Building the chest and back muscles after open heart surgery


Once you have your weight restrictions from bypass surgery lifted (and your physician’s permission)  it is time to build back the muscles you lost from surgery.

The muscles are weak from the limited lifting for the last 3 or more months. It is important to go slow and to balance the muscles. In previous posts I write about the importance of posture and stretching after open heart surgery to prevent or manage pain.  http://rehabilitateyourheart.wordpress.com/2012/05/21/stretching-your-upper-body-following-open-heart-surgery-12/

The muscles of the chest and back balance one another.

Muscles work like a pulley system, if one group is shortened the other is lengthened. By strengthening the chest muscles the opposing muscles of the back are lengthened. Therefore the back should be worked just as much as the chest to maintain a balance. A common issue is many only train their chest, neglecting the back and this sets the stage for shoulder, neck and back problems down the road. By strengthening both you create a balance to the muscles.

There are many ways one can work the muscles including free weights, dumbbells, resistive bands, or the bodies own resistance – such as push ups. . It is important to start out light. You may have had a 10-20 lb lifting restriction for some time. It is not graduated up but simply lifted.  Therefore don’t start with really heavy weights. Work your way up. Start with a few exercises, see how your body feels the next day. You shouldn’t experience days of pain from the first few workouts, you should be able to tell you worked the muscles but not be suffering.  Don’t overdo it!

Remember it is approximately one full year of healing following surgery.

The bone is knit together but to rebuild the strength, decrease the inflammation and allowing the nerves to heal it takes a full year.  Some precautions to note – if you feel any shifting, cracking or popping of the sternum stop. Try again in a month or two, or modify the movement to avoid the shifting. If you cannot move it without the shifting contact your surgeon.

Breathing with weight training is vital. 

Exhale on exertion. This means when you are pushing the weight away from your body breath out. When you are returning the weight to your body breath in. It is extremely important to your heart’s health not to hold your breath.  Holding your breath increases the blood pressure, strains the heart, and for some people can make them light-headed or pass out. Not good when you have weights in your hands to pass out!  This breathing technique should be used with all of your strenuous physical activities or lifting, pushing, or carrying.

The following images of exercises address the key muscle groups lost from open heart surgery. Start with a light weight – it may be 10 lbs in each hand or it might be 5 lbs, everyone is different but you will appreciate starting with light weights as we expect a little soreness initially. See what works for you. The initial goal is to do many repetitions, gradually build up the amount of weight over time. Try doing each exercise 10 times, if it is easy then next time add a little more weight. If it is difficult, try less weight next time. It is recommended you start with 10-15 repetitions of each exercise, and do it in 1-2 sets the first week or two. You can gradually add in more sets of the 10-15 repetitions. Don’t work the muscles every day, try for 2-3 times per week. The muscles need recovery time.

Chest muscles – note the elbows of the lady in the second picture, this is an example of good technique. Don’t let the elbows come lower than the shoulders as it puts a lot of stress on the the sternum and shoulders, and you don’t want to be hurting the next day. Breathe out as you lift the weight up. Don’t hold your breathe!

Shoulder muscles – note only lift the weights to 90* lifting higher than this tends to irritate the shoulders. Be aware to use your muscles not the swinging of your body for momentum. Lift the weight to a slow count of 1 -2, then lower it even slower a slow count of 1-2-3-4. Remember breath out as you lift the weight up.

These are standing fly’s, the knees are bent to support the lower back’s natural curves and prevent injury.                                                                                                                          

Back exercises – standing row. This works the muscles between the shoulder blades.  When doing exercises bent over remember to come back up gradually, as many heart patients experience dizziness when bent over. Again remember to BREATHE!  If you don’t have weights there are resistive bands that can be used. They can be found at your physical therapy centers, medical supply stores or fitness stores. They come in a variety of strengths, remember start light. Make sure you control the band or weight and that it doesn’t control you.                                                                                                                                                                                                                                                                                                               

Weight machines are good. Here is an example of working both the chest and the back. I love lat pull downs and seated rows. Typically I will have patients work these for 1-2 weeks before I introduce the chest press, as the back is far more neglected than the chest muscles in our day to day use.  Below are ways of doing the upper back using resistive bands.                                                                                                                                                                                                                                                                                   

I know some of you  are impatient about getting back to push ups. I generally start patients with push ups against a wall initially, gradually moving feet further back. When through the initial muscle soreness, have good breathing techniques then have them begin floor push ups.

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60 thoughts on “Building the chest and back muscles after open heart surgery

  1. I love using free weights.. Easy to do at home and always leaves me feeling well worked and satisfied with my workout! Thanks for the extra tips :)

  2. Pingback: Re building the chest and back muscles after surgery | heart diseases an heart conditions | Scoop.it

  3. If you have enough time, consider breaking up workouts into two different sessions per day. For example, you could train your chest in the morning, and then once evening strikes, you can train your back. Resting your body in between lets your energy stores recover better than training both muscles during the same workout. Top Supplements

  4. It has been 6 months since by-pass and valve replacement and wondered why my back was so touchy-the least little exhurtion has caused back pain, sometimes putting me to bed for 2 days with muscle relaxers. Now at first discomfort I take 2 Aleve and try to rest to relieve back pain between shoulder blades. Thought I’d check to see if this was another symptom of open chest surgery. Sure enough! I’ll try to do some light exercises now.

    • I hope the tips help you. Remember it is a full year for things to really be settled down and in alignment. The upper back stretching and posture can make a work of difference. Another though is to consider walking with ski poles and emphasize moving arms. If you walk treadmill try not to hold on to it, swing your arms then stretch well afterwards.

  5. Thank you for answers . now I know why I am having such pain , will start doing these exercises to help strengthen muscles and help with the pain , could not get into cardiac rehab after surgery for lack of insurance , could have really used it , should also say some thing about the depression that goes with it .

    • Julie,
      I am glad you found the article helpful. You are not alone in not being able to go to rehabilitation. Most studies show only 30% of women attend rehabilitation, a very low statistic, in need of change. We will gladly chop you open but leave you to recover on your own.
      That is one the primary reasons I developed this blog, as an outreach to those who cannot attend.
      Here is a link to a depression article http://rehabilitateyourheart.wordpress.com/2012/12/08/depression-and-heart-conditions/
      I have several articles about depression in the blog. I hope you have a great 2013.

    • Same situation here Julie..no insurance and rehabbing on my own…hike and bike in the morning for the lower half, and 10-25lbs. dumbells for the upper half…it works!

  6. Pingback: Building the chest and back muscles after open heart surgery | Dr. Donald Ryles Paranormal & Unusual Blog—#1 Google Ranked

  7. Seeing a doctor for back pain can be helpful, though you need to know what type of questions to ask him. You will want to ask the cause of the pain, how to prevent it from getting worse, what treatments are there, and what are the risks to those treatments.

    • Definitely seeing a doctor is helpful. Many are seeing their doctors regularly but fail to mention back discomfort following open heart surgery, as appointments are often very short and focused on the life threatening issues, medications and side effects, the back discomfort never gets around to being addressed.

  8. Hi there I recently had open heart surgery for a congenital heart condition 14 weeks ago. I am still getting quite a bit of pain in my right side mainly right pectoral muscle and over my right shoulder. I am exercising and also getting some massage to help. What was of interest to me was your comment to say it takes a full year for healing and for me that is really the first time i have seen that said. Most of the literature and even comments from the surgeon and cardiologist and what you get from the hospital talk about 12 weeks and then recently my cardiologist said 6 months. Can you expand on that please.

    • Hi Cathryn,
      Thanks for following my blog. Please read the post on posture and stretching as well as they may be helpful for the right shoulder discomfort. Regarding the one year, my experience from working with thousands of open heart patients is that most patients report it takes a full year to feel 100%. Part of that is due to the inflammatory response to the chest following such a major assault on the body. The bony structures are healed usually in 3 months, and the muscle and heart itself usually recovered in 6-8 weeks, but for everything to settle down, and then the muscles to be strengthened to pre – surgical levels takes quite a bit longer. Each patient is unique in their healing, and the surgical approach also plays a role in the healing. Those who have robotic surgery recover faster, those with a side approach seem to have more discomfort. One must also factor in overall health, complications etc. Many have issues with costal chondritis which is inflammation to the cartilage between the ribs, this cartilage has a poor blood supply and takes months to settle down. Physicians and literature mostly states 3 months simply based on the bone healing, and when a patient is safe to return to working or physically strenuous activity.

      I hope this helps clarify the post.

    • Thanks so much for your reply which has been very helpful and provides a much better picture. I think it also takes a while to recover emotionally and psychologically. For me it is about trusting my body again and trusting that my heart is Ok.

  9. I am coming up on 1 year since open heart. But I had to be cut open 3 times after surgery due to infections. Do you think its normal to still be having pain in my chest?

    • Hi Linda,
      Patients who have to be reopened several times do have slower recovery times in general. I would recommend you ask your doctor about it, and see if a referral to physical therapy would be helpful.There are conditions that can occur such as non union healing of the ribs – sternum, muscle spasms, postural changes that may be causing the discomfort. Good luck, I hope the discomfort goes away soon. Try the stretching and posture exercises and see if they help.

  10. I had open heart surgery 7 years ago and I still suffer from acute pain in my left chest and armpit. Two of my ribs didn’t attach to my sternum and doctors tell me it just muscular skeletal pain. I have tried the gym and swimming but it can be extremely painful the day after. Can you please recommend some exercises.

    • HI Dean,
      First of all thanks for reading the blog I hope it is useful for you. Ribs that don’t attach are called non- union and this can create quite a problem. With twisting and bending the ribs have subtle movement, and when not attached have a greater degree of movement. Like a chain when you twist one line the rest must twist in compensation. Unfortunately there isn’t a lot you can do for this, Swimming involves a lot of thoracic/middle back movement which involves ribs moving. Let pain be your guide, if it causes pain it is probably best to avoid. There are no specific exercises that will hold those ribs in place. If it is very problematic you could talk to the physician for a physical therapy assessment. The armpit pain may be able to be addressed from the doorway stretch. Try varying the position of the arm height higher and lower to see if you can isolate it to the painful area. I wish I could offer you more, but this is an unfortunate issue when the ribs are non union.

    • Thanks for all your advice. I will try out the exercises. I really appreciate your help and this fantastic resource you have set up to assist others. Thank you.

  11. i had chest surgery from tymoma tumer a year ago still my chest is sore when i wax the car or work hard is that normal.

    • Yes it isn’t uncommon. Stretching the chest, watching your posture and strengthening the chest and back muscles should help. It is a really big surgery you went through and takes considerable work to repair and rebuild. Just as if you had surgery on a knee, you would exercise it to get it strong again to return to previous activities. After open heart surgery it takes work to build back to pre surgical strength, flexibility and posture. Good luck!

  12. Thank you so much for sharing this! I am almost at my one year anniversary from Mitral Valve repair. No one ever suggestion cardiac rehab – like you said, they left me to my own devices only telling me what I could NOT do. It indeed takes a full year to recover in my opinion. I have recently started swimming daily to regain strength in my arms and chest. I will start on these exercises as well to add to my full recovery process. The soreness and pain still exists but is lessening every day. Sneezes still put me on the floor at times!

  13. It’s been five months post open-heart surgery for ascending aortic aneurism. I am a 42 yr old firefighter paramedic who has always been in good shape and active. I’ve had lots of thorasic discomfort, specifically the back, neck and chest areas where sternum and ribs meet. I agree with your statement that much is said about the sternum healing is 6-8 wks and the heart self-healing within said period as well. However, I was never prepared for the muscular-skeletal pain and stiffness. i now appreciate how much I need to stretch and improve my posture. Another thing that works is epsom salt bath, really gets the pain away. The doctor told me before surgery that I’d be out of work for 3-6 months; it’s been five so I guess I still within the window. I was real naive before, I thought I’d be back to work in 2 months. Dr said open heart surgery is often more negative for muscular men because of the trauma to the areas. He said I wouldn’t have the pain and tension if I were skinny or an elderly female. I’m now convinced I’m gonna have to return to work not “100 %”. Any response or recommendations?

    • HI Alex I had open heart surgery for an adult congenital condition in early January. I also experienced alot of back pain and into my ribs. I do yoga and swim. The stretching from both these activities helps me enormously. I start to feel it after a couple of days if I don’t do some sort of stretching. The swimming is such a big upper body movement that I do feel it afterward but the benefits I gain far out way any short term discomfort. It does get easier. I really appreciate this site it has been very helpful. I still don’t think my body is back to where it was pre surgery (I’m a pretty fit lean person) and my upper body doesn’t feel as strong at this stage that it did pre-surgery. One of the things this site did for me was to state up front that it takes about one year for a full recovery. I hadn’t heard that anywhere and when I read it I allowed myself that sort of time frame.

    • You sure did fill it out correct. Thanks for stopping by blog site. The healing does take a full year for the inflammation to resolve.And there is no speeding up the process. Focus on stretching the chest and the back to get the muscle balance back in order. If you haven’t started working on strengthening it is time to do so. Start light and build up. Avoid movements that cause popping in the chest or ribs.Be diligent about watching your posture. Thanks for recommending the epsom salt baths. Let me know if I can be of further help.

    • First lets review the stages of inflammation

      Inflammatory Phase — The first phase, the inflammatory phase, begins immediately after the wound is created, and lasts approximately two to six days. During this phase some warmth, redness, swelling and pain will surround the surgical site.

      Proliferative Phase —The proliferative phase takes place next, and lasts for about three to four weeks. During this phase, collagen (scar) is being produced to pull the edges of the wound together. This can cause visible thickening of the wound edges, and new red bumps called granulation tissue may be visible in the shrinking wound. Sometimes there is a minor amount of yellowish drainage. A little bit of pain, tightness, pulling or tenderness is often present in the wound too. Those minor symptoms should be stable or steadily improving daily.

      Sometimes at this stage of healing patients experience sharp, shooting pains in and around the tissue that was operated on. In most cases this represents a return of nerve sensation to the operated area, and these sensations should subside in frequency and intensity with time.

      Remodeling Phase — The maturation, or remodeling phase, is the final stage of healing. Over a period of six months to several years “remodeling” begins to break down the excess collagen, changing a thick, red, raised scar to a thin, flat, white scar.

      Surgically you were cut through skin, fascia, muscle and bone. The ribs were spread with a spreader which compresses the cartilage between each rib. So you have multiple area in which inflammation occurs. The costal cartilage between the ribs has a very poor blood flow and takes typically 3-6 months to settle down.

      The scar tissue remodeling can take a long time, and some people form more scar tissue than other – keloid formers especially. You most have several metal wires now in your chest in which your body has to get used to.

      Now the question I have for you is the discomfort you still feel very localized or general?

    • Discomfort is both generalized around sternum and ribs, with a slight worse sensation on right side of sternum at nipple line. he worse tightness is at my neck and where neck/shoulders meet.

  14. I am 40 days out of surgery, and I have begun a cardiac rehab program. I want to thank you for your information and suggestions. You have provided so much that the surgeons and cardiologists do not. My posture was suffering, and the stretching has helped a lot.

    • You are welcome. Thanks for stopping by and reading my blog. Glad to hear you have started rehab, have fun with it! From twenty years working in the field I know there is lots you don’t in education from the physicians, so it is nice to have blogs etc. to share the experience. Best wishes for a speedy recovery and healthy lifestyle.

  15. I had open heart surgery to replace the ascending aorta due to an aneurism on the aorta. Where the surgeon inserted the heart and lung tubes in my upper right hand chest area, there is a significant loss of muscle. It appears to have formed a hole in my upper right side. Are there any specific exercise to build this area back up?

  16. I had open heart surgery for acute aortic dissection (stanford-A) 11 weeks ago. I was wondering if anyone has ever heard of someone having open heart surgery, recovering, and then continuing to practice AIKIDO (a martial art). If so, to what extent? I have been practicing for 11 years and want to continue if at all possible.

    • Yes it is realistic to be able to return to your sport. I would allow yourself a full year of healing before taking any impact to the chest. Talk to your surgeon first however. If you read the comments on the blog you will find several commented about returning to strenuous impact sports following open heart surgery. 11 weeks is pretty fresh yet. Really work on rebuilding chest muscles when all of your lifting restrictions are cleared, bench, planks, TRX, flys, etc…but don’t neglect your back either. Good luck!

  17. I had triple by pass surgery in Septemeber and feel very lucky after reading your blog. Because of a bad hip, I have done stationary bike riding since nine days into rehab. I am now ready for light weights(8lbs) and wondering if this is OK. Not looking to gain muscles. It will come. Just trying not to hurt myself.

    • Your physician is the best one to ask, but for most people it is essential to return to working out which improves the strength of the heart and the ability for the muscles to efficiently use the blood flow. So most likely absolutely. What did you have done to your heart.

  18. You are far enough out that the orthopedic issues should not be a problem. Start light and gradually build. Avoid anything that causes snapping or popping in the chest. Balance chest exercises with back exercises to help prevent muscle imbalance problems. Check with your doctor about clearance but this far out usually not an issue. Don’t hold your breath with the exercises. Exhale with the exertion phase…like when doing the push up.

  19. Sir one more question
    i get a blood test done for checking prothrombin time called PTT/INR every month.
    i want to ask that
    will working out affect it?

    and sorry if u get any problem in my english
    my english is’nt good

  20. Sir i dnt knw any complete information but it was problem of ascending aortic aneurysm with sever AR
    (Bentall’s procedure)
    and a bicuspid aortic valve (Artificial)

    Hope u’ll understand sir :(
    and help me

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