The prone position refers to lying flat with the chest down and the back up.
Defining the Prone Position
The prone position involves an individual lying horizontally on their stomach, with their face typically turned to one side or facing downwards. This means the ventral side of the body faces down and the dorsal side faces up. It contrasts with the supine position, where a person lies flat on their back, face up. Another common position is lateral, where an individual lies on their side.
Medical Applications of Prone Positioning
In healthcare settings, prone positioning is utilized for therapeutic and surgical purposes. For patients with Acute Respiratory Distress Syndrome (ARDS), proning improves oxygenation and respiratory mechanics. In the supine position, the weight of the heart and abdominal organs can compress the lungs, particularly the dorsal areas. Proning helps redistribute blood flow and ventilation more uniformly, improving air-to-blood matching and reducing collapsed lung tissue. This can lead to increased oxygen levels and may reduce the need for mechanical ventilation or improve survival rates.
The prone position is also used in surgical procedures requiring access to the patient’s back, including spinal, neck, neurosurgery, colorectal, or tendon repair. Positioning the patient face down provides optimal access. Careful attention is given to proper head and limb alignment to prevent nerve damage and pressure injuries.
Physical therapists use prone positioning for rehabilitation exercises. For instance, “prone I’s, T’s, and Y’s” are exercises performed lying face down to strengthen back and shoulder muscles. Prone lying or prone on elbows can also be therapeutic for some individuals experiencing low back pain, as it can help decompress the spine. For children, prone extension exercises, often referred to as the “Superman” pose, help develop anti-gravity neck and trunk strength, body awareness, and the vestibular system.
Everyday Uses and Safety Considerations
Beyond medical settings, the prone position is adopted in various everyday activities. Many adults sleep on their stomachs, which is a form of prone lying, and it is also common during exercises like push-ups, planks, or certain yoga poses. Sunbathing is another common scenario where individuals might lie in the prone position. Competitive shooters also use the prone position for stability and accuracy.
Safety considerations are important, especially concerning infants. The American Academy of Pediatrics (AAP) and other health organizations strongly recommend that infants always be placed on their backs to sleep to significantly reduce the risk of Sudden Infant Death Syndrome (SIDS). The “Back to Sleep” campaign, initiated in the 1990s, has been associated with an approximate 80% reduction in SIDS deaths. This recommendation emphasizes a firm, flat sleep surface free of soft bedding, pillows, or toys.
For adults, the prone position is generally safe, but certain health conditions might make it uncomfortable or inadvisable. Individuals with specific back or neck injuries may find this position uncomfortable or detrimental. Pregnant women, particularly in their later trimesters, might find it challenging to lie prone due to the abdominal volume, though specialized supports can make it feasible in some medical contexts to improve oxygen saturation or reduce blood pressure. Contraindications for prone positioning in clinical settings can include unstable spinal or pelvic fractures, severe burns, or certain cardiovascular instabilities.