Several of my lower back pain students suffer from sacroiliac joint pain, and I’ve experienced it myself. The nagging or sometimes excruciating pain in the lowest part of the back can be caused by the misalignment and/or inflammation of the sacroiliac joints. Even when slightly out of alignment, the sacroiliac joints can give you a dragging-down, heavy feeling in the lower back. My last blog demonstrated yoga therapy practices that can help relieve this pain. This blog discusses what can exacerbate sacroiliac joint pain in terms of movements and postural habits. Read on if you’re prone to this kind of lower back pain.
The sacroiliac (SI) joints are semi-moveable joints between the iliac crests (top of the hip bones) and sacrum (lowest part of the spine). It’s important for these joints to move slightly, so that the sacrum can move in relation to the hip bones. This allows the joints to mediate between upper body and lower body movements. The SI joints are crucial for balancing, weight-bearing and shock-absorbing. They are held together by strong ligaments.
Problems arise when the SI joints are either too rigid or overly mobile. When they are too flexible, the SI joints can become misaligned. When too rigid, they can become inflamed and arthritic. The inflammation of SI joints is called sacroiliitis. Sacroiliitis is a common symptom of another back condition called ankylosing spondylitis (see my previous blog about AS here: https://beneyoga.co.uk/yoga-for-ankylosing-spondylitis-and-axial-spondyloarthritis/).
The yoga therapy intervention for rigid or arthritic SI joints focuses mainly on promoting sacroiliac mobility. This blog will only focus on unstable and misaligned SI joints that have not yet caused wear and tear problems. Both SI joints can be unstable, but for the majority of people only one side is unbalanced.
SI joint instability
A possible cause for SI instability is the uneven pressure on one side of the pelvis, as would happen with scoliosis (sideways curves) of the spine or a leg-length discrepancy. Another cause can be a traumatic injury, or it can be the result of pregnancy, when the ligaments become looser. Unfortunately, lower back surgery and a hip replacement have also been known to burden the SI joints. Finally, prolonged, forceful stretching of the glute muscles and hips can also endanger the stability and health of these joints.
When one or both SI joint become misaligned, the ligaments and muscles will go into spasm, in order to protect the joint. The pain can be extreme, and radiate to the groin area or down one leg. When less severe, the pain is dull and heavy in the lowest part of the back or buttock.
What can exacerbate sacroiliac joint pain – movements
If you are prone to SI joint pain, there are some daily movements and certain sports that can put one or both SI joints under strain. The shift in alignment can be sudden and very painful but can also have a subtle start with nagging pain. It’s a good idea to be careful with these movements until the pelvic girdle is stronger and balanced. Yoga therapy has excellent relieving and strengthening practices. If you would like to learn more, set up a free consultation call right here: https://beneyoga.co.uk/consultation/
Getting out of a low car
Instead of twisting yourself up and out, first turn your body and place both feet to the side. This allows you to get out of the car in a more symmetrical way without twisting.
One-sided sports such as golf and tennis
Contact sports and running can stress the SI joints, and so can sports in which you twist repeatedly to one side. I once gave myself a very painful right SI joint by playing golf. I continued playing for a while with a belt that is recommended for supporting the SI joints, but then gladly gave up this activity that I wasn’t good at anyway.
Another similar activity to be careful with is using a shovel to shift heavy things, such as snow or earth.
Forward bending, and forward bending combined with a twist
Forward bending can pull too strongly on the Si joints, especially if one side of your back and/or hamstrings are tighter, or if one leg is longer. This can happen easily in daily movements, but also in yoga classes that focus too much on reaching ‘the end position’. In my back care classes, I’m always cautious with forward bending, and poses that combine a forward bend with a twist. Some of these poses are not necessary for a healthy back. Even with dog pose, it is best to be careful and not force the stretch.
In terms of daily movements, we often bend forward (with or without a twist) to pick something off the floor or to put shoes on. The answer is to be mindful, and use the legs to go down to the floor. My free ‘Keep Your Back Safe at Home Guide’ illustrates the easiest ways to look after your back while doing daily tasks.
I once hurt one SI joint by pulling a washing machine towards me. This kind of pulling and lifting can put too much strain on the joints. If you must lift, bend your legs and keep your back straight, lift with the strength of your legs. And really, there’s no good way of pulling a washing machine towards you, so best is to get help.
What can exacerbate sacroiliac joint pain — postural habits
Standing on one leg
Most of us habitually stand on one leg, which tilts one hip down and forward. What’s more, we usually stand on the same leg. As often as you can remember, stand on both feet equally. Prolonged standing can aggravate the SI joints anyway, so standing with as good a posture as you can is important. I have a blog about how to improve our standing posture here: https://beneyoga.co.uk/correcting-posture-standing/
Always sitting with one leg crossed over the other
Too long sitting or coming up from sitting to standing are likely to be painful with sacroiliac joint derangement. Again, sitting with a good posture, upright and with both hips symmetrical, can help. Definitely try not to cross one leg over the other, because this places the pelvis in an asymmetrical position.
Sleeping can cause pain when you sleep on the affected side. Sleeping on the opposite side will obviously help. Placing a pillow under the top knee, as on the picture below, can be more comfortable because it keeps the hips stacked on top of each other.