Tripod (Orthopneic) Position

What is tripod position (orthopneic position)?

Tripod position, or orthopneic (orth-OP-nee-ic) position, means leaning forward slightly while supporting yourself with your hands, arms or a table. Tripod position can help you breathe better if you’re short of breath, especially if it happens when you’re lying down (orthopnea). Respiratory therapists often teach it during pulmonary rehabilitation as a tool to help people with COPD and other chronic conditions breathe better.

There are several variations of tripod position. The most common are:

• Sitting in a chair and leaning forward (you put your hands or arms on your knees for support)
• Sitting in bed with your arms on a table (you lean forward and rest your head on your arms or pillows on top of the table)
• Standing up and leaning forward with your hands on your knees (this stance is probably familiar — you’ll often see people standing this way to catch their breath after exerting themselves)

You can get yourself into the position, or a healthcare provider (like a respiratory therapist) can help move you into the position. If you frequently have breathing issues, you might find yourself naturally getting into a tripod position to relieve breathlessness. If you’re having difficulty breathing, call 911 or get emergency medical attention.

What is tripod position used for?

Tripod position can help manage shortness of breath while you treat the main cause. Tripod position might partially relieve difficult breathing that comes with many heart and respiratory conditions. These conditions include:

• Asthma attacks
• Congestive heart failure
• COPD flare-ups
• Epiglottitis (swelling of the flap of cartilage at the back of your throat)
• Interstitial lung disease (scarring or inflammation in your lungs)
• Pneumonia or other respiratory infections
• Pulmonary edema (fluid in your lungs)
• Pulmonary hypertension (high blood pressure in the arteries around your lungs)

How do you get into tripod (orthopneic) position?

To get into tripod position, you can:

1. Sit in a chair or at the side of a bed
2. Put your feet flat on the floor
3. Lean your chest forward slightly
4. Put your hands or elbows on your knees (you can rest your chin on your hands), or you can fold your arms on a table and rest your head on your forearms or some pillows
5. Relax your neck and shoulders

Here’s another way to get into tripod position (sometimes with help from a provider):

1. Sit in bed with your legs on the bed in front of you.
2. Put a bedside or portable table across your lap at, or slightly below, chest height.
3. Put a pillow behind your back for extra support.
4. Lean your chest forward slightly.
5. Rest your arms on the table.
6. Rest your head on your forearms or on some pillows.

Standing and leaning forward with your hands on your knees for support is also a form of tripod position.

How long will I need to be in tripod position to feel better?

For some people, sitting upright can help make breathing easier right away. But tripod position is a temporary solution. You’ll need to treat the condition causing shortness of breath to feel better.

What are the benefits of tripod position (orthopneic position)?

Tripod position can help you breathe better by:

• Allowing your chest to expand as much as possible, increasing the amount of air you breathe in
• Engaging additional muscles to help you breathe
• Reducing excess fluid in your heart and lungs

Together, these help to reduce the amount of work your body has to do to breathe, making it easier.

Are there any risks of tripod position?

Some people with chronic breathing issues, like COPD, can develop areas of dark or thick skin on their legs and elbows. This is from the pressure of leaning on them in tripod position. Healthcare providers call this “thinker’s sign” or “Dahl’s sign.” While not harmful, it could be a sign that you’re having frequent episodes of breathlessness.

When should I call my healthcare provider?

Contact your healthcare provider if you find yourself needing to move into tripod position often to relieve shortness of breath. If you have a medical condition that causes difficulty breathing, a provider may be able to adjust your treatment or give you strategies to help you manage your breathing better.

If you don’t know why you’re having trouble breathing, contact a provider right away. Serious health conditions can cause breathlessness while lying down.

What position is best for difficulty breathing or COPD?

Tripod position can help people with COPD by giving their lungs more space to expand and letting more air in. Talk to your provider about ways you can manage shortness of breath with COPD or other conditions. If you’re having difficulty breathing, call 911 or your local emergency number, or get emergency medical attention.