Physiotherapy plays an important role following surgery to aid recovery. The physiotherapist works closely with the surgeon to develop a treatment plan. Pre-operatively, assessments are conducted and exercises taught to prepare the patient. Post-operatively, assessments check for complications while treatments focus on breathing, circulation, mobility and ADLs to promote healing and prevent issues like pneumonia or blood clots. Regular physiotherapy is beneficial for many types of surgery to help patients regain independence and normal function.
2. ROLE OF PHYSICAL THERAPY
Physiotherapists treat a patient by stimulating natural healing mechanisms of the body without the
use of drugs, to restore the patient to optimum functional ability.
Physiotherapists are expected to identify and maximize movement potential through health
promotion, preventive health care, treatment and rehabilitation.
Physiotherapy is a holistic approach to health care, and plays a vital part in pain relief, healing of
injured musculoskeletal tissue, improving cardiorespiratory fitness and functional rehabilitation in
most surgical conditions.
Physiotherapy has its applications in all most all disciplines of modern surgery: Orthopaedics,
Neurology, Cardiothoracic, Oncology, Obstetrics and Gynaecology, General Surgery, Plastic
Surgery and Cosmetic Surgery, etc.
In pre- and postoperative situations, the physiotherapist are required to assess the nature of actual
or potential postoperative complication, identify the site and actual cause of a problem and relate
it to the complaints and clinical background of the patient before arriving at a working diagnosis.
3. Once a clinical decision has been made, the situation should be explained to the
patient and then the most appropriate therapeutic treatment should be started with
the concurrence of the surgeon.
The response to the treatment should be reviewed at every treatment session and
the therapy modified as required.
Physical therapy should attempt to prevent or treat the common postoperative
complications such as postoperative atelectasis, DVT, pressure sores, etc.
Physical therapy can also help in minimizing long term disability in those patients
who have lost, partially or totally, cardiopulmonary fitness due to prolonged bed
rest or the use of a body part that has been damaged due to the adverse effect of
surgery, thereby depriving the patient of functional independence.
Physical therapy helps patients to regain fitness, improve muscle strength and
postural balance, improve mobility and restore walking skills, and to cope better
with the pain and trauma associated with surgery.
The benefits of physical therapy are multiple, meaningful and mostly permanent, as
each patient can receive help and guidance tailored specifically for his/her
individual needs.
4. how can physiotherapy help after surgery?
The benefits of physical therapy after any kind of surgery are undisputed.
The overall goal of physiotherapy is for the patient to regain a proper degree of normalcy in all
aspects of their life after any illness, including surgery.
The physiotherapist needs to interact closely with the surgeon to understand the preoperative
needs of the patient, surgical approach planned for surgery, precautions needed, possible
postoperative complications, etc
Only then the therapist should evaluate the options available for the rehabilitation process and
make an informed decision on the available assessment data.
5. The principal reasons why someone would need the aid of a physical therapist after surgery are as
follows:
1. to control and minimize postoperative pain
2. to promote rapid healing of surgical wounds
3. to reduce respiratory incompetence
4. to combat loss of cardiac conditioning due to prolonged bed rest.
5. to strengthen and mobilize weakened and stiff muscles
6. to prevent worsening of pre-existing disorders, such as arthritis.
Each of the above and other similar conditions can benefit greatly from physical therapy.
6. In general surgery we include following surgery:
1. Trauma surgery/ Surgical Critical Care
2. Laparoscopic surgery
3. Colorectal surgery
4. Breast surgery
5. Vascular surgery
6. Endocrine surgery
7. Transplant surgery
8. Surgical oncology
9. Cardiothoracic surgery
7. PRE-OPERATIVE
Principles/Aims of physiotherapy
1. To prevent chest complication
2. To prevent circulatory complication
3. To maintain muscle power and joint ROM
4. To prevent pressure sore
5. To maintain good posture
6. To improve & enhance bed mobility
7. To gain confidence
8. To educate the patient
9. PREOPERATIVE ASSESSMENT
Read the notes
Assess the respiratory function
Check for circulatory problem
Detailed history of the patient
it include both subjective and objective assessment
10. Clinical notes reading:
Causes of surgery
Comorbid conditions:- like Asthma, Obesity, Diabetes etc.
Read other notes by the surgeon/physician
Respiratory assessment:
Chest deformities- Kyphosis, Kyphoscoliosis, pectusexcavatum and pectuscarninatum
Breathing pattern- Normal rate(12 breath/min), Eupnea, inspiration expiration ratio
Abnormal breathing pattern- dyspnea, Hyperpnea, Tachypnea, Bradypnea, Apnea
Chest movements- Symmetry of chest movement, Depth of respiration, Accessory
muscle involvement
Chest expansion- both observational and palpation
Dyspnea / Breathlessness- NYHA scale of dyspnea
Orthopnea- Breathlessness when lying flat
11. Circulatory assessment:
Homan’s Test
Oedema
History Taking:
Medical history
Subjective history
Benefits:
To gain good understanding
To know the functional status
To understand patient’s goal
12. Preoperative training
Start with any exercise that will be started during the very early
postoperative period,
these often include….
Breathing exercise
Coughing technique
Arm and leg exercise
Posture correction
Benefits
To educate and train the patient about the post operative exercise and
physiotherapy importance
13. Patient education
To teach the patient about surgery
Give preoperative instructions
Explain about the general plan of care
Breathing exercise
who is at risk for developing pulmonary complications, such as atelectasis or pneumonia.
Risk factors for pulmonary complications include general anesthesia, abdominal or
thoracic surgery, history of smoking, chronic lung disease, obesity, and advanced age.
Coughing technique
Coughing exercises are also taught to the client who is at risk for developing pulmonary
complications. The purpose of coughing is to loosen, mobilize and remove pulmonary
secretions.
14. Arm and Leg Exercises
Leg exercises are taught to the client who is at risk for developing thrombophlebitis
(inflammation of a vein, which is associated with the formation of blood clots). Risk
factors for developing thrombophlebitis include decreased mobility preoperatively
and/or postoperatively, a history of difficulties with peripheral circulation, and
cardiovascular, pelvic, or lower extremity surgeries.
The purpose of leg exercises is to promote venous blood return from the extremities. As
the leg muscles contract and relax, blood is pumped back to the heart, promoting cardiac
output and reducing venous stasis. These exercises also maintain muscle tone and range
of motion, which facilitate early ambulation.
Bed mobility
The client who is at risk for circulatory, respiratory, or gastrointestinal dysfunction
following surgery is taught to turn in bed. Although this may be a simple task prior to
surgery and after surgery. To make the procedure more comfortable, the client may need
to splint the incision by using the hand placed on a small pillow or blanket. Additionally,
the client should be taught that analgesics can be given to ease postoperative discomfort
involved with turning. Encourage the client to turn every 2 hours while awake.
15. Postural correction
During your consultation, we will ensure that all possible risk factors are addressed and
that you are educated in the management, treatment and prevention of the posture related
problems.
A detailed explanation will be given to you based on a comprehensive history taking and
complete physical assessment and analysis of the possible sources of pain.
A physical assessment will include:
1. Evaluation of weak or tight muscles, joint stiffness or hypermobility and muscle
imbalance
2. Assessment of the spine and the pelvis alignment, asymmetry and instability
3. Assessment of the limbs, legs malalignment and length discrepancy
4. Global postural and biomechanical assessment in different positions
16. Treatment and correction of posture
An individualized treatment plan will be designed according to the postural assessment,
symptoms, daily activities and needs.
• Exercise prescription is essential to modify your poor or painful posture. You will be
provided with a bespoke Home Exercises Program to enhance postural awareness,
increase joint mobility, control and strengthen muscles and correct imbalances.
• Postural re-education and advice about correct sitting, standing or posture specific to
your occupation, activities and sport
• Workstation assessments, ergonomics, moving and handling techniques
• Activity modifications, to prevent reoccurrences and promote healthy lifestyle
As poor posture usually causes pain or other symptoms, you may benefit from other
treatment modalities such as Manual therapy, Massage, Acupuncture or Dry needling
sessions to reduce the impact of psychosocial factors on your pain and symptoms
18. Aim
To avoid respiratory and circulatory complication
To prevent pressure sore
To prevent muscle wasting and joint stiffness
To prevent wound infection
Scar management
Postural awareness
Complete rehabilitation in ADL
19. POST OPERATIVE ASSESSMENT
Full SOAP assessment should be taken
Surgery notes reading
Vital signs checking
Understanding the attachments
Objective assessment
Inspection of the surgical incision
20. Surgery notes reading
Type of incision
Type of anesthesia
Any complication during surgery
Check the vital sign
BP
RR
PR
Temperature
CHECK OTHER REMAINING THINGS
SPO2
Heart sound
ECG
Lung volume
ABG analysis
21. Understanding the attachments
IV lines
Nasogastric tube
Catheter
Drains
Orientation assessment
Determine if the person is "awake, alert, and oriented, times three
(to person, place, and time).
Objective assessment
Detailed objective assessment will assist with the planning and management of an individualized treatment
programme that focuses on the presentation and needs of the client.
Respiratory
Circulatory
Muscle power/ROM
Mobility
22. Respiratory
Vital signs :: Temperature, Pulse, Respiratory rate, Blood pressure, Oxygen saturation (SpO2).
General Appearance
Body weight - BMI and weight in kg
Height
Nails - clubbing
Eyes - pallor (anaemia); Plethora (high haemoglobin); Jaundice (yellow color due to liver or blood
disturbance)
Tongue and mouth - Cyanosis - hypoxemia
Jugular venous pressure - increased in right heart failure , chronic lung disease , dehydrated patient
Peripheral oedema - seen in decreased albumin level , impaired venous or lymphatic function , increased
steroids
Pressure sores (in bedbound patients)
23. Observation of chest:
Kyphosis
Kyphoscoliosis - restrictive lung defect
Pectus carinatum - pigeon chest
• Hyperinflation or barrel chest
CIRCULATORY ASSESMENT
• Homan’s sign
• Oedema
POSTURE AND MOBILITY
• Check the posture
• And bed mobility
• Ambulation
PAIN ASSESSMENT
• VAS
• NPRS
24. POST OPERATIVE TRAINING
• To prevent chest complication::
breathing exercise
coughing technique
Inhalation
PD
Breathing control technique with arm movement
• To prevent circulatory complication::
Arm and Leg exercise
Trunk rotation
Ankle toe
Bed mobility
Early ambulation
25. To prevent pressure sore::
The areas of skin most at risk of getting sore depends on whether you are
lying down or sitting. The following diagrams show the areas most at risk:
26. Relieving direct pressure
• change position and keep moving as much as possible
• stand up to relieve pressure if you can
• ask your caretaker to reposition you regularly if you can't move
• change position at least every 2 hours
• use special pressure relieving mattresses and cushions
Skincare
• keep your skin clean and dry
• avoid scented soaps as they can be more drying
• moisturize your skin thoroughly after washing
• avoid using talcum powder as this dries the skins natural oils
• keep your skin well moisturized
27. To prevent muscle wasting and joint stiffness::
• Strengthening exercise to week muscle
• Endurance training
• Walking, Stair climbing
• ROM exercise
• Mobilization when joint stiffness present
To prevent wound infection::
• Wash the wound right away with soap and water.
• Apply a small amount of antibiotic ointment.
• Cover wounds with a bandage or gauze dressing. Change it daily or whenever it gets wet or dirty.
• Keep the wound clean and dry for the first 24 hours.
• Wash your hands before and after you care for your wound.
• Change the dressing daily; follow the instructions your healthcare provider gave you.
28. Scar management::
Prevention of a scar of priority and can be done by 3 preventive measures
1. Tension relief
2. Hydration/taping/occlusion
3. Pressure garments
Benefits:
• Protect fragile skin
• Promote better circulation of damaged tissues
• Decrease extremity pain through vascular support
• Decrease itching
• Reduce thick, hard scars
• Increase skin length by putting pressure on contracture bands
Friction massage
• Cross Friction Massage, also known as Transverse Friction Massage, is a deep tissue massage technique that is
performed at the site of an injury. The purpose of the massage is to breakdown scar tissue and remodel the tissue into
more flexible, pliable, and functional, healthy soft tissue that functions normally.
29. Postural awareness::
Fix our posture and start taking care of our health
• Shoulders even
• Neutral spine
• Arms at your sides
• Hips even
• Knees even and pointing straight ahead
• Body weight distributed evenly on both feet
Complete rehabilitation in ADL
• Ergonomic advice at home place environment and for job environment.
• Home exercise program
• Walking advice
• Jogging
• Stair climbing
30. REFRANCE
Principle of PT in general medical and surgical condition
Textbook of Physiotherapy in Surgical Conditions
