From the Guidelines
When working with a patient who has a sternal fracture, physical therapists should avoid upper body exercises that cause sternal tension for up to 3 months after the injury. This recommendation is based on the guidelines for exercise after coronary artery bypass grafting (CABG) surgery, which involve a similar type of sternal healing process 1. The goal of these sternal precautions is to protect the healing sternum and prevent complications such as non-union of the fracture or increased pain.
Some key precautions to implement include:
- Limiting upper extremity movements that place stress on the sternum
- Restricting arm movements to within a comfortable range of motion
- Avoiding pushing, pulling, or lifting objects that may cause strain on the sternum
- Teaching proper body mechanics, such as log-rolling techniques for getting in and out of bed
- Instructing patients to avoid using their arms to push up from sitting to standing
- Supporting the chest with a pillow when coughing or sneezing to minimize pain and protect the fracture site
It's essential to note that the specific precautions and duration of restriction may vary depending on the individual patient's condition and the physician's recommendations. However, as a general guideline, avoiding upper body exercises that cause sternal tension for up to 3 months is a crucial aspect of promoting proper healing and preventing complications in patients with sternal fractures 1.
From the Research
Sternal Precautions for Patients with Sternal Fractures
When working with a physical therapist (PT), patients with sternal fractures should follow specific precautions to ensure safe and effective rehabilitation. The following guidelines are based on existing research:
- Pain management: Patients with sternal fractures often experience significant pain, which can limit their range of motion and participation in physical therapy 2, 3.
- Range of motion exercises: Gentle range of motion exercises can help improve mobility and reduce stiffness in the upper extremities, but should be done cautiously to avoid exacerbating the fracture 2.
- Avoid heavy lifting or bending: Patients with sternal fractures should avoid heavy lifting, bending, or twisting, as these activities can put additional stress on the fracture site and delay healing 4, 5.
- Surgical fixation: In some cases, surgical fixation of the sternal fracture may be necessary to stabilize the fracture and promote healing. Physical therapy can be adapted to accommodate the patient's postoperative status 2, 6.
- Monitoring for complications: Patients with sternal fractures are at risk for complications such as pneumonia, respiratory failure, and cardiac complications. Physical therapists should monitor patients for signs of these complications and adjust treatment accordingly 4, 5.
Key Considerations for Physical Therapists
When working with patients with sternal fractures, physical therapists should:
- Assess the patient's overall condition: Before initiating physical therapy, assess the patient's overall condition, including their pain level, range of motion, and any comorbidities 2, 4.
- Develop a personalized treatment plan: Develop a treatment plan that takes into account the patient's specific needs and goals, and is adapted to their postoperative status if applicable 2, 6.
- Monitor progress and adjust treatment: Regularly monitor the patient's progress and adjust treatment as needed to ensure safe and effective rehabilitation 2, 5.