A Patient’s guide to physiotherapy exercise and advice following excision of soft tissue from the lower limb

1. Lying in bed, bend and straighten your ankles briskly. 
   
2. Lying in bed with your legs straight, push the back of your knees down against the bed, hold for five seconds then relax. 
   
3. Lying in bed, squeeze your buttocks firmly together, hold for five seconds then relax. 
   
4. Place a rolled towel under your knee. Pull your toes towards you and push your knee down onto the towel so your heel lifts off the bed and your knee straightens. 
   
5. Place a slide board or plastic sheet under your leg. Bend and straighten your knee by sliding your foot up and down the board. You can use a bandage to assist this movement. 
   
6. Slide your leg out to the side and then back. Make sure your knee and toes face up to the ceiling throughout the exercise. 
   

Unless otherwise instructed you should take full weight on your operated leg and walk as normally as possible. The nursing staff will alert the Physiotherapist if you need to be reviewed prior to discharge. It is important to continue with the exercises detailed overleaf to maintain joint movement and strength post operatively.

For larger and more complex excisions, a Physiotherapist will review you day one post operatively. Unless otherwise stated by the Surgeons, the aim will be to start walking on day one with an aid if required. You willbe informed of any restrictions which can be written in the notes pages at the end of the booklet. You will be taught an exercise programme to continue at home, and your Physiotherapist will discuss whether you need an onward referral to Outpatient Physiotherapy at RNOH or locally to you.

You will be measured for and taught how to use crutches prior to your surgery where possible, to enable to you to start walking as soon as you feel able after surgery. The nursing staff/Physiotherapist will inform you post operatively if there is any restriction to your weight bearing status.

1. Place a slide board or plastic sheet under your leg. Bend and straighten  your knee by sliding your foot up and down the board. You can use   a bandage to assist this movement. Repeat _____ times.
   
2. Slide your leg out to the side and then back. Make sure your knee and toes face up to the  ceiling throughout the exercise. Repeat _____ times.
   

1. In a standing position holding on to a solid support, squeeze your buttocks tightly together and gently bend both knees then straighten. 
   
2. In a standing position holding on to a solid support, keeping your knees together, bend your operated knee bringing your heel up behind you then lower. 
   

Always go up and down one step at a time. If you have a handrail, then use it and hold your other crutch in your spare hand.

Ascending stairs

1. Stand close to the step.
   Step up with your good leg first.
   
2. Then step up with your operated leg onto the same step. Lastly, bring up your crutches.
   

Descending stairs

1. Stand close to the step. Place your crutches down first.
   
2. Then place your operated leg down. Lastly, place your good leg down onto the same step.
   

Elevation

It is important following surgery to the lower limb to control any swelling by keeping the affected limb elevated at rest. This is particularly important following foot/ankle and knee surgery. If the swelling persists or your wound becomes hot or red, then please contact your GP, or local A&E. Alternatively if you have an allocated Clinical Nurse Specialist you can contact them for advice.

Driving

For your own safety and that of other drivers, it is important that you do not drive until you have regained the ability to adequately perform an emergency stop. You should contact your insurance company and the DVLA to ensure that you are covered following your operation.

Returning to Work

If you have a smaller excision you may feel able to return to work soon after your surgery dependent on your duties and job requirements. For larger excisions, it is advisable to discuss this with your Consultant at clinic or your GP. Your workplace Occupational Health department can help to guide a phased return to work if required.

Leisure activities

Being able to return to leisure activities is dependent on the extent of your excision. It is advisable to gradually increase your walking distance daily and complete low intensity exercise only until your wound is fully healed. After your wound is healed you should gradually increase the intensity of your exercise over time. Water based exercise or swimming is recommended to start with. If you have any specific concerns or queries regarding high intensity exercise then please speak to your Consultant or Physiotherapist while an inpatient or in clinic.

If you require Chemotherapy or Radiotherapy after your surgery for a cancerous tumour

It is important to remain as physically active as possible while undergoing and after treatment for cancer. It helps to manage side effects of treatment and lowers the risk of any other medical problems.

If you have surgery, followed by radiotherapy it is important to regain as much movement and strength as possible prior to starting radiotherapy. Try to continue your exercises and stretches during radiotherapy and keep as active as possible for 6-12 weeks after.

If you have surgery, followed by chemotherapy, try to continue your exercises either in the bed or chair during your treatment, and remain as physically active as possible.

Scars form as a result of the natural healing process of the skin. The scar may stick to underlying tissues and limit movement at that joint.

Massage can help soften the scar tissue and make it flatter, paler, cooler and smoother. Massage can be commenced once all stitches are removed and the wound is closed; normally at about 6 weeks post-surgery. Use an unperfumed moisturising cream or lotion. Massage the scar and any tight/hard areas lying close to the scar for 5-10 minutes 2-3 times per day for optimum results. It may take several months to achieve a flat and movable scar. A scar can take up to 18 months to mature fully.

1. Start with small circles along the length of the scar either with your thumb or first two fingers. Use a firm even pressure.
2. Next, work horizontally across the scar- to and fro in small movements.
3. Then, work vertically along the length of the scar.