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Episode 21: Is the SI Joint Painful Due to Instability?
500 Plays2 years ago
Welcome to Episode 21 of the Movement Logic podcast! In this solo episode, Laurel shares her history with sacroiliac joint (SIJ) pain, and how no less than shifting her identity as a teacher, the way she thought of her SIJ, and the way she moved her body on a regular basis is what was required of her to get herself out of pain.
The SIJ is an area of the body that is surrounded by misinformation and tainted by a rather pessimistic outlook on its stability and robustness.
These fragilizing, pessimistic attitudes often result in triggering language around the SIJ that can lead people in pain to believe that their SIJ is unstable, out of place, or moving in the wrong ways.
This episode combines some anatomy and biomechanics along with plenty of human psychology and even human evolution to examine the power that words have over shaping our beliefs and identity, and how our beliefs and identity, in turn shape the language we use.
Laurel invites teachers to examine their beliefs about the body and question the words they use as thoughtfully as they choose their sequences, exercises, props, cues, and alignments. Additionally Laurel examines:
- Prevailing myths around the SIJ in both the movement and PT world.
- The problem with ideas around right and wrong alignment or good and bad exercises with regards to SIJ pain.
- A walk down memory lane to remember all the poses, alignments, and whole approaches to practicing the asanas that we demonized and blamed for our SIJ pain.
- Four reasons the SIJ is inherently stable, robust, and awesome.
- What pain science can teach us about SIJ pain and more and less effective ways of addressing it.
- What human evolution suggests about the SIJ and its stability.
- Why looking for a specific faultily-functioning mechanism to “fix” the SIJ is often less helpful than casting a wide net and making the body, or a general region of the body, more tolerant to loads.
- The scope of practice of a movement teacher when helping their students with painful SIJs feel better.
Reference links:
Sign up for a FREE mini course about the Hip and SIJ from Movement Logic co-creators Laurel Beversdorf, Dr. Sarah Court DPT, and Jesal Parikh.
Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area
Born to Walk: Myofascial Efficiency and the Body in Movement
The Story of the Human Body: Evolution, Health, and Disease
Sign up here for the Movement Logic Newsletter for course discounts and sales and receive a free mini Pelvic Floor course!
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Thanks for listening!
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Transcript
Origins and Initiatives of MovementLogic
00:00:00
Speaker
Hey everybody, Sarah here. Back in 2017, when Laurel and I started MovementLogic, we felt that movement teachers were being shortchanged by the available continuing education options out there, and we wanted to fill that gap. Now here we are five years later, and I'm very proud of the tutorials we've created so far. What's really exciting is, together with Jaisal Parikh, we're launching a brand new HIP and SI joint tutorial.
00:00:25
Speaker
In the movement world, the hips and the SI joint get a ton of attention. But at the same time, we see loads of injuries and misinformation all over the place. So what's going on? Clearly, there's some sort of disconnect and an information gap happening. As some of you might know, I have had several hip surgeries, including a hip replacement about 10 years ago. I don't blame my yoga practice for it because there's a meaningful genetic aspect. But I certainly don't think that my years of deep hip openers particularly helped.
00:00:55
Speaker
in large part because the way I practiced leaned into my hypermobility instead of working on the stability and the longevity that my body really needed. There's a lot of unlearning for a lot of us to do around things like hypermobility, SI joint pain, sciatica, yoga butt, and other hip-related concerns. So with that in mind,
00:01:15
Speaker
Laurel, Jason, and I have created a free hips mini course video series for you, in which we address these topics and more, including gender bias and inclusivity, whether we store emotions in our hips, and why demonizing the SI joint is not particularly helpful.
00:01:32
Speaker
Right now, you can sign up for the free mini course, and by doing so, you'll get a discount code for $25 off our full hip and SI joint tutorial. This tutorial is a 4-hour course that includes the anatomy and normal structural variations of the pelvis that can determine how a person might be able to move.
00:01:50
Speaker
how injuries happen, as well as how we experience pain, and of course, a whole lot about how movement can be a solution to specific obstacles like SI joint pain, sciatica, and yoga butt, and tons and tons of exercises for you to try out. If you're interested in learning a more thoughtful approach to movement solutions for yourself and your students, sign up for the mini course and get your $25 discount code for the full tutorial.
00:02:16
Speaker
The link to sign up is in our show notes, or if you follow us on Instagram at movement logic tutorials, the link to sign up is in our bio. And now it's time for today's episode.
Laurel's Personal Journey with SI Joint Pain
00:02:29
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist, Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up to date and cutting edge tools, evidence, and ideas to help you as a mover and a teacher.
00:03:04
Speaker
Hello, hello, hello. Welcome to episode 21 of the Movement Logic Podcast. My name is Laurel. This is our 21st episode. I'm doing this one solo today. My dear friend and co-pilot, Sarah, is doing something else. Today, I want to share a story with you about my persistent sacroiliac joint pain.
00:03:30
Speaker
and how this experience completely changed how I teach and why I teach. It also spurred me to learn a ton about the sacroiliac joint to revise my beliefs about it, which were very pessimistic, to learn about pain and pain science as well. And this story is about how I
00:03:47
Speaker
built up my knowledge base and added some teaching skills for sure but deeper than that foundational to that it's really about how i shifted my language first and foremost the language i used to talk about my body my sacroiliac joined to be specific but also by extension how it shifted my beliefs.
00:04:03
Speaker
about my body and what I thought I was doing as a teacher, teaching people to move, to be embodied.
Language and Beliefs in Movement Teaching
00:04:12
Speaker
Now, I'm no psychologist, as you know. I'm aware, though, that language is powerful. I've been made aware of that through my career as a teacher. Teachers are public speakers.
00:04:22
Speaker
The words we use are very important to what it is that we're teaching and how we're teaching. Words shape, at the same time, whole narratives, whole beliefs about what it is we're talking about. And these layers, words, language, beliefs, these shape identity, and identity shapes behavior, right? So it's all self-reinforcing too, because behavior shapes identity, which in turn shapes beliefs and
00:04:49
Speaker
language and the words we use. So when we say language influences beliefs, we have to realize that in turn, beliefs shape language and so we can't just replace some words with other words. That would maybe come off as really inauthentic, right? We have to kind of get to the root of what we believe and who we are.
00:05:07
Speaker
we believe we are. So this episode has a little bit of anatomy and biomechanics in it, but it also has a lot of stories and language and human psychology wrapped up in it as well. So hopefully you're a fan of one or two of those subjects. And here it goes. I know many of you probably know this about me.
00:05:26
Speaker
About five years into teaching, I had persistent SI joint pain and it was not fun at all. It caused me to have also this identity crisis, this existential crisis even, because the yoga practice that I'd found so much benefit from had started to make me feel bad. The postural practice of yoga hurt and
00:05:47
Speaker
my SI joint hurt the most. I had this really awful dull ache around my SI joint. It would occasionally turn into sharp shooting pain. It would flare up while I was trying to go to sleep at night. It would come up sharp and shooting and awful while walking. Sometimes in a posture would all of a sudden happen where I would just be in excruciating pain and would have to come out of the posture. My hip flexor seemed to be wrapped up in it as well. The pain would kind of wrap around to the front of my hip.
Strength Training as a Solution
00:06:14
Speaker
I believed at this time too that my SI joints were inherently dysfunctional, fragile, and unstable joints in my body. By the way, the SI joint is the joint between your sacrum and your two pelvic halves. You can feel your SI joint if you kind of
00:06:30
Speaker
Place your fingers where the top inner corners of your back jean pockets would be and sort of feel around there. You might feel like a bony protuberance there called your PSIS, your posterior superior iliac spine. That's right at the border between if you go inward toward the midline of your body from those two bumps. Underneath those bumps are the dimples, if you have dimples there. If you go inward of those two bumps, you'll hit your sacrum.
00:06:54
Speaker
So the sacrum is almost kind of wedged between your two pelvic halves and this base between the sacrum and your two pelvic halves called your sacroiliac joints. So I had pain around that area.
00:07:08
Speaker
And I believe because of that pain that my SI joints must be unstable. There's some kind of problem with the joint, I thought. I thought that I had actually made them that way by overstretching the tissues of my SI joints, the muscles, the ligaments, the tendons, the fascia. I believe that in a sense I had almost like misplaced my sacrum, like it had slipped out of place on the right side especially, I thought, that it was kind of torqued. It was too loose on the right side. It was stuck on the left side.
00:07:37
Speaker
I thought that overstretching had contributed to this problem, but also maybe incorrectly aligning my hips, my pelvis, my spine, creating some kind of uncomfortably torqued predicament. And I didn't just feel these things, I vividly imagined them. This was the story I told. That was then, this is now today. Happy to say I don't have sacroiliac joint pain. In fact, I stopped having sacroiliac joint pain almost immediately after starting to lift weights.
00:08:03
Speaker
I went to the gym, personal trainer taught me how to do goblet squats, deadlifts, and to hang from a bar to strengthen my shoulders and my hands in that vertical pull position. Those were the three exercises that I did regularly.
00:08:20
Speaker
And this was before I had my daughter. I had my daughter in 2018. I started lifting weights, I think, more toward 2015, 2016. And I lifted weights all the way through my pregnancy. In fact, I lifted weights four days before my daughter was born and she was born 10 days after her due date. So I was six days late. She was six days late and I was still lifting weights. I was doing all the things.
00:08:44
Speaker
I had zero sacroiliac joint pain during my pregnancy and after my pregnancy. And I don't tell you this to extol or evangelize the benefits of strength training. I mean, I do that plenty. I believe strength training is very helpful and I think everybody should do it actually. But I tell you this because I believe strength training worked for me personally in reducing the symptoms that I had been experiencing.
00:09:06
Speaker
I don't think that it's necessarily the solution for everyone. Research shows that actually exercise in general has been shown to be helpful for people with SI joint pain and exercise is very unspecific. What are we talking about? Strength training specifically helped me
Critique of Movement Assessments
00:09:21
Speaker
but I think it's possible that other types of exercise could have helped me as well. Maybe running or swimming or maybe even just doing Pilates instead of yoga, something maybe more moderate like yoga and intensity, which is different. The point is that during my pregnancy and now, I don't think that my SI joint pain was because I had an inherently unstable or fragile or problematic SI joint. In fact, when I look back on the time before I got pregnant, when I did have this persistent pain,
00:09:51
Speaker
I have revised my beliefs entirely. So let's go back. When I had this pain, I actually never got formally assessed or diagnosed by a clinician. Now, I love PTs. They're my superheroes. I work with Sarah. I think PTs, some of them are phenomenal educators. They are crucial in helping people solve problems with pain. But back then, I wasn't as much of a connoisseur of physical therapists.
00:10:21
Speaker
I wasn't on the up and up in terms of what it meant to be an evidence-based provider and what it meant to maybe not be as much of an evidence-based provider to provide treatment interventions that maybe weren't supported by evidence. I think that there's a lot of both types of PTs out there actually. Now, I think I'd be much more careful in who I choose to help me with something like
00:10:42
Speaker
persistent SI joint pain. Back then I probably just would have gone to the first person somebody suggested or whoever I could afford. But anyway, I'm kind of glad I didn't get assessed, okay? And let me tell you why, alright? So you know I'm a fan of the Physio Network, right? Which is this platform online where people write reviews of research papers, various types of research papers. Listen to Sarah's episode on the three rules of research if you are looking for a crash course on this. Physio Network is awesome because they take
00:11:12
Speaker
meta-analyses, papers, things like that. They look at them and then write about what's in the paper so that people like me can read it and digest it a little bit easier. I don't have to comb through all the stats and whatnot and try to make sense of this really very technical language. These reviewers, they make it really easy for me to understand. So I go on the physio network and I'm reading about SI joint pain and I'm learning that there's two ways that
00:11:37
Speaker
physical therapists tend to assess the SI joint when people complain of pain in that area. One is a provocative test. This is a movement-based assessment where they have the person move in a certain way and then they just observe whether or not that movement provoked pain in the area and then they can rule in or rule out SI joint involvement in whatever's going on.
00:11:55
Speaker
These tend to be reliable, valid forms of assessment. Then there's another type of assessment that a lot of PTs do, and it's a movement assessment where they either through touch or sight palpate or watch someone move and they notice how their SI joint is moving, either by touching the area directly or watching it. As it turns out, despite many PTs thinking that they can accurately assess,
00:12:19
Speaker
SI joint movement and then after that follow through with some type of causative relationship between the way it's moving or not moving in someone's pain they can't actually they can't they cannot reliably assess someone's SI joint movement not only that but SI joint movement is not implicated there's not a strong relationship between SI joint pain and
00:12:42
Speaker
And the way anyone's SI joint moves, not even in cases of joint laxity, so people who have hypermobility syndrome, pregnant people who might have a little bit of joint laxity, whether or not someone has laxity is not necessarily predictive of whether or not they're going to have pain either.
Exploring Causes of Pain
00:12:57
Speaker
I think that I'm glad I didn't get assessed because it's very likely that it would have ended up in a clinic where somebody would have done some type of movement assessment on me and gone, oh, yep, I can feel the side moving more and I can feel the side moving less. And that's why you have pain because your SI joint is torqued.
00:13:13
Speaker
It's displaced. It's whatever. It's dysfunctional and unstable. And this language, I think, would have made my condition worse. Now, maybe the exercise they had given me or the advice they had given me would have made it better. I'm not saying that I completely dodged a bullet by not going and getting assessed. I'm just saying that it's often the case that these non-evidence-based, non-effective assessments
00:13:38
Speaker
just contribute to the narrative of fragility and the narrative of instability and dysfunction that's potentially causing people to be afraid of their body and avoid movement that would otherwise be helpful if they didn't have these fearful beliefs and if they moved a little bit more without so much fear. So why did my SI joint hurt? Well, I don't know, actually. I don't know, but what I do know is it probably wasn't just one thing. It wasn't one thing that I was doing and it wasn't one
00:14:05
Speaker
thing going on with the structure and it wasn't one way that I heard it. It was probably hurting if I put the pieces of my life together back then because I was only doing yoga asana as all of my exercise and most of my physical activity. I was leading a very physically active life. I was teaching multiple yoga classes and teacher trainings all over the city, actually all over the world, living in New York City, running all over the place.
00:14:32
Speaker
practicing fairly challenging yoga poses. In other words, I don't think that my yoga practice as the thing that was supposed to prepare me to be able to do all of this was adequately preparing me to be able to do all that. I don't know that it was challenging my body enough. It wasn't necessarily making me more robust or resilient from a musculoskeletal sand point. Additionally, in my practice of these postures,
00:14:55
Speaker
that I was teaching I was adhering to what I believed was this optimal alignment all the time so I had this belief that there were optimal ways of aligning a body that we should seek to find all the time and then there were these suboptimal ways of aligning the body that we should just avoid.
00:15:10
Speaker
And I identify it as an alignment-based teacher. So here's how my identity as an alignment-based teacher, how I differentiated myself in the marketplace, my specialty and why people came to me, or at least why I thought they were coming to me was to help them align and move their body intelligently.
00:15:28
Speaker
Well, safely, these are words that I would use. In terms of language I use, I think I'd often encourage certain types of alignments as being more stable over others that were less stable or more safe over others that were less safe. I was micromanaging joint positions a lot, like preventing movement at one joint to maximize it in another. Not that that's inherently wrong, like it's not
00:15:48
Speaker
Inherently wrong to be able to differentiate say movement of the hip from movement of the lower back it's just that if you are always doing that because you feel like letting for example the lower back flex when the hip flexes is dangerous or letting the pelvis tilt.
00:16:03
Speaker
forward at the base of the spine when you're back bending so the lower back arch is a little bit more, right? If you feel like those things are inherently dangerous to do, you're never going to do them, right? But you're also going to have this sort of hypervigilant fear around the body in those positions as though like, if we don't go there, watch out, right? And that type of expectation for pain or danger is certainly not going to help someone who has pain
00:16:28
Speaker
have less pain. Meanwhile, and in addition, a recipe for overuse injury, if you're interested in having an overuse injury, just kidding. I know no one is, but if you have an overuse injury, it's possible that one of the ways you got that was by repeating emotion over and over and over again without variation. And if you think about it, this was the way I was approaching my yoga practice. It was repetition without variation. I repeated the right alignment all the time. Neutral spine, hips rotated or flexed or extended, just so feet aligned,
00:16:58
Speaker
particular way, very linear, a lot of straight lines, a lot of sagittal plane movements, like movement forward and back, but not side to side as much or maybe not as much rotation. Certainly not multi-planar, right? A combination of movement through the planes, twists had to be done a certain way. There's a lot of rules about how things should look, even how they should feel. Lots of prescriptive language, lots of prescriptive movement, lots of moving for the purpose of aesthetic
00:17:24
Speaker
kind of looking a certain way and not as much for discovery, for inquiry. Then I was avoiding these myriad wrong ways of moving and aligning myself in a very kind of repetitive way over and over again. It may have even, unbeknownst to me, been incredibly helpful for me to
00:17:39
Speaker
explore those wrong alignments regularly because that would have given my body more variety. Additionally, the language I used to describe the sacroiliac joint in particular was also pretty pessimistic in the sense that I thought that everyone's, basically everyone's SI joint was pretty unreliable. Like just watch out for that area. It's very delicate. It's very fragile. And then a lot of people with pain, I thought it's because me included, it was a dysfunctional or unstable area.
00:18:06
Speaker
I had a lot of friends at the time who were yoga teachers along with me who also had SI joint pain, so it wasn't just me. We kind of all bought into this idea that there were actually certain poses that were probably the culprit, certain categories of poses that were the culprit. We started kind of axing out these poses and just deciding, you know what, I don't do that pose anymore because it's not good for me. It's bad. It causes me pain.
00:18:30
Speaker
Let me give you some examples, and maybe you've had this as well, or you can identify with this, or you still believe these things. I don't know, but for example, twists were very, very suspect. But it wasn't just like all twists. It was like how you were doing the twist. So there's this idea that you shouldn't let your pelvis turn in the direction your spine was turning. You should prevent it from turning, and that would be better for your SI joint. Then there was this whole other camp.
00:18:58
Speaker
that said the exact opposite, which was that if you keep your pelvis fixed, level, saying parivritta tricunasana, twisted triangle, can you picture that pose where you're folded forward, your legs are kind of
00:19:12
Speaker
scissored apart, you fold it over the front leg, your spine is neutral probably, right? If you're doing it right, quote unquote, right. And then let's say your left hand is down and your right hand is reaching up and your spine is rotating to the right. So if you let your pelvis rotate with your spine, that means the left side of your pelvis would move toward the floor as the left side of your rib cage moves toward the floor. Some people said that was what was causing the problem. Some people said that that was what you should do.
00:19:40
Speaker
to avoid the SI joint pain problem. But then there was this other camp of people that would say, no, no, no, no, no. You have to keep your pelvis fixed, level with the floor. Don't let the pelvic halves shift position. Don't let the pelvis rotate. Keep the pelvis level and just rotate the spine from there. And that's going to be better for your SI joint. But then the other camp was like, no, no, no, no. That's what's causing the problem. That's what's torquing the sacrum.
00:20:08
Speaker
I mean the minutiae of what we're talking about here is like a matter of a few degrees of movement and somehow we've decided that like allowing the pelvis to move or not move is responsible for yanking the sacrum out of place at the SI joint. Wow, I mean relatively speaking like those would be very low forces distributed through the joint compared to like some trauma that you would experience.
00:20:32
Speaker
in a car accident, right? But yet we felt that those forces were high enough or that the sacrum, the SI joint was fragile enough to where those very low forces would be enough to dislocate the joint. Warrior I was banished. Asymmetrical poses in general were thought to be problematic. Definitely no more splits pose, wheel pose, especially if you lifted one leg up in that big back bend.
00:20:56
Speaker
Don't do that anymore. Back bending in general became rather suspect, especially there was a big argument about how the hips should be rotated. Should you let the hips turn out? Oh God, no, that's really gonna crunch your sacroiliac joints. And that was the word that people would use. Teachers would use crunch, right? Or gosh, don't engage your glutes. Or if you engage your glutes, don't engage them too much. Or I've even heard, engage the lower glutes, but not the upper glutes.
00:21:24
Speaker
Pretty sure there isn't a lower in an upper glute. Then there was the idea that, oh no, actually you should engage your glutes a lot as much as possible. That's going to protect your SI joint. Oh, and you know what? I think we have SI joint pain because our glutes have turned off. Gluteal amnesia is to blame. All types of, by the way, gluteal amnesia is not a thing. Your glutes, if you can stand up from the chair you're sitting on, your glutes are working just fine.
00:21:50
Speaker
uh there was you know a lot of distrust for a lot of different poses and then also sometimes whole ways of engaging with the practice like passive stretching got a really bad rap i think what we thought we were doing with passive stretching i'll speak for myself is like if i were doing something like the splits pose or like a big kind of
00:22:09
Speaker
try to get your leg behind your head type of pose. It was akin to ripping the drumstick off of the turkey or something, that we were these sort of inanimate objects that would just kind of fall apart if we pulled on ourselves too much. And one of the thoughts was that doing these big passive stretches would potentially dislocate your SI joint somehow. There were a lot of things we just thought were causing the problem. We avoided then. We canceled even.
00:22:36
Speaker
hypervigilance was really at the root of all of this though. It was like people were afraid. I was afraid. I didn't know what was causing my pain. And so there was just a lot of fear and distrust of the practice, especially the poses that provoked pain, of course, but then also just of my body. Now, meanwhile, did you know that according to science, the only established cause
00:22:57
Speaker
of SI joint pain, this is the established cause, this is the one they can show for sure, is trauma. So think car accidents. That's a lot of force, that's a lot of impact that would take place through the pelvis potentially. You're in a car accident, yes, that would be causative of SI joint pain.
00:23:15
Speaker
That's different than correlation. That's different than being predisposed to SI joint pain. There are also activities and conditions that can predispose people. These conditions don't necessarily cause SI joint pain, but people who have these conditions are found at higher percentage levels to maybe suffer from SI joint pain. So for example, pregnancy.
00:23:35
Speaker
People who are pregnant could have more SI joint pain than people who are not. Golf is a sport. Golfers tend to have a lot of SI joint pain. That tracks with my anecdotal experience. My father was a golfer. He did golf a lot and he had a lot of low back pain and SI joint pain. Even people who do stepperobics and use the elliptical at the gym might be more predisposed to SI joint pain.
00:23:54
Speaker
I mentioned this a little bit, but anecdotally, I said I wasn't alone back then. A lot of yoga teachers said SI joint pain too, and so I wonder if there's something about the yoga practice that might also predispose people to having SI joint pain. You know, I would cover teachers' classes who couldn't teach because they were in so much pain. A lot of my friends who we would commiserate over, you know, all the poses that we hated now because our SI joints were hurting.
00:24:17
Speaker
And listen, for sure, stopping the poses that we thought were hurting us was a good idea. That makes total sense. Of course, you would stop doing the thing that was hurting you, at least for a while. But stopping movement, continuously stripping away movement, demonizing movement, is not going to address the underlying cause of why someone has pain to begin with, which likely wasn't that specific, right?
00:24:41
Speaker
It wasn't probably as specific as saying a pose or a type of pose is what's causing this pain. My studies in pain science, as I mentioned at the top, is really where I attribute the most amount of growth I've experienced in terms of how I think about my body, specifically when I have pain.
Pain Science and Language
00:24:59
Speaker
And it's been very helpful for me to understand pain science. During these times when I am in pain, it's helped me avoid these really unhelpful, catastrophizing narratives that
00:25:10
Speaker
in my past with my SI joint pain really just made my pain worse. One of the things that pain science has taught me that is really not intuitive, I'm just going to say it, it really doesn't make a whole lot of sense, but it's been born out numerous times, very strongly, strongly supported by the research is that
00:25:31
Speaker
pain and tissue damage don't strongly correlate. So you can have an injury like that you could see in an MRI and have no pain. You could have pain and get an MRI and have no injury. You could even have pain and the MRI could show an injury, but it could turn out that that injury was not what was causing the pain. It was something else. It's wild. But this has helped me rewrite my narrative around
00:26:00
Speaker
why my SI joint hurt. And it's helped me do so in a way that no longer problematizes my SI joint, my student's SI joints or the SI joint in general. Pain Science has always also been incredibly helpful for helping me to recognize the power that words have
00:26:17
Speaker
influencing what people believe is happening in their body. Listen to Sarah's episode on pain and she tells a story in there about how one of her patients thought that their spinal disc was putrid and rotting and Sarah explained to her that it actually, the opposite, it had fully healed because
00:26:35
Speaker
The timeline had been such that the disc would have already healed and just in rewriting that narrative, this woman's pain decreased fourfold. She had like an 80% amount of pain on the scale and it went down to like 20% or something like that.
00:26:49
Speaker
It makes sense, right? The language shapes our beliefs. Scary words make us afraid. They provoke us. They trigger us. Beliefs that something like the SI joint is inherently unstable structure shapes how we show up as teachers, our identity as teachers, as maybe people who are there to protect our students' SI joints because they're vulnerable structures. And so then the language we use is very protective. Not to mention the fact that when we're afraid,
00:27:15
Speaker
that we're gonna hurt ourselves we're less likely to move and when we move less we tend to have more problems with pain. Words are powerful and I think words the language we use should be as closely considered and worked on as the movements and alignments we teach. The problem is that it's not so simple
00:27:36
Speaker
to just start replacing some words with other words until you've really examined your beliefs and until you've found strong enough evidence to compete with the beliefs that you currently hold and the evidence that was provided.
00:27:49
Speaker
to you for those beliefs and also until you start to examine and maybe shift your own identity and why you're there and the story you tell about
SI Joint's Role in Evolution and Stability
00:27:59
Speaker
that. Therefore, in service of that process, perhaps I could share four reasons why the SI Join is inherently stable, functional, reliable, amazing even.
00:28:11
Speaker
So here we go, let me give you four reasons and some books to read. Okay, reason number one, evolutionarily speaking, I think there's a very strong argument for the statement that humans are the most successful animals on the planet. Not necessarily the best mammals or animals for the planet, but we've been very successful.
00:28:30
Speaker
And our sacroiliac joint is in no small part responsible for that. So if you've read this book, you know it's excellent. If you haven't read it, you should read it. It's called The Story of the Human Body, Evolution, Health, and Disease by Daniel Lieberman. And he writes a lot about Darwin, of course. One part of the book he talks about how Darwin's theory for why humans were able to evolve to having such
00:28:54
Speaker
Huge powerful brains is actually, it started when our human ancestors that had just evolved from apes became upright. In other words, where we went from walking on four legs or limbs to two legs. Because what happened then is by going from four to two, we freed our hands up.
00:29:12
Speaker
And our hands then allowed us to explore our environment and make tools. And these tools allowed us to further explore and learn from our environment to make more sophisticated tools and on and on and on. And it was really the emancipation of our hands to make tools.
00:29:29
Speaker
that caused our brains to grow. Well, why could our hands be free? Well, because we were walking upright. One of the most important, what you'll, I'll quote another author here soon, but one of the most important hubs of force mediation is your sacroiliac joint. Okay, so another book to read is the book Born to Walk.
00:29:48
Speaker
by the author James Earls. If you like fascia, you'll like this book. It goes in depth about the mechanics of walking and how humans are the most efficient land mammals on the planet. Did you know that we can out walk every other mammal on the planet? We can't run faster than them, but we can walk longer because we're so energetically efficient at walking. We don't have to expend a whole lot of energy. One of the reasons is that we can walk with very little active muscle contraction.
00:30:15
Speaker
This is because we can use our soft tissues and the elastic recoil of those soft tissues and the efficiency of that passive force production from the tendons in the fascia to propel us along. And James Earls named the sacroiliac joint as that hub of force mediation through the pelvis that allows us to transmit forces from the ground all the way up to the swinging of our arms, which comes from the rotation of our spine. It's a beautiful, beautiful book.
00:30:44
Speaker
Unstable structures are very poor force mediation structures when compared to stable structures, and since one of the main purposes of the SI joint is to transmit forces from the ground to the spine, it follows that it would be a very stable structure inherently. The sacrum is the base of the spine, and it's wedged between the two halves of the pelvis, which are the innominate bones.
00:31:10
Speaker
The forces from the ground travel up our legs, into our hips, to our pelvic halves, through the pelvic halves to the sacrum, from the sacrum up the spine. And this has been a very successful structure, evolutionarily speaking. Unsuccessful structures, unsuccessful traits, unsuccessful characteristics.
00:31:32
Speaker
in terms of the evolution of biological organisms don't tend to stick around very long. So the SI joint evolved to allow us to transmit forces from the ground so that we could walk with incredibly efficient mechanics of gait as well as all the other ways we humanly move. Alright, reason number two, the SI joint can move a little, not more than 0.5 degrees when standing.
Anatomy and Stability of SI Joint
00:31:55
Speaker
However, believe it or not, clinicians cannot assess accurately whether or not it's moving and how much. And I mentioned this before, but it bears repeating. What this means is that because of this unreliability in clinicians' ability to accurately assess sacroiliac joint movement, it follows that if this assessment of the movement of the joint is unreliable, any prescriptive diagnosis they make based on that movement as being causative to pain is bullpucky.
00:32:24
Speaker
Man, bullpucky, there's a word. Haven't used that one probably ever in my life, but hey, saved it for the podcast. So what does this mean? It means that additionally, yes, the SI joint can move, whether or not and how much it moves has not been shown to be causative to pain, nor has laxity of the joint.
00:32:43
Speaker
So you can have ligamentous laxity and have no pain, and that'd be just as likely to happen as if you don't have ligamentous laxity and do have pain, right? So it's not causative. Reason number three that your SI joint is not unstable, bones and joint
00:32:59
Speaker
Tissues of the SI joint are what make it incredibly stable, namely how the bones fit together and then how the ligaments, the very powerful ligaments made up of incredibly strong collagen hold those bones together. The sacroiliac joint is made up of the surface of the sacrum.
00:33:18
Speaker
the two sides of the sacrum kind of faceted to the two sides of the pelvic halves. And there's surfaces, both surfaces, the sacrum and the pelvic half are rough, so they kind of fit together in this very high friction way, which prevents translation, movement, sliding, makes it very stable. But there's also this curved shape to the sacrum and then kind of a bony ridge, a prominent ridge at the top, which locks the sacrum into place.
00:33:46
Speaker
So it's very secure from that standpoint. But then on top of that, we've got all these massive ligaments. If you look at an anatomical rendering of that area of the body and you see the ligaments across the joint, they're huge. And then there's the way that, just from a mechanic standpoint, gravity helps kind of wedge the sacrum between
00:34:08
Speaker
the pelvic house, but then how ground reaction force helps wedge the pelvic house back into the sacrum. So through compression, this joint is held together very securely. This is what's called form closure. Reason number four that your sacrum is reliably stable is that it's thought that the muscles
00:34:30
Speaker
do contribute to the stability of the SI joint, but it's possible that they aren't as important as we think. This is something that is debated. This idea of there being forced closure or muscles being responsible for the relative stability of the SI joint is one model. It's one way of thinking about how this joint is or isn't stable. One of the largest, most powerful muscles of the body, the gluteus maximus,
00:34:56
Speaker
is not very active during walking, right? We know that human gait is very energetically efficient, which means that there's low muscular involvement in gait. The gluteus maximus is also one of those muscles that contributes to this forced closure, right? It crosses the SI joint. But if it's not active during standing, it's not very active during gait, that would mean then we'd be almost at risk of our SI joint kind of slipping out of place while standing or walking and we're not. So that one's up for debate, but if
00:35:24
Speaker
our biggest, strongest muscles aren't as active in this movement that we do all day long and that we can do very efficiently like the gluteus maximus in walking. It would follow then that maybe muscles aren't as important to the stability of the SI joint as we think and that it's actually more of bony and ligamentous stability that we're benefiting from in this area.
00:35:47
Speaker
And what that means is that a muscle's relative strength or weakness maybe has no impact on how relatively stable or unstable our sacrum is.
Narratives and Pain Perception
00:35:58
Speaker
We could potentially alleviate the symptoms of pain around the area by strengthening our muscles, but it wouldn't be because we made our SI joint more stable, if that makes sense.
00:36:06
Speaker
So back to when I had persistent pain. During this time, I was operating under this narrative, as you know, that my SI joint was unstable. I had thought it was torqued. I thought specifically that my right side was really loose. My left side was stuck. And I visualized this looseness on the right side and this stuckness on the left side any time I had pain. I could visualize almost like this floppy right side and this really rigid, wedged, jammed left side. And I would do things to try to get the floppy side
00:36:35
Speaker
to not be so floppy and the left side to be less jammed or stuck. But the things I was choosing to do were like, you know, yoga type stuff, somatics, things like that. Pelvic clocks, you know, various kind of cat cow type things while sitting, really low load stuff. It wasn't working. However, unpredictably to me, there would be times when I didn't have pain.
00:37:03
Speaker
Of course, since I didn't know what caused the pain, I also didn't know what caused the relief from the pain either. But during these times when I didn't have pain, I thought, oh, okay, my sacroiliac joint now is in place. It's not torqued.
00:37:17
Speaker
So I had this whole specific story of what was happening and what was causing my pain. The story I had was almost like a knife or a scalpel. It would be able to dissect away all of the other possible causes for my pain, all of the possible contributors, and carve out this really neat, tidy explanation. And then the actions that I took to fix my pain had to fit very narrowly
00:37:42
Speaker
within this narrative as well. And that being said, you know, I'm not trying to say that stories, right, are the problem. I think those are incredibly human as well. We use stories to cope and make sense of our complicated, unreliable, illogical, nonlinear lives and hopefully try to make them feel more coherent, less confusing, more consistent. They can ground us. Stories can give us a feeling of control over situations that are
00:38:07
Speaker
ungrounded and out of control. We like stories. We like stories with a protagonist and an antagonist. We feel very satisfied when we can name a specific culprit, the dysfunctional tissue, the unstable joint.
00:38:24
Speaker
And we also like it when we can name one solution, right? Such and such a teacher's class, this particular exercise, these brand of therapy balls, this one muscle that I needed to release the psoas, this one muscle that I needed to strengthen, the glutes, right? Or when we engage in a specific modality like,
00:38:48
Speaker
strength training, right? We like to name those specifics as being the protagonist or solution to our specific antagonist or culprit. But the fact of the matter is, what I've learned is that pain is always multifactorial.
Identity and Beliefs in Teaching
00:39:04
Speaker
There's always a myriad reasons why we have pain. This means that there's probably going to be a number of things we can do to decrease our pain
00:39:12
Speaker
And the wider the net we cast, the more things we try, not just physical things, but also lifestyle things. The biopsychosocial approach, addressing the biology of the issue, but also the psychology of the issue, the sociology of the issue, things that we can change about our environment, for example, the people we hang around. These are all possible solutions to the pain because there's rarely one mechanism at fault. And as a result, there's rarely one solution. We need a multi-pronged, multi-layered approach.
00:39:43
Speaker
But yeah, stories, they can give us a feeling of control, lend some coherence. And so doing sometimes what happens is that we cut off or close off ourselves to solutions that don't fit that story, that don't fit that narrative. For a long time, I would never have even been willing to entertain the idea that I needed to strength train because my identity was wrapped up in being a yoga teacher.
00:40:06
Speaker
which means that my identity was wrapped up in being relaxed, calm, peaceful, present, mindful. And there was associations with these qualities with moving slowly, not efforting, breathing quietly and deeply.
00:40:24
Speaker
But let me tell you what, when you strength train, you are not relaxed. You are probably not breathing slowly. Sometimes you might be holding your breath. You might be grunting. Exertion levels are high, right? You can be mindful while strength training. But in the beginning as a beginner, strength training, this was very confronting. It really challenged my identity because you see, I had identified as a yoga teacher, but more than that, I had identified with this idea that being good,
00:40:53
Speaker
But being a good person meant that I was relaxed and peaceful and calm and not efforting so much, not trying too hard. And the flip side of that was that any time I wasn't calm and peaceful and moving slowly and mindfully and breathing deeply and feeling soft and relaxed meant that I wasn't good, meant that I was not the kind of person that I thought I wanted to show up as in the world.
00:41:23
Speaker
Okay. That's deep, I hope.
00:41:26
Speaker
I've painted a clear picture at least from my personal perspective of why getting out of SI joint pain was more than just about starting strength training and why changing my teaching was more about just starting to teach new modalities. No, I had to change my language, change my beliefs, change my identity. I had to reconceive of myself. And that took a lot of time. Why did I have SI joint pain?
00:41:55
Speaker
Well, I think in general, there was a lack of movement variety. There was a lack of sufficient stimulus to challenge my tissue's capacity. But ultimately, I don't think it's our job as teachers for sure to tell students why they have pain. We don't diagnose.
00:42:14
Speaker
We don't need to be like an out of scope surgeon with a scalpel dissecting away everything that could be causing pain to get to one cause or one solution. That's not what we do. Instead, maybe we can be more like successful Fisher people who cast a wide net over the problem. We offer movement solutions that make the systems of our students' bodies more resilient. We expose their brain to novel sensations.
00:42:41
Speaker
so that their brains can respond with novel movement output, hopefully pain-free output. We can catch a lot of fish potentially in this way, and maybe potentially many of these fish slash outcomes will be helpful in addressing the underlying causes of their pain.
00:43:02
Speaker
We can simply make the areas of their body that are not as resilient and robust as they could be more resilient and more robust, more tolerant to loads.
Approaches to Exercise and Resilience
00:43:11
Speaker
And we don't do this by narrowing how we move. We do this by expanding how we move. We don't do this by reducing tissue tolerance to load. In other words, we don't do this by reducing the forces that our tissues can manage. But in many ways, we do it by
00:43:25
Speaker
increasing the forces that our tissues can manage over time. This looks different to different people, right? So I think probably it's the case that many yoga people, and I know that in my little community, my little bubble, there's lots of yoga people who have started strength training and seen immediate improvements to their pain. But what about people who exclusively strength train and have SI joint pain, for example? I bet you a lot of them would benefit from doing yoga. It may be that initially you needed to stop doing certain things, yes,
00:43:52
Speaker
But eventually, after this pain, the SI joint pain, for example, is calmed down, you might want to find ways to add those things back in at the appropriate dosage and to train your tissues, to train our students' tissues and nervous system to be able to handle those loads. And maybe even loads even greater in significance. Hopefully, what you've taken away from this episode is that as movement teachers, we're not just teaching movement.
00:44:20
Speaker
We're shaping our students' beliefs about their bodies, and this has a direct impact on how they feel in their bodies, both when they're in our presence and when they've gone and left to continue on with the rest of their day and even the rest of their life. We change lives with the words that we use, because to a large extent, teaching movement is about choosing language to communicate. And I would encourage you
00:44:49
Speaker
Choose language that is optimistic that instills a sense of resilience, positivity, confidence in the body. Not by sugarcoating it, not by telling a lie. If someone's in pain, they're in pain and it's important to definitely validate and acknowledge and listen to that.
00:45:08
Speaker
but don't reinforce whatever fear or hyper vigilance they have by referring to their body as being inherently incapable or unstable. Instead, examine your own beliefs about the body.
Encouragement for Continued Learning
00:45:22
Speaker
Are they true? Is whatever pessimism you have
00:45:26
Speaker
well-founded, question your narrative, challenge it by trying to move in new ways, challenge it by listening to dissenting voices, and see if over time, like it did for me, if it actually changes how you see yourself, if it changes what you think you're there to do, if it shifts what you show up to help your students discover and learn.
00:45:51
Speaker
All right, well thank you so much for joining me today. As a reminder, nudge nudge, if you would like a free mini course that will go a long way toward shifting your beliefs about the hip and SI joint, not in a way that tells you what to believe, but rather in a way that might help you open up around some of the beliefs you currently hold and start to question them,
00:46:16
Speaker
maybe soften some hard edges around some of the beliefs you have and make space for other more nuanced views. You may want to get on it and get signed up for the free mini course that you will get delivered straight to your inbox. Head on over to the show notes and sign up for that. That mini course is going to only be available until I believe November 8th, so it's available for a limited time only.
00:46:44
Speaker
Thank you so much for listening today. I hope this conversation has been helpful. You know what I'm going to ask. If you can spare a minute, please rate and review.
00:46:55
Speaker
our podcast, Movement Logic Strong Opinions, loosely held. It helps us enormously get the good messages out there about the SI joint and also all the other topics that we talk about to help teachers teach with more purpose, more clarity, more nuance, more critical thinking, and just more joy and fun.
00:47:16
Speaker
If you want to watch me talk to myself in my basement, you can watch the video version of this over on our website www.movementlogictutorials.com. If you're not on our mailing list, you can get on our mailing list. If you don't want the free hip and SI mini course, fine, still get on our mailing list because there's more coming down the pike.
00:47:35
Speaker
in terms of continuing education around the hip and SI joint that you are definitely not gonna wanna miss. Movement solutions for conditions like sciatica, yoga butt, hypermobility syndrome, tightness, just generally having tight hips, sacroiliac joint pain of course, and so much more. So get on our mailing list if you're not already. Thanks for joining me and we'll see you next week. This was baked into my identity and it's how I earn money for survival.