Stretching and strengthening post surgery

Stretching and strengthening post surgery

The All-Clear

Five years ago today, I was a patient at Hunters Hill Private Hospital in rehabilitation after double hip replacement surgery.

I’ll give a little time to let that sink in. Yes, two hips at the same time. I had bi-lateral surgery, a 3.5 hour procedure, whereby I received titanium protheses. I had to learn to walk all over again, and I did. Then, within 3 months, I resumed yoga practice and teaching.

Last week my orthopaedic surgeon viewed my recent x-rays and gave my new hips a good report. We’re hoping these new hips will outlast me.

As a yoga practitioner who has undergone major surgery, I thought it would be helpful for other yogis to understand the process I went through. So, I wrote the following article for Australian Yoga Life Magazine. In case you missed the original article, I’m re-publishing it here.

Yoga and Surgery

Hearing the news from your doctor that you will need to submit to surgery can be both shocking and frightening. At best, the event will be a simply an interruption of normal activities and at worst it may be life-threatening.

For many yogis, the body is a temple, and cutting skin, muscle, even bones, seems like an unwarranted invasion. On the positive side though, the practice of yoga can mean that from the pre-operation period right through to rehabilitation, you will be able to exercise a measure of authority over your body and mind.

At some point in your life you may be facing the prospect of elective or non-elective surgery. Whatever your level of yoga experience, this ancient healing system will stand you in good stead when you need it.

Yoga practice is not everything you’ll need to prepare and recover from surgery, but at every pre-operation and post-operation stage, you’ll find that dipping into your yoga toolbox will give you untold resources.

I have just undergone major surgery, and I’d like to share with you some of what I’ve learned.

Preparation

The yoga precepts according to the sage Patanjali instruct us to be honest with ourselves. You may have been in denial about getting assessed and treated for your condition for some time. That’s very human. Maybe the thought of undergoing surgery makes you feel guilty, angry, depressed, scared. We learn in yoga to be as sensitive to our feelings as we are to our body, but also how to detach so we can intelligently do what needs to be done.

When you are ready to consult with a specialist, it is advisable to meet with more than one. This will give you an opportunity to get different views. Only one of the orthopaedic surgeons of the three I saw suggested that I have a bi-lateral hip replacement – meaning two hips done at the same time – a procedure that has worked brilliantly, but I hadn’t even thought it was remotely possible. Another one of the doctors said that I probably could afford to wait a while longer until I knew it was exactly the right time for the surgery. Eventually I decided to have the surgery because my active life was becoming more and more circumscribed by osteoarthritis.

Before your appointment with a specialist, arm yourself with everything you need to know about your condition and think about the questions you need answered. The internet is an indispensable aid for researching and will even generate “ask your specialist” questions you may not have thought of. A friend of mine asked the surgeons she saw whether she could fax them questions that occurred to her after the consultation, and they all agreed to do this. The more informed you are, the better patient you will be because you are a partner with your doctor.

Understand exactly what will go on before and in surgery. You should have an opportunity to meet with the anaesthetist ahead of your operation, and he or she will advise what sort of anaesthesia will best suit you. These specialists know their stuff but feel free to enter into a dialogue so that you feel you understand anaesthetist’s thinking.

Find out how long the operation will probably last. Will there be a chance that you will need a blood transfusion, a graft? How long will you be in the recovery room?

One of the hardest things about scheduling elective surgery is deciding when is the best time to do it. Many factors enter into this decision but ultimately it is your choice, with constructive input, of course, from your consulting surgeon.

As physical preparation for surgery, yoga offers training in strength, flexibility, balance, breathing, focus, and mental equilibrium. It is very important to go into surgery with as much fitness as possible because the operation is probably going to be quite an assault on your body. And, you’ll need reserves of strength and mental fortitude to help speed your recovery.

In the lead-up to my recent hip replacement surgery, I was suffering badly from the effects of osteoarthritis. My range of movement was limited; I had a pronounced limp on one leg, experienced periodic periods of pain and took painkillers when needed. Nevertheless, I still benefited from doing a two-hour yoga practice each day.

I created a well-rounded practice that incorporated poses for mobility, “chest openers” for optimum breathing, tractioning poses for my hips, legs and back, inversions for stamina and mood enhancement, restorative poses, pranayama and meditation.

Chest Opener Post Surgery

I started visualising what my new life would be like post-surgery: the cycling, tennis, dancing, and bush walks that I could resume. This simple mind exercise kept me from getting discouraged during my recovery when I was full of drips and drains and tubes.

I took refuge in my yoga practice and it was an excellent sanctuary that my body remembered in post-operative recovery.

Post-Op and Recovery

Surgery and the necessary use of drugs while you are in theatre will have taken their toll on your body. You may need to continue with pain relief afterwards to mitigate residual pain – perhaps for a day or so. Medical staff blood pressure, oxygen saturation, temperature and pain levels.

Looked at from an Ayurvedic point of view, the drugs administered before and after surgery create some Vata imbalances: constipation, dry skin, temporary memory loss, fogginess, and disturbed sleep. You may experience some discomfort with these symptoms but as the drugs are eliminated from your body, these problems will gradually diminish.

The doctor will have prescribed deep breathing to raise low blood pressure,

oxygen levels, and improve circulation, advice that is totally in line with yoga practice. You’ll probably be wearing compression stockings for a while after surgery to help you offset deep vein thrombosis. It is also recommended that you begin to stretch toes, rotate feet and ankles and move your legs, if possible to thwart any blood clots forming.

The custom now in hospitals is to get patients first standing, then moving, and giving them assistance with showers and toilets until they soon attain self-sufficiency. One’s natural healing ability will kick in no time.

Pawanmuktasana, the class of yoga poses that free the joints, are ideal for post-operative recovery. These simple rotating and stretching movements systematically work every part of the body to keep prana flowing. However, they maybe contra-indicated for use depending on where the site of the surgery is. Initially, after my hip surgery, I could only move my legs with great difficulty, but I could still easily move my upper body and feet and ankles. With abdominal surgery, movement in the core area of the body needs to be limited so stitches are undisturbed and can heal.

Yoga nidra, the yoga practice of mentally going through the body to methodically relax each part in turn, is a beneficial way to deal with sleeplessness and restlessness. The practice incorporates “san culpa”, creating an intention, which can be used to advantage for self-healing or giving gratitude for all those who supported you through surgery and recovery.

Rehabilitation

For surgery that involves joint reconstruction or replacement, rehabilitation is a must. The surgeon’s incisions will have cut through muscles or stretched them beyond their normal range, and they gradually need to be strengthened. You are not ready to take on a regular yoga practice at this time, but experienced physiotherapists will help you get in better condition than you will have experienced in a long time. Physio exercises are the stick and hydrotherapy is the carrot. Exercise in warm water is pleasurable because of one’s almost weightless condition, with ease of movement a revelation.

Simple walking is a great activity because you can see your stamina improve daily. You can “yogify” your walking by being attentive to the evenness of your gait, your posture, your breathing.

Pranayama, if done pre-surgery and post-surgery, is now probably set as a habit, and you now can deepen this practice by giving it more time and attention. Yogic breathing is your life-long companion, one that will accompany you through all stages and ages – the good times and the difficult times.

In your rehabilitation, you may be able to incorporate some restorative poses into your program. My body craved propped up “chest openers”, using bolsters, blankets, and blocks. These helped relieve the stiffness in my back (with double hip surgery, I was advised to sleep only on my back for six weeks) and expanded my chest for better breathing. This special class of poses recharges your body without a great investment of effort on your part, like opening the window just as a cool southerly breeze kicks in on a sweltering day.

Back Into Life and Work

A good question to ask is have you allowed yourself enough time for recovery and rehabilitation. Job insecurity, family pressures, or even boredom may motivate any short cuts that you take at this time; nevertheless, your steady recovery is the most important thing. Having just spent 10 days at a rehab centre, I heard from some patients that they required revision surgery because they had rushed their recovery or didn’t do the hard yards with the physiotherapists the first time round.

A good rehab facility will also provide consultation with an occupational therapist who will advise you on setting up your home for ease of mobility, how to get in and out of cars, and walking aids you might require.

Now is the time when you may want to re-introduce some of the yoga poses you had been doing in the lead-up to surgery, always taking on board your surgeon’s advice.

Most people report that when they have had a long break from yoga practice, and are now free from the discomfort they’d formerly experienced, that they enjoy their yoga with more zest and pleasure than they could have imagined.

This is the time to make haste slowly and not be overly ambitious which is always yoga best practice any way.

I was never so grateful for my nearly 40 years of yoga practice, as I have been in this difficult period. I’ve been astonished by the ease and speed of my recovery. Every bit of yoga has been useful to draw on and has contributed to my walking out of the rehab centre less than 3 weeks after double hip surgery without walking sticks, without a limp, and without pain.