Postural Drainage

Contraindications and Considerations

The objectives of this chapter are to provide the following:

1 A review of the relative and absolute contraindications for postural drainage positioning.

2 A review of the situations and conditions in which traditional postural drainage positions and/or chest wall manipulation may require modification.

3 A discussion of clinical considerations for postural drainage that maximize treatment effectiveness and patient comfort.

Preferred Practice Patterns

The most relevant practice patterns for the diagnoses discussed in this chapter, based on the American Physical Therapy Association’s Guide to Physical Therapist Practice, second edition, are as follows:

• Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated with Airway Clearance Dysfunction: 6C

Please refer to Appendix A for a complete list of the preferred practice patterns, as individual patient conditions are highly variable and other practice patterns may be applicable.

Postural drainage is the positioning of a patient with an involved lung segment such that gravity has a maximal effect of facilitating the drainage of bronchopulmonary secretions from the tracheobronchial tree.¹ The validity of postural drainage (with or without breathing exercises and chest wall manipulation) has been scrutinized in the literature over the past years, and the evidence is unequivocal. However, the use of postural drainage as an adjunct to other airway clearance techniques (ACTs) such as percussion, active cycle of breathing, autogenic drainage, oscillatory positive expiratory pressure (PEP), high-frequency chest compression, and exercise is recommended for patients with cystic fibrosis.²