Yoga for the Sacroiliac Joint

Exploring Anatomy and Healthy Movement Patterns

Jenny Loftus (she/her) RN, BSN, LMT, E-RYT 500, YACEP

www.jennyloftus.com Anatomy of the SI Joint

● The SI joint is a very stable joint between the sacrum and the ilium of the pelvis held together by many ligaments. ● The articulating surfaces of the SI joint are rough and cratered, meant for stickiness, not glide. ● The joint should not have much movement, generally our focus in practice should be on stabilization, not mobilization. ● Significant weight bearing joint, transmits force from ground,legs and pelvis and supports weight from spine and structures above. Ligaments Supporting the SI joint

● Ligaments connect bone to bone, for SI joint, sacrum to pelvis (ilium) ● Ligaments are hypovascular and therefore do not heal well ● Sacroiliac Ligament: connects the sacrum to the ilium ● Sacrotuberous Ligament: connects the sacrum to the ilium and the ischium ● Sacrospinous Ligament: connects the sacrum to the spine of the ilium ● Iliolumbar ligament: Connects the Lumbar Spine to the Ilium Regional Muscles to Stabilize SI joint

● Piriformis~ stabilizes SI joint, crosses the SI joint and the hip joint, abduction, ext. rotation (int. rotation with hip flexion) only “deep 6 lateral rotator” to connect to the sacrum, creates force closure of SI joint ● Psoas~ contributes to force closure of SI joint, walking dance with piriformis ● Multifidus~ nutation of sacrum ● Pelvic Floor muscles~ counternutation of sacrum ● Quadratus Lumborum ● Transverse Abdominus ● Adductors/Abductors ● Hamstrings ● Gluteals Movement of the SI Joint

● Nutation/Counternutation ● Form closure: how a joint is shaped affects mobility/stability

SI joint~ rough surface, lots of strong ligaments

● Force closure: how the 2 joint surfaces come together

SI joint~ relies on many core supporting muscles

● With good form and force closure, excellent potential for well coordinated muscle control What Destabilizes SI Joint Ligaments?

● Overstretching ● Lack of muscular recruitment and awareness ● Extreme range of motion of femur bone in hip joint ● Incongruence of sacral movement with pelvis and spine ● Slumped poor posture ● Pelvic torsion: Common misalignment of the pelvis, one ilium will twist forward, the other side will twist backward (rotated or twisted pelvis) ● Imbalance in Psoas and Piriformis muscles ● Pelvis / Tailbone injury ● Hamstring tendonitis and/or tightness ● Scoliosis / Leg length discrepancy SI Joint Instability, Hypermobility, and Yoga Poses

● Hip and SI joint problems very common in yogis, increase in hip replacements and SI joint instability ● The Holy Grail of extreme “hip openers” pitfalls ● Seated posture pitfalls ● Twist/Lateral bend pitfalls ● Forward bend pitfalls ● Backbend pitfalls ● Once hypermobile, only choice is to recruit and strengthen regional muscles to help create force closure of joint Resetting the SI joints

● Helps realign pelvis/SI joints ● Helps stabilize loose joints as well as loosens tight joint spaces ● Practice only with legs hip width apart if experiencing SI instability/pain ● Initiate movement from core ● Inhale when slowly applying pressure on strap or block, exhale to slowly release ● Gradually increase to 20% contraction ● With ABduction, press inner edge of foot into floor before movement ● With ADduction, press outer edge of foot into floor before movement ● Finish with moving bridge poses Stabilizing Poses for SI Joint: Coactivation

Oppositional actions on SI joint:

● Bird dog pose (Multifidi/Gluteal co-contraction) ● Supine bent knee oppositional isometrics (Psoas/Gluteal co-contraction) ● Multifidus/Pelvic floor/Core engagement for nutation/counternutation co- contraction ● In walking, Psoas/Piriformis

Symmetrical actions on SI Joint:

● Isometrics of abduction/adduction, block between knees ● Prone backbends on floor, lifting legs, ext rotation legs Mobilizing Safely for SI Ligaments

● Supta Padangusthasana: Keep symmetry of pelvis left and right ● Wide leg standing poses: ● Align front leg sit bone, knee, ankle ● Allow pelvis to organize itself around rotation of femur bone ● Let torso/shoulders follow the pelvis ● Adjust placement of feet wider than heel to arch alignment ● Yield to feel force from floor through sacrum, pelvis and spine ● No more than 2-3 standing poses on one side to avoid fatigue ● Avoid manual adjustments to deepen rotation of hips Piriformis Syndrome

● Most common cause of appendicular sciatic pain ● Entrapment of sciatic nerve by piriformis accounts for 70% of all non- lumbar sciatic pain ● Variations of how sciatic nerve passes thru/under/over piriformis ● 6x more likely in women~ Q ratio is larger ● Irritating habits include sitting with top leg crossed over, sleeping on side with top leg crossed over, phone/wallet in back pocket ● Sciatic nerve can normally stretch 3-5 inches, can entrap in tight muscles, fascia, scar tissue anywhere along the way Working with the Piriformis

● Work gently~ can easily aggravates sciatic pain~ don’t overdo and keep ROM before pain ● Strengthen before lengthen, esp for high Q ratio, knock knees ● Piriformis abducts and externally rotates when leg is not flexed ● Piriformis adducts when hip is flexed 60-90 degrees ● Standing and All 4’s piriformis strengthener ● Abduction with resistance ● Reverse pigeon, supine cow face leg stretch ● Ardha Matsyendrasana and Marichyasana~ be careful ● Sciatic nerve glides Other Considerations

● Avoid a narrow block under sacrum in supported bridge, stress on ligaments ● Avoid supine hip openers like supta baddha konasana without support under thighs or knees (femur bones are too strong of a lever without support, torque on SI joint. ● After injury to SI joint: ● Symmetrical supine work first ● Then prone symmetrical backbends ● Then standing poses ● Then seated postures ● Twists, esp seated twists, are the last thing to reintroduce after an SI joint injury