Therapeutic Positions

Fowler’s Position, or a semisitting position, is a bed position in which the head and trunk are

raised 45 to 90 degrees. In low-Fowler’s or semi-Fowler’s position, the head and trunk are

raised 15 to 45 degrees; in high-Fowler’s position, the head and trunk are raised 90 degrees. In

this position, the knees may or may not be flexed.

Indication: Fowler’s position is the position of choice for people who have difficult breathing and for

some people with heart problems. When the client is in this position, gravity pulls the diaphragm

downward, allowing greater chest expansion and lung ventilation.

Orthopneic Position, the client sits either in bed or on the side of the bed with an overbed table

across lap.

Indication: This position facilitates respiration by allowing maximum chest expansion. It is

particularly helpful to clients who have problems exhaling, because they can press the lower part of

the chest against the edge of the overbed table.

Dorsal Recumbent Position, the client’s head and shoulders are slightly elevated on a small

pillow. In some agencies, the term dorsal recumbent and supine are used interchangeably; strictly

speaking, in the supine or dorsal position the head and shoulders are not elevated. In both

positions, the client’s forearms may be elevated on pillows or placed at the client’s sides. Supine

are similar in both positions, except for the head pillow.

Indication: The dorsal recumbent position is used to provide comfort and to facilitate healing

following certain surgeries or anesthetics.

Prone Position, the client lies on the abdomen with the head turned to one side. The hips are not

flexed. Both children and adults often sleep in this position, sometimes with one or both arms

flexed over their heads.

Indication: This position has several advantages. It is the only bed position that allows full

extension of the hip and knee joints. When used periodically, the prone position helps to prevent

flexion contractures of hips and knees, thereby counteracting a problem caused by all other bed

positions. The prone position also promotes drainage from the mouth and is especially useful for

unconscious clients or those clients recovering from surgery of the mouth or throat.

Lateral Position (side-lying), the person lies on one side of the body. Flexing the top hip and

knee and placing this leg in front of the body creates a wider, triangular base of support and

achieves greater stability. The greater the flexion of the top hip and knee, the greater the stability

and balance in this position.

Indication: This flexion reduces lordosis and promotes good back alignment. For this reason, the

lateral position is good for resting and sleeping clients. The lateral position helps to relieve

pressure on the sacrum and heels in people who sit for much of the day or who are confined to bed

and rest in Fowler’s or dorsal recumbent positions much of the time. In the lateral position, most of

the body’s weight is borne by the lateral aspect of the lower scapula, the lateral aspect of the ileum,

and the greater trochanter of the femur. People who have sensory or motor deficits on one side of

the body usually fin that lying on the uninvolved side is more comfortable.

Sims’ Position (semiprone), the client assumes a posture halfway between the lateral and the

prone position. The lower arm is positioned behind the client, and the upper arm is flexed at the

shoulder and the elbow. Both legs are flexed in front of the client. The upper leg is more acutely

flexed at both the hip and the knee than is the lower one.

Indication: Sims’ position may be used to unconscious clients because it facilitates drainage from

the mouth and prevents aspiration of fluids. It is also used fro paralyzed clients because it reduces

pressures over the sacrum and greater trochanter of the hip. It is often used for clients receiving

enemas and occasionally for clients undergoing examinations or treatments of the perineal area.

Many people, especially pregnant women, find Sims’ position comfortable for sleeping. People with

sensory or motor deficits on one side of the body usually find that lying on the uninvolved side is

more comfortable.

Massage

Effleurage (Gliding)

Effleurage is the first and most widely used stroke. It is performed with long, gliding strokes

towards the heart without trying to move deeper tissues. Effleurage can be applied with broad

surfaces, such as the palms, the pads of the fingertips, or the pads of the thumbs. Each stroke is

used to evaluate the client (e.g. condition, tissue tension, texture, temperature, pain tolerance).

Effleurage is best applied with relaxed hands that conform and cover as much on the body surface

as possible. Pressure should be uniform and the stroke flowing rhythmic. Effleurage is a great way

to begin and end each segment of the body being worked. Types of effleurage strokes include

nerve strokes and feathering (a very light stroke), both of which can maintain the client’s relaxed

state.

The main purpose and benefits of effleurage are to relax, stimulate, stretch and broaden tissue,

promote blood and lymph movement, reduce edema, and improve circulation.

Petrissage (Kneading)

Petrissage is a technique that manipulates the fleshy areas of the body. Using the fingers and

hand, together or separately, the stroke is applied with various movements such as grasping,

lifting, compressing, rolling, and kneading. Other petrissage versions include chucking and rolling.

Chucking involves grasping flesh with one hand and moving the hand up and down along the bone

while the other holds the limb steady. Rolling involves using both hands to compress the muscle to

the bone and then rolling in back and forth. Pressure in all forms of petrissage is firm and directed

toward the center of the body. The shoulders and arms should be relaxed and held close to the

body.

The main purpose and benefits of petrissage are to assist removal of metabolic wastes, break up

adhesions, promote fluid movement in deeper tissues, stretch and broaden muscles, tissue and

fascia, revitalize dry skin by preventing blood and lymph circulation, and rehabilitate weak muscles.

Friction

Friction is a technique that uses direct pressure on skin, with or without gliding, and a vigorous

rhythmic movement using fingers and palms. There are many styles of the technique, each with its

own benefits, but only a few are desired as having good therapeutic value. The bony areas of the

body receive the greatest benefit from friction. These areas (i.e. joints, bony attachments for

ligaments and tendons) receive by blood flow are prone to injury and adhesions. Friction warms,

stimulate fluid movement, promotes flexibility, and breaks down adhesion. The most widely used

forms of friction are circular friction, deep cross-fiber friction, parallel stroke, and pumping.

Circular friction. A superficial circulation of tissue underlying with skin by using small,

circular movements to promote circulation and to stimulate nerves and muscle tissue.

Deep cross-fiber friction (or transverse friction). As described in Cyriax’s works, transverse

friction is applied perpendicularly to muscle fibers in an effort to break up scars, adhesions,

and fibrous tissue.

Parallel stroke. According to Harold Storm, a parallel stroke benefits the client’s stimulating

underlying tissue and reducing adhesions.

Pumping (or compression). Use pumping and compression movements to benefit the

fleshier parts of the body.

The main purpose and benefits of friction are to increase circulation, break down deposits in fascia,

promote circulation, and promote joint flexibility.

Tapotement (Percussion)

Tapotement is a technique that uses striking movements (e.g. pounding, tapping, beating,

slapping, hacking, cupping, and pinching). These techniques are generally rapid and alternating

using minimal force with the therapist’s hand relaxed. Tapotement can be highly stimulating by

promoting muscle tones through a repetitive muscle contraction and relaxation response. This

technique is used primarily over fleshy areas, but good judgment should be used. Tapotement

should not be used over injuries, tightly contracted muscles, lymph areas, the upper lumbar region

where kidneys are located, or any area considered sensitive by the client. However, tapotement

promotes circulation in the stump of amputated limbs, and is the treatment choice used by

respiratory therapists to break up lung congestion.

The general purposes and benefits of tapotement are to stimulate tissue repair, promote muscle

tones, increase circulation, loosen phlegm, and increase expectoration in respiratory tract

conditions.

Vibration

Vibration is a technique characterized by highly rhythmic shaking and trembling manipulation of

surface tissues of the body. It is applied with rigid hands, and the movement comes primarily from

the forearms or wrists.

The general purpose and benefits of vibration are to reduce intensity in deep tissue work, to soothe

and relax when applied lightly, or to stimulate when applied vigorously.