Postural drainage is an airway clearance technique that uses gravity to help move mucus from the smaller peripheral airways toward the larger central airways, where it can be coughed out. This non-invasive chest physiotherapy method treats conditions causing excessive mucus production, such as cystic fibrosis and bronchiectasis. The goal is to position the body so the specific lung segment needing clearance is oriented upward, allowing gravity to pull the secretions toward the mouth. Because the human lung has multiple distinct segments, the technique involves many precise body positions that can be challenging to memorize and execute correctly.
Grouping Positions by Lung Lobe
The most effective way to memorize the positions is by understanding they are based on lung anatomy, which is divided into upper, middle, and lower lobes. The guiding principle is placing the segment being drained in the highest vertical position relative to the airway opening. This framework simplifies the process by grouping the approximately twelve positions into three categories based on the required level of body inversion.
Positions for the upper lobes require the least inversion since these segments are already at the top of the chest cavity. Draining the apical segments often involves sitting upright, while anterior segments require lying flat on the back (supine). These positions allow gravity to assist mucus downward without needing a head-down tilt.
The middle lobe and the corresponding lingula segment on the left lung require moderate inversion. This typically involves elevating the foot of the surface by about 15 degrees. The body is usually turned slightly to the side to target these central segments, ensuring gravity assists drainage from this mid-level location.
Draining the lower lobes, which include the large basal segments, requires the most significant inversion because they are the lowest parts of the lungs. These positions often involve raising the foot of the surface to an angle of 20 to 30 degrees, or even up to 45 degrees in some contexts. The patient may be positioned on their back, front (prone), or side, all while maintaining the head-down tilt to maximize the gravitational effect.
Mnemonic Strategies for Recall
Once the anatomical grouping is understood, simple memory tools can be applied to recall the specific details of each position. Visualization is a highly effective technique, imagining the lung segments as a clock face or a map of a house. For example, picturing the apical segments as the “attic” (always upright) and the basal segments as the “basement” (always inverted) provides an immediate mental link to the correct body angle.
Acronyms and rhymes simplify the complex names of the lower lobe segments, which are often the hardest to remember. A phrase can link the position to the segment, such as “S for Sleeping flat” to recall the Superior segment is drained by lying prone on a flat surface. Similarly, “Lateral Lying, Lower Lobe” connects the side-lying position to the lateral basal segment.
Another strategy involves using a “Body Memory Palace,” where each position is mentally associated with a specific part of your body or a familiar room. For the posterior basal segment, visualize a person lying prone with hips elevated, and mentally place a unique, memorable object on their lower back to lock in the required orientation. Linking the abstract information to concrete, visual anchors helps recall the correct position for each segment quickly and accurately.
Remembering the Execution Protocol
Memorizing the physical positions is only one part of the therapy; remembering the when and how long of the treatment is equally important. Postural drainage should be performed before meals or at least 90 minutes after eating to minimize the risk of vomiting or gastric reflux from inverted positions. Morning sessions clear secretions built up overnight, and evening sessions help ensure a clearer night’s sleep.
The duration for holding each position is a specific memory point, generally ranging from five to fifteen minutes. A useful way to remember this is to associate the time with a short, familiar activity, such as listening to two or three favorite songs. Throughout the process, specific breathing techniques must be used, including taking slow, deep breaths and exhaling fully, often for longer than the inhalation.
At the end of each drainage position, the patient must perform a “huff cough,” which involves a forced exhalation through an open mouth to move the loosened mucus. Safety checks, such as monitoring for dizziness, lightheadedness, or discomfort, must be remembered as a non-negotiable part of the protocol, especially in head-down positions. These procedural details ensure the therapy is both effective and safe.