Pain…acute to chronic

July 17, 2017

Pain…acute to chronic

Many of us have suffered injuries in the past, especially if we have a history of sporting practice. As a yoga teacher I work daily with the after affects of compounded muscles from repetitive sports with my students. One of the areas within the body that seem to hold a lot of problems for people is the area of the  SI joint (or sacroiliac joint).

This article is based of the facts surrounding the SI joint and strain and the subject of acute and chronic pain. It is a subject that is the base of my recent book, Breaking the Attachment to Pain.

I invite you to read this with  with an open mind and a willingness to possibly question your own biases, as I have had to question my own many times as I moved from chronic pain to pain free since my car accident and as I continue to study and learn about the body.

Although the SI joints are some of the strongest joints in the body, we often receive the impression  that they are actually quite fragile structures that are vulnerable to injury and instability from the slightest misalignments in yoga.

One reason we tend to believe that our SI joints are vulnerable to damage in yoga is that we generally learn about sacroiliac joint anatomy by looking at a skeleton model or a drawing like this one here:

sacroilliac

When we see the bones by themselves like this, we can certainly get the impression that the sacrum can “slide around” easily relative to the pelvis, resulting in an SI joint that can be pulled “out of place” or “strained” due to small misalignments in yoga poses.

However, what we rarely see after learning about the bony anatomy of the SI joint’s structure is an image like this, which depicts all of the extremely resilient, tough ligaments that surround and support the SI joints from all sides, holding them firmly in place:

sacroilliac anatomy

The ligaments that support the SI joint include the anterior sacroiliac ligament, interosseous sacroiliac ligament, sacrotuberous ligament, posterior sacroiliac ligament, and sacrospinous ligament.

A rarely cited fact is that the ligaments of the sacroiliac joint include some of the strongest ligaments in the human body! While our SI joint can certainly be injured and we can absolutely experience pain there it would take much more force to injure a healthy SI joint than the relatively low loads involved in a yoga practice.

The SI joints serve to transfer the load of the upper body to the lower body, as well as to distribute forces moving up the body from below. Therefore, stability is built into their very design so that these forces can be transferred efficiently through the pelvis. In fact, the SI joints are so inherently stable that there is only the tiniest amount of movement available at these joints.

In fact SI joint pain is certainly a common experience among yogis and non-yogis alike, but SI joint pain does not necessarily mean that there is an SI joint injury.

Pain is actually a much more complex, multi-factorial phenomenon than simply “I have tissue damage and therefore that is what is creating my pain.”

As an example, if someone has SI joint pain and they have experienced a recent blunt force trauma to their pelvis region (think from a car accident or a major fall of some sort), then their pain is very likely due to an actual SI joint injury. Once this injury has healed, this pain should subside.

But in contrast to those examples of short-term pain associated with acute injury, when someone’s pain is more long-term or chronic in nature (chronic pain is sometimes defined as pain lasting longer than three months), it’s less likely that this pain is connected to a specific injury or damage to the area and more likely that the person’s nervous system is instead sensitive around that spot.

Nervous system sensitivity and an output of pain can be the result of many different factors aside from actual tissue damage. Other influences include emotions, past experiences, stress levels, beliefs—and particularly beliefs about one’s body. In fact, the more that someone believes that a particular area is fragile and vulnerable, the more likely their nervous system is to perceive threat in that area and to output pain there. And conversely, the more someone learns that their joints are strong, inherently stable structures well-supported by some of the most durable ligaments and muscles of the body, the less likely their nervous system will be to perceive threat and output pain in this area.

In summary, SI joint pain and chronic pain is common among yogis and non-yogis alike and there are many factors that can contribute to it, including physical, psychological, and social ones. However, how we align our body in yoga is probably not a mechanism for SI joint injury, and if one practices with mindfulness and compassion for ones body, concentrating on what their body is telling them and not watching and comparing themselves to others, then injury is rare in Yoga.
 Rather than worrying too much about alignment for SI joint protection, a more effective means of injury prevention is to simply strengthen and condition the muscles and connective tissue that support the SI joint to increase their capacity to handle loads. This can be applied to all the joints of the body.