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Chest Physiotherapy

Chest Physiotherapy

What is Chest Physiotherapy

Chest physiotherapy (CPT) is a means of clearing the lungs of accumulated mucus and to regain respiratory function. It uses gravity and physical therapy techniques to help move the secretions out of the lungs and stimulate coughing. It is used for persons with increased amounts of mucus or thick secretions, those with weak breathing muscles, or individuals with ineffective coughs. CPT consists of postural drainage, clapping, vibration, deep breathing, and coughing exercises.


To Perform Chest Physiotherapy

**Please note that the following guidelines are for reference only. You should consult with a physiotherapist and get proper training before using those techniques. **

1. Postural Drainage

Postural Drainage involves a patient assuming various positions to facilitate the flow of secretions from various parts of the lung into the bronchi, trachea and throat so that they can be cleared and expelled from the lungs more easily. Each position should be drained for 5 to 15 minutes as advised by your physiotherapist.

Some common postural drainage positions are shown as follows:

Upper Lobes:

  • In sitting position. Clap over upper shoulder and blade on each side of the back.
  • In sitting position. Clap just below collar bone on each side of chest


Middle Lobe:

  • Lying on the side with 15∘head down and rotate 1/4 turn backward. A pillow is placed behind for support. Clap over the chest on each side.


Lower Lobes:

  • Lying 30∘head-down and on the side. Clap on the lower part of the chest.

  • Lying on the dummy in a 30∘head-down position. Clap on lower back on each side of spine.


2. Clapping With the Cupped Hand


  • Clapping with the cupped hand on the chest wall over the section of the lungs to be drained generates vibrations which are transmitted to the air passages (bronchi), stimulating the movement of secretions. These vibrations may help to remove secretions sticking to the walls of the air passages.
  • The hand is cupped by holding the fingers together so that the shape of the cupped hand conforms to the chest wall. The cupped hand helps to trap a cushion of air which softens the blow of the clapping.
  • Clapping should not be done on bare skin, but over soft comfortable clothing or towels. Rings should be removed before clapping. Ribs are strong and flexible, but can be broken by a strong blow with the hand.

3. Vibration

Vibration is more difficult than clapping, but is valuable because it helps stimulate the flow of secretions. It should be done by the physiotherapist only, as when vibration was done without proper training and knowledge, it may cause injury.


4. Active Cycle of Breathing Technique (ACBT)

ACBT is a technique uses various degree of breathing exercises to remove the secretion from the lung. It can be used alongside with postural drainage and percussion. It consists of 3 main components:

4.1. Breathing Control

  • Rest one hand on the abdomen, keeping shoulders and upper chest relaxed and allow your hand to rise gently as breathing in.
  • Sigh out gently
  • Ensure shoulders remain relaxed
  • Over a few seconds, gradually increase depth of breathing while remaining relaxed

4.2. Deep Breathing Exercise

  • Take a deep-breath in, allowing the lower chest to expand
  • Try to ensure neck and shoulders remain relaxed
  • At the end of the breath in, hold the air in for 3 seconds
  • Let the air out gently
  • Repeat for 3-4 times

4.3. Forced Expiratory Technique

  • Take a small breath in and blow air out steadily through an open month (huffing)
  • Follow this with breathing control
  • Repeat
  • As the secretion moves into larger airways, take a deep breath in and huff, or cough.
  • Breathing control
  • Repeat the cycle until your chest is clear or as advised by your physiotherapist.


Do's and Don’ts of Chest Physiotherapy

  • The chest should be protected by at least one layer of clothing or by a towel. This prevents irritation caused by clapping the bare chest with the hand.
  • To minimize the chance of vomiting, chest physiotherapy is best done before meals or no sooner than one hour after eating/drinking. Early morning and right before bedtime are usually recommended. CPT exercises before bedtime help clear airways of accumulated secretions and may reduce nighttime coughing.
  • Do not clap directly over any bony portions of the chest, for example, the breastbone or the spine. Never clap below the bottom of the rib cage. Encourage the child to cough following CPT.



The above information was produced by Physiotherapy Department, Canossa Hospital (Caritas).

Please call 28255392 for physiotherapy appointment





  1. Shepherd R.B. Physiotherapy in Paediatrics (3rd Ed) Butterworth Heinemann (1995).
  2. http://www.cff.org/UploadedFiles/treatments/Therapies/Respiratory/PosturalDrainage
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