Nobody wants to have breathing difficulties. You feel uncomfortable when you get the flu and your chest is congested. That’s when chest physical therapy (Chest PT, CPT) comes into play.
It’s a collection of techniques that aim to clear your lungs and airways to help you with breathing. Anyone can benefit from it.
Close to 80% of the population has poor breathing techniques, which causes other pulmonary issues.
Most people who can benefit from chest PT and should be doing it are unaware of what it is. They tend to ignore the breathing issues as long as they can function, which isn’t a healthy way to deal with breathing problems.
In this article, we’ll introduce you to the topic and explain the different types of CPT that are used in this field.
Quick Introduction: What Is Chest Physiotherapy?
Chest physiotherapy is a sub-domain of the field that works on the lungs, thorax, and upper back. Both respiratory therapists and physiotherapists do quite similar work in this field.
It includes various active and passive techniques that we’ll cover later in this article.
The goal of chest physiotherapy is to help you breathe better, whether that’s by optimizing your breathing pattern, improving gas exchange in the lungs or mobilizing sputum, mucus, and secretions in your lung to clear the airway.
Who Needs Chest Physiotherapy?
Although it’s primarily applied to patients who suffer from acute or chronic lung diseases and those on ventilators, it’s not exclusively for these populations.
Athletes, the elderly, healthy adults, ex-smokers, and people who move to high-altitude areas can benefit from chest physiotherapy as well.
Chest Physiotherapy and Covid-19
Chest physiotherapy techniques got the most attention during Covid-19. It helped patients recovering from the virus to improve lung volume and gas exchange. Many of those who went on the ventilator suffered from ventilator-associated lung injury and needed chest physiotherapy to start breathing better again. (Reference)
Is Chest Physiotherapy Safe and Effective?
Chest physiotherapy requires a steady hand and careful application. It is safe for infants, kids, and adults.
In fact, many of my patients report feeling relaxed during or immediately after the treatment because it has a soothing effect.
You can perform chest physiotherapy on yourself or others at home after learning the proper techniques from a physiotherapist or a respiratory therapist. Parents often do chest PT on kids with cystic fibrosis and caregivers of COPD sufferers often help the patient with the therapy at home.
When done right, chest physiotherapy is highly effective for reducing the length of hospital stay, the incidence of hospital-acquired lung infections, and the need for mechanical ventilation to name a few areas. (Reference)
Mechanical ventilation is the term used for breathing through a machine called the ventilator.
Types of Chest Physiotherapy
Here are the main categories of CPT:
1. Postural Drainage
This is a chest physiotherapy technique where we employ gravity to help us remove mucus from the lungs.
We ask you to sit or lie in different positions during this process. Then we might perform claps or percussions on the chest wall while you’re in those positions or ask you to take deep breaths.
Otherwise, we’ll just ask you to maintain those positions as much as you can throughout the day to help bring secretions into the larger airway and then remove them.
You should do postural drainage therapy at least 1-2 hours after having a meal.
The goal is to mobilize sections by having gravity pull on them and move mucus from the smaller airways to the larger ones.
The lung has five lobes and there are different postural drainage chest PT positions for each lobe.
Lobe of a lung: your lungs are divided into imaginary segments. Each segment is called a lobe. These include the superior lobes or left and right lung, the middle lobe of the left lung, and the inferior lobes of both lungs.
2. Passive Chest Physiotherapy With Percussions
Here, we provide percussion or claps on the specific areas of the chest wall to move the secretions.
The first question I usually get about this technique is if it’s comfortable for the patient. The answer to that is yes. Percussions aren’t painful when you use correct hand placement and pressure.
We place the patient in specific positions before giving percussion. These positions are the same as the postural drainage ones.
You can also provide vibrations before or after percussions, or in place of them if percussions can’t be provided for any reason. Your physiotherapist can either give you a vibration jacket or show you how to do it with your hand.
Some precautions for chest percussion include making sure that your stomach is relatively empty and ensuring that there are no broken or bruised ribs or active scars or stitches in the area.
3. Chest PT With External Suction
Sometimes, chest percussions are not enough on their own to remove mucus.
Patients have to cough out the secretions that move into the larger airway. If they can’t, then we use external oropharyngeal suctioning to pull the secretions out from the back of the throat or the mouth.
4. Active Chest Physical Therapy With an Incentive Spirometer
Chest physiotherapy isn’t all passive.
Active deep breathing techniques are excellent to dislodge secretions that are attached to the airways while also improving the volume of air inhaled with each breath.
For that, we use a device called an incentive spirometer to help patients breathe better. It’s best for those who have severely compromised pulmonary function, which usually happens after surgery, due to COPD, cystic fibrosis, etc.
As the name suggests, it gives the user immediate visual feedback on the amount of air they can inhale.
It has three gas chambers with different color balls in them. Each of these represents a different flow rate. Simply put, each chamber has a different level of resistance to inhalation. The deeper you inhale, the more balls of the incentive spirometer you can move.
Some amount of mucus comes out with each deep breath. We usually advise 2 sets of 10 deep breaths with the incentive spirometer at a time.
5. Breathing Exercises as Part of Chest Physiotherapy
Chest physiotherapy also includes teaching you to breathe properly by utilizing your diaphragm and involving the base of your lungs as well.
The Active Cycle of Breathing Technique (ACBT) is designed to force lung secretions out through deep powerful breaths.
It includes three cycles:
- Breathing control: take relaxed normal breaths. Place your hands on your stomach for sensory stimuli that your stomach should move more as compared to the chest, which happens when you take shallow breaths.
- Thoracic expansion: take deeper breaths with 3 seconds hold after inhalation. Then exhale slowly with either an open mouth or pursed lips. Place your hands on the sides of your lower chest to feel your thorax expanding with each deep breath.
- Forced expiration or huff: take a deep breath, and force it out in one go from the back of your throat. This is to stimulate cough and remove excretions.
You can repeat stages 1 and 2 multiple times before moving on to stage 3. Also, save the cough for the end of the entire cycle.
6. Chest Physiotherapy for Babies
Chest physiotherapy for babies and kids is different from adults due to the size difference. We use percussor cups for providing percussion because the adult hand of a physiotherapist is too big for a kid’s chest.
To place your baby in postural drainage positions, put them in your lap and support their head if necessary.
How Should Chest Physiotherapy Be Performed?
While performing chest physiotherapy, your positioning matters as much as the patient. This process can be tiresome so you need to take breaks as needed and have someone help you out.
For doing percussion on the chest wall, make sure that your hand is in a C-shaped position. That way, you’ll be able to trap some air between your hand and the patient’s chest. This makes the procedure a lot more tolerable for the patient.
You also have to maintain a rhythm while clapping the hands on the chest wall. And only do it for 30 seconds at a time.
For providing vibrations to mobilize secretions, you have to keep your hand flat on the chest wall. Then vibrate your hand and arm while pressing down on the chest.
The Takeaway
Chest PT effectively clears the lungs of excess secretions and improves long volume.
All of the techniques aren’t applied to the same patient at the same time. You might start with passive physiotherapy and move to an incentive spirometer and breathing techniques later.
Your physiotherapist or respiratory therapist is the person to tell you which exercises are best for your lungs.
I hope this article helped you understand what chest physiotherapy is, how it’s performed, its types, and its variations for kids and adults.
Feel free to contact us if you have any more questions or need help with improving your pulmonary performance.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.