This document provides information on postural drainage for physiotherapy. It describes postural drainage as positioning patients to allow gravity to assist in draining secretions from the lungs. It outlines specific positions to drain different lung segments and areas. Contraindications for postural drainage include conditions that could be exacerbated by changes in positioning like head injuries, hypertension, or cardiac issues. The document also covers how to perform postural drainage at home using pillows or other supports to position the body at angles.

1. POSTURAL
DRAINAGE
DR. T.SUNIL KUMAR
ASSISTANT PROFESSOR
DEPARTMENT OF PHYSIOTHERAPY

2. INTRODUCTION
• POSTURAL DRAINAGE CONSISTS OF POSITIONING THE
PATIENT TO ALLOW GRAVITY TO ASSIST THE DRAINAGE OF
SECRETIONS FROM SPECIFIC AREAS OF THE LUNGS.
• THE LENGTH OF TIME SPENT IN EACH POSITION, AND THE
TOTAL TREATMENT TIME WILL DEPEND ON THE QUANTITY
OF SECRETIONS IN EACH AREA AND THE NUMBER OF
AREAS THAT HAVE TO BE DRAINED.
• IT MAY BE NECESSARY TO SPEND AN AVERAGE OF 15 TO
20 MINUTES IN EACH POSITION TO ALLOW ADEQUATE
DRAINAGE AND THIS MAY MEAN THAT DIFFERENT AREAS
WILL REQUIRE DRAINING AT ALTERNATE TREATMENTS.

3. • THE WORST AREAS SHOULD BE DRAINED FIRST. A
RECENT RADIOGRAPH, OR BRONCHOGRAM IF AVAILABLE,
IS A USEFUL ADJUNCT IN ISOLATING THE AFFECTED
AREAS.
• POSTURAL DRAINAGE SHOULD NEVER BE CARRIED OUT
IMMEDIATELY BEFORE OR AFTER A MEAL, FOR THE
PATIENT WILL FEEL EITHER TOO TIRED TO ENJOY HIS
MEAL, OR NAUSEATED AND PERHAPS VOMIT.
• POSTURAL DRAINAGE CAN ONLY BE CARRIED OUT
EFFECTIVELY IF THE PATIENT TAKES AN ACTIVE PART IN
HIS TREATMENT.

4. • THE TREATMENT BECOMES INEFFECTIVE IF THE PATIENT
JUST LIES IN THE APPROPRIATE DRAINAGE POSITION.
• IF POSTURAL DRAINAGE IS USED IN CONJUNCTION WITH
ANOTHER TECHNIQUE, THE TIME IN EACH POSITION MAY
BE DECREASED.
• FOR EXAMPLE, IF PERCUSSION AND VIBRATION ARE
PERFORMED WHILE THE PATIENT IS IN EACH POSITION, 3
TO 5 MINUTES IS SUFFICIENT.

5. • A PATIENT WHO REQUIRES CLOSE MONITORING SHOULD
NOT BE LEFT UNATTENDED IN A TRENDELENBERG
POSITION, BUT THIS MAY BE APPROPRIATE IF PATIENTS
ARE ALERT AND ABLE TO REPOSITION THEMSELVES.
• THE PATIENT SHOULD BE ENCOURAGED TO TAKE DEEP
BREATHS AND COUGH AFTER THE TREATMENT AND IF
POSSIBLE AFTER EACH POSITION. HAVING THE PATIENT
SIT UPRIGHT OR LEAN FORWARD OPTIMIZES THIS
EFFORT.

6. EQUIPMENT REQUIRED FOR POSTURAL DRAINAGE
• FOR THE HOSPITALIZED PATIENT, THERE EXISTS A
VARIETY OF BEDS THAT EMPLOY MANUAL OR ELECTRIC
DEVICES TO POSITION THE PATIENT.
• AIR THERAPY BEDS, MOST OFTEN USED IN THE INTENSIVE
CARE UNIT (ICU), ARE VALUABLE AIDS ALLOWING EASE OF
POSITIONING, ESPECIALLY IN LARGE OR UNRESPONSIVE
PATIENTS.
• MAKE USE OF PILLOWS OR BEDROLLS TO SUPPORT BODY
PARTS OR RELIEVE PRESSURE AREAS.
• FOR HOME TREATMENT, AIDS IN POSITIONING MIGHT
INCLUDE PILLOWS, A SLANT BOARD (OR IRONING BOARD
IF THE PATIENT IS SMALL), A FOAM WEDGE, SOFA
CUSHIONS, OR A BEAN BAG CHAIR.

7. PREPARATION FOR POSTURAL DRAINAGE
• NEBULIZED BRONCHODILATORS BEFORE PD MAY
FACILITATE THE MOBILIZATION OF SPUTUM.
• AN ADEQUATE INTAKE OF FLUIDS (IF ALLOWED)
DECREASES THE VISCOSITY OF THE SECRETIONS,
ALLOWING EASIER MOBILIZATION.
• BECOME FAMILIAR WITH THE WORKINGS OF THE MODEL
OF BED THE PATIENT IS OCCUPYING, ESPECIALLY THE
MOVEMENT OF THE BED INTO THE TRENDELENBERG
POSITION.

8. • IN THE ICU, IT IS IMPERATIVE TO BE FAMILIAR WITH THE
MULTIPLE LINES, LEADS, AND TUBES ATTACHED TO THE
PATIENT. ALLOW ENOUGH SLACK FROM EACH DEVICE TO
POSITION A PATIENT FOR POSTURAL DRAINAGE.
• MAKE SURE THERE ARE ENOUGH PERSONNEL TO
POSITION THE PATIENT WITH AS LITTLE STRESS TO BOTH
PATIENT AND STAFF AS POSSIBLE.
• HAVE SUCTIONING EQUIPMENT READY TO REMOVE
SECRETIONS FROM AN ARTIFICIAL AIRWAY OR THE
PATIENT'S ORAL OR NASAL CAVITY AFTER THE
TREATMENT.

9. POSTURAL DRAINAGE POSITIONS
UPPER LOBE APICAL SEGMENTS
• THE PATIENT SHOULD SIT UPRIGHT, WITH SLIGHT
VARIATIONS ACCORDING TO THE POSITION OF THE LESION
WHICH MAY NECESSITATE LEANING SLIGHTLY BACKWARD,
FORWARD OR SIDEWAYS. THE POSITION IS USUALLY ONLY
NECESSARY FOR INFANTS OR PATIENTS BEING NURSED IN
A RECUMBENT POSITION, BUT OCCASIONALLY MAY BE
REQUIRED IF THERE IS AN ABSCESS OR STENOSIS OF A
BRONCHUS IN THE APICAL REGION.

10. UPPER LOBE POSTERIOR SEGMENT
(A) RIGHT
• THE PATIENT SHOULD LIE ON HIS LEFT SIDE AND THEN
TURN 450 ON TO HIS FACE, RESTING AGAINST A PILLOW
WITH ANOTHER SUPPORTING HIS HEAD. HE SHOULD
PLACE HIS LEFT ARM COMFORTABLY BEHIND HIS BACK
WITH HIS RIGHT ARM RESTING ON THE SUPPORTING
PILLOW; THE RIGHT KNEE SHOULD BE FLEXED.

11. (B) LEFT
• THE PATIENT SHOULD LIE ON HIS RIGHT SIDE TURNED 450
ON TO HIS FACE WITH THREE PILLOWS ARRANGED TO
RAISE THE SHOULDER 30CM (I2INCH) FROM THE BED. HE
SHOULD PLACE HIS RIGHT ARM BEHIND HIS BACK WITH
HIS LEFT ARE RESTING ON THE SUPPORTING PILLOWS;
BOTH THE KNEES SHOULD BE SLIGHTLY BENT.

12. UPPER LOBE ANTERIOR SEGMENTS
• THE PATIENT SHOULD LIE FLAT ON HIS BACK WITH HIS
ARMS RELAXED TO HIS SIDE; THE KNEES SHOULD BE
SLIGHTLY FLEXED OVER A PILLOW.

13. MIDDLE LOBE LATERAL SEGMENT & MEDIAL SEGMENT
• THE PATIENT SHOULD LIE ON HIS BACK WITH HIS BODY
QUARTER TURNED TO THE LEFT MAINTAINED BY A PILLOW
UNDER THE RIGHT SIDE FROM SHOULDER TO HIP AND
THE ARMS RELAXED BY HIS SIDE; THE FOOT OF THE BED
SHOULD BE RAISED 35CM (14INCH) FROM THE GROUND.
THE CHEST IS TILTED TO AN ANGLE OF 15°.

14. LINGULA; SUPERIOR SEGMENT: INFERIOR SEGMENT
• THE PATIENT SHOULD LIE ON HIS BACK WITH HIS BODY
QUARTER TURNED TO THE RIGHT MAINTAINED BY A
PILLOW UNDER THE LEFT SIDE FROM SHOULDER TO HIP
AND THE ARMS RELAXED BY HIS SIDE; THE FOOT OF THE
BED SHOULD BE RAISED 35CM (14INCH) FROM THE
GROUND. THE CHEST IS TILTED TO AN ANGLE OF 15°.

15. LOWER LOBE
APICAL SEGMENTS
• THE PATIENT SHOULD LIE PRONE WITH THE HEAD
TURNED TO ONE SIDE, HIS ARMS RELAXED IN A
COMFORTABLE POSITION BY THE SIDE OF THE HEAD AND
A PILLOW UNDER HIS HIPS.

16. ANTERIOR BASAL SEGMENTS
• THE PATIENT SHOULD LIE FLAT ON HIS BACK WITH THE
BUTTOCKS RESTING ON A PILLOW AND THE KNEES BENT;
THE FOOT OF THE BED SHOULD BE RAISED 46CM (I8INCH)
FROM THE GROUND. THE CHEST IS TILTED TO AN ANGLE
OF 20°.

17. POSTERIOR BASAL SEGMENTS
• THE PATIENT SHOULD LIE PRONE WITH HIS HEAD TURNED
TO ONE SIDE, HIS ARMS IN A COMFORTABLE POSITION BY
THE SIDE OF THE HEAD AND A PILLOW UNDER HIS HIPS.
THE FOOT OF THE BED SHOULD BE RAISED 46CM (I8INCH)
FROM THE GROUND. THE CHEST IS TILTED TO AN ANGLE
OF 20°.

18. MEDIAL BASAL (CARDIAC) SEGMENT
• THE PATIENT SHOULD LIE ON HIS RIGHT SIDE WITH A
PILLOW UNDER THE HIPS AND THE FOOT OF THE BED
SHOULD BE RAISED 46CM (I8INCH) FROM THE GROUND.
THE CHEST IS TILTED TO AN ANGLE OF 20°.

19. LATERAL BASAL SEGMENT
• THE PATIENT SHOULD LIE ON THE OPPOSITE SIDE WITH A
PILLOW UNDER THE HIPS AND THE FOOT OF THE BED
SHOULD BE RAISED 46CM (I8INCH) FROM THE GROUND.
THE CHEST IS TILTED TO AN ANGLE OF 20°.

20. ALTERNATIVE METHOD OF POSTURAL DRAINAGE FOR
LOWER LOBES
• IF IT IS NOT POSSIBLE TO RAISE THE FOOT OF THE BED,
AN ALTERNATIVE POSITION CAN BE USED. TWO OR THREE
PILLOWS ARE PLACED OVER A 15CM (6IN) PILE OF
NEWSPAPERS OR MAGAZINES AND THE PATIENT CAN HE
OVER THIS SO THAT THE CHEST IS TILTED DOWNWARDS.
• IT IS IMPORTANT THAT THE SHOULDERS DO NOT REST ON
THE PILLOW SUPPORTING THE PATIENT’S HEAD.
• THIS METHOD CAN BE USED FOR DRAINAGE OF THE
LOWER LOBE SEGMENTS WHEN NECESSARY AND IS
OFTEN A USEFUL METHOD OF HOME POSTURAL
DRAINAGE.

21. POSTURAL DRAINAGE AT HOME
• MANY PATIENTS WHO REQUIRE POSTURAL DRAINAGE AT
HOME ARE ABLE TO CARRY OUT THEIR TREATMENT
EFFECTIVELY AND INDEPENDENTLY BY USING THE
FORCED EXPIRATION TECHNIQUE.
• THOSE WHO ARE MORE DISABLED MAY NEED
PERCUSSION OR SHAKING FROM AN ASSISTANT IN
CONJUCTION WITH THE FORCED EXPIRATION TECHNIQUE.
• IN FACT MANY PATIENTS CAN CLEAR THEIR SECRETIONS
EFFECTIVELY WITH A CORRECT HUFFING TECHNIQUE AND
DO NOT ALWAYS NEED PERCUSSION OR SHAKING OF THE
CHEST WALL.
• ASSISTANCE MAY BE NEEDED IF THERE IS AN INCREASE
IN THEIR DAILY SPUTUM PRODUCTION, OR SECRETIONS
BECOME MORE DIFFICULT TO CLEAR.

22. • WHEN TEACHING RELATIVES OR FRIENDS PERCUSSION
AND SHAKING, IT IS IMPORTANT THAT THEY UNDERSTAND
THE NECESSITY FOR PERIODS OF RELAXED
DIAPHRAGMATIC BREATHING.
• ANY PATIENT WHO NEEDS TO CONTINUE POSTURAL
DRAINAGE AT HOME OFTEN BENEFITS FROM CARRYING
OUT HIS OWN TREATMENT FOR ONE OR TWO DAYS PRIOR
TO DISCHARGE FROM HOSPITAL.
• THE PHYSIOTHERAPIST HAVING CAREFULLY INSTRUCTED
THE PATIENT THEN ONLY SUPERVISES HIS TREATMENT.
• IN THIS WAY THE PATIENT IS MADE TO REALISE THAT HE
CAN MANAGE HIS PHYSIOTHERAPY INDEPENDENTLY AT
HOME.

23. • THE AREAS REQUIRING DRAINAGE AND THE TIME NEEDED
FOR TREATMENT MUST BE DISCUSSED INDIVIDUALLY
WITH EACH PATIENT. IN MOST CASES TREATMENT WILL BE
REQUIRED FOR AT LEAST 15 TO 20 MINUTES TWICE DAILY,
• A SUITABLE DRAINAGE POSITION WILL HAVE TO BE
DISCUSSED WITH THE PATIENT. MANY PATIENTS WILL FIND
IT DIFFICULT TO ELEVATE THE FOOT OF THE BED AT HOME.
• SOME PATIENTS HAVE A BED PERMANENTLY TIPPED IN A
SPARE ROOM, WHILE OTHERS HAVE A PORTABLE FRAME
TO LIE ON AT THE CORRECT ANGLE.
• ANOTHER METHOD IS TO PLACE A 15CM (6IN) PILE OF
NEWSPAPERS OR MAGAZINES TIED TIGHTLY TOGETHER,
IN THE CENTRE OF THE BED AND PLACE PILLOWS ON TOP.

24. • THE PATIENT CAN LIE OVER THIS IN VARIOUS POSITIONS
TO DRAIN SEVERAL AREAS OF THE LUNG. IF THESE
METHODS DO NOT PROVIDE AN EFFICIENT DRAINAGE
POSITION IT MAY BE NECESSARY TO PROVIDE THE
PATIENT WITH A HOSPITAL TIPPING BED.
• THE DRAINAGE POSITION IN WHICH THE PATIENT LIES
PRONE OVER THE SIDE OF THE BED IS UNSUITABLE. IT IS
UNCOMFORTABLE, CANNOT USUALLY BE TOLERATED FOR
VERY LONG, AND ONLY DRAINS THE POSTERIOR
SEGMENTS OF THE SLOWER LOBES.
• BABIES AND SMALL CHILDREN CAN BE GIVEN POSTURAL
DRAINAGE OVER THEIR MOTHER’S KNEE . IT IS USUALLY
ADVISABLE TO GIVE THE TREATMENT BEFORE A FEED.

26. INDICATIONS
POSTURAL DRAINAGE SHOULD ONLY BE RECOMMENDED
FOR CERTAIN PATIENTS UNDER CERTAIN CONDITIONS.
HERE ARE SOME EXAMPLES:
• TO MOBILIZE RETAINED SECRETIONS SO THAT THEY CAN
BE SUCTIONED OR EXPECTORATED
• CYSTIC FIBROSIS
• ATELECTASIS
• BRONCHIECTASIS
• CHRONIC BRONCHITIS
• FOREIGN BODY OBSTRUCTION

27. CONTRA-INDICATIONS
• HEAD INJURIES INCLUDING CEREBRAL VASCULAR
ACCIDENTS BECAUSE INTRACRANIAL PRESSURE WOULD
BE INCREASED.
• SEVERE HYPERTENSION AS VENOUS RETURN IS
INCREASED WITH TIPPING AND THIS CAN OVERLOAD THE
HEART.
• FOLLOWING OESOPHAGECTOMY THERE CAN BE UNDUE
STRESS ON THE ANASTOMOSIS AND TIPPING MAY CAUSE
REGURGITATION.
• SEVERE HAEMOPTYSIS, WHEN ALL FORMS OF
PHYSIOTHERAPY SHOULD BE DISCONTINUED UNTIL
THERE HAS BEEN DISCUSSION WITH THE DOCTORS.
• AORTIC ANEURYSMS WHICH WOULD BE PUT UNDER
TENSION IF THE PATIENT IS TIPPED.

28. • PULMONARY OEDEMA WHICH COLLECTS IN THE DEPENDENT
AREAS; POSTURAL DRAINAGE WOULD CAUSE EXTREME
DYSPNOEA AND PROBABLY WORSEN THE SITUATION.
• SURGICAL EMPHYSEMA WHICH MIGHT TRACK TOWARD THE
FACE IF THE PATIENT IS TIPPED AND MIGHT RESULT IN
DYSPNOEA.
• TENSION PNEUMOTHORAX WITHOUT AN INTERCOSTAL
DRAIN. THIS CONDITION SHOULD NOT REQUIRE
PHYSIOTHERAPY, BUT MUST NEVER BE TIPPED AS THE
CARDIAC EMBARRASSMENT MAY LEAD TO A CARDIAC
ARREST.|
• CARDIAC ARRHYTHMIAS WHICH CAN BE WORSENED BY
POSTURAL DRAINAGE; IN SOME POSITIONS THE MYOCARDIAL
OXYGEN DEMAND WOULD BE GREATER AND SO ITS
SENSITIVITY TO ABNORMAL RHYTHMS IS INCREASED

29. • HIATUS HERNIAS SHOULD NOT BE TIPPED AS THE PATIENT
MAY REGURGITATE GASTRIC JUICES.
• THE FILLING CYCLE OF PERITONEAL DIALYSIS. THE
DESCENT OF THE DIAPHRAGM IS IMPEDED DURING THIS
PHASE AND TIPPING MAY CAUSE MORE RESPIRATORY
DISTRESS.
• FACIAL OEDEMA FROM BURNS WILL BE INCREASED WITH
TIPPING.
• EYE OPERATIONS WHERE THERE MAY BE SOME
ASSOCIATED EDEMA WHICH COULD BE INCREASED WITH
TIPPING.

30. • SOMETIMES IT IS VITAL FOR A PATIENT WITH ONE OF THE
ABOVE CONTRAINDICATIONS TO HAVE POSTURAL
DRAINAGE.
• CARE MUST BE TAKEN AND THE CASE DISCUSSED WITH
THE DOCTORS. GENERALLY IT IS UNNECESSARY TO TIP
THE ELDERLY, AS THEY FIND IT VERY DISTRESSING.

31. THANK YOU