The sacro-iliac is quite possibly the most mysterious and misunderstood joint among dancers. As a dancer and a yoga teacher, when I hang around with my dancer friends, I spend a lot of time releasing stuck, jammed and pinched sacrums (they call me the SI joint whisperer). As delightfully satisfying as a recently-released SI joint can feel, (note from Monika- BEST. FEELING. EVER.) I have realized that constantly putting it back where it came from is like using a cup to catch water from a leaking bucket just so you can pour it back into the bucket – that is, rather inefficient. This realization plus my own lengthy history of pain in the posterior hip and spine have led me on a search for long-term solutions in the form of alignment, conditioning and neuromuscular re-patterning.
An injury back in high school began my long journey to understanding my SI joint. I was dancing every night as well as playing soccer, and woke one morning with a pain in my back/hip, a pain that eventually moved into my knee.
For weeks I felt I’d ‘lost my bounce’, because jumping sent a ricochet of pain all the way from my toes to my neck along my right side. Being young and stubborn, I did not seek medical attention or even apply an ice pack. Instead, I just tried to dance it off. Though the intense pain eventually went away, my right hip and knee were never the same. Fifth position and attitude derriere caused pinches and twinges in my back and I constantly had an incredibly tight IT band.
But I continued to dance anyway (See Monika’s article “The Problem with Dancers Today” for more on this).
For three years I was held hostage by the twinges, aches and pains that seemed to move around to a different part my body every week. Then, in my second year at York, a ballet teacher suggested that maybe one of my legs was longer than the other. Intrigued, I went to a physiotherapist who said that they were, in fact, the same length, but my SI joint was stuck on the right side.
That first SI adjustment changed my life – for a few weeks anyway. Not knowing that this was something I would eventually become very passionate (ok, maybe a little obsessed) about, my early efforts to maintain this new and wonderful SI joint balance were half-assed at best. Going to physio each week became more like going for an SI release every week. That is, until my PT got fed up and showed me how to release it myself. Then, she began teaching me how to activate my deep core muscles, which blew my stubborn dancer’s mind.
In the 6 or 7 years since, the amount of attention I’ve paid to the problem has varied in relation to the wide assortment of injuries and misalignments I encountered. I would try to dance (or swim, do yoga or even walk) with my SIJ locked. Then, I would have to spend several days dealing with the after-effects only to have it happen again the very next week.
I learned the hard way that the best offense is a good defence, and began addressing my SIJ with daily re-patterning work about a year ago.The improvement has been magical.
Certain activities (especially if done when tired or distracted) will still throw my SIJ off, but now that I know the symptoms (non-specific pain in my knee and IT band) and the solutions (I live for pelvic smile and seated fourth release!) I no longer suffer daily from the repercussions of poor patterning.
My method may not be the simplest, but I find it very effective, as do many of my students. Stabilizing your SIJ, especially if you are a dancer who expects your body to maintain a large range of motion, should be a daily practice. Tight muscles will pull the SI out of alignment, and the body’s compensatory efforts will keep it stuck there.
If you have SI joint issues, chances are good that they are supported by years of well-intentioned but inefficient movement patterns. (Note from Monika- I agree… the road to dance injury is paved with the best of intentions).
I don’t say that to discourage you, I say it to help you understand that you can’t half-ass this if you want it to work. Trust me on this one, I’ve lived through the drama and made it to the other side. A happy SI joint will improve your movement in a million little ways that you can’t even imagine until you’ve experienced it. It takes some time and effort to find what works for you, and to figure out how your body tells you that it needs attention, but it is SO worth it!
Anatomy: What is the SI joint and how does it work?
The Sacro-Iliac joint is in fact two joints – one on each side of your sacrum where it meets the back of your pelvis – specifically, the inner edges of the ilium. You can find these spots by looking for the dimples at the back of your pelvis (just above the crease between your cheeks). The bump you will feel near each dimple is your PSIS or Posterior Superior Iliac Spine – anatomy-speak for “the bony bump at top of the back of your Ilium.” The SIJs are weight bearing joints that provide shock absorption for your spine and distribute the weight of your upper body onto your pelvis and into your legs and feet.
There is some misinformation out there that states that the SI joints do not move, but in a healthy body this isn’t true. To be fair, the SIJs are not designed for a large range of motion as they are stabilized by many deep ligaments. Especially in the type of loose-jointed (which is to say, long-ligamented) bodies that dancers tend to have the bones do move in relation to one another, and when they do they cause widespread (though usually subtle) shifts in overall alignment. Rather than a ball and socket joint like the hip and shoulder, or a hinge joint like the elbow and knee, the SIJ is a gliding joint, more like those found in the spine, where two relatively flat articular surfaces slide against one another. (You can find out lots more nerdy pelvic anatomy stuff on Wikipedia if you’re interested!).
So, if your loose ligaments aren’t holding the SI joints stable, what is? That would be your deep core muscles, namely the transverse abdominus, multifidus, piriformis and ilio-psoas. But there are a number (some say as many as 35) of other muscles that have a connection with the SIJs including the gluteus maximus and minimus, erector spinae, latissimus dorsi, quadratus lumborum (QL), hamstrings, quadriceps and tensor fascia latae as well as the IT band. You would think with so many supporters the SIJs would be good and stable, however all of these muscles also have other jobs to do when the body is in motion, and when those other jobs take priority over SIJ stability, it can throw all kinds of things out of whack.
Side note: SI joint dysfunction is sometimes called “piriformis symdrome” because the piriformis in one of the primary culprits for malfunction, especially in dancers who overwork their turnout. While piriformis syndrome may well be caused or aggravated by SIJ dysfunction, it is a distinct problem that affects only a small portion of the general population. In less than 20% of bodies, the sciatic nerve runs through the middle of the piriformis muscles (instead of underneath it) and when the piriformis is overly tense it pinches the nerve, causing a radiating pain down the back of the leg. The only way to determine if you fall into that 20% is by cutting your butt open to take a look so you may never know for sure, but if you have a shooting nerve pain that starts in your buttocks, you can bet that your sciatic nerve is being irritated by your piriformis.
Symptoms – What do unstable SIJs feel like?
SI joint instability is a bit of a misnomer. What I see in many dancers are SI joints that have become locked into place by tight, weak muscles. In an effort to protect what is an especially loose joint in dancers, the body tenses up resulting in a joint that is in fact too stiff for its own good.
As I said before, the SI joints should move, not a lot, but just enough to transfer information from the pelvis and legs to the spine and back again. When this doesn’t happen, because the joint has locked into place in the interest of self-preservation, pain can sometimes be felt at the back of the hip near the dimples. But the body is crafty, and in a dancer’s loose body, the spine, pelvis and hips can shift subtly to work around the blockage. In cases like this, pain might not be felt at the SI joint at all. Rather, the over-stability there will cause instability in other locations – typically in the front of the hip, the low back and the knee, but sometimes all the way down to the toes and up into the neck. (For me, I don’t feel anything in my SIJ until after I notice a pain in my knee).
Usually the piriformis, and often the QL and glutes will be very tense, (Note from Monika- Yep. So. Tense.) and could even be in spasm. To make it more complex, a problem with the right SI joint could very well cause pain in the left side of the body, as the brain will just reassign whichever nearby muscle is strongest to cover for the weak ones that are busy tensing up to create more “stability” – essentially, to use the technical term, an “anatomical cluster-f#$%.”
Try this at home: If you suspect your SI joint is locked, you can get a friend to try and help you determine on which side. Standing tall with the feet parallel, have your friend stand behind you and place their hands on the SI joints, just above the dimples. Raise one knee to hip height slowly, then lower. Repeat on the other side. If your friend feels the SI joint lift upwards when you raise your knee (instead of staying still or moving down slightly) the SI joint may be locked on that side.
Causes – What makes dancers so vulnerable to SIJ cluster-f#$%s?
Most people are stronger in the outer hip and weaker in the inner thighs as a result of sitting for long hours and standing with poor posture. Dancers tend to be looser-jointed than the average population, as the dance world has a way of discouraging those less flexible folks. Add to that the dancer’s affinity for overusing the outer rotators to create more turnout as well as a penchant for general over-exertion and you’ve got a recipe for SI disaster. The SI joint was simply not designed with turnout in mind, as most mammals move most efficiently in the saggital plane. But that’s not to say that dancers and their SI joints can’t be friends. In fact, you too could very well become BFFs with your SI if you regularly practice the exercises which will be outlined in part 2.
Here’s a little about Bizz:
Bizz (Elizabeth) Varty has a passion for dance, music and mind-body fitness. While completing her Honours BFA in Dance at York University she discovered her love for dance science and kinesiology. She also studied Arts Management at Humber College and is certified as both a pilates and yoga teacher.
Bizz has studied dance for more than 20 years. She has choreographed and performed across the province including her 2009 work, the Janis Joplin-inspired piece Honey, I Know How You Feel for the BAZAAR dance festival at Toronto’s Opera House. Along with Beth Lifeso, she is co-director of Cocktail Dress Productions, who have performed at Massey Hall and The Rivoli in Toronto.
Her interest in fitness began at a young age and she has been practicing Yoga and Pilates for 15 years. Her teaching style combines the precision and efficiency of pilates and the philosophy and flow of yoga with the creative expression of her dance background. Bizz’s attention to anatomical detail and her fun, engaging instruction have earned the respect of students of all ages and backgrounds. For more info and free videos, visit www.basicfitness.wordpress.com.