If you've had open heart surgery, then you may require the skilled services of physical therapy in a cardiac rehabilitation setting, where you can work on improving your strength and endurance, and work to improve your functional mobility.
After surgery, your doctor may require that you follow sternal precautions: a method to protect your sternum, or breastbone, after you've had open heart surgery.
Open heart surgery usually requires that your cardiac surgeon divide your sternum to visualize your heart and surrounding structures. After the surgery, your surgeon must repair your sternum by aligning the bone in the proper place. Usually, a strong wire is used to hold the bones together while healing takes place.
Why Use Sternal Precautions?
Sternal precautions help to prevent the separation of your breastbone as it heals. Separation of your sternum may slow the healing process of the bone, and these precautions also help to prevent excessive pulling on the surgical incision. This may help to keep the skin closed to prevent infection in your incision.
If you've had open heart surgery, you must follow your doctor's orders, as some doctors use different surgical techniques and have different requirements after surgery. You must fully understand what is expected of you after open heart surgery.
Sternal precautions include:
- Do not lift more than 5-8 pounds.
- No pushing or pulling with your arms.
- Do not reach behind your back or reach both arms out to the side.
- Do not reach both arms overhead.
Your sternal precautions may be different depending on your surgeon or the facility in which you are participating in acute cardiac rehabilitation. Some doctors, for example, allow you to reach one arm overhead, and others allow you to lift up to 10 pounds. Just be sure to speak with your doctor to understand your specific sternal precautions.
Sternal Precautions and Physical Therapy
Your physical therapist can work with you in cardiac rehabilitation to help you understand your sternal precautions. You may find that basic functional mobility is difficult while maintaining sternal precautions, and your physical therapist can teach you basic functional mobility while maintaining sternal precautions. These include:
- Scooting in and rising from a chair
- Walking up stairs without pulling on the railing
- Rolling in bed
- Sitting up in bed
- Using an assistive device, like a walker or quad cane
- Performing basic ADLs, like brushing your hair and dressing
How Long Should I Maintain Sternal Precautions?
If your doctor asks you to follow sternal precautions, then he or she should be able to tell you when you no longer need to follow the precautions. In general, your breastbone should be healed within 4 to 6 weeks following your open heart surgery, and sternal precautions should be lifted at that time. Again, follow the advice of your doctor regarding when to stop following sternal precautions.
Are Sternal Precautions Really Necessary?
There is some debate as to whether sternal precautions are absolutely necessary to protect your breastbone as it heals after open heart surgery. There is a lack of evidence that indicates you are in danger if you do not follow sternal precautions, and some professionals recommend performing normal activities based on your own tolerance. Feelings of crunching or popping in your breastbone are a sign that your sternum is moving a bit, so if this happens, the activity that caused it should not be performed, and your doctor should be notified.
Regardless, if your doctor recommends that you follow specific sternal precautions after open heart surgery, you should follow her advice. Your physical therapist can help you understand and maintain your sternal precautions.
Source: Hillegas, E. and Sadowskyi, H.S. "Essentials of Cardiopulmonary Physical Therapy." 1994. W.B Saunders Co. Philadelphia.