Breathing (respiratory) complications are one of the main problems that can happen after a major operation. They can happen for many reasons. They often happen due to:

  • the effects of anaesthesia
  • discomfort after an operation
  • reduced movement after surgery

Physiotherapy after a major operation is important. It can reduce your risk of getting some complications for example:

  • chest infections
  • deep vein blood clots.

 This leaflet will explain the physiotherapy you may get after your operation. It will help you to practice exercises that will prevent and treat common complications.

Some advice before your operation

What to bring into hospital

Please bring well fitted footwear to walk in after your operation like slippers that cover the whole of your feet. Do not bring flip flops or slippers that can come off your feet easily. If slippers are not suitable you may find ‘slipper socks’ with grips on the sole better. Bring some comfortable clothing that you can get dressed into.

Active Cycle of Breathing Exercises (ACBT)

These are breathing exercises that help expand your lungs and clear any secretions (phlegm) from your lungs. They are important in reducing your risk of chest infections. They are also used to treat lung complications. We recommend you practice ACBT before your operation to get used to the technique.

Breathing control (diaphragmatic breathing)

This is normal gentle breathing.  Rest your hands on your tummy with your arms relaxed. Breathe in through your nose if possible rather than your mouth. Your tummy should rise gently. Your upper chest and shoulders should be relaxed.

Deep breathing 

Keeping your hands over your tummy as in step 1. Take deep breaths. Your hands should rise more than with ‘breathing control’. Try and hold at the end of the breath for 3 seconds. Do 4 deep breaths this way.

Return to ‘breathing control’ to rest (step 1). Repeat ‘deep breathing’ (step 2).

Huffing 

Take a small breath in then open your mouth wide and force the breath out hard and fast. This is like misting up a mirror to polish it.

You can go back and repeat the whole cycle if you can feel and hear phlegm.

Supported coughing / huffing

Coughing and huffing can be uncomfortable if you have a tummy incision. It helps if you can support your wound as you huff or cough. Do this with your hands on either side of your wound giving firm pressure towards your wound. Or you can do this by placing a clean, folded towel over your wound and press gently as you cough.

It is very important to be able to deep breathe and cough. If you cannot do this please tell your nurse and doctor on the ward.

We advise ACBT and supported cough as often as needed. As a general guide every hour as soon as you wake up from your operation. They can be reduced as you return to normal mobility and if your chest remains clear of secretions. 

Bed exercises

For the first few days after the operation it is important to do regular exercises in the bed to help circulation. This is also for those patients who cannot get out of bed straight away.

1. Move your feet up and down at the ankles 10 times

2. Bend and straighten your knees 10 times

3. Tighten the muscles at the top of your thighs by pushing the knees down into the bed 10 times

 Try to do these exercises every hour.

Physiotherapy after your operation

Walking

Getting out of bed and walking on the first day after surgery is very important. Your physio will help you walk and will continue to keep you moving until you are back to normal. You may be connected to a drip, drains and have a catheter. We will help you walk with these in place.

We recommend at least 4 walks a day if you are medically fit. The team try to do 2 walks a day. In the evening the nursing staff try to do another 2. We encourage you to ask for your walks. You may find it helpful to time your walks when you are going to get back into bed. There may be times when we are unable to walk with you twice a day. This may be due to staffing levels and emergencies. We appreciate your understanding in this matter.

Sitting out 

Sitting out in a chair is important for your lungs. You will be expected to do this as much as possible from the first day after your surgery. It is recommended to sit out for 8 hours. This does not mean in 1 session. Many people break this up into small chunks with a rest on the bed between sitting out. Please tell the staff if you need a rest on the bed.

Chest physio

A physiotherapist will listen to your lungs using a stethoscope. They will check how you are managing the breathing exercises. Sometimes you may need more complex physiotherapy for your lungs or mobility. This will be explained to you if needed.

When physio stops

You will stop being seen by the physiotherapy team when your walking and lungs are back to normal.

When you are discharged home

If you are worried about managing at home after your operation please talk to your physiotherapist and nurse while you are on the ward.

After you are sent home we advise you to gradually increase your activity. It is important to do gentle exercise daily. This is to increase your strength and stamina. Start with going for a short walk. Increase your distance each day. If you take part in sport or exercise you should introduce this gradually. Please avoid excessive lifting, bending and stretching during the first 6-8 weeks after your operation. Advice about more strenuous forms of exercise should be guided by your consultant or specialist nurse.

If you are worried about your progress when you are at home contact your GP who can advise on the best service for you.

Other members of the team

As well as seeing a physiotherapist you may see a technical instructor or a physiotherapy assistant. They work with the physiotherapist to assess and treat you. You may also be seen by a student physiotherapist. This will be under the guidance and supervision of a qualified physiotherapist. This will be explained to you if appropriate.

How to recognise the physio team

There are many different uniforms that health care workers wear in the Trust. The Physios wear a white tunic or polo shirt with a navy blue trim and navy blue trousers. The technical instructors and physio assistants wear a light blue tunic or polo shirt with navy trousers.

If you need any more advice about physiotherapy before or after your operation please contact us on: 01228 814741

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302