Is Yoga Possible After a Hip Replacement?

In the first six weeks after a hip replacement, regular and gentle exercise is advised to help with muscle building and restoring movement. You will typically be expected to perform 30 minutes per day, two to three times per day. Is it possible to also do yoga?

Yoga is possible after a hip replacement provided you take it slow, staying away from anything too active. Seated yoga, focusing on upper body strength, is a great way to stay active without overextending your new joint. Restorative yoga is another way to stretch and restore proper movement gently.

In this article, we will discuss yoga and its benefits, along with what you can expect after a hip replacement surgery. We will look into how you can safely incorporate yoga into your recovery, in addition to other forms of physical therapy.

What Is Yoga?

Yoga dates as far back as 2700 BCE and was originally used as a healing practice that promoted physical and mental health, along with inner enlightenment.

In recent years, yoga has been linked to reducing the risk of heart disease, improving the health of diabetics, and aiding in the treatment of mental illnesses, such as Alzheimer’s.

Traditionally, yoga encouraged its practitioners to find balance and spiritual enlightenment by performing breathing exercises and postures. The various branches of yoga are thought to represent the traditional messages promoted by the practice. The branches include:

  • Bhakti Yoga, a key aspect of Gandhi and laid out a path of devotion to a higher power.
  • Hatha Yoga, the physical practice of breathing and postures to maintain your mind and body.
  • Karma Yoga encourages us to make selfless decisions, rather than only those that will benefit ourselves.
  • Jnana Yoga, all about self-awareness, along with knowing and understanding others.
  • Raja Yoga works with all of the different branches of yoga to find a true concentration.

Benefits of Yoga

Over the years, the benefits of yoga have been well researched and documented. By performing the required breathing techniques along with stretching and various poses, yoga can improve heart health, regulate blood pressure, improve digestion, and increase your energy.

After a hip replacement, the slow and calming practice of yoga can help in many ways:

  • Muscle-strengthening – by stretching and holding poses, you are working your muscles through a cycle of tensing and relaxing. Over time, these muscles will slowly become stronger and sometimes more defined. Strong muscles are key to balance and stability and, after a hip replacement, will aid in recovery.
  • Better flexibility – immediately after your surgery, you should not be overextending your joint. However, slowly you can begin to work on the new joint and the surrounding tissue.
  • Better overall joint health – working your joints helps encourage oxygenated blood to flow, which aids in healing and improving bone strength. Though you may find your movement is more limited, the gentle actions involved in yoga can help promote better movements in the new joint and maintain the health of the old.
  • Reduction of inflammation – movement in the body helps your lymph nodes to drain toxins, replacing them with oxygen and nutrient-rich blood. This has helped reduce inflammation and tension in the body and is also known to help with stress.
  • Encourages healthy living – an exercise of any kind will help with movement, dietary concerns, weight management, and muscle building. All of this is important when it comes to not putting too much strain on your new joint.
  • Relaxation – mental health is just as important within your recovery. Being positive and engaged can often make all the difference, and yoga will help in keeping calm and stress-free. It will help in clearing your mind and moderating your pulse, along with improving your sleep.

What to Expect From a Total Hip Replacement

Hip replacements are most common in cases of damaged or worn-out hip joints. The causes can include arthritis or fracture caused by accidents such as a bad fall. The main goal is to replace the worn-out or damaged parts of the joint.

Symptoms and Causes of Hip Issues

Typically, a hip replacement is necessary for the event of pain or disability that cannot be fixed with other treatments. Such issues are experienced by more than 300,000 people in America each year and can inhibit many day to day activities.

Symptoms to look out for can include:

  • Pain in the hip and/or groin when walking. This pain is often severe enough to prevent you from walking extended distances, climbing stairs, and getting in and out of a car.
  • Pain when exercising can sometimes present as sharp or soreness. However, if you find that this pain/soreness prevents you from doing normal activities, it can be a sign of arthritis. Usually, the pain is felt in the thigh area, between your hip and knee. Though in some cases, it can be caused by back issues rather than hip problems.
  • Pain at night can often be a clear sign of a deeper issue. When we sleep, we are generally relaxed and not engaging muscles. If you feel any pain from normal night-time movements, it is a sign there might be a problem.
  • Stiffness and limited movements are common with hip issues. You may experience tension, clicking, popping, or even grinding in your hip joint from walking to leaning to put shoes on.
  • Other treatments have been unsuccessful. If you have tried physical therapy, pain, and anti-inflammatory medications, and walking with support devices, only to find you are still in pain even when limiting your movements, then it is likely a bigger hip issue.

In some cases, a fall or accident can crack or fracture your hip and leave it vulnerable and need replacement. However, other causes include:

  • Osteoarthritis is usually an age-related issue. In this case, the hip joint is suffering from years of use whereby the cartilage has worn down or away, leaving the femur and hip bones to rub against each other without any cushion.
  • Rheumatoid arthritis is a chronic inflammation of the connective tissue in the joint. This leads to damaged cartilage, stiffness, and pain in the joint.
  • Post-traumatic arthritis can be the result of an accident. Once the cartilage has been damaged after a fall or fracture, it can lead to stiffness and pain over time.

Hip Replacement Surgery

During a partial hip replacement surgery, your doctor will only replace the femoral head. This is the highest point of the femur and the part that connects to the hip joint and allows for movement.

A total hip replacement surgery differs in the amount of damaged or worn tissue and bone removed and replaced with prosthetic parts. In this case, the femoral head and the socket into which it fits are replaced.

This is done in a few steps:

  1. Your doctor will remove the damaged femoral head and replace it with a metal piece that fits into the hollow part of the femur. It is secured with surgical cement, or sometimes the prosthetic is textured to allow the bone to grow around over time. A metal or sometimes the ceramic ball will be fitted on top to slot into the socket.
  2. The next step is to remove the damaged cartilage from the hip socket. Once cleaned out, it is replaced with a new metal socket and secured in place either by surgical cement or screws.
  3. A spacer must be placed between the new metal components to allow for smooth movements. This piece can be metal, plastic, or ceramic.

Traditional Posterior vs. Anterior Hip Replacement

The more traditional hip replacement surgery will involve making incisions at the back of the hip, which includes deep cuts through tissue and muscle. In contrast, the anterior approach involves an incision in the front.

In the table below, you can see some of the key differences between the two procedures:

 

Posterior Approach

Anterior Approach

Who is suitable?

Majority of patients

Candidates that are overweight are not suitable

Surgery position

Patients are on their side

The patient is on their back on a special table

Incision size

4-6 inches

4-6 inches

Length of surgery

60-70 minutes

90-100 minutes

Difficulty of procedure

Most commonly performed and quite routine

Technically challenging and requires additional practice and learning

Possibility of nerve damage

Less than 1%

Higher risk due to the proximity of the lateral femoral cutaneous nerve

Time in hospital

1-2 days, but can be done as an outpatient in some cases

1-2 days, but can be done as an outpatient in some cases

Recovery

2 weeks sedentary work

2 weeks sedentary work

Some doctors prefer the anterior approach due to the minimal trauma to muscle tissue and the seemingly faster recovery in patients. In this case, the surgeon will move the muscle aside to work and will cut minimally, if at all.

During a traditional posterior approach, the surgeon must cut muscles and soft tissue in the back and buttocks, which will take time to heal after surgery.

How to Approach Yoga After a Hip Replacement

Exercise after surgery will help with stiffness, promote muscle healing, flexibility, and strength. As we have covered, yoga can help with all of these things and is a great thing to try. However, you should always speak with your doctor before beginning any exercise regime.

When looking at starting yoga or resuming yoga as a form of physical therapy, it is important to keep in mind your goal should be to strengthen your new hip joint and help your body recover from the trauma of surgery. However, you are also looking to preserve the integrity of the joint for as long as possible, without disturbing the healing process. It can take more than six months of rehab before their hip function is considered normal for some people.

Before starting any kind of yoga, you will need to consider how far into your recovery you are, whether you had the anterior or posterior approach, and what kind of yoga is best suited for your recovery and rehabilitation.

First Few Weeks

Exercise is a vital part of your recovery after hip surgery. Your doctor and physical therapist will help you find exercises that will restore strength, mobility, and blood flow. Assisted walking and mat-based exercises, such as ankle rotations, will promote a speedy recovery.

Initially, the best kind of yoga practice will be done in a chair, focusing on the upper body. This will maintain your upper body strength and raise your heart rate and blood flow without running the risk of damaging your hip joint.

The following video explains the difference between hip replacement surgeries and how it can affect your post-operative yoga practice:

As you can see, certain chair poses will be acceptable for anterior hip replacement patients, where they would be damaging for posterior patients.

Once you are feeling strong enough, you can look into restorative yoga. This class uses gentle, long-held poses to promote flexibility and relaxation. Using props and support, you can expect to transition on the mat slowly, and your practice can be modified to your specific needs.

Check In With Your Doctor

After getting through the first few weeks, you should revisit with your doctor to discuss your progress before moving onto more active poses.

Some things to consider include:

  • Your doctor may have different recommendations based on your performance
  • If you have experienced multiple dislocations – which is not uncommon – you may need to dial your work back
  • Partial hip replacement patients may have a faster recovery but should still be cautious
  • Certain poses are more or less dangerous depending on the type of surgery you had

With the all-clear from your doctor, you can begin to incorporate more into your yoga practice. Approach slowly, beginning on your bed or mat, moving to the edge of your bed, and then do supported yoga with a hand on the wall.

If you had a posterior hip replacement, you should avoid poses that involve:

  • Crossing the leg too far over the midline of your body for at least three months, such as child’s pose
  • Internal rotation for at least three months, such as eagle pose
  • Over-90° flexion for at least six months, such as standing forward bend

All of the above movements can potentially increase the risk of dislocation. Not only is your muscle in recovery, but the prosthetic replacements are slightly smaller than your natural joints and can dislocate more easily with overextending.

If your hip surgery was performed anteriorly, you should avoid the following poses for at least six months:

  • The triangle pose
  • Warrior two
  • Warrior one (for at least a year)

Poses chosen for recovery from an anterior hip replacement should limit abduction, external rotation, and extension. Even after the allotted time, there is still a risk of dislocation with some poses.

Drawbacks of Yoga

When practiced in a class and under supervision, yoga is a safe and gentle way to help recover strength and promote healing. However, when looking to practice at home, it is possible to over-do it or overextend yourself.

In the first few weeks after your surgery, you should be looking at very light activity, and any yoga practice at home should be focused on your upper body strength. Though restorative yoga is recommended, it should only be practiced in a class with a teacher and the correct props and supports.

Similarly, after the first few weeks, yoga should still be slowly taken as you begin to feel stronger. Research poses and speak with your doctor or yoga teacher before trying them at home. Your new hip joint can be prone to dislocation in the first few months, and too many can damage the joint to the point it needs to be replaced.

Unfortunately, even after a full recovery, you may find that your movement is still somewhat limited. If you were a yoga practitioner before, you may not be able to perform in the same way and might still need to modify your poses in the future.

Other Ways to Exercise

If you are new to yoga and unsure, you should only try it out in a class with a teacher who is fully aware of your limitations. This way, they can help you to modify poses and offer support where needed.

However, there are other forms of exercise that will help in your rehabilitation:

  • Walking is recommended from the very beginning. Starting with short walks using a support device, gradually work up to slightly longer walks without any kind of crutch or walking stick. This shouldn’t be until after the first few months of recovery.
  • Ankle pumps performed in bed. You will likely experience swelling after your surgery, and lying flat with your leg slightly elevated will help with this. While you are lying down, performing ankle pumps will help to strengthen your leg.
  • Aqua therapy is a safe and gentle way to promote movement. Without working the joint too much, water therapy can help reduce inflammation and swelling, along with increasing your range of motion and overall strength.

Conclusion

Yoga is possible after a hip replacement if you take it slow and consult with your doctor. Initially, you will need to remain seated and work only on your breathing and upper body strength. However, once you become stronger and your doctor approves, you can look into more poses.

The key thing with practicing yoga after a hip replacement is to remember you will need to modify your poses. Working with a teacher will help prevent injuries, though you will likely have more limited movement, even after a full recovery.

Sources

Sita

Mother of three and Yogi of 20+ years and 200 Hour Certified Yoga Teacher. I am also a Certified Thai massage therapist and I have taught Gymnastics for more than 10 years. In the last couple of years, I've been a big promotor of intermittent fasting.

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