Physiotherapy in Thoracic Surgery: Enhancing Recovery Under the Care of Dr. Harsh Vardhan Puri

Thoracic surgery—whether for lung resection, esophageal surgery, mediastinal tumor excision, or pleural interventions—imposes significant stresses on the respiratory system and the musculoskeletal framework of the chest. To optimize outcomes, reduce complications, and accelerate rehabilitation, physiotherapy has become a cornerstone of perioperative care. Under the expert care of Dr. Harsh Vardhan Puri, physiotherapy protocols are tailored to each patient’s needs, combining evidence-based respiratory techniques, early mobilization strategies, and functional rehabilitation.

Why Physiotherapy Matters in Thoracic Surgery

Thoracic surgery entails incisions through musculature, lung resections, chest tube drainage, pain, and impaired respiratory mechanics. Without intervention, patients are at higher risk of:

• Postoperative pulmonary complications (PPCs), such as atelectasis, pneumonia, and secretion retention
• Reduced lung volumes and impaired ventilation
• Prolonged hospital stay and slower return to baseline function
• Shoulder stiffness, postural issues, and deconditioning

Studies show early postoperative physiotherapy can reduce PPCs, improve lung expansion, and shorten hospital stays. Integrated into Enhanced Recovery After Surgery (ERAS) protocols, physiotherapy is now considered a fundamental pillar for thoracic patients.

In the practice of Dr. Harsh Vardhan Puri, physiotherapy is not an afterthought but a parallel track in the care plan—starting before surgery and continuing until full functional recovery.

Preoperative Physiotherapy (Prehabilitation)

The period before surgery offers a valuable window to improve physiological reserve. Prehabilitation aims to reduce surgical risk and set the stage for smoother recovery.

Key goals of preoperative physiotherapy include:

1. Respiratory muscle training
   Patients are taught inspiratory muscle strengthening techniques, deep breathing exercises, and incentive spirometry, to prime the lungs for postoperative demand.
2. Airway clearance and secretion management
   Techniques such as active cycle breathing, huffing, and assisted coughing are introduced preoperatively in selected patients to reduce postoperative secretion burden.
3. Education and coaching
   Teaching the patient about breathing strategies, chest physiotherapy, what to expect postoperatively, and how to support the incision when coughing.
4. General conditioning / aerobic training
   Light to moderate aerobic or walking programs to boost cardiopulmonary fitness and muscle strength.
5. Smoking cessation and respiratory risk mitigation
   Smoking cessation, optimization of pulmonary infections or COPD, and nutritional optimization are often integrated.

In Dr. Puri’s approach, prehabilitation is personalized—patients with compromised lung function or comorbidities receive more intensive respiratory coaching.

Postoperative Physiotherapy: Phase-by-Phase

Once the surgical procedure is complete, physiotherapy follows a staged progression, carefully balancing safety with therapeutic intensity.

Phase 1: Immediate / Intensive Care Unit (ICU) Phase (Day 0–1)

Breathing Exercises & Lung Expansion

Even while sedated or semi-awake, passive or assisted deep breathing maneuvers, use of incentive spirometers, and recruitment of basal lung segments commence.

Supportive Coughing & Secretion Clearance

Once alert, patients are encouraged to cough, aided by wound support (e.g., rolled towel) to protect incision sites.

Early Passive Mobilization

Sitting on the edge of the bed, dangling legs, or tilt table-assisted standing may begin as soon as vital signs permit. Analgesia must be optimized to allow cooperation.

Safety Guidelines:

• All lines, drains, and catheters must be secured.

• Monitor for orthostatic hypotension.

• Ensure adequate analgesia before mobilization.

Phase 2: Early Postoperative Phase (Days 1–3+)

Progressive Ambulation

A standardized mobilization plan often begins on Day 1 (e.g., 60 m walk four times), increasing gradually (e.g., 80 m on day 2, 100 m on day 3).

Chest Physiotherapy & Breathing Techniques

Continuation of deep breathing, segmental expansion, PEP devices, and chest percussion if needed.

Range of Motion (ROM) & Shoulder Exercises

Gentle shoulder and trunk mobilization to prevent stiffness. Exercises start early (shoulder shrugs, arm elevation) per pain tolerance.

Functional Tasks

Sit-to-stand, transfers, bed mobility, and stair climbing (if safe) are integrated gradually.

Phase 3: Intermediate / Ward Phase (Up to Discharge)

Incremental Walking & Aerobic Activity

Walk multiple times per day, gradually extending distance and pace.

Advanced Breathing & Airway Clearance

Include more active bronchial hygiene techniques, assisted coughs, breathing against resistance, segmental expansion.

Strength & Conditioning

Lower limb strengthening, core activation, and postural exercises are added.

Shoulder, Scapular & Trunk Mobilization

Progress to active shoulder overhead movements, trunk rotations, scapular retraction, and stretches.

Education for Discharge / Home Exercises

Patients are instructed on ongoing exercises, activity pacing, progression, and warning signs to watch for.

Phase 4: Long-Term Rehabilitation / Home Phase

Continuing Aerobic / Walking Programs

Gradual increase in duration, intensity, and frequency consistent with tolerance.

Upper Limb & Thoracic Mobility

Advanced stretching, resistance band work, thoracic extension, and scapular stabilizers.

Functional Training & Activity Integration

Return to daily activities, hobbies, work tasks, stair training, and balance work.

Monitoring & Adjustment

The physiotherapist reassesses and tailors the home program based on progress, symptoms, and imaging/lung function.

Safety, Monitoring & Contraindications

• Analgesia must be optimal before mobilization or deep breathing—pain limits effort and cooperation.
• Check all lines, drains, catheters, chest tubes to prevent dislodgement.
• Monitor vital signs and symptoms (BP, HR, oxygen saturation, dyspnea, dizziness, chest pain) during activity.
• Use assistance initially (gait belts, multiple staff) until independence is safe.
•  Avoid excessive exertion—use rating of perceived exertion < 13 (on a 6–20 Borg scale) or ~60% max HR as a ceiling in early phases.
• Be cautious with drains: keep drainage systems below chest level, maintain upright tubing during ambulation, and prevent kinks.
• Recognize signs to pause therapy: sudden shortness of breath, chest pain, excessive fatigue, dizziness, desaturation—stop, rest, reassess.

In Dr. Puri’s protocols, each session begins with a “safety check” including assessing patient readiness, checking lines, securing analgesia, and communicating clearly with nursing staff.

Outcomes, Evidence & Supporting Data

• A standardized mobilization plan for thoracic surgery patients (progressing from 60 m to 80 m to 100 m) has proven to be safe and effective, helping promote faster and smoother recovery.

• Early chest physiotherapy, including deep breathing and chest expansion exercises, effectively lowers the risk of postoperative pulmonary complications (PPCs) following lung resection.

• Including breathing, cough, and upper limb exercises after thoracotomy reduced postoperative pulmonary complications (6.6% vs 20.6%) and shortened hospital stay compared to the control group.

• The narrative review “What Physiotherapists Need to Know” emphasizes that while evidence continues to evolve, the key principles—early mobilization, respiratory care, and individualized planning—remain widely accepted and recommended in practice.

• Recent surveys show that physiotherapists routinely deliver preoperative education and postoperative care in thoracic surgery settings.

Why Choose Dr. Harsh Vardhan Puri’s Approach?

Dr. Harsh Vardhan Puri integrates the latest evidence, patient-centered care, and interprofessional coordination in thoracic surgery rehabilitation. His approach includes:

• Early and seamless physiotherapy referral starting at preadmission
• Personalized physiotherapy protocols based on patient risk, lung function, comorbidities
• Emphasis on safety, pain-aware mobilization, and continuous monitoring
• Coordination with surgical, anesthesia, and nursing teams
• Follow-up and adjustment of rehabilitation in the outpatient/home phase

With such integration, patients are more likely to benefit from fewer respiratory complications, faster functional recovery, and smoother return to daily life.

Conclusion

Physiotherapy in thoracic surgery is no longer optional—it is essential for optimal recovery. From the initial prehabilitation steps to intensive breathing and mobility techniques, then onward to long-term strength and functional training, a structured physiotherapy plan can transform patient outcomes.

Under the skilled guidance of Dr. Harsh Vardhan Puri, patients receive evidence-based, personalized physiotherapy care aimed at minimizing complications, accelerating recovery, and restoring quality of life. Whether you or a loved one is contemplating thoracic surgery or in the recovery phase, investing in purposeful physiotherapy is a key decision that pays dividends.