Spinal Cord Injury: Costophrenic Assist (Assisted Cough)

Spinal Cord Injury: Costophrenic Assist (Assisted Cough)

Getting Started

A strong cough is important to help clear the lungs of mucus. If you have a weak cough or a lot of mucus, you may need an assisted cough.

In a costophrenic assist, another person pushes on your rib cage to help you cough. This is done while you are sitting up in a bed or chair. If you're in a wheelchair, be sure to set the brakes and use the seat belt. Wait 30 minutes after a meal before you do an assisted cough.

Use these steps to do a costophrenic assist.

Caregiver doing costophrenic assist to person sitting in chair, showing hands placed on lower rib cage and pushing down and in.
  1. Your caregiver places their hands on the lowest part of your rib cage, with their fingers wrapped around your sides and their thumbs pointing toward the centre of your chest.
  2. You take a deep breath and hold it until the caregiver tells you to cough.
  3. When you cough, the caregiver quickly and firmly squeezes your ribs, pushing down and in and holding for 3 seconds. It may take practice to coordinate your cough with the motion.

Talk to your doctor before trying this. Some people shouldn't try an assisted cough. This may include those who:

  • Are in pain.
  • Have a chest or back injury, such as an unstable spinal injury or a broken rib.
  • Had recent surgery.
  • Have osteoporosis.
  • Are pregnant.


Current as of: February 16, 2023

Author: Healthwise Staff
Medical Review:
Adam Husney MD - Family Medicine
Martin J. Gabica MD - Family Medicine
Kathleen Romito MD - Family Medicine
Nancy Greenwald MD - Physical Medicine and Rehabilitation