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.