Arm Exercises With Sternal Precautions

Sternal precautions are standard for all surgical procedures requiring a median sternotomy, or splitting of the chest bone. The sternum, or chest bone, is cut down the middle and spread apart. Most surgeries on the heart and lungs require this procedure to allow access to the chest cavity. Sternal precautions take this into consideration and focus on decreasing pressure of the chest bone to allow for faster healing. Any exercise program must adhere to the restrictions imposed by sternal precautions.

Lifting Restrictions

No lifting anything more than 5 to 10 pounds, per surgeon specification, is the most common sternal precaution prescribed. It is in effect from six to eight weeks to allow maximum sternal healing. This lifting restriction also applies to your own body weight. You cannot use your arms to push or pull yourself out of a chair or into a sitting position on the edge of the bed. This restriction can limit your functional status, requiring you to need assistance after surgery.

Movement Restrictions

Cardiac Precautions for Therapy

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Do not lift your arms higher than 90 degrees or past shoulder-height. This restriction is also in effect for six to eight weeks and limits overhead activity. You can bend your elbows with your shoulders at 90 degrees, so most individuals can manage to complete basic grooming and dressing tasks.

Exercises

Safe exercises to complete with your arms while adhering to sternal precautions include basic motions of the elbow, wrist and hand and shoulder flexion and abduction to 90 degrees. Most surgeons state that lifting small weights such as 3 to 5 pounds for these exercises is also acceptable. If you have access to an arm bike, ask your surgeon if you can use it without any resistance. Your physical therapist can advise you of specific exercises for your surgery.

Additional Information

What Are the Treatments for a Broken Sternum?

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The fear of not adhering to precautions is that it will impede healing of the “broken” sternum. There is also a belief that too much stress or pressure can cause the sternum to rebreak, requiring additional surgery to repair it. A literature review published in 2011 in the "Cardiopulmonary Physical Therapy Journal" stated there is a belief that sternal precautions are too restrictive. In a 2008 study, Parker stated that coughing can produce as much as 40 pounds of pressure across the sternum. He further stated that the sternal repair could adequately sustain that force. It has been recommended that each patient have particular precautions based on their medical condition and hospital course. If you have concerns about the stated precautions or limited help postoperatively, speak with your surgeon to see if there is any leniency permitted in your particular case.