Supported back bends

Written by Kaye Tribe:

I had an interesting experience while supervising my massage and myotherapy students at the Wellnation Clinic in Melbourne. A client presented with back pain that she felt was the outcome of her recent Yoga class. She had stopped attending classes for 2 weeks due to the pain experienced. Since I am a Yoga teacher, a trainer of Yoga teachers and Yoga therapists as well as a Myotherapist these types of comments from clients always require a few more carefully worded questions, such as:

1.     What posture were you practicing when you felt the pain?

2.     How many students were in your class?

3.     How many classes do you normally attend?

4.     What style of practice is this Yoga class?

5.     What have you done to support yourself since the injury?

The answers that I get from the clients are typical, I hear of this situation often enough for me to have my answers ready, and my role as the functional anatomy educator for both the client and the trainee therapist begins.

This client/Yoga student was practicing a supported backbend with a block under her sacrum in a half-bridge pose. This posture is usually a component of a comfortable practice if done with accuracy and careful instruction.

But………the Yoga teacher was not aware that this student already had postural imbalances that were creating strain on the Sacroiliac Joint, and that the support back bend created even more strain on the ligaments that support the joint.

The students had been directed to place the block longways, just under the sacral bone like this:
 

 
sacrum1.jpeg
 

As I set up the Yoga props and the skeleton to take this photo, the block was a bit wobbly and it took an extra hand to hold things in place and this illustrates the main issue with the block placement. The block is raising only the sacrum which allows the pelvic bones (the iliac component of the sacroiliac joint) to tilt forward. If a student already has an imbalance in the pelvic region, this is going to increase the current imbalance.

Ideally the block should be placed so that both the pelvis and sacrum are support like this:

 
sacrum2.jpeg
 

And if you want to lift higher you use 2 blocks on top of each other so that the pelvis continues to be supported.

What happens to the joint if you lift only the sacral bone in a support back bend?
The sacroiliac joint is a synovial joint that is designed to not move very much. The joint is much more important as a stabilising influence on the pelvis rather than to allow more mobility. Weight is transferred from the trunk of the body to the legs in any upright position via this joint, and it plays a role of a shock absorber along with your intervertebral discs. There is a small amount of movement with each step that you take and the ligaments that cross over the joint are support by muscles to encourage the joint to return to a neutral or resting position in between each step. If these ligaments are over-stretched and/or the muscles are chronically tight or weak, the integrity of the sacroiliac is compromised. This tightness/weakness in the muscles is very common so most new Yoga students will have a slightly imbalanced pelvis until they become more aware of the outcome of long-term sitting positions in their workplace plus the benefits of strengthening the muscles near this joint.

If you move only the sacrum, as occurs in the block placement in the first photo; the joint becomes stressed and the sacrum moves forward on the ilium, a movement called nutation by most physiotherapists. This forward movement is only meant to occur when you are walking or practicing a posture that is working asymmetrically, and the ligaments and muscles are strong enough to realign the joint as you come out of the pose.

By placing the block sideways, you remove the stress from the joint, and it can become a soothing, relaxing practice for the nervous system if done with awareness and focussed breathing.

The group of students who need that extra care when practicing a support backbend, or any posture that is going to stress the sacroiliac joint are:

  • Women of child-bearing age due to a higher level of hormones that increases flexibility
  • Women who are ovulating due to the much higher levels of hormones
  • Men and women with a postural imbalance in the pelvic region

So, it is always best to practice moderation with group classes and offer postures and modifications that will suit most of the students in your class.