Stabilizing the Sacrum|
Posted Apr 27, 2008 - 07:24 PM
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STABILIZING THE SACRUM
By Luna Jordan, ERYT-500, LMT
Destabilization of the sacroiliac joint (SI joint) can occur when the pelvis and sacrum move in different directions relative to one another. Twisting and forward bending can exacerbate this problem especially in seated positions. When the muscles surrounding the pelvis do not work together to stabilize the sacrum within the pelvis, the result can be strain in the ligaments surrounding the SI joint.
The sacroiliac joint is where the auricular surface of the ilium (pelvis) and the auricular surface of the sacrum join. The ilium and sacrum are held together by many ligaments around the joint. When standing, the two sides of the pelvis move toward one another ďlockingĒ the sacrum into place. While seated, on the other hand, the two sides of the pelvis move away from one another leaving the SI joint vulnerable to strain.
Many times SI joint pain is felt over one of the SI joints in an area about the size of a quarter. The cause of this pain is due to the sacrum moving either forward or backward relative to the pelvis. This usually occurs on one side of the sacrum, but the pain felt may actually be on the other side of the sacrum. Pain may also be felt in the hip area, buttock, outer leg or deep in the belly close to the anterior side of the SI joint. Even if you have these common symptoms, itís a good idea to confirm that you have SI dysfunction with a health care professional, such as a chiropractor or other musculoskeletal expert.
The health of the sacroiliac joint is improved with stabilization around the area. Overstretching the muscles around the SI joint can cause further strain. Becoming aware of the contraction of muscles around the sacrum, and balancing those contractions with each other, will help you achieve more support for the sacrum.
Now to bring your attention to a few muscles which are important in understanding sacroiliac strain:
1. Piriformis is one of six muscles known as the lateral hip rotators. It is the only one of these muscles which attaches to the sacrum. If your knees are higher than your waist when you sit cross-legged on the floor, your hip rotators could be tight.
2. Iliopsoas is actually two muscles, psoas major and iliacus. Their action is flexion at the hip joint, as when bending forward or lifting your leg at the hip joint. Simultaneous tightness and weakness are not uncommon in these muscles.
3. Adductors are the muscles of the inner thigh responsible for drawing the thighs toward one another. They attach to the ilium (pelvis) and contribute to the stability of the pelvis. To feel these muscles engage, place a block in between your thighs while standing and press your thighs into the block.
4. Quadratus Lumborum is one of the muscles of the low back. Itís located toward the outer edge of the back and attaches to the lumbar spine and the iliac crest of the ilium. It contracts when you side-bend your trunk or raise your hip.
When these muscles are working in relative balance, the SI joint is stable. If one of these muscles overpowers the action of another, then stabilization will be lost. This can occur with overdevelopment of a muscle, excessive tightness, laxity, weakness or any combination. An overdeveloped muscle will pull the SI joint toward its contraction while an antagonist muscle which is weaker will not be able to resist the contraction of this overdeveloped muscle. Safely increasing range of motion as well as toning these muscles will help balance movement in the pelvis and may help reduce strain in the sacral region.
Yoga offers many poses from very gentle to strenuous for students seeking to balance the actions of the muscles attaching to the pelvic area. Strengthening in standing poses and backbends are the foundation for stability in the sacrum and low back. During times of acute pain, twisting and forward bending should be limited.
One of the most valuable resources a student brings to their practice is focused attention. This attention can result in increased awareness of the activation of the muscles of the legs, hips, abdominals and back to support and protect the SI joint.
To begin to cultivate awareness of the activation of these muscles, lie down in Supta Baddha Konasana (Reclined Butterfly Pose).
Notice the stretch in the adductors of the inner thigh while the knees are open. Bringing the knees slowly together as you exhale will increase awareness of the contraction of the adductors. Then inhale and open the knees again.
To increase awareness of the stretch of the piriformis, try lying on your back with both feet on a wall and your legs making a right angle.
Now cross one leg so that the ankle is on the opposite knee. Place your hand on the knee of the crossed leg and gently press that knee away from the torso as you inhale and then release the pressure are you exhale. Repeat a few times and see if you notice a stretch close to the center of your buttock of the crossed leg. (You may notice tightness in the inner thigh of the crossed leg indicating a different imbalance still related to an unstable sacrum.)
Next, stand in Samasthiti (Even-Standing Pose. Without twisting, bend the torso from side to side and see if you can notice quadratus lumborum engage on the side you are bending toward and stretch on the opposite side.
Now, from Samasthiti, lift one leg with the knee bent and bring your awareness into the contraction of your psoas on that side.
Once you can consciously engage and stretch these muscles, they can assist you in keeping the SI joints stable in seated forward bends and twists. In seated poses, it is important to come forward on your sitting bones (engaging the psoas). And in seated twists, allow the pelvis to move in the direction of the twist to prevent strain in the SI joints. Advanced twisting where the pelvis and sacrum are held steady through muscle contraction alone (not allowing the pelvis to move with the twist) is beyond the scope of this article and is NOT recommended without proper instruction by a knowledgeable teacher.
Seated Twists and Forward Bends:
Seated forward bends and twists are not recommended during periods of acute pain in the SI joint.
Letís try-out some of these actions in the seated pose, Janu Sirsasana (Head-to-Knee Pose). Extend your left leg in front of you and bend the right knee out to the side with its foot pressing into the left thigh. With your torso erect, sit to the forward edge of your sitting bones. This will contract the psoas on your front body and your low back muscles of your back body. Sit on a folded blanket if you cannot bring your torso erect.
Next, press the right foot and left thigh together and feel the adductors of both thighs engage. Exhale as you forward bend over your left leg. Allow the right-side of your pelvis (the bent-leg side) to move forward with this action. Feel the right side of your back (quadratus lumborum) begin to stretch.
If there is any discomfort in either SI joint, stop. Itís likely that the actions of the muscles surrounding the pelvis are still unbalanced. In this case, try the pose without the forward bend and simply twist your torso very gently to the left seeing if you can maintain awareness of the actions mentioned without feeling any strain.
Now letís try Maricyasana III. From seated, extend your left leg and bend your right knee bringing it toward your chest with the right foot on the mat in-line with its own sit bone. Your right knee should be lined up with its own ankle which will engage the right adductors of the inner thigh. With your torso erect, sit to the forward edge of your sitting bones. Exhale and twist your torso to the right and allow the left leg to inch forward as the pelvis turns with the twist. Keep the right inner thigh engaged and DO NOT use your left arm to pull you deeper into the twist. Using the arms in this way during seated twists creates torque on the SI joint. Instead become more conscious of the deepening effect of your conscious exhale.
Keep in mind, a balanced asana practice (yoga poses) involves addressing the entire musculoskeletal system. This article addresses certain key areas which may help to stabilize the sacrum. However, these are not the only areas of the body which play a role in an unstable sacroiliac joint. Further, during acute pain, working with a knowledgeable yoga therapist along with a health care professional, such as a chiropractor, is well- advised.