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I must admit: before I started my viniyoga teacher training, I’ve never heard of sacrum issues. Sure, I knew what sacrum was, but my first teacher training program never talked about it, my students never complained about it, I haven’t had any trouble myself. So I’ve moved through life blissfully unaware, until I started my viniyoga teacher training.  Then all of the sudden sacrum became front and center. I would hear “this pose can be problematic if you have sacrum issues”, “do this to take care of your sacrum”, “make sure you don’t feel any discomfort in your sacrum”, etc. You know how when you decide to buy a certain car you start seeing it everywhere? Same happened for me with sacrum. All of the sudden I’ve discovered that sacrum issues are everywhere and yoga practice often creates or contributes to the problem.

Well, to be more specific, it’s not really the sacrum that we have issues with, but the sacroiliac (SI) joints. Quick anatomy reminder: sacrum is located at the base of your spine and consists of 5 vertebrae that are fused together to form a bone about the size of your hand. It fits snuggly between the two sides of your pelvis and is connected to them via the sacroiliac joints. SI joints are weight bearing because the sacrum bears the weight of the spine and transfers it through those joints to the pelvis and then down into the legs. Like any weight bearing joint, it needs to be stable, so there are several ligaments that bind the sacrum to the pelvis to restrict it’s movement.

Now some of us have more mobility in the sacrum then others and that’s what can create potential problems. The sacrum has an ability to tip slightly forward in relation to pelvis (called nutation) or slightly back (counternutation). It can tip 5-10% at most, but even that can create the sense of instability in the pelvic area.

Who is at risk? Anybody can suffer an SI injury but the following populations are at a much greater risk:

1. Women of reproductive age. Theoretically, the movement of the sacrum is designed to accommodate the passing of the baby through the pelvis: first counternutation for the head to enter the pelvis and then nutation to get the tailbone out of the way. And we all know that in pregnant women hormone relaxin is released, which makes ligaments more lax for the same purpose of accommodating the birthing process. So whether or not your students are pregnant right now, if they are of reproductive age or gave birth before, they are more likely to have more mobility in their SI ligaments.
2. Ligamentous folks. Some of us were born with looser ligaments, which enables us to do more advanced yoga poses, but also puts us at risk for SI issues because of extra sacrum mobility.

 The problem. So that young uber-flexible girl in your class, who is happily trying to stick her foot behind her head runs the risk of pulling or injuring her SI ligaments. Her sacrum is more likely to pop out of place, usually on one side, and once it’s out of place it will pull on the ligaments that are supposed to keep it in place, causing sharp obnoxious pain on one side of her lower spine. And as we know, ligaments are highly avascular, which means that if there is a tear in a ligament, it will take a long time to heal because of poor circulation to the area. Unfortunately, once you injure the area, you are likely to reinjure it again, especially if you maintain an advanced yoga practice and ignore your body’s pain signals. We say that a student has a “hot sacrum” if her SI joints are sensitive and prone to injury. Folks like that will have to modify their yoga practice dramatically while they are in the healing stage, otherwise they will keep reinjuring it and turn it into a chronic problem.

Now what can we, as teachers, do to minimize the risk of the sacroilliac injury?

1. Approach advanced assymetrical poses with great care, especially the ones where one hip is in a fixed position and the spine is being strongly pulled the other way. Look at Janu Sirsasana, which is not necessarily an advanced posture but it typically aggravates “hot sacrums”.

It is wise to take the following precautions for any advanced asymmetrical posture:

• Do not use arm leverage to pull yourself into the pose if you sense resistance in your SI joints.
• Make sure that the students’ bodies are adequately prepared before they attempt a posture (read more on how to prepare the body for a difficult posture)
• Please, please, please DO NOT demonstrate advanced poses if you are not warmed up appropriately yourself. This is a major source of injuries for yoga teachers.
• Remind your students (and yourself) to stop if it hurts.

2. Do not teach too many asymmetrical poses on one side, it can lead to cumulative stress on the SI joint. I was recently in a class where the teacher did the following poses:

This entire sequence was done on one side first, holding each pose for 4-6 breaths, without any queuing about changing the position of the feet or using abdominal contraction for support.  Do you see a problem here? The position of your left leg is fixed, which means that the left side of the pelvis will be anchored in mostly forward-facing position. Then you move your spine through a side bend, forward bend, back bend, side bend and then twist. Your sacrum follows the movement of your spine, tugging and twisting and torquing your left SI joint. This reminds me of trying to pull off the top of a plastic bottle – to break the thin piece of plastic you would bend it forward, bend it back, twist it one way, then the other and hopefully it will come loose after that. Why would you want to do that to your SI ligaments? They won’t break off, of course, but they will get destabilized and become more vulnerable and susceptible to injury.

Solution: Switch sides more often and alternate asymmetrical poses with symmetrical forward bends.

3. Do not insist on keeping the legs straight in forward bends; it creates shear stress on the sacrum.

4. When you sequence your classes, be sure to include poses that stabilize the sacrum. In the traditional approach to sequencing summarized by Sri Krishnamacharya, prone back bends always follow the standing postures to make sure that whatever you have done to your lower back/sacrum area in standing could be neutralized via symmetrical prone poses.

Vimanasana is one of those “magic” yoga poses that does it really well. However, you need to make sure that

A. Your student’s back is strong enough to handle it
B. Your student keeps her pelvis grounded on both sides when she attempts it.

These are some simple basic ideas that are not hard to implement, but they will help protect your students’ SI joints. If your student does get injured, in the class or elsewhere, it is best to limit or eliminate the activities that irritate the area, including one’s yoga practice. Once the acute stage has passed, she can seek guidance from a physical therapist or a qualified yoga therapist on how to stabilize and strengthen the sacrum area before returning to a regular yoga practice.

Have you ever had trouble with SI joints? If so, what did you find helpful?

Additional resources on the subject:

Anatomy of Hatha Yoga: A manual for Students, Teachers and Practitioners by D. Coulter
The Female Pelvis Anatomy and Exercises by B. Calais-Germain
Protect the Sacroiliac Joints by R. Cole

Conventional Wisdom always gets an eyebrow raise from me. I can’t help it. Eventually, I take an honest look at whatever the experts are saying, but skepticism gets first dibs. I’d call it an instinct if it weren’t learned behavior from years of being burned. For example, I once took to task the most pervasive “truth” around: that everyone needs to drink eight glasses of water a day or risk kidney failure, toxin buildup, bladder cancer, and debilitating constipation. It was pretty easy to do.

But it’s not all BS. Smoking is bad for you, for example. See? I can admit when they’re right!

I wonder about the CW position on sleep, though. We generally agree on the recommended duration of sleep. “About eight solid hours” is what you’ll see everywhere, from official governmental health guides to paleo nutrition blogs (I’m sure there’s some niche community out there claiming to have “transcended” sleep, though). I’m not going to argue with around eight hours, but note the use of “solid.” What does it connote?

Unbroken. Monophasic. Constant. Actually, it both connotes and denotes these things. Solid sleep is good sleep, right? And solid sleep means sleeping for about eight hours without waking. If you wake up, you’ve got a problem. Right?

 Maybe not.

For most of human history, nighttime meant darkness. Not the blueish whitish permaglow from storefronts, billboards, and headlights enjoyed by modern city-goers. Not the yellow-orange bath radiating down from street lamps on quiet suburban streets, so ubiquitous that you only notice them when they go out. I’m talking about real, permeating darkness. Camping darkness. Small country road with the car lights out darkness. For our ancestors as recently as a couple hundred years ago, this kind of nighttime darkness lasted up to fourteen hours (well, it does today, too, but we mask it with all that lighting and housing). Artificial lighting meant candles and firewood, and those cost (money or time) and don’t really replace daylight (anyone who’s stifled yawns around a campfire knows that) like today’s artificial lighting replaces daylight. People got to bed earlier – because, unless you’re rich enough to burn candles all night, what else are you going to do when it’s dark everywhere but, as Thomas Middleton said, “sleepe, feed, and fart?” – and their sleep was biphasic, or broken up into two four hour segments, with the first beginning about two hours after nightfall.

The first segment of biphasic sleep was called “first sleep” or “deep sleep,” while the second was called “second sleep” or “morning sleep.” Numerous records of these terms persist throughout preindustrial European archival writings, while the concept of two sleeps is common in traditional cultures across the globe. Separating “first sleep” from “second sleep” was an “hour or more” of gentle activity and wakefulness. People generally didn’t spend this time online gaming or surfing the web or trolling the fridge for snacks; instead, they used it to pray, meditate, chat, or to simply just lie there and ruminate on life, the universe, and everything. It was still dark out so they tended to keep it pretty mellow. Sounds nice, huh?

Robert Louis Stevenson liked the idea, too. Sleep historian (awesome-sounding job!) Roger Ekirch writes of Stevenson who, in the fall of 1878, while trekking through the French highlands on foot, alone, made a remarkable discovery. As anyone who backpacks or spends time outdoors will corroborate, Stevenson found himself drifting off to sleep shortly after sunset. He awoke around midnight, smoked a cigarette, and, only after “enjoying an hour’s contemplation,” fell back asleep. That hour, that “one stirring hour” moved him; Stevenson had never before experienced a “more perfect hour.” He had awoken not because of an interloper, a night terror, or any other external actor, but because of what he later described as a “wakeful influence [that] goes abroad over the sleeping hemisphere” and is unknown to “those who dwell in houses.”

Ekirch thinks that the Industrial Revolution, especially the invention and proliferation of cheap electric lighting, forced modern society into its current monophasic sleep pattern by making artificial lighting that really lit up a room available to everyone. People with access to light bulbs could stay awake longer in brightly lit rooms because they were no longer subject to the circadian entrainment of natural light patterns. We’ve gone over light entrainment before. It’s likely worse nowadays, since we’re not just coping with access to ambient lighting, but also loads of interactive consumer electronics (like this laptop I’m using now) blasting circadian-disrupting light directly into our faces. Whereas Owen the London chimney sweep may have flicked on the light bulb and settled down to a good book and a bottle of ale after his shift and gotten to sleep around nine or ten, Jeff the SEO analyst stays up late arguing on Internet message boards with the laptops blue light beaming into his very soul. Sound familiar?

It’s likely that societal expectations about sleep structure – that it’s supposed to be eight hours of unbroken, deep, heavy slumber, as everyone knows – are making problems out of what may be normal sleeping patterns. Clinicians are finding that if they can make insomnia patients understand that waking up in the night is actually normal and natural, they feel better about their condition. Because they “perceive interrupted sleep as normal,” they stop stressing over waking and are able to get back to sleep more easily. Some forms of insomnia, in which people wake up in the middle of the night, might not actually be clinical conditions, but rather the manifestation of the natural human sleep cycle trying to assert itself. Insomnia may just be a problem of perception; if you look at your “problem” in a different light as explained by Ekirch, it disappears.

 Imagine the possibilities if you could work just such an hour of free waking life into your sleep cycle! You wake up and, instead of exasperatingly checking the time, making a huge huff, and angrily grumbling and tossing and turning in a vain attempt to get back to sleep…

You vigorously and enthusiastically discuss last week’s post with your significant other (whose sleep schedule is also entrained to the biphasic cycle), thus stimulating your mind and supplying a steady rhythmic stimulus to your hip extensors.

You linger in twilight mindspace, that odd world between waking and sleeping that we rarely get to explore, and ponder dreams with a clarity that the 7 AM alarm for work simply doesn’t allow.

You light a candle and quietly read for an hour or so until sleep returns.

Sleep phase entrainment isn’t that easy, though. We do “dwell in houses.” We have by and large been sleeping monophasically for probably our entire lives. Our world is the product of the Industrial Revolution, for good and for bad, and so we must work with that reality. Candles at night will help, as will camping trips when possible, and limiting excessive late night computer exposure (or installing the ever-popular f.lux) is always a good move. You can try getting outdoor light exposure during the daytime – maybe go for that hike, that walk at lunch, or that outdoor workout.

But we’ve gone over that stuff before. It’s good, but it’s been done. In light of this new (old?) information about biphasic sleep patterns, perhaps the most effective change we can make is in our perception of sleep and waking. Make like those insomnia patients and change the way you think about waking up during the night. Don’t stress and fret; welcome it. Maybe, instead of assuming that this is all a horrible mistake and your cortisol is going to spike and you’re going to crave extra sugar in your coffee in the morning next time you wake up in the middle of the night, welcome it. Ever notice how you’re not all bleary eyed and zombie-like when you wake up at 2 AM like you are at 7 AM with the alarm blaring?

I’m thinking we should all explore why that is.

What are your experiences with waking up in the middle of the night? Do you need a solid block of sleep each night, or do you just assume that’s the case? After reading today’s post, see if your next mid-night wakeup feels different.

Read more: http://www.marksdailyapple.com/biphasic-sleep/#ixzz2wK7c2HJH