A Practice to Relieve Sacroiliac Discomfort
...and help you maintain healthy alignment.
Editor's note: The below are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional.
Sacroiliac (SI) joint pain is often one-sided in the lower back, buttocks, hips, groin, or thighs, and can be worsened by asymmetric movements or positions, including some yoga poses. It can necessitate changes like these to the way you move in your regular yoga practice and throughout your day.
While a diagnosis of SI dysfunction may mean that you must maintain an awareness of pelvic alignment, the good news about SI joint pain is that movements called “sacral resets” or “pelvic resets” can often alleviate it relatively quickly. Depending on how severe the pain is, and how long it has persisted, resets might lead to instant alleviation of pain; in other instances, they might need to be repeated over the course of a few days. (For those with longstanding symptoms, a few weeks of resets might be necessary.)
The cause of SI joint pain is often an asymmetrical positioning of the sacrum in relationship to the ilia, or “wings” of the pelvis. While some physicians (and yoga teachers) may generally downplay the role of asymmetry in pain—and all asymmetries do not always lead to pain—when an asymmetry has lasted long enough, or is severe enough to have caused symptoms, chiropractors, physical therapists, and doctors of osteopathy often focus on creating symmetry in their treatment.
Once diagnosed, mild SI pain can often be successfully alleviated with sacral resets, which are designed to correct the pain-causing asymmetry and restore optimal alignment between sacrum and ilia.
The practice below begins with several different sacral resets, followed by some strengthening exercises for the core, glutes, and hips to create the lumbo-pelvic stability that may alleviate and prevent SI pain. The final poses, which stretch the hip flexors, release the tightness that may be caused by, and contribute to, pelvic misalignments.
It is vital, however, to receive an accurate diagnosis before embarking on this practice. If your back pain arises from causes other than SI pain—for example, disc herniations—some of the resets below may be ineffective, or even hurt rather than help. If you have severe back pain, have had back surgery, have spinal cord issues, or have been told to avoid manual manipulation, you should consult with your physician before trying this practice.
How to Approach the Practice
Before starting any exercise program, check in with your physician. These exercises are designed to provide relief for those who have been given a diagnosis of sacroiliac or lumbo-pelvic dysfunction. Though you should generally not practice a vigorous sequence of traditional yoga poses when you are experiencing severe SI pain or, for that matter, pain of any kind (and should instead consult with your physician), those with minor symptoms of SI dysfunction often find it beneficial to do the following simple and common resets to correct the pelvic positioning that is leading to the pain.
While practicing the resets, you might feel or hear a pop from your pubic symphysis area or on either side of the SI joint. This pop is a good sign: It can signal the resetting of your sacrum, and there’s often an abatement of your symptoms immediately after. However, you don’t necessarily need the pop for the sacrum to have been successfully reset and to feel relief.
In addition to an easing of your symptoms, after a reset, your hips might be closer to level, your legs of equal length. We recommend practicing savasasa with your hands on your frontal hip bones and your feet against the wall at the beginning and end of the practice to see if you notice any changes, but you might also want to pause in savasana between all the poses shown. This way, you can notice any differences that occur along the way and which poses “did the trick.”
In addition to an easing of your symptoms, after a reset, your hips might be closer to level, your legs of equal length.
Depending on the particular asymmetry of your sacrum—which way it is tilted or twisted in relationship to the ilium—two or three of these resets might work best for you, that is, be followed by a relief from pain and a greater feeling of symmetry. You won’t know your go-to reset until you have tried several of them.
If you are currently experiencing mild symptoms of SI dysfunction, you may find it beneficial to perform at least three of the resets that prove to be most helpful two or three times a day and to then do a longer practice that includes the poses for the core and hips (listed below, after the resets) at least once a day. As your symptoms abate entirely, you may do less, but do not neglect these resets and poses entirely: Continue to practice them to keep symptoms at bay. Always stay attuned to hints of pain, aiming to catch it early and alleviate it with the resets that worked for you.
Note that the poses below should not intensify your pain. Stop the reset if your pain has increased and try a different one. Do not proceed to the next poses (numbers 7 to 12 in this sequence) if your symptoms have not abated. If after a few days of trying all of the corrections none help your pain, this might indicate that you do not have SI dysfunction. If you do not experience improvement within one week, discontinue and see your doctor. Consult your physical therapist or physician for further evaluation.
For this practice, you will need a yoga strap (or resistance band), a block, a chair, a large exercise ball on which you can sit, and two small dumbbells, one to five pounds each (or more, if that amount of weight provides no challenge for you). If you are practicing at home, you might want to use your bed for the psoas stretch (number 12). (You may want an SI belt like this one, not only for this practice, but to wear throughout your day as needed.)
A word about SI belts: It is better to make an adjustment to your pelvic alignment through one of the resets below prior to applying the belt so the belt doesn’t simply hold your misalignment in place. Once your sacral alignment has been corrected and your pain alleviated, put on the belt, cinching around the pelvis, over the SI joints—about two inches below the waist. The belt helps to create the stability that the muscles and ligaments might not be doing effectively.
Make a habit of wearing your sacral belt during yoga and other activities that aggravate your pain, which for most people are activities like working out, walking, running, climbing, and biking.
1. Savasana: Feet Against the Wall
Lie on your back with your feet on the wall and your index and middle fingers touching your frontal hip bones.
Notice: Is one of your frontal hip bones higher—closer to your shoulders, or closer to the ceiling—than the other? Are you able to press both feet evenly against the wall?
After noticing the relative positioning of the two sides of your pelvis and the length of both legs, draw your attention to your belly and lower back. As you inhale, the belly and the lower back ideally expand. As you exhale, the belly and the lower back ideally draw in toward each other.
2. Sacral Reset: One-Sided Bridge
1. Lie on your back, bend your knees, and place your feet on the floor so your knees are stacked over your ankles. Make sure there’s a gentle inward curve in your lower back; allow your arms to rest alongside your body.
2. Bring the sole of your right foot to your left thigh just above the kneecap.
3. Press your left foot into the mat, push your right foot into your left thigh, and squeeze and lift your right buttock until your left thigh and torso make one continuous diagonal line (or as much of one as you can comfortably make), with your right hip lifted slightly higher than your left. Hold here for one breath.
4. Tuck your chin to your chest to lift your head slightly off the mat, holding for another breath or two.
5. Lower your head, keeping your hips raised for one more breath.
6. Slowly lower your hips.
7. Bring your right foot back to its starting position on the ground.
Switch sides. Then, root down with both feet, lift both hips, and lift your head for one breath.
3. Sacral Reset: Single Knee to Chest Contract-Relax
1. Lie on your back, with your legs stretched out in front of you, toes pointing up.
2. Draw your right knee toward your chest, grasping the shin or the thigh.
3. Hug it into your body as far as you comfortably can for a couple of breaths. Then, push your leg—your shin or your thigh—into your hands, but resist with your hands, so that your leg hardly moves. Hold here for a few deep breaths.
4. Release your right leg, lengthening it out in front of you.
Switch sides. Alternate sides until you have repeated the pose five times on each side.
4. Sacral Reset: Supine Push-Out Squeeze-In
Place a looped strap (or resistance band) around your thighs, a few inches above the knees, leaving a little slack if you are using a yoga strap. Have a block nearby.
Lie on your back with your knees bent and ankles under your knees, as if you were preparing for bridge, but bring your feet together as if in tadasana (mountain pose): big toe joints touching and space between your heels. Allow for the natural gentle curve in your lower back and maintain it throughout the following movements.
As you exhale, press your thighs firmly outward into the strap or band, widening your knees. Hold for a couple of breaths. Relax, then repeat five more times.
Then, Keeping your feet together, place the block between your knees on its medium setting.
Squeeze the block between your knees for a few breaths. Relax, then repeat five more times.
5. Sacral Reset: Seated Push-Out Squeeze-In
Sit upright on the edge of a chair with your feet on the floor (or on blocks or books if they don’t reach the floor). Bring your hands to the outside of your thighs, just above your knees. Press your thighs out into your hands, but resist with your hands: Don’t let your legs move.
Hold here for a few breaths, then relax.
Next, make two fists and place them between your thighs ( thumbs of your fists touching), just above your knees. Squeeze your fists between your hands for a few breaths, then relax.
Alternate between pressing out and squeezing in, doing each five times.
6. Sacral Reset: Standing Twist
Stand with your feet parallel, a chair just to your right. Then step your right foot up onto the seat of the chair (or another firm surface such as a low table), right heel in line with your left arch, right leg externally rotating so that your right knee and foot point to the right.
Bring your right forearm or elbow inside your right knee. Place your left hand on your left hip.
Keep your right foot grounded. Push your right elbow into your right knee, moving your right knee to the right, tracking your knee toward the center of your right foot. If you do not yet feel the effects of this pose—for instance, a stretch in the inner thigh, groin, or lower back, a pop from the SI joint—you may gently press your knee further to the right, rolling onto the outside of your right foot as you do so to ensure that your knee continues to point toward your second toe.
Twist your torso to the left, as far as is comfortable. Focus on turning your torso rather than your head.
Hold here for several deep breaths, then switch sides. Alternate sides until you’ve done the exercise five times on each side.
7. Core Work With Ball: Pelvic Tilts
Pelvic tilts will reinforce your new symmetry and help you gain control of the movements of the pelvis. If you feel unsteady on the ball, set yourself up near a sturdy chair or wall you can touch for support, or even place the ball against a wall to help to keep it in place. Take as long an intermission as you need between tilts.
Sit on a large exercise ball, with your hands on your thighs. Press down evenly through both sitting bones and lift up through the crown of your head.
Then bring one hand to your belly and notice how your belly moves with your breath, expanding on your inhale, and drawing in with your exhale.
Now bring your hands to your hips, and move between cat and cow, sending the ball forward slightly as you inhale into a cow pose, and then back slightly as you exhale into a cat pose. Try to do this with your belly more than with your legs.
Return to neutral, then rock your pelvis from side to side as if you were in a boat, moving the ball a few inches in one direction, then the other.
Then, keeping your spine vertical, circle your pelvis in one direction for several breaths, gradually increasing the size of these circles. Then circle your pelvis in the other direction.
8. Core Work With Ball: Slow Kicks
This exercise strengthens the core and all of the quadriceps. As in the previous pose, feel free to touch a wall if you could use the support or position the ball against a wall to keep it from moving.
Sit on an exercise ball, lengthening your spine. Resolve to keep the ball steady and your spine long throughout the following movements.
As you exhale, root down with your left foot and, keeping your left foot planted, lift your right leg as if you were doing a slow kick, extending your leg out in front of you, until it is about parallel to the ground. As you inhale, bring your right foot back to its starting position.
Repeat on the other side: As you exhale, root down with your right foot, and slowly extend your left leg out in front of you until it’s parallel to the ground. Inhale and replant the foot. Repeat these movements at least 10 times on each side, or until fatigue.
9. Core Work With Ball: Snow Angels With dumbbells
This exercise strengthens the upper abdominal muscles, which engage when you lift your arms.
With your weights in your hands (palms facing forward) and your arms at your sides, sit on the ball, lengthening your spine. Resolve to keep the ball steady and your spine long, ears over shoulders, throughout the following movements.
As you exhale, slowly lift your arms out to the sides and then up alongside your ears—or as high as you comfortably can lift them—keeping your palms facing forward the whole time. As you inhale, slowly lower your arms.
Repeat several times, or until fatigue.
Note that this exercise, which strengthens the hip abductors and external rotators, muscles that aid in pelvic stabilization, is asymmetrical: If the previous poses have gone well, you may begin to slowly introduce asymmetrical poses. If, however, this or any asymmetrical pose increases your symptoms, it is important to stop immediately.
Sit down on your yoga mat, and loop a strap or resistance band around your thighs, just above your knees. If you are using a yoga strap, it must be loose enough to allow about two feet of space between your knees.
Roll onto your left side with your knees bent, right knee stacked on top of the left knee. Either bend your left elbow and rest the left side of your head in your left hand or keep your left arm on the ground and rest the left side of your head on your left upper arm.
Keeping your top foot close to your bottom foot, as you exhale, externally rotate your right leg to lift your right knee toward the ceiling. Hold for one or two breaths, pressing against the resistance of your band or strap.
On an inhale, slowly lower your knee. Repeat about 20 times lying on your left side, then switch sides.
11. Bridge Pose
Bridge pose stretches the quadriceps and hip flexors while strengthening the hip abductors and extensors.
Roll onto your back, with your knees bent and feet hip distance apart and parallel, knees over ankles, and your arms alongside your body.
Keeping a gentle inward curve in your lower back, press down with your feet, especially your heels, and lift your hips up to the degree that feels sustainable.
Walk your shoulder blades toward each other as much as is comfortable, and interlace your hands on the floor beneath your hips if you like. (If interlacing your hands causes strain in your neck or shoulders, or causes your shoulders to lift off the mat, then keep your arms alongside your body.)
Hold here for several breaths. Then release your hands if they were interlaced, and lower down slowly. Repeat five more times.
12. Iliopsoas Stretch from Bridge
As your SI symptoms improve, you can gradually introduce asymmetrical poses like this gentle iliopsoas stretch, but stop if symptoms start to return.
Have a block nearby. It’s important that both your hips be supported by the block; if your pelvis is wider, you may need two blocks: You can place these side by side under your hips. Alternatively, you could place a bolster across the mat for a similar effect.
Lie down on your back, with your knees bent, feet hip distance apart and parallel, knees over ankles. Press down with your feet and lift your hips up. Slide your block on its lowest setting under your buttocks, making sure that both sides are supported by the block.
Draw your right knee in toward your chest, holding it there with one or both hands. Slowly straighten your left leg out in front of you, pressing down with your left heel, and pointing your toes up toward the ceiling.
Remain here for several deep breaths, exhaling tension from the front/top of the left thigh.
Release your right leg and switch sides.
After you’re finished with the second side, bend both knees and place your feet on the floor, then press down with your feet to lift your hips. Slide the block out of your way and release onto your back, resting for a few breaths with your spine in its neutral position.
Note: If you’re practicing at home and have a bed nearby, consider trying what is sometimes called the “Thomas Stretch”: Lie across the bed with your buttocks close to the edge of your bed. Hug both knees in, then extend one leg, letting it hang over the edge of the bed.
13. Savasana: Feet Against the Wall
Lie on your back with your feet against the wall, as you did at the beginning of practice.
Bring your hands to your hips. Is your pelvis level? Are both feet able to press into the wall evenly?
After noting any changes that have taken place in the space of your practice, lengthen your arms comfortably alongside your body.
Relax here for five to ten minutes (or even longer if you like), breathing comfortably and encouraging both the right and left sides of your pelvis, and indeed, the right and left sides of your entire body, to grow evenly heavy.
As you transition out of savasana, gently make your up to a symmetrical seated position, like hero pose.
Notice how you feel after your explorations. On the transitions from seated to standing (and standing to seated) the sacrum is especially vulnerable, moving from its unlocked (less stable) position while seated to the locked (more stable) position while standing. When you get up, can you maintain symmetry? Move to all fours, then to plank, then to downward facing dog. Walk your feet up the mat to your hands, then walk your hands up both legs, bending your knees slightly, as you rise up to stand. Press down with both feet evenly for a moment, before stepping back into your day.
Bill Reif, the author of The Back Pain Secret: The Real Cause of Women’s Back Pain, is a Masters of Physical Therapy graduate of SUNY Buffalo & Emory University Physical Therapy programs, the... Read more>>