Chest physiotherapy

Man holding chest

How to breathe easier with chest physiotherapy

Medical Diagram of chest, lungs and air way

“Just breathe.”

That might be easy for some, bringing calm thoughts and removing tension. But for those with chronic health conditions that impact airways, it’s not always a simple task.

Did you know that chest physiotherapy could help clear your airways and prevent infections? Exploring your options is the first step toward breathing easier.

What is chest physiotherapy?

Chest physiotherapy (or CPT) is a type of physiotherapy that helps clear airway secretions like mucus, improving the flow of air into the lungs. It is often called airways clearance therapy (or ACT). For someone with a chronic health condition, coughing or huffing is not enough to clear the build-up of mucus from the lungs, so this type of therapy assists with that natural process. 

Chest physiotherapy can help people with conditions such as:

  • Cystic fibrosis (CF)
  • Bronchiectasis (damaged bronchial tubes)
  • A lung abscess
  • Neuromuscular disorders (i.e. multiple sclerosis or MS)
  • Pneumonias in dependent lung regions

Understanding the need for chest physiotherapy

The word “mucus” might make you cringe, but it’s an incredibly important part of a well-functioning body. Mucus membranes line your mouth, nose, throat, sinuses and lungs, producing mucus to protect and support your organs. They trap bacteria and other particles you breathe in, ones that could get you sick.

When the lungs are functioning normally, little hairs (known as cilia) move the mucus higher up in the airways. Simple acts like coughing and clearing your throat get it out of the lungs.

Individuals with chronic conditions like CF have problems moving the mucus up through the airways, leading to build-up. The mucus gets stuck in the lungs, along with all the bacteria it has trapped. Without external efforts to remove the mucus, there is an increased risk of chest infections and inflammation.

Chest physiotherapy helps clear out the mucus and, along with it, any harmful bacteria that’s been collected.


The correct hand position for chest percussions

Chest physiotherapy techniques

Chest physiotherapy can provide effective airway clearance through a variety of techniques performed by a trained physiotherapist or even by a caregiver in the comfort of home.

Chest physiotherapy: Percussion and postural drainage

With percussion and postural drainage, a physiotherapist uses gravity to drain mucus from the lungs. They will adjust your body into one of many different positions that faces your lungs downward, before clapping and/or vibrating your chest. This could look like three to five minutes of clapping (with a cupped hand), followed by 15 seconds of vibrating (with a flat hand). This impact moves the mucus further up the airways. Once complete, you will be directed to cough powerfully enough to finish clearing the mucus from your lungs.

Important to note: To avoid injury or upset, the person clapping should never touch the spine, breastbone, stomach, lower ribs or back.

Percussion and postural drained should be done on an empty stomach, either before a meal or two and half hours after one.

Chest physiotherapy: Autogenic drainage (AD)

Autogenic drainage (AD) is an airway clearance technique that uses controlled breathing with escalating lung volumes to loosen and transport mucus up and out of the lungs.

This happens in three stages, working on build-up from the outside of the airways toward the middle and then to the central airways where it can be cleared. Stage one involves low volume breaths. Stage two is medium or tidal breaths. Stage three is large volume breaths that allow you to cough or hawk up the mucus. A chest physiotherapist can guide you through each stage, advising you on what you should be feeling and/or hearing and when you should start coughing.

Chest physiotherapy: Active cycle of breathing technique (ACBT)

Your physiotherapist can teach you proper active breathing techniques (ACBT) to help clear mucus from your lungs. They may start with breathing control (in and out through your mouth, if possible), following by deep breathing (sometimes holding the breath for two to three seconds before letting it go) and then huffing.

Huffing is a forceful exhalation through your throat, like you’re trying to fog up a mirror. Your stomach muscles pull in and your mouth should make a “haw” sound.

Chest physiotherapy: Positive expiratory pressure devices (PEP)

Positive expiratory pressure devices (PEP) like a mask or handheld mouthpiece assist with breathing techniques that can clear your lungs.

The PEP device allows you to breathe in freely but provides resistance when you breathe out. To push past this resistance, you need to exhale harder, about four times as long as your in-breath. This gets your mucus moving and keeps your airways open while doing so.

Chest physiotherapy: Oscillating PEP

Like in regular PEP, this device allows an easy breath in and resistance on the breath out. However, a PEP device also creates vibrations (or oscillations) on the out-breath to move mucus from the peripheral and middle airways up to the central airways. After several out-breaths, you will be instructed to cough or huff to fully clear the mucus from the lungs.

Both of these sessions with PEP devises (oscillating and non-oscillating) take about 20 minutes or 20 breaths, depending on the severity of the build-up.


Other chest physiotherapy equipment

Chest physiotherapy vest

Your physiotherapist may have you use a high-frequency chest wall oscillation, which is an inflatable vest attached to a machine. Through high-frequency vibrations, the machine vibrates to loosen mucus. The vest is turned on for about five minutes, and then turned off to allow coughing or huffing. A full session lasts about 20 to 30 minutes.

Drainage tables, palm percussors and vibrators

Medical equipment stores carry various drainage tables, palm percussors (electrical and nonelectrical) and vibrators that you can purchase to help with drainage techniques at home.


woman breathing easily

Benefits of chest physiotherapy

Chest physiotherapy has many benefits. In addition to helping you breathe more easily, it can also prevent chest infections and reduce bouts of coughing. Even if your goal is to use these techniques at home, having a trained physiotherapist walk you through the steps and any necessary equipment can give you greater safety and confidence.


patient receiving consultation regarding chest therapy

When to avoid chest physiotherapy

Chest physiotherapy is not recommended if you:

  • Have severe discomfort in the required positions or manipulations.
  • Are taking anticoagulation drugs.
  • Have had a recent rib or vertebral fracture.
  • Have severe osteoporosis.