Post Head and Neck Cancer Surgery Exercises: Procedure and Importance

Table of Contents

• Introduction
• Movement Dysfunction After Surgery
• Benefits of Head and Neck Cancer Exercises
• Types of Head and Neck Exercises
• Neck Exercises
• Shoulder Exercises
• Swallowing Rehabilitation Exercises
• How Often Should You Perform Rehabilitation Exercises
• Bottom Note
• Frequently Asked Questions
• References
• Author Bio

Introduction

Head and neck cancer exercises are an important part of the multidisciplinary rehabilitation recommended for head and neck cancer survivors. However, many survivors fail to understand that care beyond cancer treatment is crucial for their recovery and a faster return to normal activities.

Head and neck cancer survivors 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.

The radiation beams damage cancer cells by destroying the genetic material that controls how they grow and divide.

In this article, we will try to understand the possible reasons for the movement limitations among head and neck cancer surgery patients, the different types of head and neck cancer exercises that these patients can perform for better recovery, and the benefits of performing exercises after neck surgery.

Movement Dysfunction After Surgery

The movements of the neck and shoulder become limited for various reasons. The spinal accessory nerve controls the trapezius muscle, a large muscle that assists in shoulder elevation. When this nerve is injured/resected, it can lead to limited movement of the shoulders.

Some patients may experience reduced shoulder motion just after the surgery; in others, it occurs for a few weeks post-surgery.

Patients experiencing drainage and inflammation at the surgery site also have a reduced range of motion.

That said, the degree of movement dysfunction depends on the head and neck surgery complexity.

Benefits of Head and Neck Cancer Exercises

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.

Types of Head and Neck Exercises

Several types of exercises are available to improve the range of motion after head and neck cancer surgery, and they are broadly categorized under neck exercises and shoulder exercises.

1. Neck Exercises

Performing exercises after neck surgery can positively impact the overall well-being of neck cancer survivors. The doctor may recommend performing the neck exercises 2-3 times a 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, they can stop exercising.

The following neck exercises are recommended for those who have undergone surgery for head and neck cancer:

1.1 Neck Rotation

Also referred to as head rotation exercises, neck rotation exercises are crucial to address the stiffness in this region and reduce discomfort. 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.

1.2 Neck-Side Flexions

This is one of the crucial head and neck cancer exercises. In this exercise, the patient is expected 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.

1.3 Neck Extension

During this exercise, the patient should sit straight and move their head backward. The patient shall remain in this position for 2–3 seconds and then move their head back to the normal position.

Then the patient bends their head forward so that their chin approaches the chest.

2. Shoulder Exercises

Some of the exercises to improve the motion of the shoulders are:

2.1 Shoulder Circling

In this exercise, the patient moves their shoulders in a circular motion, i.e., moving their shoulders up and backward.

2.2 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.

2.3 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.

2.4. 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.

Swallowing Rehabilitation Exercises

Swallowing exercises for head and neck cancer survivors can restore their ability to drink and eat liquids and solid foods. Some of the important swallowing rehabilitation exercises are:

Shaker Exercise

This exercise helps improve neck flexibility. During this exercise, the patient lies down on a firm surface and keeps their shoulders flat. Then, without moving the shoulders, the patient must bend their head forward to a chin-down position. The patient must maintain this position for a minute and then rest for a minute by lowering their head. This exercise should be repeated as many times as directed by the physiotherapist.

Supraglottic Exercise

Supraglottic exercise helps patients practice how to protect their airways while swallowing solid and liquid foods. For this exercise, the patient must sit or stand comfortably. Then, they should take a deep breath and hold it. While holding their breath, they should try to swallow and cough gently. One must repeat this exercise as many times as directed.

Super Supraglottic Exercise

This exercise also helps the patient protect their airways while swallowing. During this exercise, the patient should stand or sit comfortably. Next, the patient should take a deep breath and hold it while bearing down or exerting pressure downward (like they are having a bowel movement). While holding their breath, they should try to swallow and cough gently. This exercise must be repeated as many times as directed by the physiotherapist.

Masako Maneuver

The Masako maneuver strengthens the muscles of the tongue base and upper throat and thereby improves swallowing abilities in those who have undergone head and neck surgeries. For this exercise, the patient must sit or stand comfortably. Then they must stick their tongue out as much as possible and gently hold it between their front teeth. With their tongue in this position, the patient must try to swallow. The patient must repeat this exercise as many times as directed.

Mendelsohn Maneuver

This is an important rehabilitation exercise for those who have undergone head and neck surgery. This exercise helps prevent food from entering the airway while swallowing. During this exercise, the patient should sit or stand comfortably. Then they should normally swallow. During the swallowing process, the patient should notice the movement of their larynx or voice box. When the larynx is at its highest point, the patient should squeeze their throat muscles, hold that position for three counts, and then relax. This exercise should be repeated as many times as recommended by the physiotherapist.

Effortful Swallow Exercise

Effortful swallowing exercises help improve the strength of the pharynx. During this exercise, the patient must sit or stand comfortably. They must then squeeze their throat muscles and try to swallow. For this, the patient may imagine that they have a grape-sized food piece stuck in their throat and are trying to swallow it. This exercise should be repeated as many times as directed by the physiotherapist.

How Often Should You Perform Rehabilitation Exercises

The frequency at which you can perform rehabilitation exercises depends on the type of exercise, the extent of the treatment undergone, the specific needs of the patient, and the patient’s overall health status.

All the head and neck cancer exercises recommended above are low- and mid-intensity exercises, and these can be performed several times a week.

Low-Intensity Exercises: Low-intensity exercises promote healing, reduce pain and swelling, manage fatigue, and maintain the basic range of motion of body parts. These exercises can be performed 3–5 times a day.

Mid-Intensity Exercises: Mid-intensity exercises help improve muscle strength and physical function, enhance sleep quality, relieve pain, and improve sleep quality. Mid-intensity exercises can be performed 3–5 times a week.

To benefit the fullest extent of rehabilitation exercises, patients must opt for individualized exercise plans developed by experienced physiotherapists.

Bottom Note

Many patients experience shoulder or scapular dysfunction after undergoing surgery for neck and head cancer due to inflammation or injury to the spinal accessory nerve and various other reasons. It is important to incorporate head and neck cancer exercises as a part of the rehabilitation strategy to manage pain, promote early recovery, reduce dependency, and improve the overall quality of life.

Frequently Asked Questions

For how long should one perform head and neck cancer exercises?

The duration for which each exercise should be performed depends on multiple factors:

The Stage of Recovery: In the initial stages of recovery, one may consider gentle or low-intensity exercises, and they can be performed 3-5 times a day.

As the strength and tolerance of the patient improve, the duration and frequency of exercise sessions can be increased.

The Type and Intensity of the Exercise: Depending on the intensity of the exercise, the duration of each session may vary.

Low-intensity or gentle exercises may take relatively less time than mid- and high-intensity exercises.

The Patient’s Overall Health Condition: The overall condition of the patient may also influence the duration of the head and neck exercises.

Although consistency is the key, there are days when patients recovering from cancer feel weaker than usual and need more rest. On those days, the duration of exercise can be adjusted as per the patient’s preferences.

That said, an experienced physiotherapist would be the right person to decide the appropriate exercise duration for patients recovering from head and neck cancers.

What are the guidelines for physical activity for head and neck cancer survivors?

There are a few things to keep in mind when considering exercises after head and neck cancer treatment:

• Head and neck survivors should get an individualized exercise plan developed that is specifically designed for their condition.
• It is important to start slowly and gradually scale up the intensity and duration of the exercise.
• One must avoid pushing their body through pain. Resting should also be a priority while performing head and neck cancer exercises.
• It is important to follow the advice and instructions provided by the physiotherapist; this is crucial for patients to benefit from the exercises to the fullest.
• Lastly, one must get clearance from their treating doctor to perform head and neck exercises after their treatment before they begin.

Why is physical activity important for head and neck cancer survivors?

Physical exercise or activity after head and neck cancer treatment helps survivors in numerous ways.

Improved Healing: Regular head and neck exercises can positively impact wound healing and promote faster healing.

Enhanced Physical Function: By improving energy levels, strengthening the muscles and bones, increasing endurance, and boosting brain functions, exercise can improve physical function in head and neck cancer survivors.

Increased Range of Motion: Regular exercising after head and neck cancer treatment can increase the range of motion in survivors and thereby promote more strength, flexibility, and increased joint function.

Improved Sleep Quality: Head and neck exercises can help improve sleep quality by improving melatonin levels, releasing endorphins and adenosine, and reducing cortisol levels.

Boosted Mental Well-being: Exercises can help in the management of stress, anxiety, and depression, and improve the mood, self-confidence, and self-esteem of head and neck cancer survivors.

Reduced Fatigue: Head and neck exercises can increase energy levels, improve muscle strength, and thereby reduce fatigue.

Decreased Pain and Discomfort: Exercises improve blood flow, reduce inflammation, and thereby help in reducing pain and discomfort.

How long does it take to recover from head and neck cancer?

The recovery time after head and neck cancer treatment can vary from one patient to another. Various factors, such as the type of head and neck cancer, its stage, the patient’s age, the overall health condition of the patient, the treatments recommended, and the patient’s response to the treatment, impact the recovery time.

Post-treatment, head and neck cancer survivors may consider multidisciplinary rehabilitation, which will involve exercises, nutritional counseling, psycho-oncology counseling, etc., for a more effective recovery.

References

Swallowing Exercises for Patients with Head and Neck Cancer

Exercise-based rehabilitation on functionality and quality of life in head and neck cancer

survivors. A systematic review and meta-analysis

Prehabilitation in head and neck cancer patients: a literature review

Rehabilitation Management of Head and Neck Cancers

A Comprehensive Review of Head and Neck Cancer Rehabilitation: Physical Therapy Perspectives

Dr. Rushil Tanna is a highly skilled physiotherapist with expertise in managing pre- and post-operative cancer patients. His primary area of interest is oncology rehabilitation. He works closely with medical and surgical oncologists to provide optimal care and rehabilitation to patients. He has worked with over 200 post-operative head and neck cancer patients, helping them to recover and regain function following their surgeries.

To book an appointment with Dr. Rushil, click here.