This document discusses the principles of physiotherapy in surgery. It begins by defining surgery and listing common reasons for surgery such as removing diseased tissue or producing an artificial opening. It then outlines key principles of physiotherapy in surgery which include preventing chest and circulatory complications, maintaining muscle power and joint range of motion, and improving bed mobility. The document goes on to describe pre-operative and post-operative physiotherapy assessments and treatments.

1. Principles of physiotherapy in
surgery
BY DR/ KHALED ALSAYANI

2.  Surgery: is a medical specialty that uses
operative manual and instrumental techniques on
a person to investigate or treat a pathological
condition.

3. Reasons for surgery
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To remove diseased tissue (ectomy)
For repair (rhaphy/ plasty)
To produce an artificial
opening(otomy/ostomy)
For inspection(scopy)

4. Principles of physiotherapy in
surgery
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To prevent chest complication
To prevent circulatory complication
To maintain muscle power &joint ROM
To prevent pressure sores
To maintain good posture
To improve &enhance bed mobility
To gain cooperation &confidence

5. incisions
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Vertical
Oblique
transverse

8. Common operations
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Gastrectomy
Cholecystectomy
Appendecectomy
Colectomy
Colostomy
Ileostomy
Herniotmy/ Herniorrhaphy/plasty
Nephrectomy
Prostatectomy
Cystectomy
Mastectomy
Hysterectomy

9. Pre operative assessment
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Read the notes
Assess the respiratory function
Check for circulatory problems
Detailed history of the patient

10. Clinical notes reading
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Co morbid conditions
Cause for surgery
Any other note by the
surgeon/physician

11. Respiratory assessment
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Symmetry
Rate
Depth
Chest expansion
Dysnoea
Accessory muscle involvement
measurement

12. Circulatory assessment
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Homan’s test
oedema

13. History taking
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Medical history
Subjective history

14. Pre operative training

15. Breathing exercises
□ Diaphragmatic and local expansion
exercises

16. coug
h
□ Teach real cough

17. Arm exercises
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Short lever exs
Long lever exs

18. Leg exercises
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Ankle& toe movements
Static Q’ceps& glutei

19. Posture correction
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Advices
Ergonomic advantages

20. Post operative assessment

21. Surgery notes reading
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Type of incision
Type of anesthesia
Duration of surgery
Immediate complications/unwanted
events/management

22. Understanding the attachments
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Iv lines
Nasogastric tube
Catheter
PCA
drains

23. Orientation assessment
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Communication ability
Alertness
Perceptual ability to follow
instructions

24. Objective assessment
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respiratory
Circulatory
ROM/MUSCLE POWER
Mobility/functional
Etc

25. Respiratory assessment
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Painful breathing
Difficulty in coughing
Impaired respiration
Accumulation of secretions
Palpation
auscultation

26. Circulatory assessment
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Homan’s sign
oedema

27. Posture& mobility
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Kypho scoliosis
Bed mobility

28. Pain assessment
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VAS
MPQ

29. Post operative
treatment

30. To prevent chest complication
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Breathing exercise
Coughing/cough support
Inhalation,humidification&PD
Breath control exs with arm movts

32. To prevent circulatory complication
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□ Trendelenberg tilt(15 degree bed end
elevation)
Leg exs
Early ambulation
Bed mobility
Trunk &abs exs
Prevention by medical means

33. Prevention of bad posture
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Firm back support
Chair with arms
Over correction

34. LEARNING POINTS
* The incidence of pulmonary complications is higher after
upper abdominal or chest surgery than operations on
other parts of the body due to a severe and prolonged
alteration in pulmonary mechanics.
The sitting position increases FRC significantly and
early mobilization is to be actively encouraged.
Sufficiently effective analgesia must be maintained
so that these activities are not impeded by pain.
•

35. * Physical therapy has a valuable role to
play in the prevention of respiratory
complications as well as their
treatment, although the relative
values and indications for different
therapies have still to be conclusively
determined.