Do you have lower back pain that starts really low, like below your belt line? When you push on
one side or both sides down on the back of your butt, do you feel pain there? And does the pain
maybe radiate halfway or even a little bit more down your leg? If so, you might have sacroiliac
joint pain, not necessarily lumbar spine pain. Hey, my name is Lucas, I'm a yoga teacher.
People come to class all the time with lower back pain and about one in five, about 20 percent of
the time instead of being lumbar spine problems, they actually have a sacroiliac joint problem.
The reason that's important is because this joint is very very different than these joints, both
the function, the dysfunction and the healing. So that's why I always like to differentiate and in
this video I'll walk you through the differences. I'll walk you through the problems, and most
importantly, I'll share with you some important corrective exercises to recreate stability down
here on the back of your pelvis. Before we get started, just a quick disclaimer. If you're having
serious pain or problems, please always work with a trusted healthcare provider. This video is just
for educational purposes, based on my experience as a yoga teacher. OK, let's get into the anatomy.
The back of your pelvis here, if you take your hand and kind of form it into a little
bit of a shape like this and you imagine five fused vertebrae. So, these vertebrae
they fuse actually quite late in life, like late adolescence, sometimes in your 30s or your 40s,
but basically by the time you're my age on the back of your pelvis you have a back door bony
plate. That door analogy is actually very helpful, we'll come back to this again and again. So, on
the back of your pelvis those five vertebrae they make one big bony plate and where that sacrum,
that bony plate, where it meets your ilium, the elephant ears of your pelvis, that is the
SI joint. The joint is where two bones meet, your sacrum and your ilium. Why is this important to
differentiate between your lumbar spine and your sacroiliac joint? Because the way they move is
so different. Up here in your lumbar spine your spine can flex and extend and slither
and rotate. Down here not so much at all. It's kind of like a closed door back here.
Anatomists argue about the amount of movement that the sacrum has, but it's very little. No
matter who you talk to, maybe two, three, maximum five degrees of movement. So very very little,
which means that when it moves more that's a huge problem. As a yoga teacher of course
people often come to me asking for stretches to loosen up their sacrum. That's a really bad idea.
That would be like if you had a door that had come off its hinges and you came to the repair man
and you said 'hey can you make the door more wobbly?' That's not what we want, we actually
want to reinforce the door. We want to stabilize and rebuild the frame, tighten up the hinges,
so that the door is stable and creates a nice structured base on the back side of our pelvis.
So this is what we tried to do with our sacroiliac joint as well. OK, so why is this area so prone to
injury? Why does it happen let's say 20 per cent of the time when we have back injuries? Lots of
different reasons. One of the most common times when this occurs is during pregnancy.
In pregnancy there's a hormone that's released called relaxin and relaxin is a very interesting
hormone in that it loosens up your soft tissues. This is great for opening up the birth canal,
so the baby can pass. This is challenging because it also loosens up that back door of your pelvis
and can lead to dysfunction, inflammation, and pain that you might have to deal with long-term.
Another common cause of sacroiliac joint pain and dysfunction is when someone has had a spinal
surgery. Specifically a spinal fusion. Really commonly, if somebody has chronic lower back
pain one of the common surgeries is to fuse, to bolt together two or more vertebrae upstream. That
might do a great job of alleviating the pain here, but unfortunately that lack of movement here can
often translate to pressure down here, which again can knock that door off its hinges. What are the
other ways you can injure your sacroiliac joint? Well, all the ways that we injure any joint.
The one difference with the sacroiliac joint is it very often happens with unilateral movements,
injuries, impact. What I mean by that is it's less likely to happen by landing on both legs,
much more likely to happen by jumping off the roof of a house and landing on one leg,
or happening in a yoga class when you're flexing, laterally rotating and then with force pulling on
one leg. Essentially, if you think about tweaking with asymmetry, so one side rather than the other.
This can happen in car accidents, it can happen by being hit, it can happen also in movements that
demand unilateral pressure, so not on both sides but one side more than the other. This bony plate
is stabilized with ligaments. Ligaments are bone-to-bone connective tissues and I like to
think about them like leather belts. It's really really strong, it has a little bit of elasticity
but it's mostly plastic and what that means is when those ligaments, those stabilizers,
those bone-to-bone connective tissues, when they get over stretched from birth, when they
get overstretched from trauma, when that door gets knocked off its hinges, now they've been deformed.
And then you can have what's called joint laxity, where that back door wiggles and wobbles on its
hinges instead of being firmly in place. That wiggly wobbly door still works, you can open
and close it, but every time you open and close it there's a little bit more damage around the frame.
Every time you open and close it the wood frame starts to fray a little bit.
That same sort of thing can happen here. Inflammation, articular cartilage can wear down,
you can get osteoarthritis, all kinds of different things can happen. So the name of the game
usually is not so much to stretch, but instead to stabilize, to strengthen, to reinforce.
We can't contract ligaments we have to let the body do its own healing process,
which unfortunately is really slow, and in the meantime we need to call in the reinforcements,
which are the muscles that surround the sacrum to pick up the slack. What do I mean by that? Well
again, let's use this analogy the door is wobbly, its office hinges, let's go in and reinforce
the frame, let's tighten up the hinges and we'll do that by focusing on two specific muscles.
These are not the only muscles involved but they're the two that we'll focus on today.
The first one is your glute max, that's your big butt muscle back here that's involved in
hip extension. But because it also attaches to your sacrum when it gets stronger it can tighten
up and stabilize this region. The second one is our piriformis muscle,
this unusual muscle starts on the anterior side of your sacrum, crosses and attaches onto your femur.
It's largely responsible for lateral rotation of your hip, but again because it's attached
here at your sacrum when it gets strong it can also serve as a reinforcement, as a stabilizer
for that sacrum as those ligaments heal and our back door of our pelvis starts to get more stable.
Let's jump in and look at some corrective exercises. Just one caveat before we jump
in - these exercises assume that you're in pain and that you want to take things very very slow.
Almost certainly you will graduate from these simple exercises and you'll progressively add
more force, add more load, do things that are more intense, but remember with joint pain all pain is
bad. When we're doing corrective exercises if the exercises make it worse they're not good.
When you're working with muscles sometimes no pain no gain is true. When you're working with joints,
all pain should be treated like a red light flashing and you want to back off. So we'll start
very slow. We'll start very mild and step by step you'll be able to progress. Let's take a look.
The first practice we'll do is called the sit stand and thrust, just like the name sounds we'll
start in a seated position, we'll stand up and then thrust our pelvis forward. Please do this
very slow and very controlled. I'm sitting on the edge of a chair, my knees are bent at 90 degrees
not more, my feet are planted flat down and I drive the weight into my heels. I sit, I stand
and I thrust. If you take your hands back behind you, you should feel your glute max fired up. That
first muscle that we chatted about before. We'd also like to take our piriformis muscle online
as well and remember that's a lateral rotator of your hip. To do that I'll use a rubber band.
This is a fitness band, anything you buy works just fine. I like these thin ones because you
can use them for lots of different things. I've tied mine in a knot just to make it a little bit
shorter and I'll double it up and watch what I do, I'll place it between my legs just above my knees.
Why am I using this? Because in order to keep my legs apart I need to engage that piriformis
lateral rotator of my hip. So this will help me to strengthen both glute max and also my
piriformis at the same time. Feet as wide as my hips, I drive my heels down, I sit, to stand,
to thrust. You can feel those muscles engage back behind you. Sit, to stand, to thrust.
I'll do these in sets of ten. Three sets of ten, every day for a week. You really have to take it
easy at first, remember what we're trying to do here. We're trying to build strength and tension
in your glutes and your piriformis to make up for the laxity in the ligaments around your
sacrum at the moment. After a week, if you're feeling okay you might start to add some load.
If you have a kettlebell or a barbell in your house, a dumbbell, you can hold that in your
hand. If you don't, grab a box, put something heavy in it. Start off with 5lbs, 10lbs,
something like that. We'll sit, we'll stand, we'll thrust and again we'll work daily and slowly.
Progressively you can build up to load. Now notice we're moving in a symmetrical pattern, so we're
doing bilateral instead of one side and the other side. This is by design. OK, let's look at the
next exercise. The next pose we'll take a look at is simply called clam shells. I'll use the exact
same band that I had before and I'll position it in the same place, right above my knees.
I'll lie down on my side and keep my feet together, but I'll clamshell like the name
suggests with my knees. So my knees come together and apart. You can place your hands back here and
you can feel specifically that piriformis muscle contracting as you open and close, open and close.
I'd like you to do ten on either side. Three sets of ten on both sides clam shells every day. Again
this is a very gentle exercise, but really helpful for creating more stability around that joint.
This final pose is called banded squat walks. I've got my exact same exercise band, I will put
it between my legs right above my knees and then this time I'll separate my feet a little bit wider
than my hips, I'll hinge at my hips, so my bum sits down and back, place my fist into my palm.
I'll then walk to the right with control, one, two, three. I'll then walk to the left, three,
two, one. Do a total of five sets per day. Take it really easy, keep in mind that these
banded squat walks they look a lot simpler than they are. If you're dealing with SI joint pain,
if you feel pain back off and stick with the first two exercises. Hope you found this video
helpful. If you'd like more science-based yoga videos please hit subscribe down below, hit that
like button and if you have questions about any of the poses that we've covered please just ask down
below. You can always find my teaching schedule at yogabody.com and i'll see you in the next video.