This document discusses pre-operative and post-operative physiotherapy for abdominal surgeries. Pre-operative physiotherapy includes patient education to reduce anxiety and prepare for recovery, as well as exercises to strengthen the core and lower limbs. Post-operative care involves monitoring vitals, respiratory care, mobilization, and exercises to strengthen muscles at risk from incisions. A rehabilitation program progresses from isometric exercises to strengthening, cardio, and sports-specific exercises over 3-4 weeks. Respiratory physiotherapy techniques help clear secretions and improve breathing.

1. Pre & post-operative physiotherapy
in abdominal surgeries
By – kajal sansoya

2. Pre- operative care
• The pre-operative period runs from the time
to the patient is admitted to the hospital or
surgicenter to the time that the surgery
begins.

4. Why is pre-operative teaching to
prepare patient for abdominal surgery
important
• Pre-operative education is important because
it increases the patient knowledge regarding
preparing for abdominal surgery, reduces
anxiety regarding the experience, enhances
ability to cope up with the peri-operative
experiences and recovery.

5. • Also decrease the risk for post-operative
complications, particularly as a result of
learning post-operative exercises.

6. Patient assessment
History taking
Examination
Investigation
Pre-operative treatment
Documentation
Communication

7. Principles of history taking
Listen- what is the
problem
Clarify – what does
the patient expect?
Narrow- differential
diagnosis
Fitness- comorbidities

8. Pre-operative physiotherapy
• A pre-operative physiotherapy therapy
appointment also helps you to prepare for the
postoperative precaution and recommended
exercises to help the patient to recovery
quickly.

9. Pre-operative exercises
• Core strengthening
• Strengthening of lower limbs
• Breathing exercises
• Spirometery

10. Post-operative care
• The aim of post operative care is to provide
the patient with as quick, painless and safe
recovery from surgery as possible.

11. Phases
• Immediate / phase 1
Post-anesthetic
• Intermediate/ phase 2
Hospital stay
• Convalescent / phase 3
After discharge to full recovery

12. Why does physiotherapist needs to
know about surgical incision?
Knowing which muscle are likely to divided by a
specific and incision thus become weak after
surgery enables the therapist to undertake post
operative strengthening of these at risk muscles
or muscle groups.
Some incision have inherent risk of developing
hernias, knowing about this enables the therapist
to take preventive measures such as braces which
can be made ready for operation and fitted onto
the patient immediately after the surgery.

14. Post-operative orders
• Monitor- vital sign, ECG, fluid balance
• Respiratory care- oxygen mask, ventilator,
tracheal suction, chest physiotherapy
• Position in bed and mobilization
• Diet- liquids, soft diet, normal or special diet
• Administration of IV fluids
• Medications

15. This is the most difficult
part , we have to
motivate the patient to
recover from surgical
complications.
Encourage the patient
for exercises, ambulate
the patient, gave
emotional support to
patient , explain benefits
to patient to encourage
the patient.

16. Complications in abdominal surgeries
• Pressure sore
• Drains
• Pain
• Wound care
• Wound discharge
• Abscess
• Paralytic lleus
• Bleed
• Anastomotic leak
• edema

17. Respiratory complication included-
• Hypoxemia
• Hypercapnia
• Aspiration
• Pneumonia

18. Post-operative rehabilitation program
• Stage 1
Learn to contract the deep muscles which stabilize
the spine. At first this takes quite a bit of
concentration. Each individual will master this at
their own pace. There is no set time, but
perseverance is the key.
• Stage 2
Increase the endurance capacity of the deep
stabilizing muscles of the spine, by practicing to
contract them in different situations for as long as
one can. This will become easier with practice.

19. • Stage 3
Begin arm and leg movements whilst contracting the
deep stabilizing muscles of the spine.
• Stage 4
Progress to the core strengthening exercises, while
contracting the deep stabilizing muscles. There are
two main deep stabilizing muscles that supports the
lower back are:
 Multifidus muscle
 Transversus abdominis muscle.

21. Instrument’s needed for core
strengthening
• Gym ball
• Exercise mat
• Medicine ball

22. Day wise protocol
Day 1- start with isometric abdominal
exercises, knee to chest (6 reps)
o Knee rolls- 6 reps
o Bridging -6 reps
Day 2to 5- carry out daily exercises as for 1
day x8 reps, 3 times each day. Initiate gentle
cardiovascular work

23. Day 6- continue exercises as for day 2-5(10
reps)x3 times each day. Continue
cardiovascular exercises. Initiate core strength
x 2 reps of each exercises as include
 Side/hold with leg lift (10 reps)
 Trunk twist with medicine ball
 Lunges
 Ball rolls- shoulder, trunk, adductor exercises x
10 times

24.  Adductor strengthening exercises
 Hamstrings exercises x 5 reps with 4 second
hold
 Hamstring & gluteal exercises
 Trunk exercises with 6 second hold
 Back extensor exercises
 Back extensor & gluteal exercises

25. Day 7- discontinue mat exercises, progress
core strength exercises to 2 sets x 8 reps. Start
cross trainer progress. Once wound is closed
and stitches removed initiate hydrotherapy
rehabilitation- aqua jogging

26. Day 9- progress core strengthening 2 sets x 10
reps, continue stepper, cross trainer program
continue hydrotherapy progression
Day 12- progress core strength 3 set x 8 reps,
continue hydrotherapy & cross trainer
progression
Day 15- continue same as day 12 , initiate
straight line jogging at slow speed

27. From 18 day- continue same as day 15 ,
progress speed in straight line & running
• Initiate single plane power exercises- squats,
calf raises
Day 21- continue same as above added
treadmill , 10 reps of 4 sets for exercises
protocol
Day 24- straight runs, increase the reps with
patient comfort.

28. Respiratory physiotherapy
• Pulmonary physiotherapy includes deep
breathing exercises, focus on diaphragm &
transverse abdominis
• Postural drainage
• Purse lip breathing, vibrator & percussions if
secretions are present.
• Glove blowing
• Spirometery – inspiratory & expiratory (notes the
ml of boll)
• Ambulate the patient.

31. Reference: Mitra P.K textbook of physiotherapy in surgical
conditions, 5th edition, page no.40-60, chapter-3, physiotherapy in
abdominal surgeries.

32. Thank you