Physiotherapy for lung surgery

Physiotherapy

This booklet is designed to give some guidelines and information about how the physiotherapist at The James Cook University Hospital will help you in your recovery following your lung operation.

Your physiotherapy treatment will focus on three main areas:

• Chest care

• General mobility

• Exercise

The exercise instructions in this booklet are given as a general guideline only as each patient is treated as an individual and the exercise regime may vary slightly depending on the type of operation or your consultant’s instructions.

If you are in doubt about the information given in this booklet, please ask your physiotherapist. All the exercises contained within this booklet will be taught to you by your physiotherapist.

Physiotherapy before your operation

You may see a physiotherapist prior to your operation, he or she will explain and teach you exercises to practice before and after your operation. This is usually done during the pre-assessment clinics.

Chest care

Chest expansion and clearance exercises begin on the first day after your operation. Some people become chesty in the first few days following surgery due to extra phlegm production as result of:

• Any previous chest condition, for example; bronchitis.
• Smoking, which can increase the amount of phlegm produced after an operation
• The discomfort or pain from your chest wound can stop you from taking a deep breath in and coughing.
• Your physiotherapist will assess your breathing and how your lungs are working. They may advise on the ideal position to improve your comfort and lung function.
• For the first few days you may not be as mobile as you would normally be and so you do not breathe as deeply.

These exercises include:

Deep breathing exercises aimed at keeping your lungs clear after your operation together with huffing and coughing.

Procedure:

• Sit upright with your hands placed over the sides of your chest.
• Take a deep breath in slowly through your nose.
• Hold this breath in for one to two seconds and then breathe the air out slowly through your mouth.
• Repeat 5 times, then huff 5 times.

To do a huff take a medium sized breath in then force the air out quickly through an open mouth, as if you are steaming up a window or glass.

If you have any phlegm in your throat then have a supported cough.

Coughing – always take a deep breath in and have a good strong cough, whilst supporting your chest wound with a small pillow.

Take normal relaxed breaths after coughing.

Exercises

Arm and leg exercises:

From the first day after your surgery we will encourage you to begin exercising. This may initially involve some gentle arm and leg exercises to prevent stiffness, help circulation and increase general mobility by walking.

Arm exercises:

While standing or seated, raise both arms straight forward over your head, then back down. Repeat five to ten times.

Gentle shoulder shrugs (up and down) and shoulder rolls (forwards and backwards)
Repeat five to ten times.

Place your hands on top of your head

Bring your hands behind your back. Slowly stretch your hands up towards your shoulder blades.

Place your hands behind your neck

Gentle leg exercises:

These exercises are taught to help keep your muscles strong and promote your circulation.

Bend and straighten your ankles and toes. Repeat ten times.

Circle your feet from ankles round in one direction and then repeat in the other direction.
Repeat ten times each direction.

Tighten your thigh muscles on the front of your legs by pressing the back of your knee into the bed and pulling your toes towards you.

Tighten your thigh muscles as previously and keep your leg straight and lift leg off the bed a small height. Hold for two seconds, then slowly lower it.
Repeat ten times with each leg.

Straighten one leg out in front of you whilst sitting. Hold for five seconds, then relax.
Repeat ten times with each leg.

Physiotherapy after your operation

Following your operation you may require oxygen support whilst recovering in the intensive care or high dependency unit. You will be attached to monitors, chest drains, catheters, and lines for your drugs or fluids. Please do not be upset, this is all routine and it is nothing to be concerned about.

It is important that you follow the advice of your physiotherapist and that you continue following the arm and leg exercises outlined above between your physiotherapy visits.

General mobility

Your physiotherapist will encourage you to progress your mobility from day one after your operation.

The physiotherapist will monitor and assess your ability to do simple tasks during your hospital stay. Any problems will be identified and treated as appropriate with other members of the team.

Routine patients are usually discharged home within five days (but may differ dependant on your surgery), after doing five minutes on the bike and completing a flight of stairs if required.

After discharge from hospital

After your operation, your lung function should improve and your ability to exercise will also gradually increase.

However because of your heart problem you may have been unable to exercise for some However because of your lung condition you may have been unable to exercise for some time, so your increase in activity needs to be done gradually, to build up your fitness slowly.

Remember it is not unusual to feel a little bit tired when you first get home. Make sure you have a good night sleep and you get up at your normal time. Have a short sleep after lunch if you feel tired during the day.

Exercises for the first four to six weeks after discharge

Walking:

• Improves your fitness after your operation
• Should become part of your daily routine
• Should start immediately after discharge from hospital

Try to take two walks per day outdoors and start off with the maximum distance you have walked with your physiotherapist whilst in hospital. Gradually increase the distance and pace as you feel able which maybe daily or every other day.

As you increase your walking distance you will be able to take one long walk per day instead of two. Start off by walking on level and progress to slopes as you improve.

If you live on a hill, walk shorter distances, uphill first. If you become short of breath, stop and rest, you should recover within a minute or two, if not you may be doing too much.

Walking schedule

The walking schedule below is merely a guide as everyone will differ, however your physiotherapist will discuss this with you prior to your discharge.

If you have access to an exercise bike or pedals, you can use this to improve your fitness by increasing the length of time on the bike rather than the resistance.

What happens if I have a chest infection?

The signs of a chest infection may be…

• Coughing up more phlegm than normal

• Your phlegm may change colour – white, yellow, green

• You may have a temperature

• You may be more short of breath than normal

However, you may not remember them exactly so please refer to the breathing exercises given earlier in this booklet.

Other advice

Your wound must be given time to heal properly, avoid putting too much strain or tension upon it. After your discharge from hospital you may do light duties like washing up, dusting, cooking light meals, pottering about the garden.

You should gradually reintroduce more strenuous activities like hoovering, ironing, digging in the garden and DIY as you feel comfortable over the following four to six weeks after your operation.

Avoid lifting anything heavy for the first four to six weeks whilst your wound heals.
Check your wound daily.

Posture

Once you have left the hospital it is your responsibility to check and correct your posture.

Try standing in front of a mirror to help in adjusting and correcting your posture or stand with your back to a wall pushing your shoulders back.

Continue doing your shoulder flexibility exercises following the arm exercises outlined earlier in the booklet.

General advice

• You will be sent an outpatient appointment in the post to see your consultant in four to six weeks following your surgery.
• At two to three months after your operation you should be able to do everything you did before your operation. Consult your doctor before you participate in any competitive or contact sports.
• Please discuss return to work and driving with your doctors either when in hospital or at your outpatient appointment.
• If you return to work make sure you continue with your exercises on a regular basis ie. daily if possible.
• Holidays abroad – follow your consultant’s advice from your outpatient appointment.
• Wound pain, discomfort may persist for a few weeks after your operation, this is due to the healing process. You may continue to take tablets supplied by your GP.

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

ST0424