As a yoga practitioner + teacher who has experienced chronic pain off and on for over 20 years due to a sports-related injury in high school, I know firsthand how vital it is to have an intimate understanding of our pelvis and sacrum. Yoga therapist Olga Kabel of Sequence Wiz (whose vision statement “every yoga practice must have purpose, order and meaning” resonates deeply with my own approach) explains it clearly here: Too many asymmetrical poses can create sacroiliac joint issues. I can attest that the simple and functional exercises I learned from a friend (also a yoga therapist in the viniyoga tradition like the author of the blog linked above) have been an enormous help to me in maintaining pelvic/sacral stability.
Embodied Wisdom: A Twenty-Year Lesson on Chronic Pain + Rehabilitative Therapies + Yoga
Back in 2006, I remember being baffled when a physical therapy assistant told me to stop practicing yoga even though the stretches for my super tight iliopsoas muscles (deemed the culprit for my back pain) were similar to the asanas (like lunges and pigeon pose) that seemed to help relieve the tension in that area. She offered no further explanation that I can recall, so I was hardly convinced it was problematic. I loved how my body felt in postures and appreciated the skill with which my teacher instructed.
Even before starting my teacher’s training with her that summer, I came to experience the potential of yoga as a lifelong journey of self study and refinement. Coupled with my study and practice of Zen Buddhism, I knew that it had less to do with what happened physically on a mat and far more to do with generating compassion, equanimity and resilience of heart and mind in order to nourish skillful understanding of ourselves and skillful relationships with others. Asana can be used as a skillful means of clearing tension in body, heart and mind. However, what has become clear to me over the years about asana is that, if not practiced or taught with a skillful understanding of the interplay between movement, muscles, connective tissues and bones, it can be incomplete, ineffective and dangerous. This may be what the PTA meant but failed to articulate.
I’ve been treated by athletic trainers, physical therapists, occupational therapists, osteopaths and podiatrists since my high school sports injury. None have quite made a deep and thorough connection between my various symptoms (broken toe bone, strain in my arches, tightness in Achilles and calf, shin splints, runner’s knee, frozen shoulder, SI issues–a spiraling line of dysfunction from my left foot, leg and hip wrapping around to the right side of my sacrum and continuing upward to my right shoulder and, sometimes, down to my right elbow and wrist—all arising from a brief stint running track followed by 3 years of shot putting + discus throwing) and the root cause: pelvic and sacral instability.
During my last trimester of pregnancy in 2010, nearly every footstep would bring searing pain to my pelvis because of pubic symphysis diastasis (PT treatment #3). The pain diminished post-partum as my ligaments tightened and knitted my pubic bones back together but returned with a vengeance in the form of sciatica and SI pain, making it difficult to sleep and even to walk when getting out of bed in the morning. For a mom, on little sleep, who uses her body for a living to teach yoga, this was madness!
Over the past two years, I’ve seen an osteopath and undergone a fourth round of physical therapy. I found that going to an osteopath was a waste of time and insurance money for such fleeting relief. I would feel better after the manual manipulation but then, because of my daily activities, would run the risk of throwing myself back into misalignment and require readjustment again…Um, no thanks! I asked numerous questions about caring for my body’s unique structural alignment as well as the impact of yoga poses and running on my problematic areas. According to them: no restrictions, limitations or modifications were needed. Hmmm, really?! And, of course, the pain returned.
So back to physical therapy for what I proclaimed would be the last time. During my initial assessment with the PT, I rattled off my history of injuries/symptoms dating back to the stress fracture in my foot from a stunt I performed (jumped off a cement post and crossed my legs as I hit the ground) when I was 8 years old! I absolutely did not care that the PT was taken aback by my onslaught of information. She actually told me she didn’t need to know all of that (meaning, insurance only covers the current, localized issue — my sacrum). But I wasn’t having it and promptly insisted that she help me to understand and to correct the chain of dysfunction, explaining that I could not keep coming back to physical therapy every few years for “Band-Aid” treatments.
Even though I asked the same questions about maintenance and self-care, I had no illusions that I would get all the answers from physical therapy. Indeed, I got the same “you’re-free-to-move-without-restrictions” prescription. (To their credit, I realize that in some ways these therapists deferred to my experience as a yoga teacher, as well as my healthy range of motion in my joints–figuring I knew how to take care of myself.) But overall I did receive a better treatment plan this time because I advocated for it. More important, in deciding to be fully responsible for my own healing and care, I diligently tested the validity of the recommendations from these healthcare practitioners alongside the knowledge of my body I had acquired through my training, practicing and teaching of asana. I continue to seek new perspectives on anatomy, physiology, kinesiology and exercise to refresh my understanding and application of relevant principles and tips to my practice and teaching.
Treating every movement as an act and extension of yoga has been key to healing and realigning my body. Through the union of purposeful asana with running, walking, strength training, and self-applied myofascial release with foam rollers and balls (see links below), I have gained more stability and a considerable sense of freedom from pain and tension in my body. I continuously share this journey with my students and encourage them to trust their bodies’ wisdom (particularly when it shows up as pain) and to develop a collaborative relationship with their care providers. They may be experts in their fields, but we must reclaim our role as experts of our own bodies.
Related:
Learn more about the role of connective tissue plays in creating and maintaining stability, postural integrity, and balancing out or holding “stuck” tension.
tscottmiller 
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