THE PRACTICE OF YOGA: POST OPERATIVE TOTAL HIP REPLACEMENT SURGERY
When I prepared the following instructions to perform Yoga, I first of all addressed the various poses as I modified for the right hip total hip replacement surgery I had on March 28, 2000. You’ll notice in most cases I only address that part of a pose I had to modify for my surgery. Any pose or part of a pose not mentioned means I was able to perform, perhaps not to the same level prior to my surgery but at least to a level that in my opinion merits no comment. Except where I have specifically commented there is no change to any of the steps in a pose detailed in the instructions I received at Bikram’s College of Yoga in Seattle, Washington.
If there is a thread that runs through all the modified poses is the sense of moving into a pose until "resistance" is felt. It is at this point I feel someone recovering from total hip replacement hip surgery can gain the greatest benefit in his or her recovery process. This is not a point to simply "hang out" it is a point where through proper breathing techniques one is able to move deeper into a pose to eventually reach the same level of the pose that one might have enjoyed prior to surgery.
As I previously mentioned I practiced my Yoga from December 12, 1999 (when it was confirmed I had lost some 75% + of the cartilage in my right hip) through March 27, 2000 (the night before my surgery). I credit the continuation of Yoga as a significant factor in the success of the surgery and the speed of my recovery. I was back to work in 6 weeks, walking without the aid of either crutches or a cane at 7 weeks and back to Yoga in 8 weeks post op.
For the most part I have not attempted to include any caveats as part of these instructions. Anyone who has had total hip replacement surgery should have been fully instructed as to what physical movements can or cannot be performed.
The ability of one to return to the practice of Yoga will be affected by a number of factors not to mention at least their level of fitness and level of skill prior to the operation. I was 54 when I had my operation and would say I was in very good shape and was proficient in most of the various poses having practiced for some 3 1/2 years. In the final analysis I knew the "risks" when I returned to the practice of Yoga. What I also knew and firmly believe is that no matter how one modifies the various poses there is benefit in the pose. You simply have to allow your body to be the messenger and use some common sense. If one first thinks through the movements involved with each pose it’s rather simple to determine where one has to be especially careful.
Lastly and most importantly anyone should be told there is life after a total hip replacement surgery. The Chinese say , "a journey of 1000 miles begins with the first step". So to with the practice of Yoga.
Ardha-Chandrasana with Pada-Hastasana
Bend slowly to the right move your left hip to the to the left until you feel resistance. Similarly on the opposite side bend slowly to the left and move your right hip to the right until you feel resistance. Slowly bend arms and body backwards until you feel resistance. In Pada-Hastasana bend forward slowly from the hip joints until you feel resistance. My first objective in Pada-Hastasana was simply to place my hands on the shins of my legs.
1. Sit down only as far as one feels resistance. In the beginning I never went further than 45 degrees.
2. In the second part of awkward I simply tried to move as high up on my toes as possible. No attempt was made to sit down.
3. In the third part of awkward I would repeat the first part of the pose. Putting the knees together for at least the first 12 weeks post op should be avoided. Your orthopedic surgeon should have made this point many times.
In the Eagle Pose bending the knees about 6 inches is OK. I would transfer my weight to my left foot and slowly lift my right leg as high as comfortable bringing it as high as possible over the left thigh. I would not attempt to wrap the calf and foot totally around like a rope. I would merely hold the calf and foot just to the left side of the left leg with the top of right foot facing the mirrors. I would not attempt to sink down.
I would interlace my fingers firmly just below my right knee. I would then pull my right knee toward my chest until I met resistance.
Standing on my right leg in Standing Bow Pulling Pose I only kicked until I met resistance in my right hip. As with all the poses what the student will find is that it is the muscles of the operative hip that will restrict the depth that one is able to achieve in the pose.
One of the most challenging of the poses. In the beginning all I would do is to step forward with my right foot in a modified salutation to the sun.
I would bend forward from the lower back until I met resistance. In the beginning I would grasp just behind my legs. Keeping the back straight and the eyes up is very beneficial in this modified pose.
Keeping my left knee locked I would turn my right foot and leg to the right until I met resistance. I would bend my right knee to the right again until I met resistance. I would then go down slowly until I met resistance in my right thigh. I would not attempt to move m right thigh parallel to the ground. Keeping my arms straight I would bend my torso directly to the right and would go no further into the pose than having my hand approximately 8 to 10 inches above my big toe.
Bending my right knee as much as necessary was essential for me to progress in the Standing Separate Leg Hand to Knee Pose. It was also helpful for my balance to keep my hands facing each other but apart rather than together. I would then bend forward until I met resistance.
Standing on my left foot I would merely raise my right foot as high as possible on the inner thigh on my left leg with my goal being to have my right thigh parallel to the ground.
Did not do prior to my operation.
I would merely pull my right knee down toward my chest until I met resistance. Similarly I would make the same motion when performing Wind Removing Pose with both legs.
I would lift my right leg until I met resistance. When raising both legs I would likewise go until I met resistance.
Poorna-Salabhasana and Dhanursana
Both the Full Locust and the Bow Pulling Poses can be performed. Just merely go until resistance is felt.
In the beginning I would merely sit Japanese style with the aid of a small wooden bench, holding my hands in prayer and simply use this moment to meditate.
I would use the small wooden bench as an aid in performing the Half Tortoise Pose.
In the beginning I would do no more than stand up on my knees and bend back slowly until I met resistance.
Once again I would use the small bench as an aid in performing the Rabbit Pose bending forward until I met resistance.
Janushirasana with Paschimotthanasana
I would bend my extended leg until I could grasp my toes and bring my forehead in contact with my knee then slowly push down with my forehead until resistance was felt.
In the Stretching Pose I would grasp my ankles slowly bending forward at the waste until resistance was met.
Again this is one of those poses where crossing my right leg over my left knee had to be avoided for at least the first 12 weeks post op. So to modify this pose I would simply bend my right knee keeping my right foot flat on the floor and position it on the right side of my left knee rather than the left side. Rather than bringing my left arm to the right and over my right knee I would simply keep it on the left side with palm down on the carpet. I would then twist my body to the right until resistance was met.
Kapalbhati in Vajrasana
With the aid of the small wooden bench the Blowing in Firm Pose can easily be performed.
It's been some 15 months since I wrote my article of August 10, 2000 entitled The Practice of Yoga Post Operative Total Hip Replacement Surgery. In September of this year I had my one year post operative physical. My orthopedic surgeon indicated everything looked great. I continue with my practice at least two times per week at Bikram's Yoga College of India located in the Freemont district of Seattle, Washington. I am very pleased to say that I am now able to perform all the poses for the most part without modification. I still adhere to listening to my body and moving into a pose until "resistance" is met, except now with the strength I've gained over the past 20 months I am even more willing to move deeper into each pose. For any one who read the article I just want them to know I am still practicing and that there truly is life after a total hip replacement surgery.