Sternal Precautions After Open Heart Surgery

Sternal precautions are used after open heart surgery to prevent the sternum, 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 overall cardiac rehabilitation plan, meant to assist your recovery and improve your strength, endurance, and functional mobility. It's important to practice them at home as you progress through physical therapy or 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.

A physical therapist working on a man's stomach
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Why Use Sternal Precautions?

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. That's because open heart surgery usually requires the cardiac surgeon to divide your sternum to gain access to your heart and surrounding structures. A common example is traditional coronary artery bypass grafting (CABG) surgery.

The surgeon must then repair the sternum by returning the bone to its proper place, using a strong wire to hold it together while healing. Sternal precautions may promote healing and prevent infection by limiting excessive pull on the surgical incision.

Protecting the Sternum After Surgery

Your healthcare team may guide you in sternal precautions meant to prevent excessive pull on your healing breastbone, called dehiscence.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.

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:

  • Avoid pushing or pulling through the arms
  • Avoid unilateral (one side) arm activity
  • Limit elevation of the arms to 90 degrees
  • Avoid lifting objects heavier than 2 kilograms (4.4 pounds)
  • When coughing, support sternum with a cushion or the arms in a self-hugging position
  • Limit use of the arms when transferring from sitting to standing and when getting out of bed
  • Avoid placing the arms behind the back

Be sure to speak with your healthcare provider to understand your specific sternal precautions.

Sternal Precautions May Vary

Your sternal precautions may be different depending on your surgeon or the facility in which 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 up to 10 pounds.

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.

Your physical therapist can teach you how to move around while maintaining your surgeon's suggested precautions.Modifications you may learn include:

  • Scooting in and rising from a chair
  • Walking on stairs without pulling on the railing
  • Rolling in bed
  • Sitting up in bed
  • Using an assistive device, such as a walker or quad cane

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.

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

A new approach to precautions during sternotomy recovery, called “Keep Your Move in the Tube,” relaxes traditionally strict sternal precautions in favor of keeping arm motion within a small cylinder (the “tube”) around your torso.The approach has shown promise in some studies, sending patients home sooner and with better mobility than those treated with standard care.


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.

Frequently Asked Questions

  • Can sternal wires be removed?

    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.

  • How do I get dressed while taking sternal precautions?

    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.

    Put your feet into pant legs, then stand and pull the waistband up bit by bit. Always remember to keep your arms close to your sides and never pull on your incision.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.