Why Twisting Incorrectly Can Make Your SI Joint Meltdown

And what you can do about it!

Have you ever had those days when you’re feeling great, then you move the wrong way and everything goes sideways? SI Joint pain can be like that.

The SI Joint (SacroIliac Joint) is not a joint that moves like your elbow or knee. It is where the Sacrum and the Iliac bones at the back of the pelvis come together (see graphic). Because they are two separate bones, there is a small bit of movement there, and when you walk and move, these to bones should glide freely next to each other.

Posterior view of the pelvis (from the back)

Sometimes however, often due to muscular imbalance, the bones don’t glide and instead get stuck, leading to lower back pain. This is a specific type of lower back pain that tends to be sharper and point specific. Tight hip flexors commonly accompany this type of pain, and if you “sit for a living” you might be familiar with this discomfort.

Twisting can be a problem

While twisting is a wonderful movement for the spine, and something we do frequently in daily life, there is good twisting and bad twisting. In the post below I write about how to twist safely, aka good twisting:

Twisting is Magic, but Only if Done Right

When you pay attention to how you twist, and you focus on your alignment, there is no reason for your SI joint to cause you problems. This is easier to do in a yoga or exercise class when you are paying attention (hopefully!) to what you are doing. However, because you are not on high alert all day long (nor should you be), sometimes bad twisting happens, and you feel it later.

Common culprits

SI joint problems often come from an imbalance in the muscles of the pelvis. One side is tighter or working harder than the other, and the imbalance leads to dysfunction. We don’t lead symmetrical lives, plus we are one-side-dominant creatures, so it’s really common to have these types of imbalances. Even if you practice yoga every single day for an hour, it’s what you do with the other 15 waking hours that will affect your body more significantly.

Certain sports, such as tennis, golf, bowling, and softball are asymmetrical as well. All the more reason to practice yoga, pilates, weight training, or other symmetrical strengthening activities to try to even out. Personally I like yoga the best because it also improves mobility, supports balance, and calms your mind, but that’s a rant for another day. My point is, cross-training is important, work for symmetry.

Some major players in SI joint dysfunction are the Psoas, Piriformis, Paraspinals, Hamstrings, and Gluteus maximus (among others). When these muscles are tight, it can cause problems with how the SI joint moves and can lead to pain. Keeping these muscles stretched and supple can ease pain in the SI joint.

If you have hypermobile SI joints, the surrounding muscles (like the ones above) tighten to create stability. If they are tight for a long time, this restricts movement and can cause pain. Sometimes the pain is on the affected side, sometimes on the opposite side. It’s always important to stretch both sides, even if you only have pain on one side. I find that the side with the pain is not always the source of the problem. Often times, the problem is on the opposite side.

Stretches and movements for SI joint problems

If you are in a lot of pain, seeing a good physical therapist can help you identify your imbalances and correct them. Not all PTs are created equal. Find someone who stays with you, watches you do your exercises, and corrects your alignment. Otherwise, it’s a waste of your time. As an acupuncturist, I treat this condition all the time. Sacrums tend to get stuck as we age when our uncorrected imbalances become more problematic. I use acupuncture needles to release the muscles that are tight so that the sacrum can move more freely.

Here are some movements and yoga poses to help keep the SI joint happier. I have also included modifications so that these poses can suit different bodies.

**When in doubt, see a medical professional first for a diagnosis before attempting to “fix” or “cure” yourself with these or any exercises.**

Rotating Reclining Bound Angle Flow

Start in Reclining Bound Angle pose/Supta Baddha Konasana, with your feet together, knees apart.

Inhale a breath. As you exhale, reach your right knee across to try to touch your left knee, as if you were closing a book. Keep your shoulders more or less on the floor, moving just your lower body. As you inhale, come back to Reclining Bound Angle, and as you exhale, reach your left knee across to touch your right. Inhale back to center. Go back and forth 3-5 times on each side.

Rotating Reclining Bound Angle Flow

This movement frees up the SI joints by stretching the Psoas, and mildly the Gluteus muscles. Plus it’s gentle core strengthening for the Obliques and inner thighs.

Cow-Face pose/Gomukhasana

There are many ways to come into this pose, but one way that I find most accessible is from Table pose. From Table, slide your right knee toward your midline, then tuck your left knee directly behind your right knee. Separate the feet so that the left foot goes to the right and the right foot goes to the left. Sit down between your feet so that you have one foot on each side of your hips.

If your hips don’t reach the floor, sit on a block or a mountain of blocks. If that is still not possible, lie down on your back and cross your right knee over your left knee, drawing your thighs toward your chest. I go into more detail about that here.

If you are seated, you can remain vertical, working to drop your right sit bone onto the floor or block, or you can tip the pelvis forward, maintaining a straight spine. Keep the spine straight, or lengthen the navel toward the knees and soften your torso toward your thighs. Hold this pose 5-8 breaths then repeat on the left.

This pose stretches the Piriformis and various Gluteus muscles. If one hip is significantly tighter than the other, you might feel the stretch on the same side even when you switch the legs. Let that be okay. Eventually you will even out.

Ankle to Knee pose/Agnistambhasana

Start seated. Bring your left shin in front of you, parallel to the front of your mat. Line up your left ankle in front of your right shoulder and your left knee in front of your left shoulder. Bring your right shin directly in front of your left shin, lining up the ankles and knees (hence the name of the pose), one in front of the other.

Keep the legs just as they are, or, if it’s available to you, stack your right shin directly on top of the left shin, still lining up the ankles and knees (again, it’s in the name). Regardless of the variation you choose, the ankles and knees should be shoulder distance apart with the feet flexed to stabilize the ankles.

Don’t let your ankles sag toward the floor. The more the ankles bend, the less hip stretch you will feel. Keep the feet (dorsi) flexed to put all of the stretch into the hips where you need it. Feel free to place blocks or rolled towels under your knees for support.

See modifications here.

Again, you can stay vertical, or you can tip the pelvis forward, keeping your spine straight. Stay there, or reach the navel toward the shins, and soften the spine forward. Stay 5-8 breaths then repeat with the left leg in front or on top.

You will feel this stretch in your Glutes. This can be an intense hip opener, so be sure not to grip and brace against it. Try to relax and drop your hips and thighs, and release your jaw. Focus on your breath, lengthening out your exhale. It does get easier as you breathe.

Half Seated Spinal Twist (aka Half Lord of the Fishes)/Ardha Matsyendrasana

Start seated with your left leg extended forward in front of you. Bend your right knee and place your right foot to the left of your left leg, near the knee. Stay as you are, or bend your left leg, bringing the left foot toward your right hip. If this causes your right hip to pop off the floor, do this pose with a straight left leg. It’s more important to have the pelvis level than it is to bend the bottom leg.

Feel both sit bones on the floor. Lengthen your spine upward to bring both your pelvis and spine to vertical. If you can’t find vertical, sit on a block or rolled towel to help you find a vertical pelvis. It always helps to have the hips higher.

Wrap your left arm around your right knee and pull it toward your chest. You may feel a stretch in your right hip. Stay there, or rotate the rib cage to the right, keeping the pelvis stable. Move your ribs by using your Oblique muscles, rather than the pull of your left arm. Use your exhale to deepen the twist, don’t force yourself around. Hold 5 breaths then unwind and do on the left.

In terms of SI joint benefit, focus more on the hip opening and less on the twist. Be sure to keep the pelvis stable as you twist, since this is the type of pose, when done incorrectly (i.e. twisting from the pelvis), can exacerbate your SI joint issues. When done correctly, it can help.

Head to Knee pose/Janu Sirsasana

Start seated with your left leg extended forward and place your right foot on your inner left leg. It’s kind of like Tree pose but you’re seated so you don’t have to balance. You can place a block or rolled towel under your right knee if it’s high off the floor and your feel your hip flexors straining.

Sit up straight and spin the right ribs forward and left ribs backward to aim your navel toward your left knee. Place your right hand on the outside of your left thigh. Stay there, or tip the pelvis forward, sliding your right hand to or toward your outer left foot. If you can’t grab the foot, bend your knee, grab your foot, and work toward straightening the knee. Your hamstring may stop you before the leg is straight, let that be okay. You can also grab the outside of your leg.

Inhale to lengthen the navel toward your left knee. Stay with a straight spine, or as you exhale, soften the spine toward your left leg. Stay 5-8 breaths, then repeat with the right leg forward.

This pose stretches the Hamstrings on one side and the lower Erector/Paraspinal muscles on the opposite side. Try not to pull yourself toward your leg. Hold the foot to stabilize the body as you inhale, then use your exhale to relax into the pose. Don’t force the stretch, but don’t fight it either. Find the path of more ease and less struggle.

Sage pose/Marichyasana A

This pose took me years to figure out, because it can be awkward and frustrating if your lower back is tight and you don’t know what you’re supposed to do. Hopefully this guidance will make it clearer for you.

Start seated with your left leg forward. Bend your right knee and place the foot on the floor toward the outside of your right hip (and a little forward). Lift your right hip off the floor so that all of your weight is on your left hip.

Reach your right hand toward your left foot and wrap the arm around the front of your right shin. You can place your hand on the floor next to your right foot, you can bring your hand to your right hip, or you can reach your left hand behind you and clasp your hands toward the outside of your right hip. Feel free to use a strap or towel to connect the hands if they don’t reach on their own.

Inhale to reach your navel toward your left knee. As you exhale, round your spine, dropping your forehead to or toward your left knee (it doesn’t need to touch). Use your right arm to squeeze your right knee toward your right ribs. Keep your weight on your left hip while reaching your right hip toward the floor. Don’t shift toward your right hip, just lengthen it downward. This gives you the lower back opening that you want.

Stay 5-8 breaths then repeat with the right leg forward.

This pose stretches the Paraspinal muscles which are at the base of the spine and extend onto the sacrum. You might also feel a Hamstring stretch in this pose, but that is secondary since you are rounding the spine.

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