-PHYSIOTHERAPY PERSPECTIVE

 Respiratory:

• Due to anesthesia-
1. Dryness and thickness of mucous secretions
in respiratory tract
2. It leads of risk of clogging of mucous plugs
in bronchi etc.

• Due to pain or administration of analgesics-

1. Impairment of cough reflex
 Chest complications that can arise-
• Post operative Atelectasis-
This occurs due to blockage of bronchus or
bronchioles causing abnormal collapse of a
segment of lung.
• Pneumonia or Bronchopneumonia-
If mucous secretions are not removed there
are chances of development of such
conditions, specially in elderly.
 Deep vein thrombosis:

• Due to inactivity, there is increase in

platelets and concentration of fibrinogen,
predisposing to coagulation.

• Varicose veins too might lead to DVT.

- DVT might lead to Pulmonary Embolism if

patient remains inactive for long.
 Pressure Sores:

• Commonly seen in very ill patients or elderly

patients.

 General Muscle Weakness and Loss of

Mobility-

• Due to severe weakness or ill health,

patients are unable to get active early,
leading to the immobility and weakness.
 The main aim of a physiotherapist is to assist
the patient return to normal activities of
daily living after surgery.
 Routine post operative physiotherapy
intervention comprises of-
• breathing exercises
• circulatory exercises and
• early mobilisation
 Breathing exercises

• Regular breathing exercises are important

following surgery to help reduce the risk of
developing a chest infection. These should
be carried out at least 3-5 times a day,
preferably in upright sitting.
 The breathing techniques are as follows:

 Breathing control:
• This is gentle, normal breathing using the
lower chest while relaxing the upper chest
and shoulders. It is important to return to
this pattern of breathing between the more
active techniques, to allow the airways to
relax.
 Deep breathing:
The emphasis is on breathing in. One should
take a deep breath in to maximum expansion
and then hold for a count of three. The
upper chest and shoulders should remain
relaxed. Breathing out should be gentle and
relaxed.
 The forced expiration technique – huffing
with breathing control:
• To huff, take a medium to small breath in,
not a deep one, and then force or squeeze
(remove) the air out by tightening the
abdominal (tummy) muscles but keeping the
mouth open like one is trying to steam up a
mirror. It is important to keep one’s head and
shoulders relaxed.
• A period of breathing control must follow
each one or two huffs to prevent the airways
tightening and shortness of breath.
• One should cough only when the secretions
are ready to clear with a good effective
cough. Repeated bouts of continuous
coughing will only cause airways to tighten
and will be very exhaustive.

• One should always support one’s abdomen

with both hands or a pillow/folded towel
while coughing to prevent excessive pain.
 The Active Cycle of Breathing Techniques

• Breathing control: 3-4 breaths or longer if

exhausted, followed by;

• Deep breathing: 3-4 breaths with 3 second

holds- less if you become dizzy, followed by;

• Breathing control: 3-4 breaths, followed by;

• Huffing: 1-2 huffs, followed by:
• supported cough to clear secretions (if
needed)
• Breathing control: 3-4 breaths.

This cycle is best done in the upright sitting

position, but can also be done in side lying
and must be practiced at least 3 times a day
in order to keep one’s chest clear.
 Enhancement of Circulation:
• It is important to maintain blood circulation
following surgery to reduce the risk of deep
vein thrombosis due to immobility.
• DVT stockings will be provided by nursing
staff post operatively.
• One can repeat the exercises 1-2 hourly,
they can be done in bed or the chair.
• The examples of exercises are:
a. ankle toe pumps and heel slides;
b. static glutes, quads etc
 Mobilisation
• Early mobilisation is a key factor in reducing
post operative complications, enabling a
quick recovery and timely discharge from
hospital. Patient is assisted to get out of bed
by physiotherapist and/or nurse on the day
of operation or the following day.
• The patient starts working with the
physiotherapist to gradually increase his
mobility – ambulation (with special aids);
stair climbing and descent etc.
 Potential complications include pressure
areas, contractures, and deconditioning.

 Techniques to avoid these complications

include:

• Instruction / training in bed mobility,

transfers, and mobilisation, as appropriate
• Assist and encourage early sit out of bed
• Prescription, and education of positioning
programs:
 Prone lying
 Knee extension while lying,
 sitting out of bed
 No pillows under the knee
 Avoidance of prolonged flexion / abduction /
external rotation at hip
 General and /or targeted strengthening /
stretching programs
 The therapist also takes note of any danger
signs like spikes of fever, sudden increase in
pulse rate; which can be indicative of sepsis,
respiratory or cardiac complications,
hemorrhage etc.
 The physical therapist should also keep keen
eye in ruling out any of the before said
complications like DVT, Embolism or
Atelectasis throughout the treatment phase.