Exercises and advice for patients recovering from head and neck

Pharmacy Medicines Helpline
If you have any questions or concerns about your
medicines, please speak to the staff caring for you or call
our helpline.
t: 020 7188 8748 9am to 5pm, Monday to Friday
Exercises and
advice for patients
recovering from
head and neck
surgery
Your comments and concerns
For advice, support or to raise a concern, contact our
Patient Advice and Liaison Service (PALS). To make a
complaint, contact the complaints department.
t: 020 7188 8801 (PALS)
e: pals@gstt.nhs.uk
t: 020 7188 3514 (complaints)
e: complaints2@gstt.nhs.uk
Language and accessible support services
If you need an interpreter or information about your care in
a different language or format, please get in touch:
t: 020 7188 8815 e: languagesupport@gstt.nhs.uk
NHS 111
Offers medical help and advice from fully trained advisers
supported by experienced nurses and paramedics.
Available over the phone 24 hours a day.
t: 111
This information sheet is for patients who have had
surgery for conditions affecting their mouth, jaw,
face and/or neck.
NHS Choices – Provides online information and guidance
on all aspects of health and healthcare, to help you make
choices about your health.
w: www.nhs.uk
Leaflet number: 2275/VER5
Date published: July 2017
Review date: July 2020
© 2017 Guy’s and St Thomas’ NHS Foundation Trust
12
Contact details
If you have any questions or concerns about
physiotherapy following head and neck surgery, please
contact:
The nature of your surgery and position of your
wound can affect your movement.
This can have consequences for your strength,
flexibility and fitness.
 the Guy’s outpatient physiotherapy department on
020 7188 5099 and ask for the head and neck
outpatient physiotherapist
The key things to think about are:




Posture.
General mobility rehabilitation (moving around).
Neck, shoulder and jaw exercises.
Exercises for the donor flap site (where tissue has
been removed).
 the head and neck physiotherapists via 020 7188
5110/5106 or hospital switchboard on 020 7188
7188 and ask for bleep 2136 or 0694
 or, if you are known to the Community Head and
Neck Team (CHANT), call the CHANT
physiotherapists on 020 3049 2350
Posture
Be aware of your posture. Try not to ‘slump’ or round your
shoulders. Try to sit and stand upright, with your head up
and shoulders and upper back pulled back and down.
When sitting, it may help to put a pillow under your arm.
2
Please leave a message if your call is not answered
and someone will call you back. Opening hours are
8.30am to 4.45pm, Monday to Friday (CHANT 9am5pm).
For more information leaflets on conditions, procedures,
treatments and services offered at our hospitals, please
visit www.guysandstthomas.nhs.uk/leaflets
11
For the first six weeks after your operation, try to avoid heavy
activities such as hanging out wet washing, and lifting
anything heavier than a full kettle, for example shopping
bags or children.
General mobility rehabilitation

If you drive, ask your consultant when it is okay to return to
driving. The main considerations for driving are:





The effects of any painkillers you may be taking. For
example, do they make you feel drowsy?
Can you turn your head to look in blind spots without
pain or stiffness?
Can you comfortably tolerate holding your arms up to
the steering wheel for the necessary length of time?
If you have had a flap from a part of your leg, could
you comfortably hop on that leg? This will be an
indicator ofyour ability to operate the brake or clutch
to do an emergency stop.

In the first few days after your operation, it is important
that you get up out of bed and start moving around.
Walking helps your lungs to re-expand and encourages
good circulation.
Generally, the day after your operation you will be
helped to get out of bed and sit in a chair. There are
exceptions to this with certain types of surgery.
Gradually increase the distances you are able to walk
until you are fully mobile again. Aim to walk at least the
length of the ward three to four times per day, if you
can.
Neck and shoulder exercises
Please refer to information on the DVLA website
www.dvla.gov.uk. If you want to return to driving, it may be
worth trying it out in a quiet area with family/friends first,
before going out in traffic.
Follow-up
You may be referred for ongoing physiotherapy when you leave
hospital. This is to prevent future problems with neck, shoulder,
jaw or flap donor site movement and pain. The amount of
physiotherapy you receive will depend on your individual needs. If
at any point a problem reappears or you develop a new problem,
please speak with your healthprofessional.
10
 For the first few days whilst your drains are in, do not
actively exercise your neck, shoulders or jaw – just
move about gently and as normally as you can. This will
allow your wound to settle and start to heal.
 Once any drains are out, exercises will help to improve
movement and reduce swelling, pain and stiffness.
Stretches can help to prevent a tight scar.
 During surgery, the nerves in the area may be stretched,
bruised or cut. If this has happened, the nerves may not
send messages to the muscles as well. This can lead to
reduced movement, particularly in the face and
shoulders, and can mean recovery takes a little longer.
How often should I do these exercises?
It is always best to do ‘little and often’, rather than lots of
exercises at one time. Exercising two to three times a
day for five to 10 minutes is best. Your physiotherapist
will be able to advise you exactly what to do.
3
Please continue with your exercises, even after you have
regained full movement and strength, until at least three
months after you have finished your full treatment programme
(including any radiotherapy).
Which exercises should I be doing?
1. Head turns
Turn your head to look over one shoulder until you feel the
beginning of a stretch.
Hold for 3 - 5 counts and return to the middle.
Then turn your head towards the other shoulder.
Repeat 5 - 10 times to each side, keeping your shoulders still.
Avoid smoking – This will help your wound to heal and
can help to avoid other problems, such as your cancer
returning.
Scar massage – Massaging the scar can help to improve
the size and appearance of your scar and the range of
movement at your neck. Massage should only be started
once the wound is fully healed (when there are no scabs or
open areas) and you have finished any radiotherapy.
How do I massage?
 Use a non-perfumed moisturising cream, such as
aqueous cream.
 Gently press on your scar, moving it and the
surrounding tissue with your fingers.
 Make small circles, moving the skin over the tissue
underneath, rather than rubbing on the surface of
the skin.
 Massage for about ten minutes, two to three times a
day.
If you notice any change in the appearance of your
skin, for example it becomes redder, painful or starts
to ooze, then stop the massage and speak to your
physiotherapist.
2. Head tilt
Tilt your head to one side until you feel the beginning of a stretch.
Hold for 3 - 5 counts.
Return to the middle then tilt to the other side.
Repeat 5 - 10 times to each side, keeping your chin pointing
forwards and your shoulders still.
Returning to normal activities
Provided there are no problems with your wound healing,
try to return to normal activities (such as washing and
dressing yourself) while in hospital.
You can start to do some light domestic chores as soon as
you go home. Try to build up to longer / heavier tasks
gradually.
4
9
 The rim of your pelvis (deep circumflex ilium artery or DCIA
flap).
 Part of your abdomen/tummy (transverse rectus Abdominus
myocutaneous or TRAM).
3. Look up/look down
Gently bend your head forward, lowering your chin towards
your chest.
Return to the middle and then gently raise your chin, tilting
your head back, to look up.
Only go as far as you are comfortable – you should just
feel the beginning of a stretch to start with.
Once your wound is fully healed you can stretch a bit more
and consider holding the stretch for a few counts.
Repeat 5 - 10 times.
Your physiotherapist will give you an extra exercise sheet,
specific to the type of surgery you have had.
How will I know if I have done too much?
You should feel a stretch when exercising – not pain.
You may well feel sore and stiff however this should ease with
gentle movement.
Make sure you exercise gently and slowly, building up the
number of repetitions to those recommended.
Aim to do your exercises about 30 minutes to one hour after
taking any painkillers.
It may help to do this exercise looking in a mirror and
aiming for symmetry:
4. a) Shoulder shrug
Slowly shrug your shoulders, trying to
move them at the same time and with the
same speed.
Repeat 5 - 10 times.
Aim for symmetry.
Please tell your health professional if your wound changes
colour, becomes swollen or starts to ooze.
Other things you can do to help yourself
Keep active – Try to keep as active as you can, for example go
for regular walks. This can help maintain a level of fitness to see
you through your treatment period. If you feel tired, try doing a
little and often, rather than a lot in one go – listen to your body.
b) Shoulder roll
Roll your shoulders forwards and then
backwards 5 - 10 times each.
Good nutrition – Good nutrition (eating healthily) is vital for
your wound to heal. This will help you get back to your normal
activities. Please follow the advice from your dietitian and any
swallowing advice from the speech and language therapists.
5. Shoulder squeeze
Sit upright.
Squeeze your shoulder blades back and
together.
Hold for 5 - 10 counts.
Relax and repeat 5 - 10 times.
8
5
Try to do the following exercises (6/7/8) sitting or standing up.
If they are very uncomfortable, try them lying down.
Jaw exercises
Sometimes, jaw opening can
become restricted after
surgery. This can lead to
problems being able to open
your mouth enough to eat,
speak, clean your mouth or
be examined.
6. Taking hand out to the side
Keeping your elbow tucked into your waist,
take your hand/forearm out to the side.
Bring it back in to the starting position
Repeat 5 times.
7. Forward arm raise
Raise your arm up in front, continuing up,
over and above your head.
If it is difficult:
a) put your hand on your shoulder and
raise your elbow up, or
b) use your other hand to help support your
arm, or
c) slide your hand up a wall, using the wall to
support the weight of your arm, or
d) do the exercises lying down on your back.
Be aware of how much your mouth can open – a good test
of this is to see how many fingers you can stack between
your front teeth or gums. Practice this every day until your
treatment is fully complete. If this gap becomes less than
three fingers wide, it may indicate that extra therapy may be
helpful. Please speak to your health professional if you
notice this is happening. Your physiotherapist may give you
additional exercises specifically for your jaw.
Donor flap site exercises
An area of tissue or bone may have been used to
reconstruct the inside of your mouth where tissue was
removed. This is called a flap. Where the flap was taken
from is called the donor flap site. The donor flap site will
need to be exercised to restore the movement you had
before surgery.
Lower down and repeat 5-10 times.
8. Side arm raise
Leading with your thumb, raise your arm out to the side and
up alongside your head. If it is difficult;
a) put your hand on your shoulder and lift your elbow out to the
side, or
b) use a stick to help guide your arm up,
c) stand facing the wall and slide your
hand out to the side and up, or
d) do the exercises lying down on your back.
Common flap sites include
 The front of the chest (pectoralis major).
 Part of the forearm (radial forearm free flap or RFFF).
 The shoulder blade (scapula).
 The front of your thigh (anterolateral or ALT).
 The fibula bone in the lower leg.
Lower down and repeat 5-10 times.
6
7
Try to do the following exercises (6/7/8) sitting or standing up.
If they are very uncomfortable, try them lying down.
Jaw exercises
Sometimes, jaw opening can
become restricted after
surgery. This can lead to
problems being able to open
your mouth enough to eat,
speak, clean your mouth or
be examined.
6. Taking hand out to the side
Keeping your elbow tucked into your waist,
take your hand/forearm out to the side.
Bring it back in to the starting position
Repeat 5 times.
7. Forward arm raise
Raise your arm up in front, continuing up,
over and above your head.
If it is difficult:
a) put your hand on your shoulder and
raise your elbow up, or
b) use your other hand to help support your
arm, or
c) slide your hand up a wall, using the wall to
support the weight of your arm, or
d) do the exercises lying down on your back.
Be aware of how much your mouth can open – a good test
of this is to see how many fingers you can stack between
your front teeth or gums. Practice this every day until your
treatment is fully complete. If this gap becomes less than
three fingers wide, it may indicate that extra therapy may be
helpful. Please speak to your health professional if you
notice this is happening. Your physiotherapist may give you
additional exercises specifically for your jaw.
Donor flap site exercises
An area of tissue or bone may have been used to
reconstruct the inside of your mouth where tissue was
removed. This is called a flap. Where the flap was taken
from is called the donor flap site. The donor flap site will
need to be exercised to restore the movement you had
before surgery.
Lower down and repeat 5-10 times.
8. Side arm raise
Leading with your thumb, raise your arm out to the side and
up alongside your head. If it is difficult;
a) put your hand on your shoulder and lift your elbow out to the
side, or
b) use a stick to help guide your arm up,
c) stand facing the wall and slide your
hand out to the side and up, or
d) do the exercises lying down on your back.
Common flap sites include
 The front of the chest (pectoralis major).
 Part of the forearm (radial forearm free flap or RFFF).
 The shoulder blade (scapula).
 The front of your thigh (anterolateral or ALT).
 The fibula bone in the lower leg.
Lower down and repeat 5-10 times.
6
7
 The rim of your pelvis (deep circumflex ilium artery or DCIA
flap).
 Part of your abdomen/tummy (transverse rectus Abdominus
myocutaneous or TRAM).
3. Look up/look down
Gently bend your head forward, lowering your chin towards
your chest.
Return to the middle and then gently raise your chin, tilting
your head back, to look up.
Only go as far as you are comfortable – you should just
feel the beginning of a stretch to start with.
Once your wound is fully healed you can stretch a bit more
and consider holding the stretch for a few counts.
Repeat 5 - 10 times.
Your physiotherapist will give you an extra exercise sheet,
specific to the type of surgery you have had.
How will I know if I have done too much?
You should feel a stretch when exercising – not pain.
You may well feel sore and stiff however this should ease with
gentle movement.
Make sure you exercise gently and slowly, building up the
number of repetitions to those recommended.
Aim to do your exercises about 30 minutes to one hour after
taking any painkillers.
It may help to do this exercise looking in a mirror and
aiming for symmetry:
4. a) Shoulder shrug
Slowly shrug your shoulders, trying to
move them at the same time and with the
same speed.
Repeat 5 - 10 times.
Aim for symmetry.
Please tell your health professional if your wound changes
colour, becomes swollen or starts to ooze.
Other things you can do to help yourself
Keep active – Try to keep as active as you can, for example go
for regular walks. This can help maintain a level of fitness to see
you through your treatment period. If you feel tired, try doing a
little and often, rather than a lot in one go – listen to your body.
b) Shoulder roll
Roll your shoulders forwards and then
backwards 5 - 10 times each.
Good nutrition – Good nutrition (eating healthily) is vital for
your wound to heal. This will help you get back to your normal
activities. Please follow the advice from your dietitian and any
swallowing advice from the speech and language therapists.
5. Shoulder squeeze
Sit upright.
Squeeze your shoulder blades back and
together.
Hold for 5 - 10 counts.
Relax and repeat 5 - 10 times.
8
5
Please continue with your exercises, even after you have
regained full movement and strength, until at least three
months after you have finished your full treatment programme
(including any radiotherapy).
Which exercises should I be doing?
1. Head turns
Turn your head to look over one shoulder until you feel the
beginning of a stretch.
Hold for 3 - 5 counts and return to the middle.
Then turn your head towards the other shoulder.
Repeat 5 - 10 times to each side, keeping your shoulders still.
Avoid smoking – This will help your wound to heal and
can help to avoid other problems, such as your cancer
returning.
Scar massage – Massaging the scar can help to improve
the size and appearance of your scar and the range of
movement at your neck. Massage should only be started
once the wound is fully healed (when there are no scabs or
open areas) and you have finished any radiotherapy.
How do I massage?
 Use a non-perfumed moisturising cream, such as
aqueous cream.
 Gently press on your scar, moving it and the
surrounding tissue with your fingers.
 Make small circles, moving the skin over the tissue
underneath, rather than rubbing on the surface of
the skin.
 Massage for about ten minutes, two to three times a
day.
If you notice any change in the appearance of your
skin, for example it becomes redder, painful or starts
to ooze, then stop the massage and speak to your
physiotherapist.
2. Head tilt
Tilt your head to one side until you feel the beginning of a stretch.
Hold for 3 - 5 counts.
Return to the middle then tilt to the other side.
Repeat 5 - 10 times to each side, keeping your chin pointing
forwards and your shoulders still.
Returning to normal activities
Provided there are no problems with your wound healing,
try to return to normal activities (such as washing and
dressing yourself) while in hospital.
You can start to do some light domestic chores as soon as
you go home. Try to build up to longer / heavier tasks
gradually.
4
9
For the first six weeks after your operation, try to avoid heavy
activities such as hanging out wet washing, and lifting
anything heavier than a full kettle, for example shopping
bags or children.
General mobility rehabilitation

If you drive, ask your consultant when it is okay to return to
driving. The main considerations for driving are:





The effects of any painkillers you may be taking. For
example, do they make you feel drowsy?
Can you turn your head to look in blind spots without
pain or stiffness?
Can you comfortably tolerate holding your arms up to
the steering wheel for the necessary length of time?
If you have had a flap from a part of your leg, could
you comfortably hop on that leg? This will be an
indicator ofyour ability to operate the brake or clutch
to do an emergency stop.

In the first few days after your operation, it is important
that you get up out of bed and start moving around.
Walking helps your lungs to re-expand and encourages
good circulation.
Generally, the day after your operation you will be
helped to get out of bed and sit in a chair. There are
exceptions to this with certain types of surgery.
Gradually increase the distances you are able to walk
until you are fully mobile again. Aim to walk at least the
length of the ward three to four times per day, if you
can.
Neck and shoulder exercises
Please refer to information on the DVLA website
www.dvla.gov.uk. If you want to return to driving, it may be
worth trying it out in a quiet area with family/friends first,
before going out in traffic.
Follow-up
You may be referred for ongoing physiotherapy when you leave
hospital. This is to prevent future problems with neck, shoulder,
jaw or flap donor site movement and pain. The amount of
physiotherapy you receive will depend on your individual needs. If
at any point a problem reappears or you develop a new problem,
please speak with your healthprofessional.
10
 For the first few days whilst your drains are in, do not
actively exercise your neck, shoulders or jaw – just
move about gently and as normally as you can. This will
allow your wound to settle and start to heal.
 Once any drains are out, exercises will help to improve
movement and reduce swelling, pain and stiffness.
Stretches can help to prevent a tight scar.
 During surgery, the nerves in the area may be stretched,
bruised or cut. If this has happened, the nerves may not
send messages to the muscles as well. This can lead to
reduced movement, particularly in the face and
shoulders, and can mean recovery takes a little longer.
How often should I do these exercises?
It is always best to do ‘little and often’, rather than lots of
exercises at one time. Exercising two to three times a
day for five to 10 minutes is best. Your physiotherapist
will be able to advise you exactly what to do.
3
Contact details
If you have any questions or concerns about
physiotherapy following head and neck surgery, please
contact:
The nature of your surgery and position of your
wound can affect your movement.
This can have consequences for your strength,
flexibility and fitness.
 the Guy’s outpatient physiotherapy department on
020 7188 5099 and ask for the head and neck
outpatient physiotherapist
The key things to think about are:




Posture.
General mobility rehabilitation (moving around).
Neck, shoulder and jaw exercises.
Exercises for the donor flap site (where tissue has
been removed).
 the head and neck physiotherapists via 020 7188
5110/5106 or hospital switchboard on 020 7188
7188 and ask for bleep 2136 or 0694
 or, if you are known to the Community Head and
Neck Team (CHANT), call the CHANT
physiotherapists on 020 3049 2350
Posture
Be aware of your posture. Try not to ‘slump’ or round your
shoulders. Try to sit and stand upright, with your head up
and shoulders and upper back pulled back and down.
When sitting, it may help to put a pillow under your arm.
2
Please leave a message if your call is not answered
and someone will call you back. Opening hours are
8.30am to 4.45pm, Monday to Friday (CHANT 9am5pm).
For more information leaflets on conditions, procedures,
treatments and services offered at our hospitals, please
visit www.guysandstthomas.nhs.uk/leaflets
11
Pharmacy Medicines Helpline
If you have any questions or concerns about your
medicines, please speak to the staff caring for you or call
our helpline.
t: 020 7188 8748 9am to 5pm, Monday to Friday
Exercises and
advice for patients
recovering from
head and neck
surgery
Your comments and concerns
For advice, support or to raise a concern, contact our
Patient Advice and Liaison Service (PALS). To make a
complaint, contact the complaints department.
t: 020 7188 8801 (PALS)
e: pals@gstt.nhs.uk
t: 020 7188 3514 (complaints)
e: complaints2@gstt.nhs.uk
Language and accessible support services
If you need an interpreter or information about your care in
a different language or format, please get in touch:
t: 020 7188 8815 e: languagesupport@gstt.nhs.uk
NHS 111
Offers medical help and advice from fully trained advisers
supported by experienced nurses and paramedics.
Available over the phone 24 hours a day.
t: 111
This information sheet is for patients who have had
surgery for conditions affecting their mouth, jaw,
face and/or neck.
NHS Choices – Provides online information and guidance
on all aspects of health and healthcare, to help you make
choices about your health.
w: www.nhs.uk
Leaflet number: 2275/VER5
Date published: July 2017
Review date: July 2020
© 2017 Guy’s and St Thomas’ NHS Foundation Trust
12
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