Sacro-Iliac Joint Instability in Pregnancy

Posted by on Jul 19, 2012 in Pre/Post-natal Yoga | Comments Off on Sacro-Iliac Joint Instability in Pregnancy

Some of us have overly mobile sacro-iliac joints from years of stretching or doing yoga, and some of us have overly mobile SI joints from the increase of relaxin (ligament-softening hormone) experienced during pregnancy, others have it resulting from labor and delivery.  What is unmistakable to those of us who have experienced it is the pain it can cause.

The sacro-iliac joint is the point on the sides of the sacrum (the flat, broad bone of the low back) where it connects it with the ilium, or the back of the pelvic girdle.  The sacrum is held strong to the pelvis with short ligaments, and if these ligaments become too long or stretched out, the hip/back connection can become unstable.  The piriformis muscle, a short, thick muscle that intends to hold stable the connection between the sacrum and femur bone (long leg bone) threads through the pelvis and rests alongside the sciatic nerve.  When the s/i joint becomes destabilized, the piriformis muscle can contract trying to keep the leg/hip/spine connection in tact.  The result is a very tight piriformis muscle that begins to place undue pressure on the sciatic nerve.  This can cause sensations that range from subtle low back ache to white-hot pain that radiates unilaterally (usually just on the side of the joint that has kicked out of alignment) through the buttocks and even down the leg.  It can have moments of release, but movements that destabilize the symmetry of the body such as getting into or out of your car or walking down stairs can cause re-firing.

There are specific yoga asana that can worsen the symptoms of s/i dysfunction or that can cause a flare up in women that have a predisposition to it.  These tend to be forward bends such as baddha konasana (bound angle pose), paschimottanasana (intense west stretch- straight legged seated forward fold), janu sirsasana (forehead to knee, unilateral fold) or upavistha konasana (wide angle seated forward bend).  They should be practiced with caution by those dealing with an overly-mobile s/i joint.   They can be approached with bent knees (rolled blanket beneath knees), with a careful movements in and out of pose, and shouldn’t be pushed to the edge.  In women who are dealing with frequent flare-ups, avoiding this asana group is advisable.

There are also specific asana that can work to create release in the piriformis muscle that is pressing on the nerve which is causing pain.  These include eka pada raja kapotasana (pigeon pose), reclined pigeon, thread the needle pose, or a simple ankle over knee squat.  If you feel the stretch moving through the outer edge of the hip and through the buttocks, you are working in the right place.  Many poses that release the I/T band are also advantageous here.

Often times working with therapeutic asana and avoiding aggravating ones is not enough.  Chiropractic care may be an option for you, but I found that my relief came from a body worker who specialized in Thai massage.  She pointed out that to stretch the piriformis muscle is good and well for temporary release, but if you don’t actually correct the instability itself, the piriformis is bound to re-tighten and the pain will return.  She performed a series of releases and I felt a little “click” in my right low back and instantly felt the pain dissipate.  I am now chronically prone to this flare up since the birth of my son (a combination of deep stretches for years, long ligaments and a posterior birth).  I can use an intuitive method of a horse stance where I internally rotate my thighs to the point that I can begin to feel my sitz bones/hip bones spread apart and create the space needed for my sacrum to fit back smoothly along the joint line.  I can also create deep abdominal pressure as I am reclined and visualize it pressing my sacrum back and out and can hear a little “click” when it’s worked.  At sensitive times, I hold back in my forward folds and mostly avoid baddha konasana.  It saddens me because it used to be my favorite pose, and perhaps due to my overly zealous practice of it, have to refrain from my moving into my deepest expression of it.

When body weight increases in pregnancy and the ligaments are getting juicy and ready for labor and delivery, women have to be so careful to protect all of their joints, try to keep movements stable and balanced and to work more on strengthening and toning rather than deep stretching (though I do tend to spend quite a bit of time with hip openers with my prenatal groups as many women can be overly limited in this area).  They are more prone to twisting ankles, spraining wrists, torquing knees and tweaking their necks.  Mindfulness in movement has never been so important!

If you do experience strong, recurrent sciatic-like pain in moments when you get out of bed in the night or swing your leg when you are getting out of the car, you may want to see a professional for assessment.  If you’ve already been on the chiropractic trail before, it may be a natural step for you.  I found it to be unsuccessful in my case, as he worked solely on releasing the tightness of the piriformis.  My body worker went right to the source and brought my joint back into alignment.  Whatever the route you choose, keep up with yoga, choose movements that are symmetrical and stable, nothing that balances one leg and then the other and avoid your forward folds.  Cat and cow is wonderful for so many reasons in pregnancy and can be your best friend at a time like this!

Edit: I have to add another possible cure for your SI joint pain… when the piriformis muscle gets tight trying to hold the SI stable, it can become very difficult to release.  Pigeon variations that get into the piriformis stretch are helpful but in crisis mode may not be enough.  I must say that the surest way I now know how to end a painful bout is to get a firm tennis ball and place it below the buttock that is firing up.  Lay on your back with the tennis ball beneath you, and roll around on it until you find that perfect (i.e. sometimes incredibly painful) place that it needs to rest.  Lay here, relax, and breathe through the sensations for about 5 minutes.  Eventually the spindle fibers that fire in muscle contraction will fatigue and the piriformis will release.  When you no longer feel pain or much sensation, roll a bit more and see if there’s any other spot to work on.  Amazing, and so therapeutic!

All content by Lisa Veronese. Please do not publish or copy my material without my consent.