Physiotherapy - Post Surgery Therapy Advice

The therapy team which includes Physiotherapists, Occupational Therapists and Integrated Therapy Assistants will come to see you the day after your surgery. The aim is to help you regain independence and to prevent post-operative complications through breathing techniques, early mobilisation, and exercise. The therapy team will also advise you on the best ways of moving to minimise pain.

The therapy team will be following the ICOUGH principles for your recover after surgery:

Incentive spirometry
Coughing
Oral healthcare
Understanding
Getting out of bed
Head of bed elevated

Incentive Spirometry

The day after your operation, your physiotherapist may listen to your chest and may provide you with an Incentive Spirometer.
During surgery, the tiny air sacs in your lungs can become sleepy and do not open as effectively. Using an incentive spirometer helps to re-open these air sacs as well as giving you feedback on how you are progressing during your hospital stay.

To use the Incentive Spirometer effectively

• Your incentive Spirometer comes in two separate mouth pieces. The chamber and the mouthpiece. You can attach both the mouthpiece and the chamber together
• Sit up right when using the incentive spirometer as your lungs will expand better in this position
• Ensure you make a tight seal around the mouthpiece and then take a steady breath in
• When you take a breath in, you are aiming for a long-sustained breath to raise the three floats
• If you breathe in too fast, the ball will shoot to the top
• If you breathe in too slowly, the ball will stay at the bottom

Please click on the link or use the QR code for further support https://www.youtube.com/watch?v=t91jXG6jJlg

Your physio will advise you how regularly you need to use your spirometer

Coughing

It also important after surgery that you can cough effectively. If you are struggling to clear mucus off your chest, we will provide you with further breathing techniques to support with this. It is important that your pain is well controlled so that you can take a deep breath and cough effectively to prevent the risk of developing a chest infection after your surgery. Please ask the nursing staff if pain is stopping you from deep breathing and coughing.

Oral Hygiene

The risk of a chest infection is increased by bacteria living in your mouth which can travel into your chest and cause an
infection. You should brush your teeth or dentures twice a day with a fluoride toothpaste for at least 2 minutes. You should also floss your teeth every day and use an antibacterial mouthwash twice a day. It is best to use the mouthwash 10-15 minutes after brushing your teeth.

Getting out of bed

The physiotherapy team will aim to support you out of bed as soon as possible, usually the day after your operation. Getting out of bed early You will be taught to roll onto your side and then push up into sitting using your arms. We will initially help you with this technique. The ward staff also know this technique and can help you to get out of bed and into a chair. The aim is for you to sit out for at least 6 hours a day.

Head of the Bed

Whilst you are resting in bed, it is important to avoid lying completely flat to help give your lungs more space to expand, which will help with your breathing and reduce your risk of developing chest infections after surgery.

Early mobilisation

As well as sitting out, early mobilisation promotes independence and helps you return to normal daily activities. It also helps to ease/prevent wind pain, prevent chest infections, and blood clots. You will be encouraged to mobilise 4 times a day, aiming for at least 60 metres each time, as this is advised by the National Health Guidelines. You may be required to complete a stair assessment prior to discharge, which will be discussed with you.

Lower limb Exercises

Ankle range of motion; Rotate your ankles in a circular motion for approximately 1 minute with both feet

Knee flexion and extension; Straighten and bend the knee either in a lying position on the bed or you can also do this in a seated position in a chair.

Hip flexion: In an upright seated position you can complete a seated marching exercise, to maintain strength and mobility of your hips.

Calf Raises: In a seated position you can life your heels up and place them down slowly, maintain ankle stability if you are not mobile after your surgery. This exercise also helps blood flow through contraction of your muscles which will help reduce the risk of bloods clots.

Sleeping

Sleep is important to aid recovery both in body and mind. How well you sleep effects your recovery, concentration, mood, and energy levels.

Everybody has their own sleep routine and being aware of some basic sleep hygiene techniques can be useful:

• Try to keep to your normal routine
• Make a note of any concerns or worries before settling down for the night. This can serve as a reminder of questions you want answering by the doctors, nurses, or therapists so you have a clear mind
• Avoid using smart phones or tablets as you wind down for bedtime. The light emitted from the screens has a negative effect on sleeping

Planning for home

The decision that you are ready to leave hospital is based on several factors. There are different services available to support with your discharge from hospital, which your therapist will discuss with you.

Exercising after Surgery

Most patients having surgery will require some advice and exercises on discharge so you can continue your recovery at home. Your consultant will advise you on what activities are safe to do and what needs to be avoided after surgery. Your therapist can provide you with information on returning to activity.
 
Please use the below links or QR codes to find out about community services available to you:

Rochdale Residents: Older Adults Activities - Your Trust (www.yourtrustrochdale.co.uk) This is a self-referral service.

Oldham Residents: Exercise Referral Scheme Oldham Community Leisure (www.oclactive.co.uk). This service requires a referral from a health care professional so please liaise with your therapist for further information

Bury Residents: Bury Live Well Service - Bury Council. This is a self-referral service; however, a health care professional can also refer so please liaise with your therapist for further information