[SI joint injury frequently intersects with other causes of low back pain, such as bulging discs, arthritis, and muscular strains; these guidelines are also appropriate for injuries to low back, pelvis, & hips.]
Previously: SI Joint Dysfunction Intro, SI Joint Injury & Yoga practice
To begin with, you need to understand the difference between pain and discomfort. Discomfort, as in a stretching or burning sensation, is bearable and may even improve during the posture. Some small amount of discomfort is to be expected during class. Pain is a different sensation – stronger, sharper, unbearable.
NO PAIN. Any increase in pain is a sign to back off. Pain IN CLASS is to be avoided. IF A POSTURE CREATES PAIN, BACK OFF OR STOP.
ALIGNMENT BEFORE DEPTH. Use yoga as a tool to strengthen the body and improve alignment.
Maintain neutral spine position whenever possible. Gentle extension (back bend) can be helpful during acute stage (keep hips tight). Flexion (forward rounding) of low back is to be avoided. Bend forward by pivoting at hip joint, and keep flat or neutral back.
Take it easy on forward bends. Take it easy on spinal twists. Take it easy on asymmetrical postures. Take it easy on separate leg postures. All of these can destabilize the SI joint, especially if done improperly or aggressively.
Do not try to “open” the hips or pelvis. No hip openers. Careful on hip stretching. No splits. No Pigeon, etc. The HIP joint is where the head of the femur connects to the ilium, part of the sacroiliac joint. Trying to “open” the hip – applying force to one side of the ilium – creates torque on the SI joint. So “opening the hips” or stretching one hip asymmetrically can further destabilize an already injured SI joint. First and foremost, work to stabilize the dysfunctional joint – heal the injury.
Advanced postures and extreme back bending (training for competition) should be avoided.
Less is more. Feel free to skip any postures that cause pain or insecurity in the injured area (pain in hips, low back, radiating pain in legs). “Insecurity” means the practitioner feels scared or unsure or weak when attempting the posture. Learn how to read pain signals – if you think you feel pain, learn to trust that communication from your body. You know your body best. There is nothing to be gained by ignoring the body’s signals and pushing through pain.
Feel free to skip any postures that cause pain or insecurity. In any given group class, you might only do 25% of the class, or half of the class, or only a handful of postures.
In a Bikram Yoga class, for example, it should be completely acceptable for a student with acute SI joint dysfunction and pain to only do: Pranayama breathing, Half Moon back bend, part 2 of Awkward, the setup to Balancing Stick, Cobra, Full Locust, Camel, and Blowing in Firm. In time, as the condition improves, they will be able to do more, step by step.
Again, the goal is to not worsen the condition while building strength and stabilization in weak areas. You will gain more by doing less of the posture the absolutely right way for your body, step by step. Focus on alignment.
Lest this all sound very distressing or negative, rest assured there can be a positive result in this experience! Any injury that forces you to slow down and be more mindful of your physical yoga practice can be a tool for growth. A mindful, conscious physical yoga practice leads to better alignment. Alignment leads to a sustainable, lifetime practice.
The SI joint, once destabilized, may always be prone to weakness because the overstretched ligaments may never go back to their pre-injury state. A mindful practice can prevent re-injury.