Table of ContentsView AllTable of ContentsWhy Use Sternal Precautions?ExamplesDuring Physical TherapyHow Long to MaintainWhy They Are NecessaryFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Why Use Sternal Precautions?
Examples
During Physical Therapy
How Long to Maintain
Why They Are Necessary
Frequently Asked Questions
Sternal precautions are used afteropen heart surgeryto prevent thesternum, or breastbone, from pulling apart as it is healing. These precautions are meant to protect you and to reduce the risk of infection in your healing sternal incision.
Your sternal precautions may be a part of your overallcardiac rehabilitationplan, meant to assist your recovery and improve your strength, endurance, andfunctional mobility. It’s important to practice them at home as you progress throughphysical therapyor related services.
This article explains why sternal precautions are used and the limited motions, lifting restrictions, and other features they typically require. It explains their benefits and answers some questions about practicing sternal precautions.
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Protecting the Sternum After SurgeryYour healthcare team may guide you in sternal precautions meant to prevent excessive pull on your healing breastbone, calleddehiscence.However, cardiac experts have different approaches on how to protect your sternum after you’ve had open heart surgery, so be sure to follow the specific advice you’ve been given.
Protecting the Sternum After Surgery
Your healthcare team may guide you in sternal precautions meant to prevent excessive pull on your healing breastbone, calleddehiscence.However, cardiac experts have different approaches on how to protect your sternum after you’ve had open heart surgery, so be sure to follow the specific advice you’ve been given.
Quadruple Bypass Heart Surgery Process and Recovery
Examples of Sternal Precautions
If you’ve had open heart surgery, you must follow your healthcare provider’s orders, since some healthcare providers 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:
Be sure to speak with your healthcare provider to understand your specific sternal precautions.
Sternal Precautions May VaryYour sternal precautions may differ depending on your surgeon or the facility you are participating in acute cardiac rehabilitation. Some healthcare providers stress the importance of pain and your own body signals in determining activity. Others may allow you to reach one arm overhead or lift five to 10 pounds.
Sternal Precautions May Vary
Your sternal precautions may differ depending on your surgeon or the facility you are participating in acute cardiac rehabilitation. Some healthcare providers stress the importance of pain and your own body signals in determining activity. Others may allow you to reach one arm overhead or lift five to 10 pounds.
Sternal Precautions With Physical Therapy
Yourphysical therapistandoccupational therapistcan work with you in cardiac rehabilitation to help you understand and maintain your sternal precautions. You may find that basic functional mobility is difficult while maintaining sternal precautions.
Your physical therapist can teach you how to move around while maintaining your surgeon’s suggested precautions.Modifications you may learn include:
An occupational therapist may help you modify other activities of daily living (ADL) such as bathing, grooming, and dressing.
Physical therapy is designed to help you return to performing basic activities of daily living, such as brushing your hair and dressing, cooking, maintaining hygiene, and managing stairs.
How Long Should I Maintain Sternal Precautions?
If your healthcare provider asks you to follow sternal precautions, they should be able to tell you when you no longer need to follow the precautions. In general, your breastbone should be healed within about four to six weeks following your open heart surgery, and sternal precautions should be lifted at that time.
Again, follow the advice of your healthcare provider regarding when to stop following sternal precautions.
How to Maintain Your Sternal Precautions
Are Sternal Precautions 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 healthcare providers may recommend performing normal activities based on your own tolerance.
Feelings of crunching or popping in your breastbone are among the signs that your sternum could be moving a bit. If this happens, the activity that caused it should not be performed, and your healthcare provider should be notified.
Some healthcare providers argue that telling you to avoid lifting items and to keep your arms in can lead to fear-avoidance behaviors or avoiding moving because you are afraid of hurting yourself.
Regardless, if your healthcare provider recommends that you follow specific sternal precautions after open heart surgery, you should follow that advice. Your surgery may warrant that type of precaution—even if another person’s doesn’t. Talk to your physical therapist to make sure you are moving about properly and maintaining your prescribed precautions.
New Approach to Sternal Precautions
Summary
Sternal precautions after open heart surgery are meant to give you the best possible chance of successful healing and recovery. They can help you to avoid infection, injury, and related complications.
Standard sternal precautions involve limited range of motion in your upper body so as not to stress the healing breastbone. This typically means temporary restrictions on your activities, how much you lift or stretch, and the need to protect yourself when coughing.
Be sure to follow your healthcare provider’s recommendations, though. Experts have differing views on whether and why sternal precautions are necessary, and the answers change based on your individual plan for treatment and recovery. Ask questions if you’re not sure about your precautions.
A Word From Verywell
Conventional wisdom says that following sternal precautions can help to decrease the risk of complications after surgery.Open heart surgery can be a serious operation, and ensuring you do all the right things after surgery is of utmost importance.
Sternal wires hold the chest wall in place while you’re healing and are not generally removed. However, some people experience pain or allergic reaction to the sternal wires. Their removal has been shown to resolve symptoms in most of these people and is a generally uncomplicated procedure.Learn MoreRecovering From Surgery
Sternal wires hold the chest wall in place while you’re healing and are not generally removed. However, some people experience pain or allergic reaction to the sternal wires. Their removal has been shown to resolve symptoms in most of these people and is a generally uncomplicated procedure.
Learn MoreRecovering From Surgery
First, sit down while getting dressed and choose items that are easy to put on and take off. Put your hands through shirt sleeves up to your elbows, then duck your head to pull through the neck of the shirt while keeping your arms close to your sides.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Katijjahbe MA, Granger CL, Denehy L, et al.Standard restrictive sternal precautions and modified sternal precautions had similar effects in people after cardiac surgery via median sternotomy (‘SMART’ Trial): a randomised trial.J Physiother.2018;64(2):97-106. doi:10.1016/j.jphys.2018.02.013
Listewnik MJ, Jędrzejczak T, Majer K, et al.Complications in cardiac surgery: An analysis of factors contributing to sternal dehiscence in patients who underwent surgery between 2010 and 2014 and a comparison with the 1990-2009 cohort.Adv Clin Exp Med. 2019;28(7):913-922. doi:10.17219/acem/94154
Wang C, Goel R, Noun M, Ghanta RK, Najafi B.Wearable sensor-based digital biomarker to estimate chest expansion during sit-to-stand transitions-A practical tool to improve sternal precautions in patients undergoing median sternotomy.IEEE Trans Neural Syst Rehabil Eng. 2020 Jan;28(1):165-173. doi:10.1109/TNSRE.2019.2952076
Cahalin LP, Lapier TK, Shaw DK.Sternal precautions: Is it time for change? Precautions versus restrictions - A review of literature and recommendations for revision.Cardiopulm Phys Ther J. 2011;22(1):5–15.
El-Ansary D, LaPier TK, Adams J, et al.An evidence-based perspective on movement and activity following median sternotomy.Phys Ther. 2019 Dec 16;99(12):1587-1601. doi:10.1093/ptj/pzz126
El Nasr MM, Taha A.Persistent post sternotomy chest pain: Does sternal wire removal have a role?J Egypt Soc Cardiothorac Sur. 2017;25(2):142–146. doi:10.1016/j.jescts.2017.04.004
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