Sternal Precautions After Open Heart Surgery

Sternal precautions are used after open-heart surgery to prevent the breastbone from pulling apart as it is healing. These precautions are meant to protect you and to reduce the risk of infection through your healing sternal incision. But are sternal precautions really necessary and should you be following sternal precautions after open-heart surgery?

A physical therapist working on a man's stomach
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If you have had open-heart surgery, then you may require the skilled services of physical therapy in a cardiac rehabilitation setting, where you can work on improving your strength and endurance and work to improve your functional mobility. Sternal precautions will be used during therapy as well.

Why Use Sternal Precautions?

After surgery, your doctor may instruct you to follow sternal precautions—a method to protect your sternum (breastbone) after you've had open heart surgery. Open heart surgery usually requires that your cardiac surgeon divide your sternum to gain access to your heart and surrounding structures.

After the surgery, your surgeon must repair your sternum by realigning the bone in the proper place. Usually, a strong wire is used to hold the bones together while healing takes place.

Sternal precautions are adjustments that you need to make in your day to day life to help prevent the separation of your breastbone as it heals. Separation of your sternum may slow the healing process of the bone, and sternal precautions also help to prevent excessive pulling on the surgical incision. This may help to keep the skin closed to prevent infection in your incision.

Excessive pulling on your breastbone while it is healing after open heart surgery can cause something called dehiscence, or a separation of the bone. This separation can become an opening for infection to enter into your body.

Sternal Precautions

If you've had open heart surgery, you must follow your doctor's orders, as some doctors 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:

  • Do not lift more than 5 to 8 pounds.
  • Do not push or pull with your arms.
  • Do not reach behind your back or reach both arms out to the side.
  • Do not reach both arms overhead.

Your sternal precautions may be different depending on your surgeon or the facility in which you are participating in acute cardiac rehabilitation. Some doctors, for example, allow you to reach one arm overhead, and others allow you to lift up to 10 pounds. Just be sure to speak with your doctor to understand your specific sternal precautions.

Sternal Precautions With Physical Therapy

Your physical therapist can 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, and your physical therapist can teach you how to move around while maintaining sternal precautions. These include:

  • Scooting in and rising from a chair
  • Walking up stairs without pulling on the railing
  • Rolling in bed
  • Sitting up in bed
  • Using an assistive device, like a walker or quad cane
  • Performing basic activities of daily living (ADLs), like brushing your hair and dressing

How Long to Maintain Sternal Precautions

If your doctor asks you to follow sternal precautions, then they should be able to tell you when you no longer need to follow the precautions. In general, your breastbone should be healed within four to six weeks following your open heart surgery, and sternal precautions should be lifted at that time.

Again, follow the advice of your doctor regarding when to stop following 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 doctors 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, so if this happens, the activity that caused it should not be performed, and your doctor should be notified.

Some doctors 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 doctor recommends that you follow specific sternal precautions after open heart surgery, you should follow that advice because your surgery may warrant that type of precaution—even if someone else's doesn't. Talk to your physical therapist to make sure you are moving about properly and maintaining your sternal precautions.

A Word From Verywell

Open heart surgery can be a serious operation, and ensuring you do all the right things after surgery is of utmost importance. Conventional wisdom says that following sternal precautions can help to decrease the risk of complications after surgery. If you have had open heart surgery, be sure to understand what is expected of you in regards to sternal precautions.​

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  2. Cahalin LP, Lapier TK, Shaw DK. Sternal precautions: Is it time for change? Precautions versus restrictions - A review of literature and recommendations for revisionCardiopulm Phys Ther J. 2011;22(1):5–15.

  3. John Hopkins Medicine. Cardiac surgery: A guide for patients and their families. Updated 2011.

  4. El-ansary D, Lapier TK, Adams J, et al. An evidence-based perspective on movement and activity following median sternotomy. Phys Ther. 2019. doi:10.1093/ptj/pzz126

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