Postural Drainage: How It Works
When your lung airways fill with sticky, thick mucus—either due to an infection or a chronic condition like cystic fibrosis—it becomes difficult to breathe. Postural drainage is a way to help get rid of the mucus, by positioning your body so that gravity can help the mucus flow out. Sometimes, postural drainage is accompanied by hands-on, therapeutic techniques to help break up the mucus, such as lightly tapping or vibrating the skin over your lungs.
Your health provider can determine if postural drainage is appropriate for you and provide recommendations about which specific positions and techniques may be most beneficial. Depending on your condition, you may be able to practice postural drainage at home, either on your own or with the help of a caregiver. Here are general guidelines about how postural drainage works.
It’s important to get rid of mucus in your lungs to help you breathe more easily, as well as to treat and prevent infection. The basic idea behind postural drainage is to change your body position so that your chest is lower than your abdomen, helping force mucus from your lungs into your airway, where you can cough it up.
Different positions are needed to drain different parts of your lungs. For example:
- To drain mucus from the front of your lungs, you would lie on your back, with your knees bent and hips raised (put a couple of pillows, rolled towels, or foam wedges beneath them).
- To drain the sides of your lungs, you would lie on your side, with two or three pillows under your hips—again, to ensure that your chest is lower than your hips.
- To drain the back of your lungs, you would lie on your stomach, knees bent, with several pillows under your hips.
Different variations on these positions exist, but all will keep your chest lower than your belly, so that gravity can help force the fluid forward.
During these positions, you will do diaphragmatic breathing, also known as belly breathing. This means, as you breathe in, you push your belly out. When you exhale, you pull your belly in.
Expect to spend at least five minutes in each position. If you need to drain mucus from both sides of your lungs, you will need to spend five minutes lying on one side of your body before switching to the other side for another five minutes (or longer, if your healthcare provider recommends it).
If you need to cough during postural drainage, you should leave your position to do what’s called controlled coughing—a technique to help expel mucus effectively. To perform controlled coughing:
- Sit on the edge of a chair, with both feet on the floor, leaning forward slightly.
- Relax and breathe in slowly and gently through your nose, while folding your arms over your belly.
- Exhale, while still leaning forward, and with your arms pushing against your belly. Cough 2 to 3 times while exhaling, using short, sharp coughs, while continuing to push on your belly with your arms.
Controlled coughing may bring mucus through your airway during the first cough, and then up and out during subsequent coughs. You can rest and repeat if you still feel the need to cough. Otherwise, once finished, you can resume your postural drainage position.
Some lung infections, such as pneumonia, may be localized to a specific area of your lungs, so you may only need one position to reach the trapped fluid. Other conditions, such as COPD (chronic obstructive pulmonary disease) or cystic fibrosis, may result in more widespread mucus. Postural drainage for COPD or other chronic illnesses will involve cycling through various positions to clear your lungs.
You can perform postural drainage while lying on the floor, on your bed, or on a special drainage table that can slant at varying angles. Usually a respiratory therapist, nurse or doctor will show you the best position or positions you need to take, depending on your condition.
- Use postural drainage when your stomach is relatively empty, such as before a meal or 90 minutes to 2 hours after a meal.
- Use your inhaler about 30 minutes before starting postural drainage.
- Wear loose, comfortable clothes.
- Keep a bowl or towel with you to collect the mucus you cough up.
Your doctor may prescribe postural drainage with chest therapy techniques to help break up the mucus. One technique is percussion, which involves rhythmically tapping your chest, using a cupped hand. Another method is vibration. This is similar to percussion, except the person doing this uses a flat hand to gently shake the ribs. You may be able to do this to yourself, or you may need a family member or other caregiver to do this for you. Devices exist that can create percussion or vibration in place of hands, if needed.
Generally, you perform percussion or vibration about 5 to 7 minutes in each area of the chest, with each treatment session lasting 20 to 40 minutes. After percussion or vibration, you take a deep breath and cough. This should bring up mucus, which you can then spit out.
Note that percussion should not be painful, since cupping the hand helps blunt the force. You should hear a hollow, popping sound—never slaps. Also, avoid clapping over certain areas, such as the spine, breastbone, stomach, lower ribs or back, to prevent injury.
If you notice certain symptoms during postural drainage therapy, call your doctor:
- Mucus increases
- Mucus is yellow, green, brown, bloody or smelly
- Fever of 100.4 or higher
- Persistent tightness in your chest
- Sudden, sharp pain in your chest area
- Fast or irregular heartbeat
If you experience more severe symptoms, such as loss of consciousness, wheezing, or severe pain, seek emergency help.
Postural drainage, with or without percussion and vibration, is not for everybody. Contraindications include having pain during the positions, coughing up blood, having fractured ribs or vertebrae, being on blood thinners, or having osteoporosis. Check with your doctor before trying this therapy.