Chest Physiotherapy

What is chest physiotherapy?

Chest physiotherapy (chest PT) is a type of physical therapy that loosens mucus in your chest to help you breathe better. A healthcare provider — often a respiratory therapist — claps or thumps your back and chest to move mucus out of your airways so you can cough it out. You might also have a family member or friend learn how to help you at home.

Certain conditions, like cystic fibrosis and COPD, cause thick mucus in your lungs that’s hard to clear. Chest PT is a bit like a forceful pat on the back — it’s enough to rattle the mucus loose, but it shouldn’t hurt. You can then cough the mucus out to open your airways and breathe better.

What conditions is chest physiotherapy used for?

Healthcare providers might recommend chest PT to help manage:

• Cystic fibrosis
• COPD (chronic obstructive pulmonary disease)
• Bronchiectasis
• Pneumonia
• Neuromuscular disorders
• Atelectasis

Chest PT can be part of a larger pulmonary rehabilitation plan your provider creates for you.

How does chest physiotherapy work?

There are two main types of chest physiotherapy: percussion and vibration. Healthcare providers can use their hands or a machine that shakes your chest and back. They usually combine chest PT with positions that help the mucus drain (postural drainage).

Percussion

During percussion, your provider curves their hands like they’re scooping up water. Then, they turn their hands fingers-down and clap or thump your back or chest in a steady, rhythmic pattern, like playing the bongos. They can also use a handheld device that looks like a cup.

Vibration

During vibration, your provider places their hands flat on your chest or back. They shake your body to vibrate the airways inside your chest.

How do I prepare for chest physiotherapy?

Your healthcare provider can let you know the best way to prepare for chest PT sessions. They might recommend:

• Using an inhaled bronchodilator 15 to 30 minutes before chest PT
• Waiting 90 minutes after eating to start

Be sure to let them know about any health conditions, including bleeding or blood pressure issues, before starting chest PT.

What happens during chest physiotherapy?

During chest PT, your provider will:

1. Help you get into position (this could be on your side, belly or back, or sitting up, and you might have a pillow or wedge for support)
2. Clap or vibrate your chest or back (they may give you instructions, like when to inhale and exhale)
3. Have you cough out any mucus

Your provider may repeat these steps while switching between percussion and vibration. They might also have you change positions to clear different parts of your lungs.

How do you do chest physiotherapy at home?

Many people do chest physiotherapy at home with the help of a family member, friend or another caregiver. It’s best to only use these techniques if a healthcare provider has recommended them and shown you how to safely do them at home. They’ll give you specific recommendations based on your health history.

What are the potential benefits of chest physiotherapy?

Chest physiotherapy can:

• Make breathing easier
• Reduce the number of times you need to go to the hospital
• Reduce the number of infections or flare-ups (exacerbations) you have
• Improve your quality of life
• Improve your ability to walk, exercise or perform daily tasks

What are the risks of chest physiotherapy?

The position you’re in for PT or the percussion and vibration can sometimes put you at risk for:

• Rib, spine or muscle injury
• Shortness of breath
• Vomiting
• Mucus getting stuck in your airways (aspiration)
• Low levels of oxygen in your tissues (hypoxia)
• Low blood pressure (hypotension)
• Bleeding in your lungs (pulmonary hemorrhage)
• Increased pressure in your head (increased intracranial pressure)
• Airway spasm (bronchospasm)
• Abnormal heart rate (dysrhythmia)

Using only head-up positions (rather than having your head tilted toward the ground) reduces your risk of these complications.

When shouldn’t you do chest physiotherapy?

Some conditions might put you at a higher risk for injury or medical issues during chest PT. Talk to your provider before doing chest PT if you have:

• A recent injury to your chest, back or lungs (including your skin)
• Had spinal anesthesia or an epidural recently
• Bone thinning (osteoporosis)
• Bleeding (for instance, if you’ve been coughing up blood) or high risk of bleeding
• Health conditions affecting your blood pressure
• Chest pain

When should I call my healthcare provider?

Let your provider know right away (if you’re with them) or call 911 if you experience:

• Difficulty breathing
• Coughing up blood
• Chest pain
• Severe headache
• Weakness
• Dizziness
• Bluish skin, lips or nails (cyanosis)

Are there ways to make chest physiotherapy more comfortable?

Chest PT shouldn’t be painful. But sometimes, it can feel uncomfortable. Always let your provider or caregiver know about any discomfort — even if something just doesn’t feel quite right. Other tips for safe and comfortable PT sessions include:

• Tell your provider or caregiver if they’re hitting too hard. Also, let them know if they’re not being forceful enough to loosen mucus.
• Never have someone percuss or vibrate your lower back or below your rib cage — this can cause organ damage.
• Find what makes you most comfortable for PT sessions. This might be wearing certain clothes, pulling your hair back or using a favorite pillow.
• Always talk to your provider about any changes to your health before starting a PT session.

What is the best position for chest physiotherapy?

The best position for chest PT is the one that’s safe for you and helps you clear out mucus. Many people move into several different positions to clear different parts of their lungs. Some positions can be dangerous, though — like ones that angle your head downward — so always ask your healthcare provider to show you which positions are safe for you.

How often do you need chest physiotherapy?

Some people have chest physiotherapy every day or multiple times per day. You might do it more or less frequently, depending on how often you need to clear mucus.