Physiotherapy after surgery,
without long bed rest

No. For most operations, moving early, as far as pain and the wound allow, is the key to preventing post-operative pneumonia, blood clots and deconditioning. This is the foundation of the international ERAS (enhanced recovery after surgery) programme. Long bed rest speeds up muscle loss: in healthy adults, immobilisation for just 5 days already costs about a tenth of leg muscle strength (Wall 2014). Keeping still to recuperate is a common misunderstanding. The right approach is to mobilise early, step by step, under professional guidance.

On its own, the evidence is weak. A Cochrane systematic review found that the evidence for using incentive spirometry alone to prevent pulmonary complications after upper abdominal surgery is insufficient and does not support routine use on its own (do Nascimento Junior 2014). What works is a combination of deep breathing exercises, early mobilisation and effective coughing. Prevention is more powerful still: seeing a physiotherapist once before major abdominal surgery to learn breathing exercises can halve post-operative lung complications (Boden 2018).

This is a very common fear. But not moving at all because of pain makes joints stick and muscles waste, and raises the risk of pneumonia and blood clots. There is in fact a safe range of movement during the wound period, for example deep breathing, sitting up at the bedside and short walks, graded by the therapist according to the operation site and the wound. The ERAS programme encourages sitting up and short walks as early as possible after surgery (often on the day of surgery or the next day) with guidance.

It helps, but may not be enough. Preventing post-operative blood clots (deep vein thrombosis) takes several measures. Drugs and mechanical prevention are prescribed by the surgeon, and the role of physiotherapy is to promote real mobilisation. Moving the legs passively in bed can reduce venous stasis, but getting out of bed and walking with weight on the legs is more effective for returning blood from the legs. The point is therefore more than being active. It is to get out of bed and walk as early as is safe.

Old age or frailty is indeed a stronger predictor of post-operative complications, and reflects the risk better than chronological age (Lin 2016). But frailty is not something that cannot be improved, and prehabilitation before surgery is aimed at exactly this. A study of high-risk abdominal surgery showed that personalised exercise before surgery reduced post-operative complications by about half in relative terms (Barberan-Garcia 2018). Rather than being put off by age, it is better to be assessed early and improve physical condition before surgery. Whether to operate is decided by the doctor, but preparation before surgery and rehabilitation afterwards can improve the outcome in a real way.

Physiotherapy costs HK$1,000 for 1 hour and HK$1,300 for 1.5 hours, with no minimum spend, and a single session can be booked. Hospital stays have become shorter, so going home from hospital often leaves a gap in rehabilitation, and a home visit fills that gap. The therapist guides breathing exercises, safe getting out of bed and the progression of walking at home, assesses the home for fall risks, and teaches carers on the spot how to support the patient correctly and how to move while protecting the wound. Transport is included in the main areas of Hong Kong Island, Kowloon and the New Territories, and remote areas may carry a surcharge of $100–200. See the pricing page for details.