Hip Replacement Yoga: Integrating Students after Surgery into Your Yoga Classes
Becca is the author of Teaching Yoga: Creative Cueing for Safer Mixed Level Classes. A long-time studio owner and teacher trainer, she now teaches online, blogs, and creates resources for other yoga teachers.
[Disclaimer: In this post I share what has worked for many of my yoga students with hip replacements over the years. This post does not constitute medical advice. All students with hip replacements must be released by their doctor before doing yoga. They must know their own limitations. If a student does not know or is unsure of their limitations, they must receive this information from their doctor or physical therapist before attending yoga class.]
You’ve planned the perfect class and are about to begin when a new student arrives with a hip replacement. This scenario happens more often than in the past. Surgery outcomes have greatly improved over the years, and so younger people are now electing to have the procedure.
We aim to be inclusive while also being mindful of safety. It is not realistic to create a specific hip replacement yoga class in most venues as there would not be enough students. However, Incorporating this younger cohort into our regular classes is doable, as long as our class isn’t a fast moving power flow and/or includes a lot of poses requiring deep ROM (range of motion) in the hips. In some cases, it may be safer to refer the student to a more gentle class or one that is focused on the needs of younger seniors.
Let's discuss how to assist the student in determining where they best fit.
Can You Really Do Yoga After Hip Replacement?
Yes, many people can attend yoga after their hip replacement surgery, but only after their doctor clears them to attend. Most surgeons do not want their hip replacement patients to attend yoga classes for at least 3 to 6 months after their surgery. In some cases, it may be even longer. If the student is unsure whether their doctor has cleared them for yoga, then recommend that they consult their doctor before attending classes.
The risk of injuring the hip is higher in the first six months after the surgery, including the rare event of a hip dislocation. Many medical professionals want the patient to complete all of their physical therapy before practicing yoga to be sure their hip is stable, and that they have regained some basic ROM.
If the student has been cleared by their medical team to take yoga class, then the next question to ask is if they were given any specific contraindications in terms of movement. Depending on the type of hip replacement and other issues specific to the student they may have been told to avoid certain movements. With this information, we can help the student assess whether our class, which is not specifically geared as hip replacement yoga, is suitable for them.
If there are a lot of contraindications, then refer the student back to their physical therapist to review all the basic yoga poses. One option is to recommend the student take a book with pictures of the poses to their appointment, to assist in their understanding of what they can and cannot do. After their medical consultation, it's best to start with a private session to ensure the student is aware of all necessary pose modifications.
☑Checklist: Can a student with a hip replacement attend my regular class?
My class is slow moving, not a power or fast flow class
The student has been released for yoga class by their doctor or PT. This is usually around 6 months after the surgery.
The student knows what movements they are supposed to avoid.
The student can get up and down off the floor on their own.
One last question to ask the student is whether they can get up and down off the floor on their own. After hip replacement surgery many people can, it often depends on what their status was before the surgery. Those that cannot get up and down off the floor by themselves are much harder to integrate into our regular classes.
In these cases, it would be better for the student to attend a senior chair yoga class if available. That said, if there are no such classes in your area, one option is to start with private sessions to teach the student how to do the poses with a chair. Again, a referral back to their physical therapist for guidance may be in order.
I want to mention here a rare situation. If a student with a hip replacement sometimes has trouble getting up and down off of the floor, but doesn’t reveal this to you before class, then a situation may develop. I have seen a few students over the years become so tired they struggled to come to standing at the end of class.
If this happens to you in a recreation facility, then observe the situation carefully. Not being able to come to standing may also be the beginnings of a medical event. If the student appears fine, but just can’t get up, then send another student to get the manager immediately, don’t try to help the student by yourself. As yoga instructors, we are not trained to safely physically assist people in this situation off of the floor, and might hurt ourselves or the student.
One possible solution is to offer the student a chair to press up on. Some people learn to place their hands on the seat of a chair to help move to standing, usually from their physical therapist. In such cases, it's acceptable to provide a chair, provided they are confident they can stand up safely on their own. The few times I have encountered this situation, offering a chair worked. The students got up and happily went on their way. Obviously if the situation continues and worsens then do not hesitate to call 911.
Modifying Yoga After Hip Replacements
Exactly how far a student can safely move into a pose is up to their physical therapist to determine, and it is the student’s responsibility to understand their own limitations. Our job as yoga instructors is to know and offer gentle accessible variations (modifications) for the poses. We must know how to make all the poses less intense, and avoid all extreme range of motion. Let’s go through some examples of poses, and ideas for variations.
Standing Poses
Pyramid, Standing Forward Bend - Use extra large blocks under the hands or place hands on a chair seat. The props reduce how far the student folds forward.
Tree - Place the foot below the knee, even as low as the ankle. Don’t force the knee on the lifted foot too far to the side, allow it to stay where the student is comfortable even if it is more in front of the body.
Eagle - Avoid unless allowed by their doctor or physical therapist. Crossing one leg over the other is often a contraindication after hip replacements.
Warrior 1, Warrior 2, and Side Angle - Avoid cueing the classic 90 degree angle of the front hip. Let the student take a shorter stance and bend the knee less to reduce the hip ROM. Avoid the traditional heel to arch alignment and instead cue the feet hip distance apart or a little wider. This improves stability.
Wide-Legged Forward Fold, Goddess - Make the stances narrower than usual for both postures. For the forward bend, place hands on a chair seat. For Goddess, reduce the external rotation of the hips, to make the ROM less intense.
Triangle, Warrior 2, Side Angle - Allow the back hips to be in neutral, no need to try to force the hip to rotate inward or place the feet at 45 degrees. Narrow the stance so that the abduction of the hips is reduced.
Backbends and Sun Salutations
Cobra, Locust, Bridge - Practice these gentle backbends, while being sure to engaging the glutes to help stabilize the hips. Avoid more intense backbends such as Bow and Wheel.
Sun Salutations - Teach the student to practice Sun Salutations with a chair. - SEE VIDEO
Low Lunges - Place the hands on a chair seat.
Downward Dog - Place the hands on a chair seat.
Avoid Poses with Extreme ROM
Pigeon, Bird of Paradise, Lotus - Avoid these poses and any others that require a large ROM of the hips. Instead work with more basic poses to strengthen the muscles around the hip.
Seated Poses
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Seated Cross-Legged - This pose may not be available to those with hip replacements. Many will need to sit on blocks or in a chair. If they can sit on the floor they may prefer Cobbler with blocks under their knees. Whether they can sit cross-legged may be due in part to whether they were able to practice this before their surgery. Again, ask them to check with their doctor or physical therapist if there is any question.
Head to Knee, Cobbler, Seated Forward Bend - Sit on a block and work on sitting up straight rather than moving forward. If they can’t get up and down from the floor, then ask them to sit on a chair, and place the feet on the floor or blocks.
Seated Twists - Sit on blocks or in a chair. Keep the feet on the same side as the corresponding hip, avoid crossing over the legs. Allow the knee to be bent less intensely, with the option of placing the foot near the lower leg or ankle.
Striking a Balance: Inclusivity vs. Expectations
As teachers we have to strike a balance between adapting our class plans to be inclusive, while at the same time attending to the regular students’ expectations and needs. If we spend too much class time teaching one student their modifications, then we may lose some of our regular clientele that came for their level of practice.
Although it can be difficult in the moment, setting boundaries with students is a good thing! If a person with a hip replacement shows up unannounced and doesn’t know their modifications, then it is OK to tell them they cannot attend that day. Offer to meet with them privately later to learn the basics, and to make sure they’ve been cleared by their doctor. In the end, this is much safer for the student.
Be Inclusive, Compassionate, and Keep Learning
As we develop as yoga teachers we continue to learn more and more about how to handle situations. Learning to integrate someone with a hip replacement is part of this professional growth. It takes time to learn and be able to handle all of the situations that arise. It is worth the time and effort, as the more people we include the more people we can help. ♢
Need Help Finding Chairs and Other Props for These Students? (these links are not affiliate links, just props I’ve used)
I use sturdy steel chairs with rubber feet on them. I take a mallet and remove the back on some of the chairs for different kinds of yoga chair work.
I love using these extra large blocks for students with hip an knee replacements.
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