Advice and exercises following Neck Dissection/ Major Head and Neck surgery

Advice and exercises following Neck Dissection/ Major Head and Neck surgery

This leaflet should be used as a guide to patients who have already been instructed by a physiotherapist

What is a neck dissection?

A neck dissection is a surgical procedure used to remove lymph nodes, in some other cases, tissue in your neck that may contain cancer cells. It is typically an incision made on your neck which extends from your ear to your lower neck or chin and allows your surgeon access into your neck and mouth. This is a common procedure performed for patients having treatment for head and neck cancer. It can be one side of your neck (unilateral) or both (bilateral). This is usually done as part of the cancer treatment and could be combined with other procedures.

What are the risks of a neck dissection?

There would be risk of a neck dissection according to the area being operated on, the location of the cancer and the extent of the disease. The details of the risks will be discussed with you by the surgical team. One common risk the operation is stiffness and weakness of the shoulder. You may also experience altered changes in sensation across the top of your shoulder, neck and face. This is due to the injury or irritation of the nerve that supplies the muscles in the area (accessory nerve).

Why should I exercise?

Following your neck dissection surgery it is important that you start to exercise your neck and shoulders in order to reduce stiffness and to regain as much movement as possible allowing you to get back to being able to complete your everyday task.

When can I start my exercises?

Most patients following a neck dissection will have up to 2 drains in place for 1-2 days to help drain off any excess fluid following surgery. These drains may limit your movement slightly, however it is still very important to gently complete your exercises from day one of your operation to prevent neck and shoulder stiffness in the long term.

What exercises should I be doing?

Following a neck dissection it is important to keep your neck and shoulders moving. As physiotherapists, we encourage you to start with a few simple exercises in sitting or standing:

1. Posture :

In sitting: ensure that you are not slumped, make sure that the small of your back is well supported and you are sat up straight.

In lying: make sure that you do not have too many pillows pushing your head forward. Pull a soft pillow around your neck to support the small of your neck.

2.      Shoulder    Shrugging/ / Rolls :    shrug    your shoulders together or roll your shoulders in both directions. Drawing your shoulder blades together and down towards your lower back.

3. Neck movements: while sitting

i) turn your head to one side until you feel a stretch. Hold for approximately 2 seconds and then repeat to the other side. Ensure your shoulders are not moving with you as you do the movement.

ii) Moving your head, look up as far as you are able until you feel a stretch, hold for 2 seconds then look down as far as you are able until you feel a stretch and hold for a further 2 seconds

iii) Moving your head, relax your shoulders and try and reach your ear to your shoulder until you are able to feel a stretch, hold for 2 seconds then tilt your head to the opposite side and hold for 2 seconds

iv) While sat comfortably, relax your shoulders, bring your chin forward and hold for 3 seconds and then tuck your chin into your neck then hold for another 3 seconds. Tip! Use your finger to help guide your neck and lightly push your chin back.

4. Shoulder exercises  

Forward arm lifts (shoulder flexion) :

Relax your arms to your side then Lift your arm up one at a time as far as you can, letting the thumb lead the way forward.

Sideways arm lifts (shoulder abduction): lift your arm up sideways as far as you can with the thumb leading the way.

5.  Shoulder Rotation While sat or stood comfortably, relax your shoulders and bring your elbow into your side and make a fist pointing forward with your thumb up. Now close your fist then bring it into your stomach keeping your elbow close to your side and then rotate away from your stomach

6.  Shoulder strengthening:

1. Shoulder flexion

While stood in front of a wall, tuck your elbows to your side and make a fist. Keeping your elbows tucked in, push your fist towards into wall horizontally and hold for 5 seconds then relax.

ii) Shoulder rotation

While stood to the side of the wall, tuck your elbows to your side and make a fist. Make yourself balanced, keeping your elbows tucked in and push outwards against the wall and hold for 5 seconds then relax.

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 three to four times a day for between five and ten minutes is recommended. Your physiotherapist will be able to advise you on exactly what you should be doing. However, as a general rule repeat each exercise 5 – 10 times in each.

How will I know if I have done too much?

None of these exercises should produce pain, however you may feel a little discomfort. If you over exercise you may feel sore and stiff straight after or the following day. It is best to avoid this if possible make sure you exercise gently and slowly.

What can I not do?

Following a neck dissection we ask you to avoid lifting heavy objects for a few weeks after your operation. You should also take care if you are to return to driving as you will be expected to have good movement of your neck and shoulder to keep your car insurance valid. The physiotherapist will give you advice post- operatively, based on the extent of the neck operation you have had, as to the likelihood of residual mobility problems affecting your ability to lift objects and driving.

Contact details

If you have any specific concerns that you feel have not been answered and need explaining, please contact the following.    

• Head and Neck Ward 01905 760545
• Head and Neck Physiotherapist 01905 763333 Ext 39119
•  

Other information

The following internet websites contain information that you may find useful.

• www.worcsacute.nhs.uk
  Worcestershire Acute Hospitals NHS Trust

• www.patient.co.uk

Information fact sheets on health and disease

• www.rcoa.ac.uk

Information leaflets by the Royal College of Anaesthetists about ‘Having an anaesthetic’

• www.nhsdirect.nhs.uk

On-line health encyclopaedia

Feedback for Inpatient Therapies

Please scan the QR code or follow the link below: 

If you have been seen by a Physiotherapist or Occupational Therapist during your admission, please leave us some feedback by scanning the QR code or following the link and filling in the short survey.

https://apps.worcsacute.nhs.uk/PublicSurvey/AHPFeedback

Ward admitted to:__________________________________

Therapy team who treated you: _______________________

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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