Physiotherapy in Surgical Conditions.

Preoperative care

The physiotherapist has an important role to play in assessing which patients being prepared for surgery are at risk of developing complications that she may help to prevent. As a member of the surgical team in the surgical ward she may be alerted about any problems or potential problems by the medical or nursing staff. The medical history of any patient must be checked for any respiratory or circulatory problems that could place the patient at risk or any other factors such as smoking, obesity, inactivity because of another disease or injury or age that could predispose to post–operative complications.

Physiotherapy for Post–Operative Care

Prevention of chest complications

The physiotherapist must take into consideration the effects of the anesthetic on secretions in the respiratory tract. One is that pain causes reflex inhibition of the diaphragm and therefore breathing is difficult. Another is that in any operation affecting the abdominal muscles the patient tends to avoid using them because of pain or fear of pain and this again hampers respiratory movements. 

Prevention of thrombosis

Adequate movement post–operatively is essential. While the patient is in bed he must be encouraged to move about and be as independent as he can. Leg exercises should be given until the patient is up and moving around the ward. The exercises may have to be modified if the patient has an intravenous drip in the leg, or if there is any from of pelvic drainage. Once the patient is up the physiotherapist should see that he is moving around as it is not sufficient for the patient just to sit in a chair. It is important that these exercises are done properly. Initially the physiotherapist should supervise them but the patient must try to set up a realistic schedule, such as before or after each meal. They must be practiced frequently if they are to be effective.

Prevention of pressure sores

These should not occur in patients who have early mobilization after surgery. However, for patients who have to remain in bed for some days or longer and particularly for the elderly there is a risk. Care must be taken in positioning the patient and he must be encouraged to move around in bed. All members of the team must watch and report any signs of pressure.

Prevention of muscle wasting and joint immobility

Muscle weakness and joint stiffness are particularly likely to occur in the elderly if they remain in bed for any length of time before or after surgery. The physiotherapist may need to give general mobilizing and strengthening exercises to enable the patient to regain independence.