Updated: May 23, 2020
Quick Disclaimer and then on to the good stuff:As always, surgeon’s protocol should be the gospel. They have the ability to look at the chest x-ray and see how well they wired/glued the sternum back up. And there are multiple types of surgical approaches. Secondly, please for goodness sake, make sure all precautions that you are providing are in writing by the surgeon. We call this CYA – cover your backside. 1) No Precautions, Precautions Patients are told, “Don’t do anything that causes pain.” We educate the patient to terminate any activities and movements that cause them pain. The idea here is that sternal precautions are unnecessarily limiting. 2) “Keep Your Move in the Tube” An alternative approach to prescribing sternal precautions after median sternotomy.
The journal article linked here claims that “A restriction such as “don’t lift more than 5 pounds” can reinforce fear of activity, leading to the substantial muscle atrophy that occurs during short-term disuse. Resistance exercise training is necessary for regaining muscle mass lost during a period of disuse; therefore, “don’t lift more than 5 pounds” is the opposite of what patients need to hear.” They also conveniently have their main points summarized in this lovely graphic:
Again FREE full article linked, this one is worth the read. New concept to me, but I love the forward thinking and from my experience in home health, you WILL run into that person that hasn’t been lifting their arms above waist length for 2 years post-op. It. Will. Blow. Your. Mind. I would be a fan of this technique for those that have a solid surgical repair and have mental deficits that require something easy to remember….but again, I’m not the surgeon. Consult the surgeon. Maybe even hand him or her this article of research. Maybe even they didn’t know about it. I DO understand, that the research here is saying “HEY, we are actually evidenced-based!” and your previous beliefs don’t make sense..….BUTTTT I’d be interested in more research. What about maintaining LIMA to LAD?? (Let me know what you think below in the comments or if you have any experience using the TUBE precautions!) 3) Sternal Precautions Algorithm As seen in the graphic. Pretty straightforward. My only concern here would be “No active trunk flexion.” Typically, a lot of core strengthening is done to help patients get up from supine without pushing/pulling/assistance. Comments below!