Which of the following correctly describes the prone position? An In-depth Guide

October 1, 2025 •

4 min read

During the COVID-19 pandemic, the medical community's use of prone positioning for patients with severe respiratory distress brought this technique into the public spotlight. So, which of the following correctly describes the prone position? It is the anatomical position of lying horizontally with the chest down and the back up.

Quick Summary

This guide explains that the prone position is lying face down, in contrast to the face-up supine position. It covers its key medical applications, such as improving oxygenation in acute respiratory distress syndrome (ARDS) and providing surgical access to the back.

Key Points

Definition: The prone position correctly describes a person lying horizontally on their stomach, with their chest and face downward and their back facing upwards.
Respiratory Benefits: For patients with conditions like ARDS, prone positioning improves oxygenation by redistributing blood flow and reducing pressure on the lungs.
Surgical Access: Surgeons use the prone position to access the posterior areas of the body for procedures on the spine, neck, and back.
Risks and Safety: Prolonged use carries risks like pressure injuries on the face, chest, and knees, as well as nerve and eye damage, necessitating careful positioning and padding.
Prone vs. Supine: The prone position (face-down) is the opposite of the supine position (face-up), and the distinction is critical for medical communication and practice.
COVID-19 Application: The prone position gained significant attention during the COVID-19 pandemic for its use in treating respiratory failure in both intubated and non-intubated patients.

Defining the Prone Position and Other Anatomical Terms

To understand which of the following correctly describes the prone position, one must first distinguish it from other standard anatomical references. The prone position describes a person lying flat on their stomach with their face downward. This contrasts directly with the supine position, where a person lies on their back, face upward. In anatomical terms, the prone position places the dorsal (back) side of the body upward and the ventral (front/abdominal) side downward. Mnemonic devices can help remember the difference: 'supine' contains 'up,' while 'prone' contains an 'o' like 'down' or is similar to 'on' the stomach.

Beyond basic orientation, the prone position has specific medical guidelines for alignment, especially in surgical or critical care settings. These include positioning the head in a neutral position to avoid excessive rotation, flexion, or extension, and ensuring the arms are positioned carefully to prevent nerve damage.

Medical Applications of Prone Positioning

The use of the prone position is not merely for comfort but serves critical therapeutic and surgical purposes. Its applications range from improving lung function in critically ill patients to facilitating complex surgeries.

Prone Positioning for Respiratory Distress (ARDS)

One of the most well-known medical uses is for patients with acute respiratory distress syndrome (ARDS), which was especially relevant during the COVID-19 pandemic.

Improved Oxygenation: When a patient is in the supine (face-up) position, the weight of the heart and other abdominal organs can compress the posterior, or dorsal, sections of the lungs, where the majority of the blood flow is directed. This can impair the lung's ability to exchange oxygen. Turning the patient into the prone position relieves this pressure, allowing for better ventilation and blood flow distribution, ultimately improving oxygenation.
Homogenizing Lung Ventilation: Prone positioning leads to a more uniform distribution of gas throughout the lungs, inflating previously collapsed lung regions and reducing hyperinflation in other areas. This process is lung-protective, especially for patients on mechanical ventilation, as it helps prevent further lung injury.
Facilitating Drainage: Gravitational force in the prone position also helps drain secretions from the lower pulmonary system, which can reduce the risk of secondary infections like pneumonia.

Prone Positioning in Surgery

In the operating room, the prone position provides surgeons with optimal access to the posterior aspects of the body for a variety of procedures.

Spinal Surgery: This is one of the most common applications. For procedures like laminectomies, discectomies, and spinal fusions, prone positioning gives surgeons a direct and unobstructed view of the spinal column.
Neurosurgical Procedures: Surgeries involving the posterior fossa and cranial base require the prone position for clear access.
Colorectal and Tendon Surgeries: Certain procedures involving the colon, rectum, or tendon repairs may also necessitate the patient being placed face-down.

Potential Risks and Safety Measures

While highly beneficial, prone positioning is not without risk, especially when performed for prolonged periods in a critical care setting. Healthcare teams must be meticulous in patient assessment and positioning techniques to mitigate these risks.

Common Complications and Risks:

Pressure Injuries: Prolonged pressure on bony prominences such as the forehead, chin, chest, knees, and hips can lead to pressure ulcers or skin breakdown.
Nerve Injuries: Improper arm and neck positioning can cause damage to peripheral nerves, such as the brachial plexus, which can result in weakness or numbness.
Ocular Injuries: Direct pressure on the eyes or orbital area can increase intraocular pressure and potentially lead to vision loss, a rare but serious complication.
Airway and Device Issues: Accidental displacement or obstruction of the endotracheal tube is a significant risk during patient turning, necessitating a trained team for the procedure.
Facial Edema: Swelling of the face, particularly around the eyes, is a predictable side effect of sustained prone positioning.

To manage these risks, hospitals implement strict protocols. The use of specialized positioning devices, such as gel pads and cushions, helps redistribute pressure. For critical patients, constant monitoring and team coordination are paramount, often involving dedicated 'proning teams'.

Prone vs. Supine: A Comparison


Feature	Prone Position	Supine Position
Body Orientation	Lying flat on the stomach, face down.	Lying flat on the back, face up.
Anatomical Sides	Dorsal side up, Ventral side down.	Dorsal side down, Ventral side up.
Respiratory Function	Often improves oxygenation in patients with ARDS by relieving pressure on lungs.	Standard position, but can worsen respiratory issues due to organ compression.
Surgical Access	Provides access to posterior (back, spine, neck) body parts.	Provides access to anterior (abdomen, chest, head) body parts.
Patient Handling	Requires a team of trained staff and specific safety protocols for turning.	Generally easier to manage, but still requires safe patient handling.
Risks	Higher risk of pressure injuries to the face, chest, and knees. Potential for nerve and eye damage.	Risk of pressure injuries to the back, elbows, and heels.

Conclusion

To answer the question, which of the following correctly describes the prone position?, the simple and accurate response is lying face-down on the stomach. However, the significance of this anatomical orientation extends far beyond its basic definition. As a medical intervention, it plays a vital role in patient care, offering therapeutic benefits for severe respiratory conditions like ARDS and providing necessary access for certain surgical procedures. Its use, particularly in critical care, highlights the complex interplay of patient positioning, physiological effects, and safety considerations. Healthcare providers must utilize careful, standardized procedures to maximize its benefits while minimizing potential risks, such as pressure sores and nerve damage.

For additional information on patient positioning and respiratory care, resources like the National Institutes of Health (NIH) offer extensive research and guidelines.

Frequently Asked Questions

A simple way to remember is to associate 'prone' with the word 'down,' as in 'face-down.' Conversely, associate 'supine' with the word 'up,' as in 'face-up,' or think of holding a bowl of 'soup' in your upward-facing hands.

For ARDS patients, prone positioning is used to improve oxygenation. It relieves the gravitational pressure from the heart and abdomen on the lungs, allowing for better airflow and a more even distribution of blood flow in the lungs.

Major risks include pressure ulcers on sensitive areas like the face and chest, nerve injuries (e.g., brachial plexus), eye complications, and the potential for medical device displacement, such as the endotracheal tube.

In surgery, the prone position is utilized to provide surgeons with clear access to the posterior side of the body. This is necessary for various operations, including spinal, neck, neurosurgical, and some colorectal procedures.

To protect the patient's face, healthcare providers use specialized face positioners and soft padding to distribute pressure away from the eyes, nose, and mouth. The head is often turned every few hours, and eyes are regularly lubricated and protected.

While traditionally used for ventilated patients, the practice of 'awake proning' was also used for spontaneously breathing patients with respiratory failure during the COVID-19 pandemic, with some studies showing positive effects on oxygenation.

The high number of patients with severe respiratory failure due to COVID-19 led to the widespread use of prone positioning in intensive care units globally. Its effective role in improving oxygenation for these patients made it a prominent topic in medical and public discourse.