TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Physiotherapy Post Head & Neck Surgery An information guide
Physiotherapy Post Head & Neck Surgery Within this leaflet you will find Post-operative advice and a simple exercise programme designed to help with range of movement and strength of the shoulder and neck after head and neck surgery. The exercises in this booklet are intended to progress as you recover from surgery, starting with the simplest exercises and working up to the later stage exercises at your own pace. When a level of exercises becomes easy, that is the time to move to the next level. If any of the information in this booklet is unclear, please ask your ward physiotherapist. 2
Breathing exercises for a healthy chest after surgery Breathing exercises are very important after surgery to help reduce the risk of chest infections and to help with your recovery. After surgery you will be shown a simple breathing exercise called the Active Cycle of Breathing Technique. In the first few days after Surgery the exercise should be completed hourly 3
Scar Tissue As your scar heals from surgery it may get tighter and thicker. It is an important part of your recovery to learn to manage your scar to reduce these effects. Scar tissue is the normal healing mechanism after surgery or injury. It can take up to 2 years to fully heal. When the skin is well healed the symptoms of tightness and thickening can be reduced by: Regular firm massage with non-perfumed cream. Regular gentle stretches. Special care should be taken with this during any Radiotherapy as your skin may become more fragile. Any red or sore skin should be looked at by a Doctor or Nurse. Range of movement After surgery and/or radiotherapy, the range of movement in your shoulder and neck may be reduced and the muscles may become weaker. The exercises in this booklet should help to reduce the loss of strength and movement and help to restore as much movement as possible. Your Physiotherapist will suggest how many of each exercise you should try to complete each day. It is normal after head and neck surgery to feel tired sometimes, you will need to pace yourself during the day and may need to start with a low number of repetitions or reduce the number of times you do them each day but it is very important for your recovery that you do some exercises every day. If you have any concerns please ask your ward physiotherapist before discharge. 4
Muscle Graft sites If you have had a muscle graft your physiotherapist will provide you with a separate exercise sheet to help with a range of movements that will strengthen the limb affected by the graft. Neck and Shoulder Exercises The exercises in this booklet are split into 2 levels, starting with the easiest exercises that you should start immediately after surgery and getting harder as your range of movement and strength improve. The exercises should be challenging to start but not painful. You are ready to move onto the harder exercises when the ones you are completing feel easy. Your ward Physiotherapist will advise you on how many to complete and will regularly check on your progress throughout your stay in hospital. If the exercises cause pain, stop doing it and discuss this with the Physiotherapist. If you have had a muscle graft you should avoid pushing movement into a painful position. Your Physiotherapist will give individual advice depending on where your graft is. The exercises should be continued and progressed after you leave hospital as well, to make sure you get the best outcome from your surgery and reduce the risk of long term restriction in movement and strength. 5
Level 1 Exercises Sitting Roll your shoulders forwards and backwards. Repeat 5 times each way. Sitting Tilt your head toward one shoulder until you feel a stretch on the opposite side. Hold for a count of 5. Repeat 5 times on each side. 6
Sitting Turn your head to one side until you feel a stretch. Hold for a count of 5 Repeat 5 times on each side. Sitting Tilt your chin upwards until you feel a gentle stretch. Hold for a count of 5 Repeat 5 times. 7
Sitting or Standing Keep your upper arms close to your sides and your elbows at right angles. Turn your forearms outwards as far as you can Hold for a count of 5 Repeat 5 times with both arms. Lie on your back or sitting with your elbows bent. Hold one wrist with the other hand. Lift your arm as far as you can, helping with your other hand. Hold for a count of 5. Repeat 5 times 8
Level 2 exercises Sitting Tilt your head toward one shoulder until you feel the stretch on the opposite side. Using your hand gently pull your head further to the side. Hold approx. 10 secs. Repeat to other side. Repeat 5 times. Sitting Turn your head to one side until you feel a stretch. Using your hand gently push your head further round. Hold approx. 10 secs. Repeat to other side. Repeat 5 times. 9
Sitting with a straight back Draw your chin back,(it should give you a double chin) keeping your neck and back straight (not tipping your head forwards). Hold at the end position for 5-10 seconds and feel the stretch inyour neck. Repeat 5 times. Sit with your back straight holding 1-2 kg weights in both hands (You could use food tins or water bottles). Alternately lift arms up and bring back down. Repeat 5-10 times. To make this exercise harder, use heavier weights. 10
Stand keeping your arm close to your side and your elbow at a right angle. Hold an exercise band. The other end of the exercise band should be securely attached to an object that will not move, for example a handle on a firmly closed door. Push the band forward, lifting your upper arm to 45 degrees. Hold 10 seconds. Repeat 5-10 times Stand facing an exercise band with your knees and hips slightly bent. The exercise band should be securely attached to an object that will not move, for example a handle on a firmly closed door. Pull the band alternately with the left and right hand keeping your hips still. Repeat 5 10 times 11
Stand or sit. Hold an exercise band in front of your elbows straight and your shoulders at a right angle to your body. Pull the band with both arms, trying not to lift your shoulders Repeat 5 10 times. Stand keeping your upper arm close to your side and your elbow at a right angle. Hold an exercise band. The other end of the exercise band should be securely attached to an object that will not move, for example a handle on a firmly closed door. Pull the band sideways by turning your forearm outwards. Repeat 5 10 times. 12
Stand keeping your upper arm close to your side and your elbow at a right angle. Hold an exercise band. The other end of the exercise band should be securely attached to an object that will not move, for example a handle on a firmly closed door. Pull the band sideways so that your arm comes across your stomach. Repeat 5 10 times. 13
After Discharge. If you would like any further advice or support with anything in this booklet please speak to the Physiotherapist on your ward before discharge. After discharge from hospital you should continue with the exercises outlined in this booklet until you have returned to your normal level of function. If you are struggling to return to normal activities after 6 weeks, or feel your progress has stopped please contact your GP for further advice and referral to Outpatient Physiotherapy or your Head and Neck specialist Nurse can also complete a referral to Outpatient Physiotherapy in Clinic. 14
15
If English is not your frst language and you need help, please contact the Ethnic Health Team on 0161 627 8770 Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu 0161 627 8770 For general enquiries please contact the Patient Advice and Liaison Service (PALS) on 0161 604 5897 For enquiries regarding clinic appointments, clinical care and treatment please contact 0161 624 0420 and the Switchboard Operator will put you through to the correct department / service Date of publication: May 2018 Date of review: June 2018 Date of next review: June 2020 Ref: PI(DS)1083 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests www.pat.nhs.uk