a patient’s guide

East

an

d N

ort

h H

ertf

ord

shir

eN

HS

Tru

st

Phys

ioth

erap

y ad

vice

an

d e

xerc

ises

fro

m f

ou

r w

eeks

aft

er

nec

k d

isse

ctio

n s

urg

ery

Patie

nt In

form

atio

n Se

ries

PI47

2

Co

nta

cts

Mem

ber

s o

f H

ead

& N

eck

Team

:

Con

sulta

nt o

ncol

ogis

t: .

......

......

......

......

......

......

......

......

.....

tel:

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

Clin

ical

nur

se s

peci

alis

t (C

NS)

: ...

......

......

......

......

......

......

....

tel:

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

Spee

ch &

lang

uage

the

rapi

st (S

LT):

.....

......

......

......

......

......

tel:

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

Lym

phoe

dem

a Th

erap

ist:

....

......

......

......

......

......

......

......

....

tel:

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

Phys

ioth

erap

y D

epar

tmen

t: .

......

......

......

......

......

......

......

....

Phys

ioth

erap

y D

epar

tmen

t

Mou

nt V

erno

n H

ospi

tal

Rick

man

swor

th R

oad

Nor

thw

ood

Mid

dles

ex

HA

6 2R

N

tel:

0192

3 84

4261

The

illus

trat

ions

in t

his

leafl

et

have

bee

n us

ed w

ith t

he p

erm

issi

on o

f Ph

ysio

Tool

s Lt

d. A

ll rig

hts

rese

rved

. © C

opyr

ight

Phy

sioT

ools

Ltd

.

3

Phys

ioth

erap

y ad

vice

an

d e

xerc

ises

fro

m

fou

r w

eeks

aft

er n

eck

dis

sect

ion

su

rger

y

Co

nte

nts

Con

tact

s 2

Intr

oduc

tion

4Ef

fect

s of

sur

gery

5

Gen

eral

adv

ice

6H

ouse

hold

act

iviti

es

6D

rivin

g 6

Retu

rnin

g to

wor

k/sp

orts

7

Exer

cise

s 7

Nec

k ex

erci

ses

8Sh

ould

er e

xerc

ises

10

Wha

t to

do

if th

e ne

rve

to y

our

shou

lder

is a

ffec

ted

13Po

stur

al a

dvic

e 13

Con

clus

ion

13O

ther

hel

p an

d su

ppor

t 14

If yo

u no

rmal

ly p

ay f

or N

HS

pres

crip

tions

14

Con

sent

15

Iden

tifi c

atio

n 15

Preg

nanc

y/fa

ther

ing

a ch

ild

15

4Intr

od

uct

ion

This

leafl

et

offe

rs a

dvic

e an

d pr

ovid

es d

etai

ls o

f ex

erci

ses

to p

atie

nts

from

fou

r w

eeks

aft

er h

ead

and

neck

dis

sect

ion

surg

ery.

The

info

rmat

ion

may

not

be

need

ed b

y pa

tient

s at

ot

her

stag

es in

the

ir re

cove

ry.

If th

ere

is a

nyth

ing

in t

his

leafl

et

that

is u

ncle

ar, p

leas

e as

k yo

ur p

hysi

othe

rapi

st. I

f yo

u ha

ve n

ot y

et b

een

refe

rred

to

a ph

ysio

ther

apis

t, p

leas

e sp

eak

to y

our

cons

ulta

nt o

r C

linic

al

Nur

se S

peci

alis

t (C

NS)

who

will

arr

ange

thi

s fo

r yo

u.

The

exer

cise

s ar

e de

sign

ed t

o im

prov

e th

e st

reng

th o

f yo

ur

shou

lder

mus

cles

, to

allo

w y

ou t

o re

gain

as

near

to

norm

al

arm

mov

emen

t as

pos

sibl

e. T

his

will

als

o al

low

you

to

rega

in

and

then

kee

p yo

ur n

eck

mov

emen

t. Y

our

phys

ioth

erap

ist

will

gui

de y

ou t

hrou

gh t

he e

xerc

ises

.

As

the

scar

fro

m t

he s

urge

ry h

eals

, it

will

ten

d to

bec

ome

tight

er a

nd t

hick

er. S

o it

is v

ery

impo

rtan

t yo

u lo

ok a

fter

you

r sc

ar a

s pa

rt o

f yo

ur t

reat

men

t to

min

imis

e th

ese

effe

cts.

It is

impo

rtan

t th

at y

ou d

o th

e ex

erci

ses

and

gent

le s

car

mas

sage

reg

ular

ly t

o ge

t th

e be

st r

ange

of

mov

emen

t of

you

r sh

ould

er a

nd n

eck,

and

to

redu

ce t

he e

ffec

ts o

f th

e sc

arrin

g.

Som

e pa

tient

s m

ay a

lso

need

to

have

rad

ioth

erap

y af

ter

thei

r op

erat

ion,

whi

ch c

an c

ause

fur

ther

sca

r tis

sue

to f

orm

ove

r a

perio

d of

tim

e.

For

thes

e pa

tient

s, it

is b

ette

r if

the

effe

cts

of s

carr

ing

from

th

e su

rger

y ar

e re

duce

d as

muc

h as

pos

sibl

e be

fore

the

ir ra

diot

hera

py s

tart

s.

5

Effe

cts

of

surg

ery

Scar

Tis

sue

Scar

tis

sue

is p

rodu

ced

as a

res

ult

of t

he b

ody’

s no

rmal

he

alin

g m

echa

nism

fol

low

ing

inju

ry o

r su

rger

y. It

tak

es

abou

t 18

mon

ths

to 2

yea

rs f

or s

cars

to

fully

dev

elop

.

The

sym

ptom

s of

tig

htne

ss a

nd t

hick

enin

g ca

n be

gre

atly

re

duce

d by

:

regu

lar

fi rm

mas

sage

with

a n

on-p

erfu

med

cre

am

re

gula

r ge

ntle

str

etch

ing

Thes

e sh

ould

onl

y be

don

e if

the

skin

is w

ell h

eale

d an

d in

tact

.

By d

oing

thi

s ea

rly o

n in

you

r re

cove

ry, y

ou w

ill h

elp

to e

nsur

e yo

u re

gain

som

e of

the

mov

emen

t yo

u m

ay h

ave

lost

. You

r ph

ysio

ther

apis

t w

ill s

how

you

how

to

do t

his.

To s

tart

with

it m

ay s

eem

as

thou

gh y

ou a

re n

ot m

akin

g m

uch

diff

eren

ce. H

owev

er, i

f yo

u ca

rry

on y

ou w

ill b

egin

to

notic

e a

chan

ge in

the

fee

l of

your

nec

k an

d th

e ra

nge

of y

our

head

m

ovem

ent.

Spec

ial c

are

shou

ld b

e ta

ken

durin

g an

y ra

diot

hera

py a

s yo

ur

skin

may

bec

ome

mor

e fr

agile

. Any

red

or

sore

ski

n sh

ould

be

see

n an

d as

sess

ed b

y th

e nu

rsin

g st

aff.

Ran

ge

of

mo

vem

ent

The

rang

e of

mov

emen

t in

you

r sh

ould

er m

ay b

e re

duce

d as

a

resu

lt of

the

sur

gery

and

/or

radi

othe

rapy

whi

ch m

ay w

eake

n so

me

of t

he m

uscl

es t

hat

enab

le y

our

arm

to

mov

e.

If th

is h

appe

ns, t

he e

xerc

ises

in t

his

leafl

et

are

desi

gned

to

rest

ore

as m

uch

mov

emen

t as

pos

sibl

e, a

nd t

o st

reng

then

m

uscl

es t

hat

will

hel

p to

com

pens

ate

for

the

loss

fro

m a

ny

nerv

e da

mag

e.

6

The

rang

e of

mov

emen

t in

you

r ne

ck m

ay a

lso

be r

educ

ed

beca

use

of t

he s

urge

ry a

nd/o

r ra

diot

hera

py. T

he n

eck

exer

cise

s sh

own

in t

his

leafl

et

aim

to

help

you

to

rega

in a

nd k

eep

as

muc

h m

ovem

ent

as p

ossi

ble.

Gen

eral

ad

vice

Aft

er a

n op

erat

ion,

it is

usu

al t

o fe

el t

ired

for

som

e tim

e.

It is

impo

rtan

t th

at y

ou p

ace

your

self

durin

g th

e da

y so

th

at y

ou a

re a

ble

to c

arry

out

the

exe

rcis

es in

thi

s bo

okle

t on

a

regu

lar

basi

s.

You

may

nee

d to

red

uce

the

num

ber

of r

epet

ition

s or

the

nu

mbe

r of

tim

es y

ou d

o th

em, b

ut it

is im

port

ant

that

you

do

som

e ex

erci

ses

ever

y da

y. P

leas

e as

k yo

ur p

hysi

othe

rapi

st

if yo

u ar

e co

ncer

ned.

Ho

use

ho

ld a

ctiv

itie

sIt

is im

port

ant

to b

egin

by

doin

g lig

ht a

ctiv

ities

, suc

h as

du

stin

g, p

eggi

ng o

ut li

ght

clot

hing

, was

hing

up

and

putt

ing

out

the

rubb

ish.

You

can

gra

dual

ly in

trod

uce

heav

ier

activ

ities

su

ch a

s ga

rden

ing

from

six

wee

ks o

nwar

ds.

Dri

vin

gYo

ur c

onsu

ltant

will

adv

ise

you

abou

t w

hen

you

may

driv

e ag

ain.

To

ensu

re y

ou a

re s

afe

on t

he r

oad

and

have

ful

l con

trol

of

you

r ve

hicl

e, y

ou m

ust:

be a

ble

to t

urn

your

hea

d en

ough

to

look

beh

ind

you

have

reg

aine

d go

od s

tren

gth

in y

our

arm

s

be

abl

e to

mak

e an

em

erge

ncy

stop

7

Ret

urn

ing

to

wo

rk/s

po

rts

Retu

rnin

g to

wor

k/sp

orts

will

dep

end

on w

heth

er o

r no

t yo

u ar

e to

hav

e ra

diot

hera

py a

fter

you

r su

rger

y. P

leas

e ch

eck

with

yo

ur c

onsu

ltant

.

Exer

cise

sTh

e ex

erci

ses

on t

he f

ollo

win

g pa

ges

are

desi

gned

to

help

yo

u re

gain

or

impr

ove

norm

al m

ovem

ent

in y

our

neck

and

sh

ould

er. I

f yo

u ar

e un

able

or

unsu

re o

f ho

w t

o do

the

m,

plea

se c

onta

ct y

our

phys

ioth

erap

ist

for

help

.

It is

impo

rtan

t th

ese

exer

cise

s ar

e do

ne c

orre

ctly

to

prev

ent

abno

rmal

mov

emen

t pa

tter

ns. Y

ou s

houl

d ta

ke t

ime

to d

o th

ese

wel

l, an

d tr

y no

t to

rus

h th

em. E

xerc

ises

sho

uld

be d

one

in a

war

m e

nviro

nmen

t an

d in

com

fort

able

clo

thin

g.

Plea

se t

ry t

o do

the

exe

rcis

es t

hree

tim

es a

day

, inc

reas

ing

or r

educ

ing

the

num

ber

of r

epet

ition

s de

pend

ing

on t

he

cond

ition

of

your

ski

n af

ter

radi

othe

rapy

or

on y

our

pain

leve

l.

Any

dis

com

fort

fro

m d

oing

the

exe

rcis

es s

houl

d se

ttle

qui

ckly.

If

it do

es n

ot s

ettle

, ple

ase

ask

your

phy

siot

hera

pist

for

adv

ice.

Your

phy

siot

hera

pist

may

als

o gi

ve y

ou s

ome

mor

e sh

ould

er e

xerc

ises

to

do t

o su

it yo

ur o

wn

need

s.

8Nec

k ex

erci

ses

Repe

at e

ach

exer

cise

_ _

_ _

_

times

, 3 t

imes

a d

ay

Exer

cise

1

Tilt

your

hea

d aw

ay f

rom

the

af

fect

ed

side

to

give

ge

ntle

str

etch

. H

old

for

15 s

econ

ds.

Exer

cise

2

Use

you

r ha

nd t

o pu

ll yo

ur

head

gen

tly f

urth

er o

ver

Exer

cise

3

Turn

you

r he

ad t

o lo

ok o

ver

your

sho

ulde

r an

d gi

ve a

ge

ntle

str

etch

. H

old

for

15 s

econ

ds

9

Exer

cise

6

Hol

ding

you

r af

fect

ed

shou

lder

dow

n,

turn

you

r he

ad a

way

an

d gi

ve

a ge

ntle

str

etch

Exer

cise

4

Use

you

r ha

nd t

o pu

sh

your

hea

d ge

ntly

fu

rthe

r ro

und

Exer

cise

5

In a

sitt

ing

posi

tion,

til

t yo

ur c

hin

upw

ards

to

giv

e a

stre

tch

10

Sho

uld

er e

xerc

ises

Thes

e ex

erci

ses

shou

ld o

nly

be d

one

unde

r th

e su

perv

isio

n of

a p

hysi

othe

rapi

st (w

ho m

ay a

lter

or a

dd

to t

hose

sho

wn

here

dep

endi

ng o

n yo

ur o

wn

need

s).

Repe

at e

ach

exer

cise

....

......

.....

tim

es, 3

tim

es a

day

.

Exer

cise

1

Sit

or s

tand

. Li

ft y

our

shou

lder

s to

war

ds y

our

ears

an

d sl

owly

rol

l the

m

back

war

ds.

Rela

x an

d re

peat

.

Exer

cise

2

Squa

re y

our

shou

lder

s by

br

ingi

ng t

he e

dges

of

your

sh

ould

er b

lade

s to

geth

er in

th

e m

iddl

e of

yo

ur b

ack.

11

Exer

cise

3

Sit

or s

tand

. Kee

p yo

ur

elbo

ws

at r

ight

ang

les

and

into

you

r si

de.

Mov

e fo

rear

ms

outw

ards

an

d ba

ck a

gain

.

Exer

cise

4

On

your

bac

k w

ith

knee

s be

nt, h

old

stic

k w

ith h

ands

sho

ulde

r-w

idth

apa

rt.

Rais

e ar

ms

abov

e he

ad s

low

ly, t

hen

low

er.

Exer

cise

5

Lyin

g co

mfo

rtab

ly o

n th

e be

d, p

lace

you

r ha

nds

at t

he s

ide

of y

our

head

and

pus

h yo

ur e

lbow

s ge

ntly

into

the

pill

ow.

12

Exer

cise

6

Att

ach

ther

aban

d se

cure

ly. H

old

othe

r en

d an

d pu

ll ba

nd t

owar

ds

your

sto

mac

h, a

nd

slow

ly r

etur

n.

Exer

cise

7

Att

ach

ther

aban

d se

cure

ly.

Hol

d ot

her

end

and

pull

band

out

war

d, k

eepi

ng y

our

elbo

w in

to

your

sid

e.

13

Wh

at t

o d

o if

th

e n

erve

to

yo

ur

sho

uld

er

is a

ffec

ted

The

acce

ssor

y ne

rve

supp

lies

one

of t

he b

ig m

uscl

es in

volv

ed

in s

houl

der

mov

emen

t. If

thi

s ne

rve

is a

ffec

ted

durin

g su

rger

y or

rad

ioth

erap

y, y

ou w

ill h

ave

diffi

cul

ty li

ftin

g yo

ur a

rm a

bove

yo

ur h

ead.

A s

epar

ate

list

of e

xerc

ises

is a

vaila

ble

for

patie

nts

who

hav

e be

en a

ffec

ted

in t

his

way

, see

leafl

et

PI 4

7a -

Exe

rcis

es f

or

patie

nts

with

alte

red

nerv

e fu

nctio

n to

the

sho

ulde

r fo

llow

ing

neck

dis

sect

ion

and/

or r

adio

ther

apy.

The

exe

rcis

es f

ocus

on

stre

ngth

enin

g an

d st

abili

sing

spe

cifi c

mus

cles

to

help

allo

w

for

the

loss

of

mov

emen

t in

the

sho

ulde

r.

Post

ura

l ad

vice

It is

impo

rtan

t to

do

the

follo

win

g:

whe

n si

ttin

g, u

se a

fi rm

sup

port

in t

he s

mal

l of

your

bac

k

w

hen

stan

ding

, sta

nd t

all,

with

you

r sh

ould

ers

squa

red,

bu

t re

laxe

dTh

ese

posi

tions

pla

ce y

our

join

ts a

nd s

oft

tissu

es in

a g

ood

posi

tion.

You

will

nee

d to

pra

ctic

e th

ese

until

the

y be

com

e yo

ur n

orm

al p

ostu

re.

It m

ay b

e he

lpfu

l to

look

at

your

self

in a

mirr

or w

hils

t do

ing

this

to

ensu

re t

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hea

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Co

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Preg

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ust

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ecom

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ioth

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his

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to a

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omen

bet

wee

n th

e ag

es o

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- 5

5 ye

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Thi

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