Before starting yoga, it is imperative to get medical clearance from one’s orthopedic surgeon. Patients must be aware of any specific precautions to take based on their medical history, type of surgery, the surgical technique used, and type of implant. Their new knee, hip or shoulder will often have limitations, and modifications will be necessary for a safe yoga practice. A prosthetic joint implant is designed to perform activities of daily living; it’s not exactly made for advanced yoga poses. In addition, the stress of the surgery on surrounding tissues may make them more vulnerable to injury or instability. We recommend staying within certain range of motion parameters and always avoiding any position that causes pain.
Yoga after Hip Replacement Surgery
A few orthopedic surgeons at HSS advise their patients to avoid yoga following hip replacement due to the risk of hip dislocation, and individuals should always follow the advice of their physician. It is very patient-specific, as certain medical or musculoskeletal conditions could increase your risk for dislocation. Many times there is no warning of a dislocation, so it is impossible to use pain or discomfort alone as a guide.
Many hip replacement patients are happy to receive the green light from their doctor to practice yoga once the soft tissues around the hip have had time to fully heal. Extreme external or internal rotation, along with hyperflexion and hyperextension, of the hip should be avoided to decrease the risk of dislocation. In the medical literature, there have been published cases of prosthetic hip dislocation from Uttanasana (forward bend pose) and from a transition into Salamba Sarvangasana (shoulder stand pose).
Dislocations are rare and usually very patient-specific, but I strongly recommend that individuals avoid extreme actions of the hip in all directions. I even recommend modifications in Balasana (child’s pose) by keeping the knees apart and supporting oneself with a bolster to decrease hip flexion and internal rotation. It is important for individuals to ensure they are under the direction of an experienced yoga teacher with adequate knowledge of anatomy to help with pose modifications.
Yoga after Knee Replacement Surgery
Modifications to one’s yoga practice following a knee replacement are a bit simpler. Some patients are not comfortable kneeling after knee replacement surgery. Blankets, padding, or even knee pads can be used to ease discomfort in poses where the knee is on the ground. Be mindful not to hyperextend the knees. You can do this by consciously keeping a microbend in the knee (a slight bend that is just enough to unlock the knee) while in standing poses.
You will also want to avoid poses that put a lot of pressure on the inside or outside of the knee, especially in combination with the added force of pressing your body down when in these positions. Certain positions will stretch the ligaments on the sides of the knees and, over time, could make your knee unstable. These poses can be avoided or modified with props. Your range of motion achieved from physical therapy should naturally guide any other modifications that are needed.
Yoga after Shoulder Replacement Surgery
The type of shoulder replacement (anatomic versus reverse) will determine which positions your shoulder and arm can safely move into. Although dislocation is very uncommon, any extreme positions after a shoulder replacement, especially extreme internal rotation, like in Pashchima Namaskarasana (reverse prayer pose) should be avoided. Early after the surgery, our main concern is the risk of damage to the surrounding muscles that were affected during shoulder replacement. We advise patients to wait until the subscapularis muscle is completely healed before starting any exercise routine, and this typically takes about 10-12 weeks. For patients who receive medical clearance from their surgeon, yoga after total shoulder replacement is a great way to stretch and strengthen the muscles to maximize the benefits of your new shoulder.
The Use of Props
Whether practicing yoga after knee, hip or shoulder replacement, props are your friend. Yoga props, specifically blankets, bolsters, blocks and straps, are used by even advanced practitioners for support or to enhance the benefits of a pose. I believe that yoga is not about how the poses look; it’s really about how they feel. Almost every pose has modifications to make it accessible to everyone, activating the same muscles to achieve the same benefits. Work with your yoga instructor for direction on this. Everyone’s yoga practice will look different because our bodies are unique.
The Content in this blog post is not intended to be a substitute for your physician’s medical advice. Always seek the advice of your health provider with any questions you may have regarding your health, joint replacement surgery, and yoga or exercise program.
Christine Mironenko, MSN, AGNP-BC, is an orthopedic nurse practitioner in the Postoperative Care Program at Hospital for Special Surgery. She has been practicing Vinyasa yoga for 12 years.