Twists & Our Lower Back: How to Safely Feel the "ahh" moment

 As a yoga teacher one of my many goals is to keep the students that practice with me safe. So when I see one of them come in with a slight limp and holding their lower back I know that I need to find out, not only what is going on with the student, but how I can keep them safe as they practice. After the practice I talked with the student and between the two of us we played out each asana and the effects on the painful area. The student was suffering from a very sore left SI Joint with the pain radiating down into the left leg. I could relate to the the student because I too struggle with my SI Joint; whether it be the right or left.

     How many of us have felt a sharp pain in our lower back as we move or go to sit? The pain might originate in our lower back and travel into our bum to the back of the thigh into the knee. To sit, even to stand, causes pressure in the entire pelvic region. This pain, as both the student and I suffer from could be caused by the lack of mobility in the Sacroiliac Joints.

Diagram of the Pelvic Region 

     The diagram to the right depicts the various bones and joints that make up the pelvic region. The Iliac bones form your pelvis. The sacrum triangle bone structure is located just above the tailbone. Note then that the Sacroilic Joint connects the sacrum to either the left or right iliac bone. Picture your body as you stand upright in Tadasana; the region supports the weight of your body. As you walk this joint keeps you from tipping over, helping you balance as you move. A role that needs to be highlighted is that this joint is a shock absorber for your spine (www.braceability.com)

    As I was doing research on this topic I discovered several factors that might determine why we feel this tension in our SI joint. Factors such as:

• Our body structure might be one reason why our SI joint is easily irritated. 
• As we age our bodies begin to show what we have put it through. 
• Maybe you fell or were in an accident. I know when I am off because my left side is off and I walk differently. 
• In our society today many spend the day sitting behind a desk. As a result, the hips become very tight and the pressure placed on the lower back is intensified. 
• Another could be the way that one moves as they exercise. I not only practice yoga, but I also do a Body Pump class in which each sequence (body part) is done with weights. From squats to lunges how I carry my frame determines the impact I will do to my body's structure. In addition, I play tennis which has a lot of twisting and side to side movement. Yet again, how I move determines how I feel, not only while I am playing, but also after. Will I need an ice pack on my lower back to minimize the tension. 
• Women are 8-10 times more likely to have sacroiliac joint pain then men, due to the structural differences (more flexible ligaments and wider hips), and hormonal differences than men (www.braceability.com)

     I would need both hands to show the number of times I have been to physical therapy (and now chiropractic) for my lower back. Four years ago I was diagnosed with Degenerative Arthritis in my cervical and  lumbar spine. This condition, separate from my SI struggle, has forced me to really think about how I exercise and carry myself. I find myself really thinking about how I move into a pose and out of it. I often close my eyes and feel my body, asking myself questions, "Why does the left side of my lower back hurt?".... "Do I need to internally or externally rotate my leg?" Sometimes I have a lot of questions! But, that is what we need to do. To go beyond, how am I supposed to look? to how does my body feel? 

     As I went through the sequence with my students I kept my eye on my student watching to see if there were movements that brought out the pain and those that did not. From our conversation we decided that twisting and forward folds intensified the tension and that asanas on the back did not. Are there exercises or activities that one should avoid in order to prevent the tension in our SI Joint?

• Crunches/situps
• Standing Twists/turning of the hips (golf/tennis)
• Heavy weight liftng (involving the lower back/squats)
• Seated forward bends & hip rotations (need to know how to care for SI Joint)
• Wide Legged Poses
• Excessive biking or long rides (I can attest to long motorcycle rides and a sore back)

    How then do we exercise and also avoid this irritating pain? We need to learn how to move our sacrum and Iliac bones, the pelvis region as one unit. The goal is to improve flexibility, balance, strength and stability.

      Many of the asanas/poses are done while lying  on your back on the mat.  According to www.livestrong.com: "one should perform stretches from the ground as it is the least amount of pressure on the spine. Do these stretches first before progressing to kneeling or standing asanas." Below are asanas/poses which will strengthen the SI Joint taken from a variety of websites which focus on strengthening the SI Joint.

 

BACK ON MAT

• Knee to Chest: one knee bent/foot flat on mat... other knee into chest.... hold/can extend foot that is flat on the mat.... Repeat other side.
• Double Knee to Chest: bring both knees into chest.... hold for 5 seconds/move knees up & back....8-10 times.
• Knee Rotation: feet together flat on mat....knees gently sway left/hold/center/hold/right/hold
• Bridge: build strength in glutes & lower back. On back....knees bent....palms down close to heels of feet....squeeze bum/raise hips....hold 5 seconds/complete 5-8 times
• Lumbar Rotation: knees & feet together.... arms at side.... feet off ground.... rotate SLIGHTLY left & right....10 rotations. (keep knees together the entire time).

BELLY ON MAT

• Cobra:  Effective for overly mobile SI Joints.... pelvis and legs on the mat.... pull shoulders down & away from ears.... relax lower back & bum... Repeat 3 times
• Locust: More focused on strength than stretching....arms out in front along side ears....legs back toes flat on mat....Nose down off mat....Inhale & lift arms and thighs off mat....hold 3 breaths....repeat 3 times.

TABLE TOP

• Bird Dog: Working the lower back & abdominal muscles to gain stability of the lumbar spine. Leg out/arm out (thumb up)....hold 5 seconds....5 reps per side.

SEATED

• Re-Align SI Joint & Engage Core Muscles: SI Joint stability....sit upright-knee bent-feet flat on floor....contract abdominal muscles...push one knee forward while pulling the other knee back.... Repeat alternating direction
• Seated Twists: Move spine with pelvis....Twist right-left hand on knee-right hand behind back/close to back to stay upright....turn head to right.... hold five breaths.... Head back to center/upper body back to center....Repeat other side

STANDING: 

DO NOT DO SEVERAL ASYMMETRICAL ASANAS (examples: TRIANGLE, SIDE ANGLE, WARRIOR I, WARRIOR II)  IN A ROW. BREAK UP WITH SYMMETRICAL ASANAS. 

• Triangle:  Introduce only AFTER joint has been stabilized & is pain free....feet wider than shoulder width 3'.... arms out from shoulders....bend at hip crease....front hand to outside of shin (on block or shin)....rotate hips and strengthen surrounding muscles.
• Mountain/Tadasana:  Feet hip width apart....block between upper thighs (skinny way)....squeeze for 3 breaths.

Resources: 

www.livestrong.com

www.braceability.com