Physiotherapy for Pleurisy: Relief, Recovery & Prevention

Physiotherapy is a cornerstone of conservative pleurisy (pleuritis) management, addressing pain, ventilation, secretion clearance, and functional recovery.

Key Interventions

1. Breathing Retraining:
   • Diaphragmatic breathing: Reduces accessory muscle use, improves ventilation efficiency.
   • Pursed-lip breathing: Prolongs expiration, prevents airway collapse, reduces dyspnea.
   • Segmental expansion: Targeted ventilation to affected lobes.
2. Airway Clearance:
   • Active Cycle of Breathing Technique (ACBT): Breathing control → deep breaths → huff cough.
   • Postural Drainage (modified): Gravity-assisted positions for specific segments (avoid head-down if pleural effusion large).
   • Manual Techniques: Percussion, vibration, shaking (if not contraindicated by pain/fracture).
3. Thoracic Mobility:
   • Thoracic rotation/extension exercises (foam roller, open book, thread-the-needle).
   • Chest wall stretching (pectoralis, latissimus, intercostals).
   • Costovertebral joint mobilizations (Grade I–II for pain modulation).
4. Pain Management:
   • TENS (intercostal placement).
   • Thermotherapy (heat for muscle spasm; cold for acute inflammation).
   • Relaxation training (progressive muscle relaxation, guided imagery).
5. Graded Exercise & Functional Restoration:
   • Walking program (interval training if deconditioned).
   • Upper/lower body strengthening (scapular stabilizers, core).
   • Activity pacing education.
6. Education & Self-Management:
   • Pleurisy pathophysiology, warning signs (fever, worsening dyspnea, hemoptysis).
   • Incentive spirometry technique.
   • Posture hygiene (work, sleep).
   • Smoking cessation (critical).

Contraindications / Precautions

• Unstable hemodynamics, active TB, large unresolved effusion, rib fractures, recent thoracic surgery — modify/avoid specific techniques.

PT typically 2–3×/week × 4–6 weeks; home program lifelong. Coordinates with medical management (antibiotics, NSAIDs, steroids, thoracentesis if effusion).