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physiotherapy advice for patients undergoing thoracic surgery

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Plymouth Hospitals<br />

NHS Trust<br />

PHYSIOTHERAPY ADVICE<br />

FOR PATIENTS UNDERGOING<br />

THORACIC SURGERY


During your hospital stay<br />

A physiotherapist will usually see you the day after<br />

your <strong>surgery</strong>, they will normally:<br />

• Listen to your chest and go through your<br />

breathing exercises to make sure you can clear<br />

any phlegm you may have.<br />

• Check your arm and leg exercises.<br />

• Help you to stand and either march on the spot<br />

or to walk up and down the ward.<br />

• Start you on an exercise bike if your chest<br />

drains are on suction.<br />

The physiotherapist will continue to do the above<br />

daily until: -<br />

• You are managing to do the exercises<br />

effectively by yourself.<br />

• You are SAFE to walk by yourself or with<br />

another member of staff<br />

The physiotherapist will usually assess your ability<br />

to climb the stairs be<strong>for</strong>e you go home. DO NOT<br />

DO THIS WITHOUT A MEMBER OF STAFF<br />

UNLESS OTHERWISE TOLD.


Breathing Exercises<br />

1. Make sure your pain is well controlled (you<br />

should be able to breath deeply without feeling<br />

too uncom<strong>for</strong>table) ask your nurse <strong>for</strong> extra<br />

painkillers if you need them.<br />

2. Make sure you are sitting com<strong>for</strong>tably in an<br />

upright position.<br />

3. Take a slow deep breath in through your nose<br />

and hold it <strong>for</strong> a count of three.<br />

4. Try and sniff in an extra bit of air be<strong>for</strong>e you<br />

breathe out.<br />

5. Breathe out gently through your mouth.<br />

6. Repeat this three times.<br />

7. Breathe normally <strong>for</strong> two or three breaths.<br />

8. Repeat steps 2 – 7 twice more. Support your<br />

wound with your hand and ‘’HUFF’’ (this is like<br />

a short sharp breath out with your mouth open).<br />

9. After three huffs, do a strong cough – still<br />

supporting your drain sites.<br />

If you have a lot of phlegm on your chest<br />

repeat 2 – 9 again.


How to support your wound area.


Arm Exercises after <strong>surgery</strong><br />

All exercises should be done on your operation<br />

side, up to the point where you start to feel either a<br />

stretch or pain (or both). You should not push<br />

through pain or over stretch at this point.<br />

PhysioTools Ltd<br />

PhysioTools Ltd<br />

PhysioTools Ltd


Leg Exercises after <strong>surgery</strong><br />

PhysioTools Ltd<br />

PhysioTools Ltd<br />

PhysioTools Ltd


What should I do when I get home?<br />

• Continue with your painkillers if you are still<br />

experiencing pain. This will allow you to<br />

manage your daily tasks more com<strong>for</strong>tably and<br />

aid recovery.<br />

• You may feel very tired, so take things slowly.<br />

You may find it helpful to have a rest in the<br />

afternoon.<br />

• Try and get back into your normal routine, <strong>for</strong><br />

instance waking at normal times and dressing<br />

fully.<br />

• If you were a smoker when you came into<br />

hospital you will have been given help and<br />

<strong>advice</strong> on stopping. Your long-term recovery<br />

will be slower if you continue smoking. If you<br />

feel ready it is a good opportunity to stop <strong>for</strong><br />

good.<br />

• You should receive details on smoking<br />

cessation support groups from the ward staff<br />

when you come in to hospital.


Exercise<br />

After <strong>surgery</strong> you need to gradually increase your<br />

exercise / activity levels.<br />

• Walking is the easiest way to exercise. On<br />

discharge from hospital begin with two to three<br />

walks a day, the same distance you were<br />

managing in hospital. Then over time gradually<br />

increase this distance so that in 6-8 weeks you<br />

can walk <strong>for</strong> half an hour or more (this will<br />

depend on your fitness level be<strong>for</strong>e you had<br />

<strong>surgery</strong>, discuss distance with your<br />

physiotherapist if you had problems with<br />

mobility be<strong>for</strong>e <strong>surgery</strong>). This will improve your<br />

heart and lung fitness.<br />

• When walking remember that you should be<br />

able to hold a conversation, if you become too<br />

short of breath to do this, stop, rest and recover<br />

be<strong>for</strong>e you continue.


Exercise Progression<br />

Gradually over the next 2-3 months you can begin<br />

other activities to progress from walking. Aim to do<br />

these two – three times a week <strong>for</strong> twenty minutes<br />

to improve your general fitness. Your wound should<br />

be fully healed over be<strong>for</strong>e you begin these<br />

exercises.<br />

Activity<br />

• Bowls<br />

• Swimming<br />

• Gym work<br />

• Badminton<br />

• Tennis<br />

• Golf<br />

Time to begin<br />

2 months<br />

2-3 months<br />

2-3 months<br />

3 months<br />

3 months<br />

4-6 weeks (putting only)<br />

2 –3 months (full swing)<br />

• Gardening 4 – 6 weeks. Light pruning /<br />

Potting / Weeding etc<br />

2-3 months mowing / digging.


Lifting<br />

Once home you are safe to do light activities. To<br />

begin with do not lift more than the weight of your<br />

chest drain. After 6-8 weeks you can gradually<br />

increase your activities, as long as it remains<br />

com<strong>for</strong>table on your wound. Avoid heavy lifting <strong>for</strong><br />

at least three months.<br />

Driving<br />

Do not drive a car <strong>for</strong> 6-8 weeks (unless otherwise<br />

stated by your consultant). It is a good idea to<br />

in<strong>for</strong>m your insurance company following major<br />

<strong>surgery</strong>, so you do not invalidate your insurance<br />

policy.<br />

Back To Work<br />

Do not return to work until after your out patient<br />

clinic appointment. Your may be advised to stay off<br />

<strong>for</strong> a longer period of time if you have a manual job.<br />

Good luck with your exercises. If you have any<br />

questions or problems with the above in<strong>for</strong>mation<br />

you can contact your physiotherapist on<br />

0845 1558208 Ask <strong>for</strong> bleep 153 or 175<br />

Donna Pike July 2004

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