How to teach someone with dual hip replacements?

[admin]

Does anyone have any experience or advice about how to teach (in a class setting, not a private) a man who has had both hips replaced? With those hunks of metal binding his femur and hip ... do we avoid any hip openers and just have him do work on the spine? I have a student who loves Yin Yoga and wants to bring her husband. He has had the hip replacements and she asked me if this would be a good idea. I did ask her to have him talk to his doctor and then see. Any other advice?

namaste, Bernie

[julie]

Hi Bernie -
This is a purely medical answer to the question, as I don't consider myself a yoga teacher. I strongly believe that the person who has had his/her hips replaced is no different anatomically for yin yoga. The reason is that the CONNECTIVE TISSUE is not replaced. Only the head of the femur and the acetabulum are replaced. This is bone replacement, not ligament/fascia replacement, so it should not affect yin yoga (or yang yoga for that matter). It will, however, enable the student to be more comfortable during practice because the surfaces are now smooth instead of irregular. I hope this helps. Of course, I am assuming the student is fully healed from the surgery.

My father has had two hip replacements, and I am still pre-hip replacement. I find that my yin yoga practice helps tremendously with my hip pain, but I will probably also need to get both hips replaced within the next 10 years.

I miss the Kula. I am going to Paul Grilley's retreat next week at Land of the Medicine Buddha, so I hope to reconnect with some friends.

Julie

[julie]

Just to clarify my last post, in a hip replacement the femur is not "bound" in any way to the acetabulum. Don't think of it like a spinal fusion or something like that.

[jenny tumas]

Hi,
I asked the opinion of my husband, an ER doc, who said that hip replacements are at greater risk for dislocation. This suggests to me that hip poses should be modified, and some--like swan--should be avoided.
Thanks for this website, Bernie!
Best,
Jenny

[admin]

Julie/Jenny ... thanks for the prompt replies. (I miss the kula too Julie...thus this kula board )

My initial sense was that as long as the student doesn't feel any pain or even major discomfort AND is fully healed mild hip openers yin poses should be ok. Jenny you said your doctor husband urges caution due to increased chances of dislocation ... I wonder if yin yoga would strengthen the ligaments and actually reduce those chances. After all, that is one of the key benefits of the practice: to make the liagments thicker and stronger.

ttfn
Bernie

[mofro]

It is very important to liase with qualified medical people when dealing with this issue;age ,procedure used, and underlying medical conditions need to be established and evaluated. This is a complex issue and must be treated seriously.This is not to poo poo yoga as an appropriate activity as most people need to do something with their bodies
all the best mofro

[positivepractice]

I have had both hips repaced - one is a full hip replacement (July 07) and the other a resurface (Dec 07). I have no restrictions and am now getting back into a modified Ashtanga practice. My Yin practice has helped greatly pre op and post op.

I have metal on metal replacement whith a larger ball and socket. This allows a greater range of movement with the hip, therefore no restrictions as there are with some implants i.e no crossing of legs or taking knee across the mid line of the body.

Even with my experience both as someone who has had replacements and as a Yoga teacher I would state strongly that the consultant who performed the operation is the only person to advice on what movements can and can not be done.

I am, however so impressed with the methods of Yin Yoga, learnt through Bernies book and also Paul Grilley and Sarah Powers DVD's that I am planning to provide a regular class in the York area.

Best health

Rob
City Yoga
http://www.yogayork.com

[Bernie]

Rob, thanks for your post. It is great to hear about this topic from someone who has actually gone through the surgery and knows yoga. I am curious as to your views on Yin Yoga: why do you think it helped you pre and post op? Did it strengthen the ligaments or increase the range of motion or both?

Your advice that the consultant that performed the operation is the only person who can give advice and what movements can be done and when is very good. Did your consultant understand the movements involved in yoga, and specifically yin?

thanks for sharing
Bernie

[positivepractice]

Hi Bernie, Better late than never! Very sorry for not posting sooner. Nearly 4 years post op now. I am positive that my Yin practice has helped me back to strength and flexibility. I found that a including PNF techniques before release into postures was an excellent way of working within postures.

This is not to say that I do not get the occasional twinge but I reckon that's to be expected after major surgery.

You asked me if my surgeon had knowledge of the postures. He didn't, but he had given me the all clear to explore full range of movement. This depends on the type of implant; hence the advice to consult before attempting any form of yoga.

[Bernie]

Thanks for the update! I hope you continue to do well.
Cheers!

[gjulien]

I am a certified fitness instructor, and Hatha (500 hrs) yoga teacher who regularly practices Yin Yoga. I am 48 years old and had bi-lateral hip replacements 6 months ago. I was very fit going into the surgery and was dedicated to my daily physio post surgery. My surgeon used a lateral approach and a larger ball and socket to make sure I had the right hardware to stay active post surgery without the risk of dislocating. I am still struggling to get my ROM back. I am totally fine with everyday activities, walking, getting dressed, putting on my shoes, etc. BUT when it comes to yoga, I find it very hard to sit on the floor, get up from the floor, Square Pose is basically impossible, I have to stay on my hands for Dragon Pose and Shoelace is a no-no. Had my 6 months follow-up with my surgeon and he doesn't agree with my yoga habits... he warned me that if I continue putting stress on my hip joints, going to the end of my range of motion, I am putting myself at risk for an early revision (a second hip surgery!). Every time I lunge, flex and extend the hips to the full range of motion, the femur bone hits the edge of the hip socket and damages (wear and tear) the rim of the acetabulum. Minimal damages at first but over time, the wear and tear will damage the rim of the socket and another surgery will be needed to avoid dislocation risk. I am devastated! I actually own a yoga studio, and yoga and fitness are who I am, who I have been for over 30 years! I now am teaching without performing the postures, which actually makes me a better teacher, I focus more on my students, offer more adjustments and cue more what I "see" not as much what I "feel". I am still debating if I will continue my own practice or not. I discussed and demonstrated a Forward Fold and a Crescent Lunge to three Orthopaedic Surgeons who said "NO" don't do these motions! "I'm strong, I feel my muscles are protecting my hip joint" - but they were adamant, not worth the risk they said! Anyone who has advice, who has any kind of experience with hip replacement clients long term, please share your info! Thank you! Namaste!

[Bernie]

Your surgeon is the one who knows exactly what he/she did in your operation, so listen carefully to that advice. If both the head of the femur and the acetabulum were replaced (which sounds like your case), you have the situation where metal on metal stress is occurring. Inanimate materials are not self-healing. If you stress these too much, they will wear out more quickly. However, if only the femoral head was replaced, then you still have a bony acetabulum with, presumably, some cartilage. Living tissue require stress to remain healthy, but too much stress will lead to degeneration.

Depending on what was done, you may have to drastically limit certain movements to avoid wearing out inanimate material or to find some threshold of movement that can stimulate animate/living tissues without going too far and wearing them away. I can see why your surgeon doesn’t want you to go to your end range of motion. But to have no movement is also not great. See my article on Antifragility: we need to stress living tissues to stay healthy, but when we are injured the distance between too much stress and too little stress is very short. You can easily do too much, but you need to do something.

Normally, external rotation and abduction are okay for people with hip replacement, but adduction and internal rotation are not great. Shoelace is extreme adduction, so I can see why that is forbidden to you. Square pose may come back to you in time, but what’s the hurry? For now, stick to Butterfly, or try wide Square (knees wider than hip-width apart.) In your case, you are also being warned not to do so much extension or flexion either. This may be because many of the capsular ligaments that prevent too much extension were damaged or removed in your operation. Deeper flexion may be possible/available if accompanied by external rotation and abduction (ie: have your legs a bit wider apart and slightly externally rotated when you flex at the hips and see how that feels.) Again, I would listen to your surgeon and not go too deeply in these directions.

Part of your current lack of ROM may be some lingering inflammation, which should diminish in time, if you let the area heal. If you keep pushing to your edge, that inflammation may remain for longer. So, again, back off and find what your appropriate edge is today. (Another way to reduce chronic inflammation is earthing. Check out this article.)

As a yoga teacher, you are a pioneer, whether you like it or not. What you are learning will be very valuable to others about to face what you are experiencing. Please let us know how your journey goes!

Good luck
Bernie