Postural drainage is a physiotherapy technique that utilizes gravity to assist in draining lung secretions by positioning the patient effectively for 15 to 20 minutes and engaging them actively. It incorporates manual techniques like percussion, shaking, and vibration to enhance airway clearance, particularly in patients with conditions such as cystic fibrosis, chronic bronchitis, or those recovering from surgery. Contraindications include conditions like active hemorrhage, unstable injuries, and respiratory issues that could worsen with the procedure.

1. PRE S E NTE D BY
Ganesh kumar subudhi
BPT,MPT(Neurology) Asst. Prof.
Sri Jagannath college of physiotherapy, Odisha
Postural drainage

2. Postural drainage
 Postural drainage consists of positioning the patient
to allow gravity to assist the drainage of secretions
from specific areas of the lungs.
 It may be necessary to spend an average of 15 to 20
minutes in each position to allow adequate drainage.
 A recent radiograph, or bronchogram if available, is a
useful adjunct in isolating the affected areas.
G K Subudhi

3.  Postural drainage can only be carried out effectively
if the patient takes an active part in his treatment.
 It should never be carried out immediately before or
after a meal.
 It include the manual techniques such as percussion,
shaking, vibration and voluntary coughing.
G K Subudhi

4. Positions
 Positions are based on the anatomy of the lungs and the
tracheobronchial tree.
 The patient may be positioned on a:
 Postural drainage table that can be elevated at one end
eg;Tilt table
 A small child can be positioned on the physiotherapist’s
lap.
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5. Bronchial tree
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6. Bronchopulmonary segments
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7. Goals
1. To Prevent accumulation of secretions in patients who
are at risk for pulmonary complications
 This may include:
 Patients with pulmonary diseases that are associated
with increased production or viscosity of mucus, such as
chronic bronchitis and cystic fibrosis.
 Patients who are on prolonged bed rest.
G K Subudhi

8. Goals cont.
Post surgical patients who have received general
anesthesia and who may have painful incisions that
restrict deep breathing and coughing
postoperatively.
Any patient who is on a ventilator if they are stable
enough to tolerate the treatment
G K Subudhi

9. Goals cont.
2. To Remove secretions already accumulated in the
lungs of:
Patients with acute or chronic lung disease, such as
pneumonia, Atelectasis, acute lung infections, and
COPD.
Patients who are generally very weak or are elderly.
G K Subudhi

10. Indications
 Cystic fibrosis
 Bronchiectasis
 Atelectasis
 Lung abscess
 Pneumonias
 Acute lung disease
 COPD –emphysema, chronic bronchitis
 For patients with a high spinal cord lesion/ spinal cord injury,
myopathies etc.
G K Subudhi

11. Indications cont.
 After surgeries (thoracic or abdominal surgery)
 On prolonged bed rest
 Patient received general anesthesia and have painful
incision that restrict deep breathing and coughing
postoperatively
 Who is on ventilator (if stable enough to tolerate PD)
 Patient who is generally weak or old
G K Subudhi

12. Contraindications
 Increased ICP
 Unstable head or neck injury
 Active hemorrhage
 Hemoptysis
 Recent spinal injury
 Empyema
 Bronchoplueral fistula
G K Subudhi

13. Contraindications cont.
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 Flail chest
 Uncontrolled hypertension
 Rib or vertebral fractures
 Tuberculosis
 Pulmonary embolism.
 aged, confused, or anxious patients who don't
tolerate position changes

14. Preparations
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 Loosen the dress
 Sputum cup
 Pillows
 Explain the Rx and teach the patient deep breathing
and cough

15. Procedure
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 Determine segments
 Vital signs
 Position the patient
 Stand in front of pt
 Maintain position
 Apply manual techniques
 Do coughing or suctioning

16. Manual techniques
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 Percussion
 Vibration
 shaking

17. G K Subudhi
Segments

18. Upper lobe (Apical segment)
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 To drain mucus from the upper lobe apical segments, the
patient sits in a comfortable position on a bed or flat
surface and leans on a back rest.
 The PT percusses and vibrates over the muscular area
between the collar bone and very top of the shoulder
blades on both sides for 3 to 5 minutes.
 Encourage the patient to take a deep breath and cough
during percussion in order to help the airways clearance

19. Upper lobe (Apical segment)
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20. Posterior segment(Right)
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 The patient lie on his left side and then turn 45º on
to his face , resting against a pillow with an another
pillow supporting his head
 The left arm should kept comfortably behind his
back with right arm resting on a pillow, the right
knee should be flexed

21. Posterior segment(Right)
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22. Posterior segment(Left)
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 The patient lie on his right side and then turn 45º on
to his face with 3 pillows to raise the shoulder 30cm
(12 in) from the bed.
 The right arm should kept comfortably behind his
back with left arm resting on a pillow, both knee
should be slightly flexed

23. Posterior segment(Left)
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24. Upper lobe-anterior Segments
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 The patient lies flat on the bed or table with a pillow
under his head and legs and arms relaxed by his side.
 The chest PT is given to right and left sides of the
front of the chest, between the collar bone and
nipple.

25. Upper lobe-anterior Segments
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26. Middle lobe (lateral and medial segment)
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 Patient lie on his back with his body quarter turned
to the left maintain by a pillow under right side from
shoulder to hip
 Arm should relaxed by his side
 Foot of the bed should be raised 35cm (14in) from
the ground
 Chest is tilted to an angle of 15º

27. Middle lobe (lateral and medial segment)
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28. Lingula (superior and inferior segment)
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 Patient lie on his back with his body quarter turned
to the right maintain by a pillow under left side from
shoulder to hip
 Arm should relaxed by his side
 Foot of the bed should be raised 35cm (14in) from
the ground
 Chest is tilted to an angle of 15º

29. Lingula (superior and inferior segment)
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30. Lower lobes(apical segment)
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 Patient lie prone with the head turned to one side
 Arm relaxed in a comfortable position by the side
 A pillow under his hips

31. Lower lobes(apical segment)
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32. Lower lobes(anterior basal segment)
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 Patient lie flat on his back with the buttocks resting
on a pillow and knees are flexed
 The foot of the bed is elevated 46cm (18 in) from the
ground
 The chest is tilted to an angle of 20º

33. Lower lobes(anterior basal segment)
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34. Lower lobes(posterior basal segments)
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 Patient lie prone with his head turned to one side
 Arms in a comfortable position by the side
 A pillow under his hip
 The foot of the bed is elevated 46cm (18 in) from the
ground
 The chest is tilted to an angle of 20º

35. Lower lobes(posterior basal segments)
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36. Lower lobes(medial basal orcardiac segment)
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 Patient lie on his right side with a pillow under his
hips
 The foot end is raised 46cm (18in) from the ground
 The chest is tilted to an angle of 20º

37. Lower lobes(medial basal orcardiac segment)
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38. Lower lobes(lateral basal segment)
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 Patient lie on his left side with a pillow under his
hips
 The foot end is raised 46cm (18in) from the ground
 The chest is tilted to an angle of 20º

39. Lower lobes(lateral basal segment)
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40. Percussion
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 This is used to mobilize secretions by mechanically
dislodging viscous or adherent mucus from the lungs
 It is done by the cupped hand over the lung segments
being drained
 Here the PTs cupped hand alternatively strikes the
patients chest wall in a rhythmic fashion to help
loosen thick secretions

41. G K Subudhi
 The PT should try to keep his shoulder elbow and
wrist loose and mobile during the maneuver
 The procedure should not be painful
 To prevent irritation patient wear a light gown or
shirt

42. Contraindications of percussion
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 Over #
 Osteoporotic bone
 Spinal fusion
 Over tumor area
 Pulmonary embolus
 Condition in which hemorrhage could easily occur (low platelet
count ,anticoagulation therapy)
 Patient with unstable angina
 Case of chest wall pain (after any surgery CABG or trauma

43. vibration
G K Subudhi
 This is done in conjunction with percussion
 It is applied only during expiration
 It is applied by placing both hands directly over the chest
wall or one hand on top of other and gently compressing
 The therapist stiffen his arm and shoulder and apply
light pressure and rapidly vibrating the chest wall as the
patient breaths out

44. G K Subudhi
 The vibrating action is achieved by the PT isometrically
contracting the muscles of the upper extremity from
shoulder to hand
 Ask the patient to breathe in deeply and exhale slowly
and completely.
 Taking a deep breath and then exhaling slowly and
forcefully without straining will hopefully stimulate a
productive cough

45. G K Subudhi

46. Shaking
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 It is a more vigorous form of vibration which is applied
during exhalation using an intermittent bouncing
maneuver coupled with wide movements of the PTs hand
 The PTs thumb are locked together the open hands are
placed directly over the patients chest the fingers are
wrapped around the chest wall
 The PT simultaneously compress and shake the chest
wall

47. Reference
G K Subudhi
 Cash’s textbook of chest, heart & vascular disorders
for physiotherapists, 4th edition, Edited by Patricia A.
Downie

48. Thank U
G K Subudhi