How to teach pregnancy yoga to women with pelvic instability, SI or SPD

When I first started to teach pregnancy yoga I had no clue about SI (sacroilliac), SPD (symphysis pubis disfunction) or even just general pelvic instability.

So much of the information I’d read about pregnancy yoga emphasised the importance of opening the hips and pelvis to make room for the baby. No one was really talking about how damaging this could be for some women whose bodies were already quite flexible.

It wasn’t until I personally had quite bad SI pain during my second pregnancy (I was ironically teaching a lot of yoga at the time and was very flexible) that I started researching the importance of maintaining stability in the hips.

This now forms a core part of my pregnancy yoga teaching and why I’m so focused on giving options to either stretch or strengthen the hips depending on what each individual woman in my classes needs.

What is pelvic instability?

Pelvic instability (or pelvic girdle pain) is a term used to describe a group of conditions causing pain in the pelvis and hips during pregnancy. As the name suggests this pain is caused by an instability in the pelvis. Instability is caused by the muscles and ligaments surrounding the pelvis becoming too tight or too lax through bad posture, repetitive exercise and other lifestyle factors.

What is SI pain?

SI stands for Sacroiliac. It refers to the sacroiliac joints at the base of the spine. SI pain is often felt in the low back or buttocks. If you’d like to know more specifically about SI pain, I recommend checking out this post here.

What is SPD pain?

SPD stands for symphysis pubis disfunction. The symphysis pubis is the joint at the front of the pelvis. SPD pain is often felt in the vagina, the front of the pelvis, the belly or the inside of the thighs. For more information about specifically managing SPD pain see this post.

What causes pelvic instability during pregnancy?

Pelvic instability is common in pregnancy because of the hormone relaxin. This hormone allows the ligaments of the body to soften allowing the pelvis to widen so the baby can grow and move through the pelvis during birth.

While all women release this hormone during pregnancy only some will suffer from pelvic instability.

Women who are hyperflexible, or those who have weak pelvic floor or core muscles before pregnancy seem to be more prone to pelvic instability.

Pelvic instability can also occur when a woman has underworking glutes and an overly tight psoas muscle (or vice versa), causing an imbalance in the supporting structure of the hips. Or if she stands or sits in a way that pulls the pelvis out of alignment.

How do you know if a woman has pelvic instability?

It’s so important to ask every one of your students how they are feeling when they first come into the studio. Many women will dismiss aches and pains as ‘normal pregnancy complaints’ and not consider pelvic instability as a condition that they need to be aware of. This is why you should be aware of the usual ways that pelvic instability presents in the body including:

• soreness in the hips
• pain in the pubic bone or vagina
• aching low back
• shooting pain in the tailbone
• pain in the buttocks or inner thighs

Because you can’t be sure whether these symptoms are pelvic instability or just general pregnancy aches and pains, it’s best to refer your students to a Physiotherapist so that they can get the right diagnosis and treatment for their body.

How to teach pregnancy yoga to women with pelvic instability

Is pregnancy yoga right for them?

While as yoga teachers we may be hesitant to talk anyone out of yoga, it is worth questioning whether someone who is suffering pelvic instability should be in your regular yoga class or pregnancy yoga class. At this time, yoga asana as it’s presented in yoga classes may not be what they need, especially if they’re having severe pelvis pain.

This is not to say that yoga won’t be beneficial during her pregnancy, but she will need to focus more on strengthening the supporting muscles around the pelvis. Or in severe cases where even this is painful, focusing on the pranayama and meditation for the rest of her pregnancy might be the best option.

Modify any poses that encourage hip opening

To avoid making pelvic instability worse you’ll need to provide different options for any poses that create opening in the hips, pelvis and thighs.

Some of the poses you’ll need to avoid for women with pelvic instability include; wide leg forward fold, pigeon pose, warrior two, goddess pose, etc.

I know! This can feel very limiting when many of the ‘traditional pregnancy yoga’ poses involve opening of the hips. It can be done though. You just need a large bank of alternatives ready to offer when you notice women feeling discomfort or expressing pain.

Eg. While some of your students practice pigeon pose offer others the choice to sit straddling a bolster, squeezing the bolster with their inner thighs and engaging pelvic floor. This helps to strengthen those supporting muscles of the pelvis while the other women in your class have time to open their hips.

Embrace props

Yoga props like blocks, bolsters and blankets are great in all pregnancy yoga classes, but are especially helpful when you’re catering for women with SPD to provide extra support and focus on strengthening weak areas.

Eg. Bring your students to a squat on the wall with a block between their knees. Pressing into the block helps to engage the inner thigh muscles that work to support the pelvis.

If you’d like more information on teaching pregnancy and postnatal yoga I’ve created a free basics guide with all the information you need to know to get you started. Download your copy here.

If you’d like more info about the specific poses you can do as alternatives to hip opening or if you have any questions let me know in the comments below. Happy teaching!