As a physiotherapist, I am often guiding patients through post-operative rehabilitation following hip surgery such as replacement and/or resurfacing. From the pre-surgery jitters and questions through to completion, my role is to provide accurate information on timeframes, post-operative risks, and precautions as well as being the coach, the encouragement and the guide throughout the rehabilitation process. Within the yoga community, I invariably get asked the question- when can I go back to yoga?
Before answering this question it is important to understand the underlying procedure, the risks, the benefits, and expected timeframes. Although hip replacement surgery is a very common procedure, it is still major surgery and all care needs to be taken to avoid potential post-operative damage.
Hip replacement surgery is designed and intended to provide relief of hip pain and loss of hip function or mobility related to osteoarthritis. Usually prior to surgery patients will experience worsening hip and groin pain, with difficulty weight-bearing, walking and moving the hip through its range of movement.
Osteoarthritis is a gradual loss of smooth joint cartilage. I liken this smooth joint cartilage to a bitumen road- which ideally should be smooth. Over time this road can develop some small potholes and bumps- which is a bit like the early onset of osteoarthritis which can be managed quite well with activity modification, medication, and strengthening of the supporting hip muscles.
If this wear and tear worsen to the point of the road turning into a 4WD track and the smooth joint cartilage wears too thin with boney osteophytes, then the hip can become more painful to weight bear and move, which can result in surgical intervention. Often it can take years to reach the point of needing surgery, which usually means there are patterns of muscle weakness, stiffness and habitual asymmetrical walking pattern that then needs to be addressed after surgery.
Hip replacement surgery is performed usually under a general anesthetic and needs anywhere between 3 to 6 days in the hospital. The surgeon replaces both the ball and the socket part of the joint and, like any boney injury; this alone takes 6 weeks in its recovery. Patients can weight bear from day one, however, they may need assistance form crutches or walkers for the first week or so.
The surgeon has a choice between an anterior incision and a posterior surgical incision to replace the joint. This decision will be made on the surgeon’s experience, the shape of your joint and many other factors. The most common is the posterior approach, however, the anterior approach is becoming more popular.
The posterior incision approach has the disadvantage of post-surgical risk of joint dislocation in the first weeks after surgery. This means, that bending the hip beyond 90 degrees or twisting the hip across the body holds a small risk of the joint popping out of its socket. This is largely because the support muscles at the back of the hip (the gluteals) are still healing and this risk diminishes slowly after 6 to 12 weeks. It does not mean if the hip moves beyond 90 degrees of flexion that it WILL dislocate, there is just an increased risk of that. In my experience, the most common way to dislocate is to inadvertently sit on a chair that’s too low, or reach down to the floor whilst sitting. Dislocation is not common but is a risk with posterior incision hip replacements.
The anterior approach has the disadvantage of being a newer (and less ‘tried and tested”) procedure with some surgeons and also the small risk of minor nerve irritations such as disruption to the femoral cutaneous nerve.
Having outlined the disadvantages to each procedure, both surgeries actually have good outcomes by the 12 to 26-week mark with very little difference in the long term outcomes between the two surgery types.
So in the first few weeks following surgery, patients are expected to exercise caution with some hip movements (flexion and adduction) to prevent hip dislocation. This is no time to start back at yoga! The focus for the first 6 weeks is optimizing your walking pattern, returning strength and balance to the hip and pelvis as well as looking after your general health to prevent infection.
From the 6 to 12-week mark, your bones have recovered from the surgery, but you might have a long way to go with improving your strength and mobility, depending on how you were prior to your surgery. This is no time to start back at yoga! But the focus now will be on water-based exercises, physio exercises and increasing your walking capacity. Stretches for the upper body are perfectly fine, as are gentle quadriceps stretches. Physiotherapists will provide hip mobility and strengthening exercises that comply with each surgeon’s specific requirements.
After the 16 week stage, depending on your surgeon’s check and approval, you might consider a gentle return to your own practice. This does not mean you go back to class, but simply means you can start to explore your own practice in the safety of your home and with the intention of listening to your body and building up slowly over 3 months.
I recommend starting with poses that have less weight-bearing load as a start. Poses such as bridge, cobra, up dog, and gently seated forward folds using a bolster under the hips can be a good starting place. You can also explore poses such as buttkanasan and single-leg buttukanaesa with the hips elevated on a bolster. Poses to avoid when you first return to yoga- children pose, pigeon pose
From the standing poses, start with the vira one family maintaining (feet in line with the short side of the mat) as a start. Chair, tree, Avoiding taking the knee or the ankle toward the opposite shoulder is a good rule of thumb in the early days, therefore avoiding revolved trick, revolved parvo and others.
If this becomes comfortable, start to move through simple sun salutes before the moving into vira two poses, again avoiding revolved poses that take the shoulders toward the opposite knee or foot such as. Poses such as modified …. Are a good place to start
A slow but steady return over 3 to 6 months is recommended, which means it could take 6 to 12 months following your surgery to return to practice and even then it may be modified. Avoiding excessive-end range postures such as pigeon and children pose is recommended.
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