Physiotherapy following head and neck surgery

The role of the physiotherapist

The physiotherapist will assess your needs, identify any problems which can be helped by physiotherapy, and devise an individual treatment plan for you. You will normally be assessed the day after your operation, and will be seen as required until you leave hospital, or until input from the physiotherapist is no longer needed.

Physiotherapy may consist of:

• advice about your posture

• chest clearance techniques

• general mobility rehabilitation (moving around)

• exercises for any flap donor-site (where tissue has been removed and donated to your reconstruction)

• neck, shoulder and jaw exercises.

Relaxed breathing

3-5 slow deep breaths Relaxed breathing

2-4 huffs/ coughs Relaxed breathing

3-5 slow deep breaths

Posture

After your operation please be aware of your posture. Try not to ‘slump’ or round your shoulders. Try to sit and stand upright, with your head up and shoulders and upper back pulled back and down.

When sitting, it may help to put a pillow under your forearm to provide support and avoid strain on your neck or shoulder.

Maintaining a good posture will help to open up your airways after your operation, and avoid complications such as chest infection and neck/shoulder pain.

Chest clearance techniques

Everybody’s lungs produce phlegm as part of their natural clearing system. After a general anesthetic, this clearing system slows down and phlegm can build up.

Long operations can also reduce the amount of air that you can get into your lungs. Both of these things can cause problems.

Your physiotherapist will work with you to help improve your breathing. This may involve some chest clearance and breathing exercises.

You should try these breathing exercises every 1 to 2 hours starting as soon as you can after the operation. Regular airway clearance (for example, coughing) will not do any damage to your wound and will help prevent a chest infection. You may also be advised to support your wound (for example by placing a hand over your dressings while you cough).

General mobility rehabilitation

• In the first few days after your operation, it is important that you get up out of bed and start moving around. Walking helps your lungs to re-expand and encourages good circulation.

• Generally, the day after your operation you will be helped to get out of bed and sit in a chair. There are exceptions to this with certain types of surgery.

• Gradually increase the distances you are able to walk until you are fully mobile again. Aim to walk at least the length of the ward 3 to 4 times per day, if you can.

• Before going home from hospital, you may need a stair assessment to make sure that you are safe and confident getting up and down stairs when you go home. 5 6

• During surgery, the nerves in the area may be stretched, bruised or cut. If this happens, the messages from the nerves may not reach the muscles. This can lead to reduced movement, particularly in the face and shoulders, and can mean recovery takes a little longer.

How often and for how long should I do these exercises?

It is always best to do ‘little and often’, rather than lots of exercises at one time. Exercising 2 to 3 times a day for 5 to 10 minutes is best.

Your physiotherapist will be able to advise you exactly what to do. Even if you have regained full movement and strength, please continue with your exercises for up to 3 months after your full treatment programme is complete (including any radiotherapy), and longer if you have any ongoing problems.

Jaw exercises

Sometimes, jaw opening can become restricted after surgery. This can lead to problems with being able to open your mouth enough to eat, speak, clean your mouth or be examined. Be aware of how much your mouth can open.

Your physiotherapist may give you additional exercises specifically for your jaw at an appropriate time point after your surgery.

Other things you can do, before and after your operation, to help your recovery

Keep active

Try to keep as active as you can (for example, go for regular walks or there is a small gym area on the ward). This can help maintain a level of fitness to see you through your treatment period. If you feel tired, try doing a little and often, rather than a lot in one go. It is important to listen to your body.

Aim to build up towards achieving 10 minutes of activity that makes you slightly to moderately breathless, whilst on the ward. Gradually increase this (to either 3 x 10 minutes or up to 30 minutes at one time) when out of hospital.

Strengthening activities (for example, standing up and sitting down repeatedly, or stair climbing) should be performed at least 3 times per week. If you would like further advice about physical activity, please ask your health professional.

Good nutrition

For your wounds to heal, good nutrition is vital (both eating healthily and getting enough calories). This will help you get back to your normal activities. Please follow the advice from your dietitian, and any swallowing advice from your speech and language therapist.

Post-operative scar massage

Massaging the scar can help to improve the size and appearance of your scar and the range of movement at your neck. Massage should only be started once the wound is fully healed (when there are no scabs or open areas) and you have finished any radiotherapy.

• Use a moisturising cream (non-perfumed if you are concerned about skin irritation).

• Gently press on your scar, moving it and the surrounding tissue with your fingers.

• Make small circles, moving the skin over the tissue underneath, rather than rubbing on the skin surface.

• Massage for about 5 minutes, 2 to 3 times a day.

If you notice any change in the appearance of your skin, for example, it becomes redder, painful or starts to ooze, then stop the massage and speak to your physiotherapist.

For more information, give us a call on 0812 028 0496!