4 essential actions to save your back and SI joints:

In a recent post about Virabhadrasana II, I talked about hip position and whether or not the hips should be “square” to the side or not in that pose, particularly in reference to the front leg’s knee, both hips, and the lower back.

One of the ways to help understand this arrangement for the hips is to think less of the orientation in space relative to external feedback, and instead use the interior feedback given by actions of the pelvic girdle. This will not only help bring this alignment question into a more organic context, it will also help maintain the integrity and safety of the pelvic girdle and as a result, the lower back as well.

The pelvis is, in essence, made up of 3 separate bones: two hip bones (A) and your sacrum (B), which joins the two halves of the back pelvis as well as forming the base of your spine. The tailbone is part of the sacrum, but only the very bottom of it — the sacrum itself extends all the way up near the pelvic rims (the pelvic rims arc upward toward the sides, and so the sacrum’s top edge is below the pelvic rims’ uppermost edges).

© Michael Bridge-Dickson

The hip bones themselves are broken down into 3 further parts, the ilium (pelvic rims, i), ischium (sitting bones, ii), and pubis (the lower-front part of the pelvic bones, iii, that are joined by a piece of cartilage, making up the pubic symphysis). These are not separate bones (or at least in the adult pelvis it is generally agreed that these 3 parts make up a single structure and do not move independently to any significant degree), but are separated into three sections to make landmarking and communication easier.

What is important to understand about the pelvis is that the two hip bones and the sacrum form three joints: the pubic symphysis in the front, and the two sacro-iliac (SI) joints in the back. This means that one hip bone can move relative to the sacrum and other hip bone, and it will move at the pubic symphysis in the front, and one of the SI joints in the back. Similarly, it is possible for the sacrum to move between the two hip bones, sliding back at one SI joint and forward at the other, or up at one SI joint and slightly down at the other or any number of other (limited, but still extensive) possibilities.

This movement is usually very slight, and some degree of that movement at all three joints is healthy — otherwise, why would we even have those joints to begin with? The movement of your sacrum between the hip joints allows for smoother walking, running, and other asymmetrical bipedal activities, as well as symmetrical movements such as those we do in forward bending or back bending, but even the most basic of movements: breathing.

However, problems can occur when one or both SI joints are more mobile than what is necessary or healthy. Too much movement can compromise the stability and integrity of the pelvis and sacrum, leading to abnormal and excessive wear patterns at the femoral heads, and more immediately, destabilization of the lower back, and really the entire spine.

Most commonly, one SI joint will be more mobile than the other (this is true whether in the “healthy” range or not). When one SI joint is more mobile than the other, the body will tend to favor the mobile side when mobility is required, and the more stable side when stability is required. Over time, this exacerbates the asymmetry (keep this principle in mind, as it applies to most of the body’s asymmetries!), and as the asymmetry increases so do the potential problems and the pain that can result.

In Virabhadrasana II, and other asymmetrical poses, pulling one hip back or otherwise attempting to move the pelvis as a whole into a particular spatial orientation will often not be done by the whole pelvis as one integral unit, but instead this often is done by changing on hip’s relationship to the other — in other words, by moving the less stable hip either forward or back (or up or down) relative to the more stable hip.

So, let’s say your right SI joint is more mobile, but the left SI joint is more fixed. You take Virabhadrasana II with the right leg bent and the left leg extended. You attempt to “square” the hips. Because the right SI joint is more mobile, the right hip will move forward, and the left hip will remain relatively stable. As mentioned in the Virabhadrasana II post, this will usually cause the right knee to collapse inward, unless there is extreme capacity for both external rotation and abduction in the right hip joint (where the femur meets the pelvis). But more than that, because the right hip has moved forward, the left hip and the sacrum are still slightly turned toward the right.

Then, we do the second side. Let’s assume the same conditions, but now you are bending your left leg and having your right leg extended. Once again, you attempt to “square” the hips — but this time, because the right SI joint is the more mobile one, the left hip and the sacrum stay pretty much where they are, but the right hip with pull back. In this example, the left knee will not be compromised (or at least not as much), but it will compress the SI joint on the right side, and may also create additional torque or strain to the lumbar spine. There is also an effect on the right groin, whereby both sides of the pose increase right hip joint mobility, but do not increase left hip joint mobility (or at least much less on the left side).

There are of course other scenarios and ramifications, and I may have oversimplified the mechanics for the sake of explanation, but the point is that these forces will not only further destabilize the pelvic girdle, but also exacerbate asymmetries — a combination that usually leads to pain and potentially also to damage that is either irreversible or difficult to correct without severe means.

But there’s good news!

Our pelvises are not just bones, the whole structure and its integrity is maintained by a complex web of muscles, ligaments, and cartilaginous buffers — each of which are capable of performing more than their primary purpose so that the pelvis and its structure can be kept stable and mobile, even when certain members of the web are not functioning optimally.

Among the basic muscular stabilizers are the lower transverse abdominals (TVA) across the front pelvis, and the multifidi that run all the way up the spine, but serve an important function on either side of the sacrum in stabilizing the SI joints in the back pelvis.

When the lower TVA and multifidi engage well and together, they form the stability for the pelvis to move as a whole, singular unit, decreasing the favoritism of asymmetry and minimizing development of further, increased asymmetry. This stability also prevents any unnecessary or unhelpful movements in both symmetrical and asymmetrical poses. When the pelvis is stable, so too is the spine, and so this can aid the lengthening and healthy function of the entire spine, from the tailbone to the skull.

Pretty cool, eh?

Before going into how to engage that stability, it is important to remember that some movement in both SI joints and at the pubic symphysis is healthy. So, we don’t want to over-engage any of these actions, which would prevent ALL movement — both the healthy kind and the less helpful kind. To ensure that necessary and healthy degrees of movement in the pelvis still happen, only engage these actions minimally.

These actions are relatively subtle, and at first you may find you need to fully engage to find them. In the beginning, that’s OK, as long as you take breaks to disengage the muscles as well. Each time you re-engage, however, try to engage with less and less effort each time. Eventually, you may even look toward engaging these actions almost all the time, but with minimal effort so that they do not take up or waste any excess energy. Think of the effort required as being nothing more than a gentle (but constant) stream, not a raging torrent.

There are four essential actions that stabilize the pelvis. It’s a good idea to start with only the first one, practice it for a week, and then add the second action, practice both for another week or two, and so on until you have all four layers working simultaneously.

The four steps in brief are:

  1. Draw the two front hip points toward each other
  2. Soften the pubis in and upward
  3. Broaden the upper femurs
  4. Engage the multifidi

Here’s how to engage those pelvic stabilizers, in much more detail:

  1. Engage lower transverse abdominus by drawing the ASIS (anterior superior iliac spines — the front hip points) toward each other. Do this at only about 20% of your effort. If overdone, the rectus or obliques will come in and for now we don’t want those, especially rectus because when the rectus abdominus engages, it often overrides the transverse and the transverse disengages. 

    Note that this is not a drawing in movement, but rather a gathering one. The two frontal hip points will feel as though they move very slightly toward each other, and as a result, you may feel a slight lift in the torso as well as some width or increased space across the back pelvis.This will usually feel good (or great!) and there will be an urge to do it more, to draw the front hip bones even closer together with more effort to create even more space across the back. Try not to do this. I know it feels good, and we always like to have more of anything good, but that space that is opening across the back pelvis is an increase of movement in the SI joints, and if your pain is caused by excess SI joint mobility, then this will actually make it worse in the long term, not better.

    Also remember the tendency to move one hip more than the other whenever there’s an asymmetry. It is easier to maintain symmetry in smaller ranges of motion than in larger ones, and so, keep it minimal and go for symmetry more than degree. In fact, if you have the sensitivity to feel which hip has more movement, or which hip does not gather in as easily as the other, you can place a slight emphasis on directing one hip inward more than the other.

    If you’re having difficulty finding the transverse abdominals, there are a few tricks. The first is to exhale through the mouth as though whistling, but you don’t have to actually whistle (you can if you wish though, why not enjoy it!?). This will usually engage the abdominal muscles more than what we require here, but to find them this can be very useful. Once found, continually work to refine the engagement, softening the overall degree of engagement and directing it more consciously only toward the triangle between the two front hip bones and the pubis.

    It may also be helpful to visualize an elastic band stretching across the two hip bones and to then feel that elastic band getting slightly tighter, or to think of tightening the drawstring on a pair of loose-fitting pants or shorts.

    *Use care in both finding and engaging the abdominals — not only should the engagement be no more than 20% of your maximum effort (even 10% is probably enough in most cases), but this engagement should never restrict your breath. One of the healthiest things for your lower back and SI joints is the constant and gentle movements associated with your breath. Stopping these movements in favor of more superficial stability will not be helpful in the long-term. So, whenever engaging these actions, try to soften the interior of the abdomen, the space behind the abdominal wall. Soften this space before, during, and after releasing the abdominal actions, and ensure that even within the muscular tone produced by engagement, the abdomen still inflates and deflates with each breath, even if that movement is different than when totally relaxed.

  2. Soften the pubis inward and draw it upward. This is not a tucking action where the pubis lifts toward the sternum, this is much more subtle. You can even think of it as softening the space BEHIND the pubis and moving the pubis into that softness. Then, for the lifting action, lift the BACK of the pubis, not the front. If done correctly, steps 1. and 2. will create a slight lumbar curve. This is especially helpful in externally rotated poses where the tendency is for the pelvis to tuck and the lumbar to flatten.This action is much more subtle, and is an extension of the principle of softening behind the abdominal wall in 1. It may seem counter-intuitive, but the more difficulty you are having finding this action, the more you are likely over-efforting. Try less. Do less. It is small and subtle, but you will find it.

    Once you do find it, it will likely feel pretty great — just like action 1. did. Just like with 1., more is not better and may exacerbate asymmetries in the SI joints: remember, the pubis and ilium are the same bone: what’s done at the front via the pubis will wrap around and affect the back at the SI joint. The more effort you engage, the harder it is to maintain symmetry.

    Also, when working with this inward movement of the pubis, it is much easier to overdo it either by tucking the pelvis or by hardening the space behind the pubis and across the pelvic floor, and this will cause much more strain in the lumbar spine. This may be helpful to keep in mind, in case this second action doesn’t feel good, it’s possible that the action is correct and helpful to you, just too much of a good thing.

  3. Abduct the femurs. Also taught as moving the greater trochanters away from each other. The greater trochanters are the bony protrusion on the lateral side of the upper femurs. Occasionally there is confusion about what is meant by “hips” such as when there’s the instruction “place your hands on your hips” — some people will place their hands on their iliums, and others on their greater trochanters. On the side body, between the ribcage and the knees, there are only two bony landmarks: the higher of the two is your iliums, and the lower of the two is your greater trochanters. Here, in step 3., I’m talking about the lower one.Abducting the femurs can be a difficult action to find for some people, and is often confused with internal rotation. Part of this has to do with the terms “medial rotation” and “lateral rotation” sometimes used to describe internal and external rotation, respectively. Personally I’m not a fan of these terms, as they are misleading: in “medial rotation” the front femur moves medially, but the back femur moves laterally, and vice-versa for “lateral rotation” …but I digress… that’s all just to say that this action of abducting the greater trochanters is not a rotation, it is a directly lateral — or to the side — action. Learn how to abduct the greater trochanters in both internal rotation and external rotation. The lower femurs in fact resist medially (adduct) as the upper femurs resist laterally, or abduct.

    One other more practical reason this can be a difficult action to find is much more basic: some of us are just simply not familiar with this action in our bodies and have no experiential awareness that this lateral space can exist!

    So how do we find it?

    If you’ve ever done a yoga class with a block between your upper thighs or a strap around the upper thighs (or sometimes both) this is what the teacher has been getting at. The block between the thighs holds the space between the thighs, and can prevent collapse of the inner femurs, but does not really teach abduction. If anything, it teaches adduction (drawing inward), which is also a useful action that stabilizes the pelvis and lumbar spine, but can also cause compression if overdone (hence the space-holding block). Tying a strap around the upper thighs initially gathers the femurs toward each other, but also provides feedback against which to resist. It is often easier to find an action when there is feedback from an opposing force to push into, and this is what the strap does. As you press the thighs out into the strap, the space between the upper femurs widens. Having this movement restricted by the strap also provides added stability by keeping the range of movement very small (which is in essence the difference between an action and a movement, but more on that another time).

    Note: sometimes this is instructed lower down, from the knees. I do not recommend pressing the knees away from each other in this action, unless the knees are collapsing inward quite a bit. Even then, it is usually not so healthy to initiate movements or actions from the knees. If there is inward knee collapse, placing a block between the knees can sometimes help. This prevents the collapse, but it also trains the inner thighs to contract, and inward collapse in the knees can be the result of these muscles already being too active. An alternative is to tie a strap with loose contact around the lower femurs, about an inch or two above the knees and resist outward. This will teach the abductor muscles to balance the adductors, and may help create some width across the pelvis.

    A simpler way is to find it in Tadasana. Standing in Tadasana, keep the feet where they are, but press your outer feet away from each other. If you find that, further refine the action by emphasizing that action from the heels only, not the entire outer foot. There is a subtle difference between the two: pressing the outer feet away from each other affects the pelvis a little higher and toward the side front iliums, whereas pressing the heels only apart broadens the sacrum at the back pelvis, and a little lower down toward the bottom of the sacrum. Both may be useful at different times, so it’s useful to know both and the difference so that you can apply them accordingly.

    Here’s the gold:

  4. Engage lower multifidi. In fact, engage the lowest of the low multifidi. The multifidus muscles run all the way up each side of the spinal column, from the lower sacrum to the skull. They are the deepest among a series of spinal muscles that form the columns of flesh on either side of your spine.The lower multifidi sit in between the sacrum and the iliums, and are useful because they fill the gap posterior to the SI joints themselves. Engaging them can be a tricky thing though.© Michael Bridge-DicksonThe multifidi are pre-motor stabilizers — that means, they engage BEFORE movement occurs, and they normally disengage by default to larger motor muscles once movement occurs. So, this means 2 things: you have to find and engage them BEFORE going into poses or coming out of them, and to TRY engaging them through particular movement is, well, a movement, so you will override the pre-movement nature of these muscles.

    What to do then?

    Pre-motor stabilizers engage in anticipation of movement. So, these lowest of the lower multifidi work to draw the PSIS (posterior superior iliac spines — the back hip points) together in order to stabilize the pelvis before moving. Do not actively draw the PSIS together, as this, again, will bypass the pre-motor muscles and engage the larger motor muscles. Instead, *think* about drawing the PSIS toward each other. The multifidi then engage in *anticipation* of moving the PSIS toward each other. Because these muscles sit in the SI joint’s gaps between the posterior sacrum and the extreme medial and posterior surfaces of the the iliums, and since muscles usually expand when engaged, there will paradoxically be both slight feeling of swelling on either side of the sacrum as well as stabilization.

    You will know you’ve done it when a slight space opens across the back pelvis. But instead of feeling looser in that space, it will feel more stable. If overdone, you will feel the back pelvis narrow, or even compress — at this point, release and try again with less effort because you have bypassed the multifidi and are using different muscles. It’s one of those funny anatomical paradoxes that thinking about drawing the posterior iliums toward each other actually pushes them slightly further away from the sacrum.

    The result, though, is both space and stability. Win-win!!!

Again, practice each step for a week or more until it becomes almost automatic before adding the next layer. Once integrated, engage all four actions before going into poses and before coming out. Whenever possible, maintain this engagement even while in the poses, except maybe for Restorative poses, where you can be more passive while there. Even with Restoratives, it may be necessary to engage when going in and coming out, especially for poses that are problematic to your lumbar or SI joints, such as deep forward bends or back bends, and if you experience discomfort in twists.

When you apply this to Virabhadrasana II, use these stabilizing actions to articulate pelvic placement from femur movement. In other words, allow the pelvis to move and turn slightly toward the bent leg, but as you do so, integrate the pelvis with these four actions, then move the femurs relatively independent from the pelvis. See if you can use the pose to reasonably increase the range of motion in the hip joints where the femur meets the pelvis, not in the SI joints. Also, think of finding space and ease not just stretch or intense sensations — sometimes space and ease are the result of intense stretch sensations, but other times intense stretch sensations are the result of space and ease being lost. Keep this balance throughout your practice.

Enjoy!

 

*Illustrations © Michael Bridge-Dickson, do not use without permission
Principles in this post are based on the work of Joseph Pilates and revived by Doug Keller

Advertisements

2 Comments

  1. Miceal! You are not just a yoga teacher, you are a posture designer and Yoga engineer! What a awesome text!
    Congratulations!

    1. Thank you Kamran! I can’t take credit for all the principles here, but I have tried to explain those principles in a cogent and helpful way 🙂

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s