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Nagging Low Back Pain? It Could Be Your Sacroiliac Joint – Donna Farhi on Common Practice Issues in Yoga
Do you struggle with nagging low back pain, which just doesn’t go away despite of years of yoga practice? It could be a problem with your sacroiliac joint, and your yoga practice might be the cause, says acclaimed yoga teacher Donna Farhi.
In this interview with YogaUOnline, Donna talks about her concerns about sacroiliac joint issues in yoga, how they arise and some of the common teaching mistakes that predispose yoga students to SI joint issues.
YogaUOnline: One of your many areas of focus is on the sacroiliac joint and how to keep it healthy in yoga. What inspired that interest?
Donna Farhi: It's been something that's been in development for a long time. Over the last two decades of teaching wherever I go, I encountered yogis who have chronic or intermittent and sometimes acute sacroiliac dysfunction and pain. This always piqued my interest. It's not something I think you would find in e.g. practitioners of Tai Chi or other movements systems. It began a questioning process for me of what is contributing to this issue.
I myself have had long standing intermittent problems with my sacroiliac joint beginning during the period of time when I began intensively practicing in my late twenties. When I started practicing two, three, sometimes four hours a day, I began having sacroiliac dysfunction. I noticed that my peers who were also receiving training at that time at the Iyengar Yoga Institute of San Francisco, it seemed like the more practice everyone did, the worse their sacroiliac joint got. I wasn't alone in what I was experiencing.
So it's been a question for me for a long time, both in my own personal practice of how I could create greater stability and an ease in my own sacroiliac joint. Then in looking very carefully at students, how I might help them to both avoid having a problem in the first place and then resolving issues once they're there.
YogaUOnline: And do you think this issue primarily affects people who are really serious practitioners and practice many hours a day and who practice yoga for many years or is this something that affects a broader range of yoga students?
Donna Farhi: I think it affects the much broader range of yoga students simply because the repertoire of movement that is practice in yoga and especially certain types of movement in my mind is not functionally balanced.
The movement vocabulary itself, I think has especially become unbalanced as we've seen the influx of flow practices in particular. I'm not pointing the finger at anyone or any particular message, but when you get people doing one, asymmetrical movement after another, very quickly and often with very little training and not understanding about correct transitioning of movements. Then you have a recipe for people really flinging themselves around in quite extreme ranges of motion.
And then I think the other major contributor has been a serious misunderstanding of how the pelvis and the hip joints function in relationship to each other and how that manifests in standing poses and how that manifests in supine work where unlike say, a dancer who's standing at a bar and she has to lift her leg in the air, she's immediately engaging her core to lift her leg up and hold it there. It takes tremendous strength.
All the supine work where we're lying down on the floor and taking a very heavy limb and simply letting it fall to the side and doing these really extreme ranges of motion with a completely switched off core.
Those kinds of movement practices start to erode the stability of the SI joint and it can start in someone’s first beginning level class. They can start in a class where they're practicing something like Supta Padangustasana, which for those of you who don't know Sanskrit, is lying on the back with one leg in flexion holding onto the big toe or holding on to a belt, and opening the leg to the side and letting the leg fall out to the side. It's a fairly common practice throughout different methods.
YogaUOnline: How do SI joint problems show up? What would someone feel if they have an SI joint issue as opposed to just low back pain?
Donna Farhi: SI joint problems and lower back problems often go together. My chiropractor, who has been in practice for a good 20 years and treats a lot of athletes, has said anecdotally that about 70% of the time when there's a lower back problem, it's also something going on with the SI joint and vice versa.
There’s a really simple question that I ask people, because quite frequently people will come into the studio and say, “I've got low back pain.” I say, “Show me where that is.”
And they don't put their hands on their lower back. They put their thumbs on the posterior superior iliac crust of the back of the pelvis. So they've got their hands on either side of the lower back on the rim of the pelvis. And quite frequently the way that that's manifesting for them is a niggling pain with SI joint issues that arise as a result of hyper mobility. It’s not usually acute pain, a niggling, aching pain. It can radiate into the groin, into the thigh, into the buttock.
YogaUOnline: Yeah. Usually when we think about yoga injuries or muscle strain created by yoga postures, we are thinking in terms of alignment mistakes and compensations creating those problems.
But what's interesting about your work is that, particularly when it comes to the SI joint, you seem to be seeing that it really has a lot more to do with the way yoga postures are being taught and to some extent also the yoga postures that people do. Could you explain that in more detail?
Donna Farhi: One of the most common instructions that is given that has created massive problems, not just for the SI joint but for knees and for hip joints, is the idea that the hips must be squared in the front in a wide stance standing posture.
When you have one leg rotating out 90 degrees, it's the acetabulum, the hip socket, that has to be in agreement with the external rotation of one leg, especially if the other leg is doing something completely different, which is turning in.
If you knew nothing about SI anatomy and I simply said to you, when you turn your leg out in Triangle Pose or Warrior Pose, you must have your knee agreeing with your foot, then generally people understand that.
The knee shouldn’t be twisting when the foot turns out, the knee must agree with that rotation, and the hip also has to agree with it. If they follow that, the pelvis will reorient. The opposite side of the pelvis will reorient to allow for that external rotation.
But if you have it in your mind that the pelvis must be square to the front, which many people do, they’ll try and move the pelvis back against that rotation.
Now there's a whole lot of things that happen. The first thing that happens is they'll rotate their knee in where it switches—a total no-no. And the hip will swing back into a really unstable position in the hip socket.
And the SI joint has an unstable sheer force going through it where the front of the anterior portion of the joint will gap open and the back of the joint will be jammed closed.
Nine times out of 10, if I go over to someone and say, “Can I just suggest that your pelvis could come forward on the side?” Nine times out of 10, they'll say, “That feels so much better in my sacroiliac joint!” And I say, “Why don't you trust that?” And they'll say, “Because that's not the correct way to do it.”
I'm remembering one client who came to me in Australia, she'd been in an intensive and she was in acute pain. She could not sit, she could not lie down, she could not stand, she could not bend forward, she couldn't bend backwards without pain in her SI joint. And she said, “Would you take me for a private lesson?” And because it was so extreme, I agreed to meet with her after the intensive. And after about an hour and a half of showing her how she might reorient her pelvis in standing posture work, she felt immediate relief from her pain.
As she was getting up to leave, she turned to me and she said, “But, you know I can't do that tomorrow during my assessment because I won't get certified. And I certainly can't teach my students to do this because it's not in agreement with the method.”
That's the degree to which people have come to believe these instructions that have often come, with all due respect, from teachers who did not have any training in anatomy or kinesiology.
Sometimes we don't see the results of a seemingly innocuous instruction like hips square to the front until we've got practitioners who have been practicing for 20 years who discover that the labrum in both the hips has gone and they're now bone on bone.
I feel really passionate about it because I feel like we really need to avoid future generations of people having these problems.
YogaUOnline: One of the other features that I know that in your writing that you said can cause SI joint problems, is poor core strength. Could you explain that connection in more detail?
Donna Farhi: I'm an equestrian and when I began seriously riding, my hip muscles got stronger and as they got stronger, my core muscles got a lot stronger. And as I got stronger, I became less flexible in my hips. I can remember the day I went to do a sequence with half lotus and went, “Oh I can't do that anymore,” because my hip muscles were so strong.
But I also noticed that with this increase in hip stability and strength and increase in core strength that I was having a lot fewer problems with my lower back and my SI joint.
I would say that most Yogis, if they're just doing a yoga practice probably are not doing enough core strength work. I don't just mean isolated core work around the pelvic area, but whole global body integrated strength. Because whether your core is strong or not, it’s not just a matter of whether you have strong transverse abdominis muscles, but where the things are switching on across the diagonals in the body and so on.
For some yogis that could be very helpful to even consider doing some gym work. There is a device that I've recently been introduced to called the oov and that's a wonderful device that people can use to add to their yoga postures.
So in one of the videos for the SI course, my friend Sam Lowe is doing the same movements on the floor and I'm doing those movements on the oov. Doing them on the oov quite frankly, is up the level of what's going to happen as a result of those movements by about a factor of 10.
Why not? If you're going to do these core strengthening movements as a part of your yoga practice, find something that maximizes your time and your effort. I really do think that most yogis need to do a great deal more strengthening work and a lot less focus on flexibility. But of course that's not going to get you a million Instagram followers.
YogaUOnline: It’s not quite as flashy, that is true.
Donna Farhi: No, it’s generally the people that have got their feet behind their head and doing very extreme symmetrical movements and extreme range of motion movements.
YogaUOnline: That unfortunately has become the way that yoga is perceived because that's how people got to know it. They did not get to know it as a great technique for building intro-receptive awareness and settling mind and body, but more like beautiful young models doing fancy poses.
Donna Farhi: When I began practicing I was considered very flexible, very hyper mobile. But when I look at the practices that we were doing at that time, and even at the peak of doing what I would call quite virtuosic practice, those practices pale, they are almost pedestrian, in comparison to what's coming down the shute now, which is really, really extreme ranges of motion that you're more likely to see in circus performers than in the average person.
And unfortunately when people see these images, there's the sense that if I only practice long enough, I could be able to do that too. The truth is what they're seeing is an exception, i.e. a person who was born into a body that had a propensity for hypermobility within the genetic coding of collagen.
YogaUOnline: Yeah. Very interesting. Now before I let you go, I do want to hear a little bit more about this course you developed. I know you worked very hard, I think you spent three months preparing this course on common teaching mistakes in yoga that affect the SI joint and how to avoid those issues. So tell us about the course and what you will be covering.
Donna Farhi: I’m very really excited about the power points because I commissioned Sonya Rooney who's done the illustrations for Yoga, Mind, Body, and Spirit and Pathways to a Centered Body. She came on board and we worked for three months or more on creating, not just new anatomical illustrations, but conceptual illustrations to take what can be very complex concepts and to present them graphically so that they're easily understood.
So that first PowerPoint kind of lays the foundation to understand sacroiliac anatomy and the beginning of some of the kinesiological issues around how that joint functions. The first two videos, I felt that I had an obligation to speak to some of the most common causes, in my humble opinion, of sacroiliac disfunction in Yogis. Because if we don't address those, there's no point doing all the therapy work because we're literally recreating a problem every time we go back onto the practice mat or into someone's class.
So that first video unpacks some of those issues, like the eight ways that you can destroy your SI joint. And then the second video in is geared towards helping people who are already have inflammation, have pain and getting that calmed down a little bit. Because it's pretty hard to go into a movement practice when there is that inflammation and discomfort in the joint.
In the second part of the course, we look at some of the models for joint theory and joint stability that we have to work with.
We have to work with our mobility systems and especially in terms of some motor control, getting a synchronized motor control going on in the body. So that second PowerPoint also lays out a conceptual protocol, rather than giving people here's a set of postures I'm to do or not do, because so many people will be becoming into this course from different traditions.
Then in video three we start to build that core strengths, in a practice video. It's very much a practice on the straight and narrow. I can personally attest as someone who broken her pelvis in two pieces a year ago, that through practicing in this very symmetrical and consistent way it has realigned and restored the stability of my pelvis quite remarkably. I've been the test dummy for that course in a big way.
Then the fourth part, we look at something I think that has perhaps not been addressed in the past quite so well. As we move out of that straight and narrow kind of practice where we're healing and building stability in the SI joint, how do we restore multidimensional movement? We do want to restore full mobility. But the long and the short of it is that for many people during the course that it may mean that in the future there are certain practices that just get ditched.
YogaUOnline: Most people have to let go of the idea that one these days you'll look like one of the models on Instagram. The road to accepting your body and the way you do the pose is quite a path for a lot of people, irrespective of whether or not that involves letting go of the foot behind the head or just looking like a regular 50 year old in Warrior II.
Donna Farhi: Yeah. The good news is that there are millions of people worldwide who are looking for competent yoga teachers who very much want to come in to practice in a gentle and balanced way. They might be quite alienated by those images that they see in social media. In fact, that might be what's stopping them from getting to the yoga studio, because they think they aren’t flexible enough. So I think there's enormous scope for teachers to really serve the community by shifting the emphasis in practice and bringing it back to accessibility and practical relevance for the everyday person.
In some cities I'm hearing there is real saturation with lots and lots of teachers, but I think they'll always be a place for really well trained teachers. The cream rises to the top.
So don't get too distracted by what's going on out there and what's going on in social media and what’s the latest flavor of the month. Because I think when teachers really stick to what they're doing and the integrity of that in long run, that's going to serve them better professionally and again, it's going to serve the people that we're here to offer this work to.
Donna Farhi is a worldwide acclaimed yoga teacher and author of a series of popular books on yoga teaching and practice, including Yoga, Mind, Body and Spirit, The Breathing Book and Pathways to a Centered Body. She is particularly known for her great contributions to deepening our understanding of yoga anatomy and principles for effective yoga teaching.