Yoga and SI Pain.

One of the most common areas of pain and injury for yoga practitioners is the temperamental sacro-illiac joint.

Quick anatomy lesson – you have two SI joints – they connect the sacrum (the flat triangular bone at the base of the spine) to either side of the illium (the largest bone of the pelvis, the bone that you rest your hands on when you put your hand on your hip all sassy-like).

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This little joint can get out of alignment and aggravated from a number of things. No matter how it happens, let me assure you – it hurts. Both super active people can experience SI pain sometimes (like Ashtangis) as well as very sedentary people. Pain can arise from over-stretching (this is commonly why it occurs as a result of asana) or from the joint getting jammed and the ligaments being too tight (in this case, a little stretching would do the pelvis good). All this is to say, like most injuries, there is not single solution or easy “fix it”.

An injury (especially one that occurs from doing the yoga practice you so very much love!) is a bummer, no doubt about it. But, an injury can also provide you the opportunity to get to know yourself, your body and your practice on a new level. If you are not learning about yourself through your yoga practice, I don’t really see the point of it.

In a challenging practice like Ashtanga (or say, life), pain is inevitable. As you learn new asanas and deepen into familiar ones, sometimes you will experience discomfort. Your job as a responsible practitioner is to determine whether you are feeling good pain (growth, stretching, opening) or bad pain (pulling a muscle, tweaking a joint, over-extending a ligament/tendon). Sometimes you will make a mistake and this is often when injury occurs. Live and learn.

My SI injury happened as a result of my overeagerness to master dwi pad sirsasana. Despite my impatience, I’ve been taking my sweet time with these leg-behind-the-head postures in Ashtanga Yoga. Like many women with bendy bendy backs, I am blessed with stubborn tight hips. I’m afraid I don’t quite have the pelvis of my dear husband, seen here chilling out with his morning chai (decaf of course) and scripture.

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Anyways, there was a short period last year when I began practicing with great fervor sitting up out of supta kurmasana to put both my legs behind my head and then lowering into the pose (instead of waiting for the teacher to tangle my legs into place for me). And then one day, it happened! So easily and so perfectly. There was no pain – just this sense of relief that I had finally done it all by myself with no help at all after 2 years of finagling on the floor in this pose. This relief quickly subsided as soon as I finished my dropbacks and realized that a hot, piercing pain was radiating all through my sacrum and right hip and it was not going away.

That was in the middle of October and I am still recovering. Needless to say, I haven’t tried that little trick since then.

So what have I done for practice in these past few months?

I have scaled back in the amount of practice as well as the method of practice. In the very beginning there were some days when I did not practice any yoga asana at all. My body needed rest, so I listened.

This injury coincided with our moving across country so there was a good chunk of time there when our days were full with looking at real estate, moving boxes and furniture and getting organized in a new home. In the first month of my injury, I took some more Vinyasa, Kundalini yoga and Pure Barre classes. The strengthening aspect of Pure Barre (which includes lots of Pilates-like movements) has been beneficial for stabilizing my sacrum and helping me feel strong and toned during this period of less aggressive Ashtanga practice.

I stretched at home a bit each day and I only attempted Primary Series in full once or twice a week for most of November and December. I imagine that if I had been settled and connected with an Ashtanga group during this injury-healing time, I would have attended Mysore more regularly, but because we were floating in Boulder and not set up with our home and schedule in Denver yet, this was not the case.

Now that we’ve been up and running with Ashtanga Yoga Denver since the holidays, I’ve been getting into the swing of things practicing a full sequence 5 or 6 days a week.. I am now at the point where I can do all of Primary Series without any pain. I am aware of some tenderness in my SI joint, but with careful monitoring and an extra focus on strong bandhas, I feel safe and happy to practice.

Outside of yoga, I’ve found it very beneficial to get occasional bodywork to help support the healing process. I initially went in for a few chiropractic sessions. This helped because my SI joint was literally jammed and causing some extremely painful spasming throughout the day. A few chiropractic adjustments ameliorated this, but the micro-tears that resulted from the spasming were still quite sore. Since then, I had a fantastic deep tissue massage which included some manual adjustments and an acupuncture session which immediately relieved the pain in my SI as well.

Self-care such as regular application of healing salves and arnica has been an important daily step in my healing process. When I am experiencing pain, I almost always apply heat. This is because heat such as a hot water bottle or a hot bath (or even better, some hot springs!) encourages blood flow. Blood flow is essential for healing connective tissue. I know that in more traditional sports medicine, ice is almost always recommended, but my acupuncturist once told me that “the only body you ice is a dead body”, and I’m with him on this one.

Recently I reached out to one of my Ashtanga role-models, Sarah Durney Hatcher and asked for her advice on practicing with SI pain. Sarah is an amazing inspiration to me. Her practice is light-years ahead of mine.  She is the most supportive, loving and encouraging teacher I have ever met and seriously one of the most fun and enthusiastic ladies to hang out with. She truly lives her yoga practice, always coming from a place of devotion, discipline, joy and a desire to grow and learn from everything she encounters. She currently teaches at Bristo Yoga School in Edinburgh, but I met her when she was living in Philadelphia studying with David Garrigues.

These are her words of advice and encouragement:

” I have some advice for the SI but really, you are doing the right thing, taking it easy and just going slow. My approach to SI pain is basics, back to the basics.

About once a year I do a ‘reset’ button on my practice and do primary for about two weeks up to a month. Working on basics and alignment and breath and just moving. Whenever there is pain especially, I always do thi. So this could help…and if you do this, don’t lift up at Supta Kurmasana and take dwi pada – just bind your hands and cross your legs when you are already down from the kurmasana position.

Watch the speed at which you are learning intermediate. When you are in India, you know David G is going to push you. Do not have fear about this – and do not doubt, but protect yourself by doing serious meditation and worship so that your intention with the asana practice is internal and not external. For me to practice so intensely with DG for a whole year day in and day out, to stay safe and healthy, I did serious worship and meditation before every asana practice so that I was grounded. I got many very very difficult adjustments from him; because I think I was grounded and sure of myself and my intentions, I never got hurt. This is what you do, madam, especially when studying intensely with DG.

Dwi pada sirsasana takes some people 2-5 years to get it just right. Not that you should stay there until it is perfect (this happens a lot as we both now) but be cautious not to try too hard in the asana. As the back opens (kapo) and you go bigger and bigger in backbending, the hips tighten. And it is the opposite for hip opening. The more hips open…the tighter the back gets. SO!

Be sure you are keeping your tailbone down when you forward fold. And when you go forward in any standing or seated asana, anchor the backside down. Simply put: forward bend like you are wearing a short skirt! This is kind of like ‘tucking’ but not quite; it is more like engaging the bandhas – which are required for dwi pada (core core core) to hold yourself there and let the hips open.

Another thing you can do is do eka pada sirsasana three times instead of one time per side…try doing urdhva dhanurasana with wide legs for a while and narrow your feet only when it starts to feel better. Don’t do any coming up to standing or dropping back until you can have no pain walking your hands almost all the way to your feet and then walking back out and coming down to the ground.

Bandhas! You must do some serious bandha exercises. Pelvic floor – the mula bandha for us women is located in the cervix – so at the backside of the vagina. Must start engaging this with each and every dwi pada. This will protect the pelvic floor as well the si joint.”

As I’ve been practicing Ashtanga more regularly these past few weeks, this advice has been crucial. The idea of tucking the pelvis (which has long been my secret for an easy jump through with straight legs) has changed my forward folding dramatically. The image she gives of folding as if you are wearing a short skirt, has helped activate my mula bandha in a deeper and more internal fashion, all the way into the cervix, as she says, and not just on a physically superficial level.

But even more than the very important physical suggestions she offers, I am especially grateful for the encouragement and reminders of the essential components of practice: faith, fearlessness, devotion, mindfulness and trust. These are the qualities that will protect you in practice and help you grow, not only in asana, but as a person on the spiritual path.

So grateful to Sarah for all this, and so grateful for my personal practice for all that it teaches me about self-awareness and patience!

 

Long post, I know, so thanks for bearing with me. I hope you’ve gained something from this.

I would love to hear from you, dear reader, about any experience you’ve had with yoga and SI pain and what has helped you heal and grow.

 

 

Blessings and Love,

Frances

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17 thoughts on “Yoga and SI Pain.

  1. Hi Frances,

    Thank you so much for the thorough discussion of the SI joint. I am going to have to try the “tucking” of the pelvis in forward folds! When I was first learning eka and dwi pada, my lower back started to hurt more and more and more, until one day I was almost crying in pain trying to get into ushtrasana. I had to pull WAY back, slow down, and really build strength to support my flexible back. Swimming a few times a week really helped me to both stretch and strengthen my back in a low impact way!

    I still get frustrated with eka and dwi para…it seems to always be one step forward, two steps back for me…

    Best of luck to you for your time in India!

    • Hi Lindsey.
      Thanks for reading and commenting. This is a subject that a lot of us, I’m afraid, are familiar with! I totally hear you with your frustration with eka and dwi. “Progress” in yoga is never ever linear. My groin and hips have tightened up significantly in the past few months, so now that I’m slowly starting to work these poses again, it’s like I’m right back at the beginning all over again.
      I wish I was a better swimmer, because I know that can be a beneficial exercise to pair with Ashtanga. (Jennifer is a firm believer in that).
      I think sometimes it’s really good to have some “cross-training”, if you will. As silly as the Pure Barre stuff is, it’s really helped my core strength and bandhas in my practice.
      Blessings,
      F

  2. Sorry to hear about your SI joint injury, Frances. Based on my own experience with SI joint injuries, I would say that I completely agree with Sarah D that (re)learning to engage the bandhas is very key to healing. In particular, I have found that inwardly rotating the thighs and engaging uddiyana bandha while going slowly into forward folds has been very helpful for me. If you are well enough, you can even try to work on floating back from trini to chatvari position in the Suryas. I believe that the bandha-engaging actions that are involved in floating back are actually healing for the SI, if you do it carefully (i.e. first, try to lift up without jumping back, and only follow through with jumping back when you have a certain degree of control over the action. Don’t just fling yourself back.).

    I have also found that paying attention to inwardly rotating the thighs in Virabhadrasana A (during Surya B) is also very healing. In fact, one of the things that happened when my SI started to heal was when I started getting this pleasant “clicking” sensation in my lower back as I stepped into Vira A. I still get this sensation often during my first or second Surya B in the mornings: It feels like something is clicking into place.

    Lastly, FWIW, I also wrote a post sometime ago about jump-throughs and jump-backs (JTJB) and how they can heal your SI joint if you perform them properly; the basic idea is the same as with learning to float: http://yogadragonden.blogspot.com/2011/04/jump-throughs-and-jump-backs-ashtanga.html

    In any case, I feel that SI joint injury is actually an opportunity to (re)learn how to move more effectively and safely, and attain greater control over our bodies in the process. So in this way, it is actually a gift.

    Long comment, I know, but I hope this is helpful :-)

    • Greetings Nobel.
      Nice to hear from you. I really appreciate your comment. I do remember reading that post and some of your other posts awhile back when you were struggling with SI pain. It always helpful to learn from other practitioners.
      The notion of focusing on inward rotation in the thighs in Vira A will be a new addition for me, so thank you for the recommendation. Very helpful.
      This past year I just started to get the floating from trini to cetwari – it’s an awesome feeling (when it works). You are so right about that bandha work helping to heal the SI because it’s such a focused area of strengthening.
      Thank you. Hope you are well!
      Happy New Year.
      F

  3. Frances, lovely post and thank you for including me in your blog. You are going to have a great trip to India, and I am very excited for all the wonderful adventures you will share with Thad. Happy India travels to you newly-weds! And may your SI joint continue to feel better and better. X,

    Sarah

    • Thank you dear Sarah.
      My SI is rapidly improving. Grateful for your help.
      We miss you and hope to make it over to Scotland sometime. I’ve always wanted to visit and now we have the perfect reason.
      xo

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  7. Thankyou for this post! I wish I had seen it earlier. I too recently had an injury in this area (still not sure if it is disc, SI, or a combination of both). It happened November 28th, while in Kurmasana. Previously I had been upping the ante on backbending preparing for a backbending workshop the next week. It has been interesting! Yesterday the snow here in Ontario was the heaviest darn stuff to move off the driveway and after a few minutes of engaging with it I could feel everything in the lower lumbar moving around quite fluidly (I did stop shoveling). No pain, but strange. Not stable. Things are still not ‘right’, but lots of progress has been made. Best!

    • Hi there,
      Thanks for commenting. Glad my post was of help. It’s a tricky little injury this SI stuff. Mine is finally healing after months of very conscious practice and strength/stability work.
      Hope it improves for you quickly as well.
      Blessings
      F

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  10. Thanks a lot for all your posts, which gave me new inspiration and ways to practice.
    Last summer I got Dwi Pada. And it got me in the end -_- My backbending improved a lot (kapo is almost casual asana), so this seems to affect my hips. Now I try to focus my practice on core work. Also Therapy page in Sharath’ new book became part of my routine.
    I will translate into Russian some of your post on SI injury if you don’t mind.

    • Thanks for commenting. I’m glad you found this post helpful. Feel free to translate as you wish. As you said, core engagement is so important. I too have a flexy back and I think this might have been why I injured my SI in the first place…I was counting on my flexibility rather than using my strength.
      Blessings
      Frances

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