17 May, 2023
Patients experience several side effects after head & neck cancer surgery – the severity, however, varies from one patient to another. Many of these side effects limit neck and shoulder movements and significantly lower the quality of life for patients.
Therefore, it is imperative to opt for physiotherapy after the head and neck surgery. In this article, we have Dr. Rushil Tanna, a well-trained onco-physiotherapist from HCG Cancer Centre, Borivali, Mumbai, talking about the possible reasons for the movement limitations among head and neck cancer surgery patients, the different types of exercise that can help them, and their importance.
The movements of the neck and shoulder become limited for various reasons. One of the causes is an injury to the spinal accessory nerve. The trapezius muscle, a large muscle that assists in shoulder elevation, is controlled by the accessory nerve. Thus, the shoulder motions of such patients are limited. Some patients may experience reduced shoulder motion just after the surgery, while in others, it occurs a few weeks post-surgery.
Patients experiencing drainage and inflammation at the surgery site also have a reduced range of motion. The presence of surgical clips does not allow appropriate movement of the shoulders and neck. The patients may experience an improved range of motion when the inflammation is reduced and there is no drainage. However, the level of movement depends on the complexity of head and neck cancer surgery.
Several types of exercises are available to improve the range of motion after head and neck cancer surgery, and they are broadly categorised under neck exercises and shoulder exercises.
Neck exercises: Doctor may recommend performing the neck exercises 2-3 times every day. The patient is advised to perform each exercise for at least five minutes. However, if the patient is not feeling well or is tired, it is advised to stop the exercise. The following neck exercises are recommended for those who have undergone surgery for head and neck cancer:
Neck rotation: The patient should lie on their back with a pillow supporting the head. They should move their necks sideways until a maximum stretch is felt on the opposite side. Stop at this position for 2-3 seconds. Then move the neck to the other side to repeat the process. (fig.1)
Neck side flexions: In this exercise, the patient is advised to lie on their back and tilt their head on one side of the shoulder in such a way that the ears are near the shoulder. Wait 2-3 seconds in the same position, and then move the neck back to the normal position. The patient then moves the neck to the other side to repeat the exercise. The patient may also use their hands to maximally stretch the neck. (Fig. 2)
Neck extension: During this exercise, the patient should sit straight and move their head backwards. The patient shall remain in this position for 2–3 seconds and then move their head back to normal. Then the patient bends their head forward so that their chin approaches the chest. (Fig. 3)
Shoulder exercises: Some of the exercises to improve the motion of shoulders are:
Shoulder circling: In this exercise, the patient moves their shoulders in a circular motion, i.e., moving their shoulders up, backwards. (Fig. 4)
Squeezing the shoulder blade: During this exercise, the patient sits straight and extends their hands to the sides. The patient then squeezes the shoulder blades together and waits in the same position for about 5–6 seconds. The patient then relaxes and repeats the exercise. (Fig. 5)
Lifting of arms: The patient lies on their back with a pillow supporting the head. Then, they stretch their hands above the head with a straight elbow. The patient should keep their shoulders in the same position for a few seconds and then relax. (Fig6)
Shoulder rolls and shrugs: In this exercise, the patient sits upright. Then, they move their shoulders above their ears. The patient must hold the same position for 2–3 seconds, and then relax. (Fig. 7)
Several studies have reported the importance of rehabilitation after neck and head cancer surgery. It helps prevent stiffness and allows quick recovery. Apart from this, it also prevents certain complications of the surgery, such as the formation of blood clots. As cancer treatment is physically and mentally distressing, exercise helps manage the anxiety, depression, and fatigue that come along with cancer diagnosis and treatment.
Opting for exercises after head and neck cancer surgery can help patients with early mobilisation, reducing dependency on others for routine activities. Exercises improve fitness levels and enhance the overall quality of life. The other advantage of exercise post-surgery is improved wound healing. Apart from exercises, other physiotherapeutic interventions also help reduce pain and overcome restricted movement.
Many patients experience shoulder or scapular dysfunction after undergoing surgery for neck and head cancer. It may be due to inflammation or injury to the accessory nerve. It is important to incorporate exercises as a part of the rehabilitation strategy to manage pain, promote early recovery, reduce dependency, and improve the overall quality of life.