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Many people think yoga is off limits after joint replacement. In fact, it can be a great option for people adjusting to life with a new joint.
“Yoga may help you become more aware of your body, including your muscles and joints,” says Christine Mironenko, NP, who works with patients after surgery and has practiced vinyasa yoga for 15 years. “Yoga may help with flexibility and overall posture, strengthen the muscles around your new joint, provide pain relief and even improve digestion.”
Yoga’s relaxation benefits can also be a big help—after all, joint replacement is a major surgery. The stress of the surgery itself as well as the pain you may feel leading up to it can take a toll. “Many patients are not prepared for the mental stresses their recovery might entail,” says Mironenko. “Yoga can help with stress relief, as well as insomnia and postoperative pain.” Before starting yoga, you must first get medical clearance from your orthopedic surgeon. “Most surgeons recommend waiting anywhere from three months to one year, again taking into account your medical history, type of surgery and other factors,” she adds. Your doctor will also give you any specific precautions to take.
Your new knee, hip or shoulder will often have limitations. Modifications will be necessary for a safe yoga practice. “A prosthetic joint implant is designed to perform activities of daily living and is not exactly made for advanced yoga poses,” Mironenko says. “In addition, the stress of the surgery on surrounding tissues may make them more vulnerable to injury or instability. We recommend staying within a certain range of motion and always avoiding any position that causes pain.”
Here are a few other tips for practicing yoga safely after a joint replacement:
“A few orthopedic surgeons at HSS advise their patients to avoid yoga following hip replacement due to the risk of hip dislocation,” says Mironenko. “Of course, you should always follow the advice of your physician.” Certain medical conditions can increase your risk for this, and there’s often no warning that a hip is about to dislocate, which makes it impossible to use pain or discomfort alone as a guide, she adds.
Once the soft tissues around the hip fully heal, many hip replacement patients get the green light to do yoga. Turning the hips too far in (internal rotation) or out (external rotation) should be avoided to decrease any risk. Extending your leg too far forward or backward should also be avoided, Mironenko says. Again, talking about yoga poses and rotation directions with your surgeon may be tricky, so reviewing photos of poses on your phone can make it more clear.
“Dislocations are rare and usually very patient-specific, but I strongly recommend that people avoid extreme actions of the hip in all directions,” she says. “I even recommend modifications in child’s pose, or Balasana pose. Keeping the knees apart and supporting yourself with a bolster decreases hip flexion and internal rotation.” An experienced yoga teacher can help you with modifications.
“Modifications to one’s yoga practice following a knee replacement are a bit simpler,” Mironenko says. “Some patients are not comfortable kneeling, so blankets, padding, or even knee pads can be used to ease discomfort in poses where the knee is on the ground. Also be mindful not to hyperextend the knees,” locking them out straight. Consciously keep a slight bend in the knee, just enough to keep it unlocked, 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,” she adds. “Certain positions such as half pigeon pose might 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.” How much you’re able to comfortably move your knee during physical therapy is a good guide for what yoga poses are safe to try.
The muscles surrounding the shoulder are at the highest risk of damage following shoulder replacement surgery. You should wait until the muscle is completely healed before starting any exercise routine—typically 10 to 12 weeks. Work with your surgeon to develop a safe yoga plan.
Yoga after total shoulder replacement can help to stretch and strengthen the shoulder muscles to maximize the benefits of your surgery. “The type of shoulder replacement—anatomic versus reverse—will determine which positions your shoulder and arm can safely move into,” says Mironenko. “Although dislocation is very uncommon, any extreme positions after a shoulder replacement should be avoided. This especially includes extreme internal rotation, like in reverse prayer pose, or Pashchima Namaskarasana.”
Whether practicing yoga after knee, hip or shoulder replacement, props are your friend, says Mironenko. “Yoga props, specifically yoga blankets, bolsters, blocks and straps, are used by even advanced practitioners for support or to enhance the benefits of a pose. 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 and your surgeon to make a pose work for you. Everyone’s yoga practice will look different because our bodies are unique.”
Christine Mironenko is an orthopedic nurse practitioner in the Post Operative Care Clinic at HSS.