Practicing Yoga After a Hip Replacement
I wouldn’t say I’m totally unique. In fact, I’d say I’m one in 1,000.
Why? Because according to the Mayo Clinic, one baby in every 1,000 US births is born with hip displaysia. In 1977, I was one of them.
After one surgery (a PAO) to avoid a total hip replacement on my right hip in my 30’s, time finally caught up with my left hip and wore away enough cartilage that severe arthritis led me to a second surgery— a total hip replacement at the age of 44. As a yoga instructor and very active adult, this was devastating news. I knew I’d have to do it eventually, but who has time for a total hip replacement? How was I going to continue to teach my yoga classes much less continue practicing yoga after a hip replacement?
Well, there was only one way to find out! If a total hip replacement is in your future, here’s what to expect when practicing yoga after a hip replacement.
Why do I need a total hip replacement and what is it?
There are various reasons you may need a total hip replacement. The most common reason is that you have arthritis in your hip joint. This can happen naturally as you age, from an injury, or— if you’re a one in 1,000 like me— it’s because hip displaysia has finally worn away that cartilage.
Hip displaysia is when the acetabulum — or hip socket— was formed to be too shallow to support your femoral head — the ball part of your hip joint. According to my orthopedic surgeon at The Mayo Clinic, it is most commonly found in first born daughters with smaller frames. When the acetabulum is too shallow, the labrum— a special band of cartilage around the rim of your hip socket— becomes badly damaged or wears away enough that a hip replacement is required.
A total hip replacement, or total hip arthroplasty, is when the femoral head/hip joint is replaced with a prosthetic— a brand new ball and socket joint in your hip. It doesn’t sound pleasant and it’s not. I’m not going to sugar coat it. However, it is a very common surgery on adults with bad arthritis in their hip joint due to the wearing down of that smooth cartilage inside the hip socket.
The surgery involves removing the ball joint from the top of your femur as well as cleaning out the socket from the remaining damaged cartilage. The ball joint is replaced with a new one— often made of metals or ceramics— and the new hip socket is made of plastic and titanium or cobalt-chrome backing.
Before you even heal from the surgery, you can feel the difference in your joint. I like to say mine “glides like butter”. However, there is going to be pain for up to a year as the new joint heals.
I did also have a periacetabular osteotomy— or PAO— at the age of 34. The surgeon cut the right side of my pelvis and rotated it to cover the head of the femur and then it is screwed back together. This was to delay a hip replacement on the right side as it preserves my own joint and bone since the docs know I’ll have to eventually have a replacement on the right side as well. The recovery from a PAO is much longer than a total hip replacement.
This is my X-ray after my left side total hip replacement. On the right side, you can see how my pelvis has been cut, rotated and screwed back together from a peri-acetabular osteotomy or PAO. (Property of Down Dog in the Desert, LLC)
Recovery after a hip Replacement
I have always been active. The joke in our house is that I never sit down. When I do, my husband and kids think something is wrong with me.
So when it came to post-surgery life, things got tough. If you’re like me and don’t do well with asking others for help with daily tasks, you may want to mentally prepare yourself. I would say I’m independent so be warned: those first couple of weeks after your hip replacement are going to be very trying.
The day of surgery, they have you up and walking with a walker in the hospital. Had to believe— I know! At some point during your stay, an occupational therapist will visit you to work on how to move around with your recovering hip when you are at home. The goal is to get you back to your independent life. You’ll also be prescribed some painkillers to help you rest. I am not a fan of painkillers so I took the minimal amount needed. But, everyone’s pain tolerance is different. For me, after a couple of days of opioids and feeling sick to my stomach because of them, I moved to Tylenol. Ibuprofen would work even better if you can take that.
Once home, I was stuck in bed for a few days. This was hard. I couldn’t get up and out of the bed on my own— my husband was my lifeline. And when I say “bed”, I mean not leaving our room. After a few days, I was able to make it down to the couch for a change of scenery. Remember, I’m a fit, active 44-year-old with a family and it was this difficult for me. This made me realize exactly how important it is to keep my body moving, to incorporate weight training and to eat well during every stage of life. Keep this in mind if a hip replacement— or any major surgery— is in your future. Your body needs to be well to recover.
As time passed, I became stronger and regained my independence. Know that it is going to take time. I had to learn very quickly to be patient and my frustration around not being where I was before the surgery as quickly as I wanted to be caused quite a few tears. Learn to ask for help. Learn to rest. Allow yourself to heal. In yoga, we teach many ways to heal the soul using our breathing and body while holding each asana. It’s easy to forget that in rest, we heal our souls, too. Think of savasana— final resting pose— it’s that moment after all of your hard work that you allow your body to just be while the soul soaks in all that made it full during your practice.
It’s no different after a surgery. You need to allow your body the space to heal. Your body needs to be in an active savasana, if you will. It’s after you allow your body to heal that each day you will begin to notice your strength returning, little by little.
Can You Do Yoga After Hip Replacement Surgery?
When my orthopedic surgeon confirmed the inevitable, I did all the yoga I could until the day of surgery. I found a long-term sub to cover my classes for two months. I thought for sure I’d be up and teaching again in no time.
I was wrong.
In fact, I ended up having to give up my yoga class entirely. I simply couldn’t move the way I could before. My orthopedic surgeon told me it would be a year from my surgery before I was fully recovered. However, at my six-week checkup, my doctors were surprised at how quickly my recovery was progressing. So, frustration came rolling back around when I realized that yoga wasn’t going to be part of my daily life as quickly as I thought it would be. I didn’t understand— if I was recovering faster than most patients, why couldn’t I do yoga after hip replacement surgery?
I realized I needed to reframe my thinking. Instead of asking myself why I couldn’t do yoga after hip replacement surgery, I needed to ask myself “what yoga can I do after hip replacement surgery?”
If yoga is part of your lifestyle and a hip replacement is in your future, here are some recommendations of what to expect based off of my personal experience. I am not a doctor or physical therapist, so please practice at your risk. Your doctor will be able to provide the best information personal to you and your journey.
Yoga Poses After Hip Replacement Surgery: 0-6 Months
Restorative: 0-3 Months After Surgery
Most of this yoga will be done while recovering in bed or on your couch. As you heal, your body will let you know when to push your limits and when to back off. Listen to your body!
Immediately to one month after:
Use ujayii breathing to relax and de-stress
Laying down, do overhead stretches to begin to strengthen shoulder muscles and relax the spine
Flex your toes up to the sky to strengthen your anterior muscles and extensors
Rotate your feet in circles to encourage circulation to the legs
Prop a pillow or yoga bolster under your knees (think of yourself as being in an upside-down table position or Bharmanasana) strengthen your core and carefully bring your knees to your chest. Stop when the hip tells you to!
Two to three months after:
You may be able to lay on your yoga mat on the floor as you get to this timeframe. Ask for assistance getting down to the mat or up from it if you need it.
*Each asana should be held for 3-5 minutes at minimum
Supported bridge (Setu Bandha Sarvangasana)- place your feet on a firm surface and a yoga block or bolster under your bottom/sacrum. Your shoulders should be flat on the floor with arms extended. Unlike regular bridge pose, where you slowly begin to lift your butt and hips, supported bridge allows your hip flexors to relax while allowing your quads to engage. This also helps with circulation and breathing and a creates a nice stretch across your upper back.
Supported butterfly (Supta Baddha Konasana)- Bend your knees and begin to allow them to fall open as you place the soles of your feet together. Pause and place bolsters/soft pillows or yoga blocks under where your knees will naturally fall open to give yourself total support in the hips. Adjust your support where needed.
Seated supported butterfly (Baddha Konasana)- Sit up with back straight and shoulders down your spine. Move flesh away from the sit bones. Begin to bend legs so that soles of the feet come together. Begin to slide your feet toward your groin, allowing knees to fall open but resting on pillows/bolsters to the height and support your body needs. If possible, bend at the waist and stretch yourself forward, over your legs.
Reclined cow (Gomukhasana)- This is a gentle way to begin to stretch the muscles around the hips that may feel tight from lack of daily use as your new hip joint heals. Lay on your back and bend one leg. Place a bolster or firm pillow under the knee, keeping your knee supported at an elevation that is comfortable for you. Once you feel your bent knee is fully supported, take the opposite leg and cross it over the bent knee. Do not twist like in supta matsyendrasana. Another bolster can be placed under the back of the thigh, near the sacrum, where it lifts up from the floor as your leg crosses over.
Hatha: 4-6 Months After Surgery
By now, you will likely be up and moving about as close to a normal, pre-surgery day. You will notice some restrictions with your new hip— abduction (moving your leg outward) will be limited and you may still notice some pain when doing so. Each person is different so if your body is sending a signal that it doesn’t like a movement, you should avoid it or at least approach that movement very slowly.
Hatha yoga isn’t just a basic practice of yoga asanas and breathing— it is the practice of the six of the eight limbs of yoga. In hatha, the Yamas and Niyamas are excluded.
As you enter back into yoga after a hip replacement, the practice of hatha will bring you back to both your spiritual and physical self. Consider it a gentle journey that focuses on:
A steady body and mind
Even breathing
Removal of your senses
Concentration through your third eye
The awareness of your self
The absence of your mind’s thoughts
Basic Hatha Flow
Ujjayi Breathing
Child’s Pose / Balasana
Stretch arms forward (left, center, side)
Table / Bharmanasana
Cat-Cow / Chakravakasana
Thread the needle
(From all fours, open to the right, lift the right arm up into the sky, gaze follows. Stretch. Repeat on left side. On last round, right arm and shoulder come down under the chest and chest to the floor)
Child’s pose / Balasana
Down Dog / Adho Mukha Svanasana
Low Lunge
Step right foot between hands. Lift chest and slowly bend the knee to and fro. Next, place left hand down to the floor, outside of right foot, and reach right arm up to the sky.
Place right hand back down and slowly come back into down dog. Repeat the low lunge on the left side.
Down Dog / Adho Mukha Svanasana
Walk hands back to meet feet
Forward Fold / Uttanasana
Walk hands forward to down dog
Plank
Cobra / Bhujangasana
Child’s pose / Balasana
Move slowly to back
Happy Baby / Ananda Balasana
Supine Spinal Twist / Supta Matsyendrasana
Six to seven months after surgery, you may be ready to move into vinyasa flow— or you may not. Keep in mind that your muscles will be like babies. At least, that’s how I think of them at this point! Try not to get frustrated with yourself if you can’t move into some of the asanas you could before as you practice yoga after hip replacement. Your body tells you it’s not comfortable by sending you pain signals— continue to listen to your body and you’ll begin to notice new changes in your movement day to day.
At seven months post-op, I am able to take Vinyasa but I encounter asanas I simply cannot flow into or stretch as deeply into as I could before. I will likely be able to again but at a recent visit with my orthopedic PA, I learned I won’t have the exact flexibility I did before since displaysia allows for a hyperextension of the joint that most don’t normally experience.
Can I Practice chair Yoga after hip replacement surgery?
You may be able to practice chair yoga after hip replacement surgery. Or, rather, you will be able to practice it but with some limitations. Chair yoga after hip replacement surgery would be best for older individuals who are moving though a slower recovery or never did practice hatha or vinyasa to begin with. Maybe these folks didn’t have the mobility to get up and walk around actively even before the surgery.
When it comes to chair yoga, keep in mind that the lower body leg-lifting movements such as raising the legs up to point and flex the feet/toes should be done around the 3-4 month post-recovery time frame or when it feels comfortable. The reason for this is that the hip joint is still trying to heal as well as the muscles and tendons around that joint. It would be perfectly fine to do these raises with the non-surgical leg, though. This would help to increase circulation and strengthen that leg to get the patient on the road to a speedy recovery. Continuing to do arm circles, overhead stretches and core work with small hand weights or a strengthening band would be excellent!
Be Kind to Yourself and Embrace the Healing Journey
Remember, any movement without pain is good for you. Practicing yoga after hip replacement surgery can be done… slowly and with patience. You will find the right way to move your body starting with the most basic asanas and stretches. Don’t forget to incorporate what you have learned through the spiritual side of yoga, too. Yoga means “union”— the joining of the physical body and the higher being. Channeling the right energy into your body (the vessel) through the power of positive thinking and meditation is equally as important to a speedy recovery as is moving your body. And finally, don’t forget to be kind to yourself. Your body has moved your soul throughout your life and it simply needs a little time to recover from a fix under the hood. You owe it to yourself — and those who love you— to rest.
Namasté,
Jen
