooth movement. Emphasize the importance of transitioning from asana to asana as part of the practice. Really look for the end feel, meaning, where does the movement want to end? Is there a moment in the transition, where the body meets its end feel, but your student wiggles around it to ‘achieve’ the ‘full’ pose? Where is the spot where they stick? Tell them to stay there and dance with that space, even if it feels like they are no longer doing the posture or it doesn’t ‘look’ right. Emphasize how it feels, versus how it looks. Most importantly, the less mobile side needs to be the determining factor for how deeply a student goes into a pose. If the right side can only move 2 inches forward into a pose, than the left side, no matter how mobile, must only go that same 2 inches. When we do not do this, we create instability and yoga practice becomes harmful instead of helpful.
A note on end feel – To explore what wiggling past your end feel looks like, I would like to give an example. Have your students stand in mountain pose. Ask them to lift their arms in front of their body and slowly draw their arms back toward their ears or beyond. Watch their ribs as they do this. Is there a point where their arms no longer smoothly go back and they pop their ribs forward in order to ‘achieve’ the direction you have given? Have them repeat the movement without popping the ribs forward and assess where their actual end feel is for their shoulder mobility.
Asana to Avoid
In the case of the pelvis, there are certain postures that can be destabilizing to the SI joint and over the course of time, if done incorrectly, can cause damage. Should you or your student be struggling with SI instability, I would think strongly about intelligently adapting or modifying any asymmetrical asana. I give the examples of two asana below, one with lateral movement and one with forward movement so that you can get the idea and apply it to other postures.
Triangle Pose (Trikonasana), an Asymmetrical Pose with Lateral Movement
What occurs in the SI joint is greatly impacted by the rotation of our thighs. When we medially rotate our thighs, it creates space in the SI joint, allowing for greater movement. When we laterally rotate our thighs, it decreases the space in the SI joint, which can cause wear and tear between the sacrum and the ilium. (Often when an individual walks on their lesser toes, there is a coinciding lateral rotation of that leg.) In the case of triangle pose, it is very important that we look at the positioning of our forward leg. Is the student supinating their foot, ie: rolling slightly onto the lateral edge of their foot or peeling their arch off the floor? What direction is their knee pointing? When your student enters the posture, does their knee cap roll too far medially? To modify triangle pose, invite your students to gently bend their forward knee until it tracks forward. If the foot is supinated or pronated, ask them to lift the heel of their forward foot until they can stand equally into the ball of the foot. Ask them to engage their core as they slowly lean toward their forward leg and ensure that they stop at that point where they feel their true end feel, or when you observe they begin to wiggle past their sticking point. Also, make sure to look closely at their back leg and ensure that they are medially rotating the thigh while grounding firmly through the heel of the foot.
Low Lunge (Anjaneyasana), an Asymmetrical Pose with Forward Movement
I choose this pose because of the variation often enjoyed in yoga classes, where students are invited to draw the torso forward with the opportunity to place their forearms on the floor. If you consider what we have already discussed in this article regarding wiggling around our end feels to achieve postures, this variation of the pose would be an excellent example of where this occurs and can cause detriment to the SI joint.
In the humble variation of low lunge, the SI joint can be negatively impacted when the posture is forced. To enter the ‘full’ variation, a few movements need to occur. The rectus femoris, aka your hip flexor, needs to be able to lengthen fully. If the rectus femoris in the rear leg is shortened for any reason, your student’s ability to create the needed distance between their two legs will be greatly reduced. Without the pelvis positioned closely enough toward the floor, the temptation will be to force the asana by taking the stretch into the lower back and pelvis; into the SI ligaments which serve to stabilize the pelvis. Overtime, ignoring this compensation can lead to SI ligament strain, making this posture a contributor to SI instability and potential pelvic shearing, where the bones of the SI joint rub together. This is also aggravated by the second compensation students will likely utilize to ‘achieve’ getting their arms on the floor, which is a lateral rotation through the anterior leg to make space for the torso and arms. (If you recall, a lateral movement compresses the bones of the sacrum and ilium against one another, thereby closing the joint. Not an ideal scenario!
To modify the posture and make it pelvic aware, lets look at the intention of the asana. What is it that we are hoping to achieve by utilizing the pose in our yoga class? Could we achieve the same intention with an alternate pose altogether? Anjaneyasana is a precursor to hanumanasana, the Monkey God Pose or splits. Its main intention is to stretch the hip flexors of the back leg. If this is our emphasis, we can modify the pose by using a stool, by placing the foot of the back leg on a stool with our knee gently placed on a small bolster or folded blanket. (When the knee is bent we emphasize stretching into the rectus femoris. When it is straight we emphasize stretching the iliopsoas, which by the way, is not a hip flexor, but it can contribute to anterior pelvic tilt.) Other cues that I would offer and things that I would look for, is to make sure that the adductors, inner thigh muscles, are firmly engaged along with the transverse abdominus muscles of the abdomen. This protects the SI joint and prevents us from wiggling around our limitations. Finally, only go as far as you or your student is able to go without losing the straight tracking forward of the pelvis.
Asana to Focus On
Table Pose (Goasana)
This is a great posture for pelvic support. Often when I teach this pose with the option to extend the leg, one of the first things I observe is that most students will laterally rotate their extended leg to ‘achieve’ the pose. To help create better pelvic stability, you can utilize this pose to teach your students how to properly engage gluteus maximus. One way that I do this is to invite students to first start the extension process by using the grounding of their rear foot of the extended leg. By inviting them to anchor their toes to the floor and reach out through the heel, we use this time to focus on medial rotation of the thigh and engagement of the adductors. I will at times, place my hand along their inner ankle of the extended leg and ask them to press into my hand. Once this is comfortable, we attempt lifting the extended leg while maintaining the alignment. Sometimes students are only able to lift an inch off the floor before they begin to lose their alignment by laterally rotating. So, this is where I tell them to work.
Block Squeeze and Strap Press
This is a movement therapy technique that integrates seamlessly within a yoga class setting. From a supine (lying on the back) or seated in a chair, you will need a block and a strap. Place the block between the knees and ensure that the feet are tracking straight ahead. Wrap the strap firmly around the thighs. Using a count of 10, ask students to hug the block with their knees and then have them press out into the strap for an equal amount of time. I usually do 3 sets of these.
Secondary Compensations and Further Care
Beyond an SI imbalance there are further considerations that should be explored. Namely, what is happening in the knees, the thighs, feet and lumbar spine. In the case of pelvic shearing, where the SI joint has been damaged, other factors can be at play. Is there dysfunction in the gluteus medius or ligament laxity in the SI joint? How does your student step when they are walking? Did you know that we are meant to step into the greater toes, big toe (hallucis), pointer toe and middle toe, when we walk and run? When we don’t as in the case of a medial knee injury like an MCL or meniscal injury and we step into the lesser toes along the outer edge of the foot, this causes an impact that can lead to pelvic shearing in the SI joint! Also, SI imbalance can contribute to functional scoliosis.
The good news? There are wonderful health care providers these days such as Physiotherapists, Yoga Therapists, Osteopaths and Massage Therapists, who can help your student on their path to full mobility and recovery. I believe that for anyone who teaches a movement based practice, the best approach is for you to seek out these services for yourself, ask around for referrals from other yoga teachers. What is important is that you find health care providers who understand the unique movements that yoga practices can employ so that they can recommend the best recovery approaches.
Stefani Wilton and Contributors
Finding beauty in the midst of joyous imperfection