Male Announcer: You’re listening to From Pain to Possibility with Susi Hately. You will hear Susi’s best ideas on how to reduce or even eradicate your pain and learn how to listen to your body when it whispers so you don’t have to hear it scream. And now here’s your host, Susi Hately.

Welcome back. With this episode I want to dig into how yoga therapy can be supportive and collaborative in the first three months post hip and knee surgery. Now, before I get into it, I want to give a shout out to some of my physical therapy and surgeon friends who follow this podcast and are also lovers of yoga. And they're likely cringing a little bit with what I just said and how I put yoga or yoga therapy in the same sentence as post knee and hip surgery.

The reason why I decided to do it, other than the fact that awareness, mindfulness, meditation, and breath work would be way too long of a sentence, it's also because so much of the world still believes yoga to be a set of movements or exercises. So whether it's Ashtanga or hot, or what's now known as Hatha Yoga, no matter if they're gentle or they're not so gentle, there's still this belief that yoga is a set of exercises.

And I really want to change that belief, it's so much more. That when we can bring awareness, and mindfulness, breathwork, meditation, when we can draw our senses inward, so much can change in the process of rehabilitation, making the process easier and more straightforward.

Things can be caught, like problems can be caught a lot earlier because someone's tuning into what their body's saying. Much, much greater trust, a whole greater sense of safety because there's a more internal locus of control. That's what I'm talking about, that's what yoga can provide. And that is why I left the word yoga, yoga therapy in the title and how I introduced this episode to you.

Now, if as you listen to this, this is really resonating for you and you are someone who is recovering from knee or hip surgery and you would like my help, or you’re a professional who wants to get trained in how it is that I work this way, then reach out to us at [email protected]. We would love to work with you in a private level or to train you in our certification program. It's what we do really well, it's our wheelhouse, and we would love to support you in growing your skill and helping people.

So with that, let's dig in. When I'm thinking about helping my clients recover from surgery I like to think of this idea of coming out better than they went in. And it's obvious with hip and knee surgery that that's going to happen because the joint was in need of repair. So structurally that joint will be better coming out than it went in.

So what I'm talking about is three months later. How can you set yourself up or how can you set your client up for success, so that 10 to 12 weeks post-surgery they are well on their way to that better quality range, more coordinated strength, and better stamina?

Now I want to emphasize two particular words that I just used there, quality and coordinated. Our aim isn't to improve range, it's the quality of that range we're seeking to improve. Our aim isn't to improve strength, but rather coordinated strength. Because we know that simply improving range and strength are not markers for decreased pain or increased function.

So the focus is on improving the quality of the range, the coordinated strength patterns. Because what I have seen in my Zoom rooms with my clientele, with my trainees is that pain absolutely reduces and function improves when the quality has improved, that quality of range, and coordinated strength patterns.

And this is where yoga therapy can be such a collaborator with the rehabilitation process because to improve the quality, to improve coordination requires awareness. It requires you to tune into your breath, to be mindful, to even draw your senses inward. And when you do that, as I mentioned earlier, there is an inner sense of trust. There's a growing of safety within, which means with safety being high, chances for pain to get out of control are lower because we know that pain is interpreted in the brain.

So when we can bring in these aspects of yoga therapy, we can be a boon to the process because we can help eliminate a lot of the obstacles that are on the way towards better healing and recovery.

So let's take a look at the rehabilitation process. In the first three months protocol is vital. In month one the focus is on the healing process, reducing infection, getting pain under control, as well as decreasing swelling. As we move towards month two and then three the focus is on movement control, and again, that's heavy in the protocol.

The aim is to get back walking, to move leg, knee, and hip. To start moving towards more activities of daily living. And then towards the sport down the road, much, much down the road, but moving people in that direction. So it's in these phases where we can set the foundation for improved quality of range and coordinated strength.

We can grow the awareness of how you move, or how your client moves, notice where there's compensation. Learn to reduce the compensations. Understand the distinction between pain and stiffness. Notice where you're holding your breath, notice where you're bracing, notice where you're gripping. And then settle in, allow things to relax, to down regulate.

Now, something that's interesting for people who are going in for knee and hips, is typically to get to that process there's a lot of pain. And with that pain comes a lot of limping. Not that pain and limping go hand in hand, but they're both in existence when someone goes in for surgery.

And as I've mentioned on a previous podcast episode, and I'll put it into the show notes for you, is that you need to retrain walking. You will have neuromuscular patterns, you will have compensation patterns that aren't serving you on your way out of surgery.

And a lot of times people think, oh, yeah, the limp will just go away when I've got the new knee, when I've got the new hip. And the answer to that is no, not necessarily. Because those neuromuscular patterns that you have grown, that are compensatory, those are grooved patterns. They have to be retrained.

So by you tuning into your compensation patterns and what you're doing, by you being able to tune into them and starting to unravel them, a huge part of that comes from the yoga therapy process because you've got to be aware. Remember, when we compensate, it's mostly under our level of awareness. It’s one of the greatest systems going in our body, like thank goodness that we compensate.

I mean, think about it, a client or you have gotten to the point where you've gotten to to need surgery, you've had to compensate to get there just to live your life. So thank goodness you could or you wouldn't have been able to live your life.

So as you start to unravel those compensations, which yoga therapy can be super at supporting because it helps you be able to connect to the various parts of your body. It can tune in between where you're gripping and holding your breath, perhaps holding your jaw, when you hold your eyes really tight, or grip through your pelvic floor. And then by becoming aware of that, and then bringing in the breath, and just bringing in that level of trust and go, “Okay, hold on a second, let's just take a breather here.”

The other piece that is really helpful is being able to take the awareness you're gaining and recognize when pain is pain, and when pain is stiffness or something else other than that. I have worked with clients who have listened to the letter of what their medical team has said around pushing through pain.

And a lot of my clients tend to be people who are quite ambitious and are quite driven, so when they heard their medical team say push through pain, they listened and they did push through pain. And then what ended up happening is they got more swollen through their knee, they jammed in through their hip, they had other issues arise. And when we would have a conversation about it, they'd say, but that's what the medical team told me to do, was to push through pain.

See here is the problem, so when people, like the clients I've just referred to, listen wholeheartedly to that but are not paying attention to their own awareness, that's where things can go sideways. So if we can bring in a yoga therapy aspect of teaching people what to be aware of and tune into the subtleties of the distinction of what pain is, and then what pain leading to swelling is. Because sometimes those have a nuanced distinction. But if you're not paying attention to it, you have no chance of even noticing it.

But that's where yoga therapy can really help, is to help you tune into that, to help grow that awareness, to help bring in mindfulness, to draw that attention inward and to help you breathe better. I'm going to give you a few specific examples around movement, around breathing, compensation patterns, and how you can utilize these instructions to really help someone tune in, connect, and then help the whole rehabilitative process.

So the first one is as you're bringing someone into standing, they're coming out of the hospital bed and they're starting to come onto the floor and they have got their walker. So you can imagine the image right now, right? They probably have their blue or white and blue hospital gown on still, tied in the back. You get the picture.

So here's where you can begin, hands are on the walker. Can you feel the hands on the walker? Notice the grip of the hands on the walker. Now in some cases the person is going to be gripping hard and they're not going to trust their feet yet. So it's like okay, so then notice the grip, just notice it. And if you can make it lighter, make it lighter. But if you're not ready to make it lighter, you don't make it lighter.

Notice the three points on the bottom of your feet. The ball of the foot, the base of the pinky toe and the center of the heel, can you feel those three points? And it's not that you need to start feeling them, but can you? And use it as a baseline for where you are at in terms of feeling where your feet are. Hands on the walker, feeling the feet on the floor.

And then just become aware of your legs. Become aware of your torso and your arms. Notice where your breath is. And can you take a couple of breaths? Maybe your ribcage is really tight, you might be holding your pelvic floor really tight, or even your jaw. None of this at the front end needs to change, the key is to recognize where your baseline is.

And then you go. The physical therapist or their assistant is now guiding you and cueing you on how to move or how to do whatever it is that you're doing. And you're walking along and you're feeling the bottom of your feet, you're feeling your breath. Maybe you start to feel an awareness of like, huh, maybe I can take a little bit less pressure through my hand. You're still holding the walker, but maybe it's not so much of iron grip, maybe it's not so much of white knuckles.

And then how about breathing? Can you feel the inhale and exhale? Sometimes it can be helpful just to think about an inhale with each step. And exhale as you swing the leg through or as you slide the back leg through. You'll find your way, just kind of get a feel of how you can utilize that breathing.

And then as you notice your compensation patterns, whether it's through the walking mechanism with the walker, or whether it's when you're in the bed, or you're doing your other physical therapy. Just notice what's moving that should be moving. Notice what's moving that shouldn't be moving.

So really basic, when you're moving through your hip or your knee, are you gripping through your eyes, through your chest, through your jaw? Are you holding on tight to the bed or the plinth that you're on? Again, it's not that it's bad at the front end. Sometimes when you're going through the harder process of the rehabilitation process, you might hold on to stuff. The key is to notice that you're doing it. And if you can let it go, let it go.

But then as you start to gain better movement patterns, as you start to relax more you're going to notice, or you're going to hopefully notice, that these compensation patterns settle out. And if they don't, that's where you then can start to ask questions with your medical team of like, “Huh, you know what? I'm still doing these compensation patterns. I don't think my alignment is as good as it could be, help me out here.”

Ultimately, the aim here is that you're taking yourself from being conscious of these things, to a place where you're improving the quality of your movement and of your strength so that the consciousness that you need to bring to this process becomes more unconscious or subconscious. You don't need to spend so much attention on your body, because your body is now working for you.

That's, again, why it's so important at the front end to be conscious of these patterns. And then as you go, you can loosen that up because it's naturally going to be integrating as you improve the quality of your range and as you improve the coordinated strength.

And that will come with reducing those compensation patterns. I.e. improving the neuromuscular dynamics, settling through your breath, allowing your nervous system to settle so you feel a greater sense of safety and an internal locus of control so that you don't need to grip so hard exteriorly. And you can tune into some of the subtler symptoms that might be saying, “Huh, I think this pain that I'm feeling is not a normal pain.” And you can start to have a dialogue of what that subjective experience is with your medical team.

In the show notes I've also posted the breathing practices that I've shared. And I've also shared one of our yoga nidras that might be helpful for you to really help you relax and settle in and connect. Take a look at those to support you or your client in helping the rehabilitative process.

And as I mentioned, if you would like some more support from me, I'd be happy to help you, whether in the private one to ones or through our certification program. It would be a real honor to work with you, to help you in your process, whether you are a professional or you're a patient seeking to make your rehabilitation process that much easier. You can find us at functionalsynergy.com, email us directly at [email protected]. Have a great time exploring.