Patient Education Guide: Recovery and Rehabilitation After Neck Dissection

Here is a comprehensive patient education guide regarding exercises following neck dissection, based on the provided clinical sources.

Introduction

Recovering from neck dissection surgery involves more than just healing the skin incision. During surgery, the spinal accessory nerve—which controls the shoulder muscles—may be stretched, bruised, or removed. This can cause the trapezius muscle to weaken, leading to stiffness, aching, and difficulty lifting your arm above your head.

The following protocol is designed to prevent stiffness, reduce pain, and restore your range of movement.

General Safety Guidelines

When to Start:
- Days 0–4: Rest. Do not perform exercises yet.
- Days 5–9: Start exercises slowly and in a controlled manner.
- Day 10 onwards: You should begin to regain your normal range of movement.
- Note: Your physiotherapist will guide you on exactly when to start, usually once neck drains are removed.
Pain vs. Stretching: Exercises should not be painful. A feeling of “stretching” or tightness is normal, but if you experience sharp pain, stop immediately and consult your team.
Lifting Restrictions: Do not lift anything heavier than 1kg (approx. 2.2 lbs) or 3 lbs (e.g., a steam iron) for 6 months after surgery unless advised otherwise. Avoid heavy shoulder bags on the operated side.
Frequency: Exercises are most effective when done “little and often.” Aim for 5 repetitions of each exercise, 3 to 5 times per day.

Phase 1: Posture and Positioning

Good posture prevents chest tightness and muscle strain.

The “String” Technique: Imagine a piece of string attached to the top of your head is pulling you gently toward the ceiling. Keep your head in line with your neck and shoulders, and keep your shoulders back and relaxed.

Sleeping Position: Lie on your back as much as possible. If you must lie on your side, lie on the unoperated side with your operated arm resting on a pillow in front of you. Do not lie on the operated side unless cleared by your surgeon.

Phase 2: Neck Exercises

Perform these slowly. Hold each position for 3 to 5 seconds.

1. Neck Flexion (Looking Down)

Instruction: Sit comfortably. Tilt your head down, tucking your chin toward your chest.
Variation: Look down toward your armpit on the side opposite your surgery for a gentle stretch.

2. Neck Extension (Looking Up)

Instruction: Tilt your head back, pointing your chin toward the ceiling. Keep your lips closed.
Support: You may support the back of your head with your hands for stability.

3. Neck Rotation (Turning Head)

Instruction: Turn your head to the side as if trying to look over your shoulder. Repeat on both sides.

4. Side Flexion (Ear to Shoulder)

Instruction: Tilt your head to the side as if trying to touch your ear to your shoulder. Keep your shoulders relaxed; do not shrug them up to meet your ear.

Phase 3: Shoulder Rehabilitation

The spinal accessory nerve affects shoulder function. These exercises are critical for regaining overhead reach.

5. Shoulder Shrugs (Elevation)

Instruction: Lift your shoulders up toward your ears as far as you can. Hold for 5 seconds, then relax them down completely.

6. Shoulder Blade Squeeze (Retraction)

Instruction: Keep your elbows close to your body and bent at 90 degrees. Squeeze your shoulder blades together behind your back. Do not lift your shoulders up.

7. Forward Arm Lift (Flexion)

Instruction: Start with your arm by your side. Lift your arm out in front of you as high as you can, aiming to get it above your head. This can be done standing or lying down.
Variation: If lying down, use your unoperated hand to support the operated arm as you lift it toward your head.

8. Wall Climbs (Pinky Slides)

Forward: Stand facing a wall. Place the side of your hand (pinky finger) against the wall. Slide your hand up the wall until you feel a stretch.
Sideways: Stand with your operated side toward the wall. Slide your hand up the wall sideways to stretch the shoulder.

Phase 4: Strengthening and Advanced Stretches

9. Chin Tuck (Deep Neck Strengthening)

Instruction: Pull your chin straight back as if trying to make a “double chin.” Do not tip your head forward. Hold for 5 seconds.

10. Doorway Chest Stretch

Instruction: Stand in a doorway with your forearms resting on the doorframe at shoulder level. Gently step forward until you feel a stretch across your chest.

11. Jaw Lowering

Instruction: Place the tip of your tongue behind your top teeth. Slowly open your mouth while keeping the tongue in place. Use a mirror to ensure your jaw opens evenly.

Scar Massage

Once your wound is fully healed (no open areas, redness, or scabs), scar tissue may feel tight.

Technique: Use a non-perfumed cream. Massage the scar using circular, up-and-down, and sideways motions with firm pressure.
Duration: 10 minutes, 2 to 3 times per day.