Sacroiliac Joint (SIJ) instability and pain affects 15-25% of people with axial low back pain. Approx 20% of women in pregnancy suffer lower back pain due to SIJ.  It is often misdiagnosed as sciatica or lower lumbar spine issues.  There are tell tale issues which will point to this issue.  The SIJ is the largest axial joint in the body designed for stability not movement.  Common issue in pregnancy due to hormonal changes to ligaments. This compromises our stability.  It is a strong weight-bearing joint prone to issues due to strong weight-bearing and load-bearing responsibilities.  There is less resilience due to more weight bearing in pregnancy due to ligament softening form hormones.

SIJ joint surfaces become rougher, duller, coated with plaques as the body ages. In the 30s and 40s the surface irregularities,
crevice formations and bony clumps start to appear in the cartilage of the ilium surface. By 60-80 years old there is a marked
restriction in mobility.

Ligaments

The role of ligaments plays an important part in keeping stability and symmetry in this area.  Ligaments are the inflexible structures that connect bone to bone. They have a poor bloody supply so once damaged or stretched its difficult for them to recover.  This is why we produced relaxin in order to allow the birthing process.  Oestrogen and progesterone hormone levels increase steadily during pregnancy and reach their peak in the third trimester.  The changes in progesterone and the presence of the hormone relaxin cause a laxity or loosening of ligaments and joints to prepare the body (especially the pelvis) for labour. This can remain for up to 6 months postpartum.  This is why we must reduce impact to the area and build up gentle exercise until the return to normal.  The SIJ is heavily dependent upon ligaments for stability.

There is a round ligament that connects the front part of the womb to the groin.  It stretches as the baby and uterus grows.  A sharp, sudden and temporary spasm in the belly can be a symptom of round ligament strain.  Especially as the pregnancy progresses.  Sneezing, coughing, laughing and rolling over in bed can cause a sudden sharp pain in the round ligament, which quickly subsides.  There are lots more ligaments helping to reinforce the pelvis around the iliac and sacrum.  We have our iliopsoas muscle which covers part of these ligaments.

If you look at the dimples of Venus on our back (Greek goddess of beauty).  You will notice they are hollow and if there is a problem with the SIJ joint then the side which the problem correlates to is where you will often see a swollen dimple.

Signs of SIJ

• Sharp stabbing pain in lower back or hip esp during weight bearing
• Often causes a limp if been on feet longer than 20-30 min
• Turns into dull ache when stationary
• Worsens as day progresses (stairs slopes etc niggle)
• Pain radiates into hip socket, outside of hip (if its anterior ligaments) or deep inside belly, or localised to the SIJ  If you palpate the venus dimples this is sore.

It is important to have stability in the SIJ because a comfortable and stable SIJ is linked to a natural birth.  An asymmetrical pelvis with instability, because one joint is swollen than the other this may be associated with greater likelihood of birth intervention.

We can treat the joint with physiotherapy and gentle mobilistaion and massage.  In yoga we use gentle mobilisation and asanas.  Cat/cow and varjarasana can help sooth the joint.  Correcting asymmetrical aggravating factors for example carrying a toddler on one side of the hip, feeding one side, couches and lounge chairs-one of the simplest ways to help prevent and correct the joint.

• Avoid stairs
• Sit with feet flat, hips level not crossed
• Walk slowly and smoothly (avoid uneven ground or jogging jarring like running)
• Step in and out of car with legs together
• Sleep with pillow between knees
• Never bend and twist at same time keep hips and shoulders in line keep the body symmetrical so the muscles stay optimised on both sides in SIJ
• Avoid sustained postures (change at 30 minute intervals) get up and walk or stretch
• Bring shortened length and wider stance to asana practice
• Maintain lumbar lordosis in seated postures (avoid posterior pelvic tilt). The inward curve in the lumbar.

In your Pre and Postnatal classes:

• Be aware that the SIJ is most vulnerable in seated position
• Use a blanket under the hips in sitting postures if hamstrings are tight and ensure lumbar lordosis (inward facing curve of the lower back) is maintained especially in forward folding
• Reduce distance between feet in wide legged poses act conservative in poses.
• Reduce length and width of stance in standing pose
•  Pull back rather than deepen if there is any sign of pain or discomfort
• When standing in tadasana take a wider stance than usual
• Keep a microbend in the knees with forward folds and down dog to maintain lumbar lordosis
• When doing asymmetrical postures, make sure you allow the hips to move naturally with the posture, and don’t ever force the joint to move against its natural line of movement. For example, in trikonasana allow the top hip to move down and forward.

One way to think of this in classes when teaching is If you move in such a way that you separate the sacrum from the vertebral column or from the pelvis there will be stress on the joint. So focus on bending from the hip joints in all sitting poses
so that the pelvis, sacrum, and lumbar spines are moving forward and together in harmony!