Is Lower Back Pain Gender Specific?

My grandmother suffered from lower back pain for many years. She described it as sharp, debilitating pain on one side of her lower spine. The only remedy she could find was a heating pad that she regularly applied to the painful area. She was a very active woman who moved a lot, gardened, carried heavy groceries on foot from the store, and did her own home remodeling. But whenever a bout of back pain hit, she would be immobilized for days. This was a common concern in her circle of friends, and nobody had a good remedy for it.

I experienced a similar kind of pain during pregnancy. I was terrified; would I have to live with this thing for the rest of my life? Turns out, yes, I would. But I can also manage it pretty successfully because I know where it’s coming from. When you properly identify the problem, you can eliminate or reduce behaviors that contribute to it, make better choices for how to deal with it, and take appropriate steps to prevent future occurrences.

Sacroiliac Joint Dysfunction and Lower Back Pain

The pain that both my grandmother and I experienced is actually very common for women, but it is often misunderstood, misdiagnosed, and mistreated. Doctors and other health care practitioners often attribute this type of discomfort to a potential herniated disc, spinal stenosis, piriformis syndrome, sciatica, or some other issue. But in reality, it stems from sacroiliac (SI) joint dysfunction.

Your sacrum (the lower portion of your spine) fits nicely between the bones of your pelvis and is connected to it via the sacroiliac joints. The entire structure needs to be stable and symmetrical to properly transfer the weight of the structures above (head, ribcage, spine, organs, muscles, etc.) through the sacrum, into the pelvis, and then into the earth, both at rest and in motion.

The sacroiliac ligaments that bind your sacrum to your pelvis and your spine are very strong.

At some point during the 20th century, the medical community concluded that since those joints were strong, they wouldn’t be prone to spraining or tearing, and therefore, sacroiliac joint dysfunction cannot be the reason for your lower back pain; case closed. Somehow, though, they forgot about the effect that those pesky hormones can have on pliability of the SI ligaments.

Relaxin Hormone and the Sacroiliac Joint

Women have a particular hormone to thank (or blame?) for messing up our SI ligaments. This hormone is called relaxin, and it is well-established that it makes SI ligaments laxer during pregnancy to accommodate the birthing process. 

But did you know that women start to produce relaxin when they begin to menstruate? This hormone gets released during each menstrual cycle after ovulation to prepare the uterus for a potential pregnancy. If pregnancy does not occur, the level of relaxin drops, only for the entire cycle to be repeated the following month again. That is why it is not surprising that you might experience more pain and instability in your sacrum as your period approaches. This means that any woman of reproductive age is at higher risk of sacroiliac dysfunction.

During the third trimester of pregnancy, your center of gravity shifts forward, adding additional pull on your SI ligaments. After childbirth, there is no guarantee that those ligaments will return to their former length, shape, or symmetry. And if the mom begins to carry her baby on one hip, haul a heavy car seat around, sleep in weird positions, and do other asymmetrical activities, how will her sacroiliac ligaments ever return to their former glory?

Even when you move past your reproductive years, you are still not off the hook. In women over 50 the surface of the SI joints can become rough and cause discomfort with asymmetrical activity.  Oh, the joys of being a woman! 

How Asymmetrical Activity Affects Your SI Joint and Can Cause Lower Back Pain

However, asymmetrical activity can be problematic, not just for women over 50. Just like any other part of the body, SI ligaments adapt to the load we put on them. If that load is perpetually asymmetrical, it will impact the symmetry of your ligaments. This happens if you sit with one hip slightly forward or up while driving, or constantly carry heavy loads on one side of your body, or push heavy objects (like gurneys, or construction materials, or furniture) while leveraging yourself with one foot, and so on. Those types of activities abound in our daily lives and in many occupations. 

When sacroiliac ligaments become uneven, they have trouble maintaining a proper relationship between the sacrum and the pelvis. As a result, the sacrum no longer distributes the weight of the upper body evenly through both sacroiliac joints, which creates strain on one side and can lead to sharp pain that might resonate into the lower back, buttock or thigh. SI joints can also get injured in an awkward fall or while playing sports.

To summarize, sacroiliac joint dysfunction can affect both women and men, but women generally are at higher risk because of hormonal changes their bodies go through. What can we do about it? After all, we do not have control over our hormones or actions required for our occupations. But there are definitely things we can and should do to keep our sacroiliac joints less moody. 

How to Practice Yoga for SI Joint Stability and Lower Back Pain Relief

Here are a few suggestions to keep in mind when you practice yoga: 

Avoid pushing your flexibility in hip-opening poses, especially during the times in your cycle when relaxin has made you more flexible. It can be tempting to practice poses that aren’t accessible to you when your ligaments are tighter. But stability is key to keeping your SI joints happy. Over-emphasizing hip-opening poses can destabilize the joints, and those ligaments may not return to their original length after you’ve stretched them. 

Practice poses that stabilize your hips and SI joints. These include Fierce Pose (Utkatasana), Locust Pose (Salabhasana) and Sphinx Pose (Ardha Bhujangasana). Placing a strap around your thighs in Utkatasana, and pressing your legs into the strap, can help activate muscles that stabilize the SI joint. 
If your SI joint is bothering you, avoid asymmetrical poses, including twists. 

Reprinted with permission from sequencewiz.

Educated as a school teacher, Olga Kabel has been teaching yoga for over 14 years. She completed multiple Yoga Teacher Training Programs but discovered the strongest connection to the Krishnamacharya/ T.K.V. Desikachar lineage. She studied with Gary Kraftsow and American Viniyoga Institute (2004-2006) and received her Viniyoga Teacher diploma in July 2006, becoming an AVI-certified Yoga Therapist in April 2011. Olga is the founder and managing director of Sequence Wiz, a web-based yoga sequence builder that assists yoga teachers and yoga therapists in creating and organizing yoga practices. It also features simple, informational articles on how to sequence yoga practices for maximum effectiveness. Olga strongly believes in the healing power of this ancient discipline on every level: physical, psychological, and spiritual. She strives to make yoga practices accessible to students of any age, physical ability, and medical history, specializing in helping her students relieve muscle aches and pains, manage stress and anxiety, and develop mental focus.