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Post Hip-Replacement Poses

I have a student who had hip replacement surgery in September. She mentioned that she has some pain when doing lunges. What poses should she avoid doing?

—Helen

Marla Apt

Read Marla Apt's response:

Dear Helen,

Since there are different types of hip replacement procedures, it's helpful to learn as much as possible about the nature of your student's operation. You'll also want any information the doctor provided her about risks and range of motion limitations. Depending on the surgical approach and the location of the incision, many hip replacement patients are advised to avoid internal rotation, adduction, hip flexion (beyond 90 degrees), or even hip extension. These precautions, especially within the first year of the procedure, are aimed to keep the hip joint stable, since it's more prone to dislocation than a normal hip. For this reason, it is important to be cautious with a student who has had a hip replacement, especially if she complains of pain.

I recommend that you teach your student the variations of Supta Padangusthasana (Reclining Big Toe Pose)—such as holding her foot with a belt—so she can learn to keep her thighs rooted in the hip sockets when doing hip flexion, adduction, abduction, and external rotation.

Observe her alignment in all asanas to make sure that she's not collapsing her weight onto either hip. In the standing asanas (especially balancing poses where she stands on one leg), she can use the support of a wall to learn how to hold the thighs in the hip sockets; use the strength of her legs, buttocks, and abdominal muscles; and align her joints so that the weight of the body is distributed evenly.

Look to see that when her affected side is the front leg in the standing poses, her hip doesn't project outward, sideways, or backward. When her back leg in standing pose is the side with the hip replacement, help her so that the hip doesn't fall forward or out to the side. Also observe and correct if the opposite hip is compensating. When you observe these points, you may see that she needs the support of props for stability.

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Reader Comments

Mabel

It doesn't matter what kind of surgery it is....a hip surgery is going to mean one of three things:
1.) Hip joint resurfacing
2.) Total hip joint implant/replacement
3.) Replacement of the worn ball joint years after a total replacement

Regardless of the surgery, what has happened to the student is that they have been cut through many layers of muscle all the way down to the bone. The muscle and tissue must re-knit/heal completely around the ball joint.

Soft tissue heals in about three months. The student can walk freely by that time and will feel great about doing sports, yoga, walking, etc. again. They must be careful not to push their limits, as good as they might feel.

Like you say in your response, it takes up to a year to fully heal. Having said that, a hip surgery patient is always at risk for injury more so than the general population. Certain activities shouldn't be pursued, no matter how good they feel, such as downhill skiing. Even a powerful golf swing can cause damage, due to the twisting nature of the activity.

These are the following guidelines for all post-surgical individuals:

1.) No bending beyond 90 degrees.
2.) No twisting behind, as if turning to look behind yourself while keeping feet facing forward
3.) No leg crossing
4.) No crossing of the feet

I am a bi-lateral total hip replacement individual and I am 45 years young and I love yoga. It was the discovery that I could no longer do many of the poses that led to my initial x-rays and diagnosis. I reached the point I could no longer walk a city block without pain or without holding onto someone, or something. You know when you get to that point and something needs to be done.

Lack of range of motion may come on slowly, linger/get worse slowly over a period of one or two years, and then go downhill very quickly, say over a six month period, to the point that a person can't walk without aid.

I would advise any student of yoga to wait a least one full year before attempting any asana that breaks the above rules, and I wouldn't advise them to try them at all unless they had been spending that year being very careful and also building up their strength.

I am dismayed by a video I saw of a 60-ish looking woman who posted a video 3 months post hip replacement surgery. IT gives the impression that a yoga practitioner is somehow better, stronger and "above" the rules of post-surgery. This is not true.

I know of a woman who had total hip replacement surgery and MOTNHS afterward she felt completely fine. One day she was in her garden and her hip became dislocated after no obvious injury to herself.

We are all human and we are all vulnerable. SO please keep this in mind when advising students.

Thank you!


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