This is Part 2 a continuation from Pectus Excavatum Repair part 1 and this hub will discuss specific exercises you can try to help your pectus excavatum condition.The main question in managing pectus excavatum is how to pull forward the sunken sternum and bring the chest wall outwards and forward.  

Steps to improve your Pectus Excavatum  

When improving your pectus excavatum through exercises the following steps should be followed in sequence in their daily exercise program.  

These are  

1. To increase the mobility and flexibility of the spine and chest wall. 

2. To lengthen any tightened and shortened structures. 

3. To strengthen muscles in elevating and expanding the depressed chest wall. 

4. To restore normal posture.   

The first two steps are to mobilize the articulating joints and to lengthen any tight soft tissue around the chest wall so that less impedance will be encountered during the elevation of depressed chest.   

 1. Forward arm stretching in pone kneeling

The patient is positioned in an inclined prone kneeling position with hands stretching forward and  supported by wall bar (about 2 to 3 feet high from ground) Slowly lower his upper body and press his scapula (are around underarms) towards the floor. Experience the stretch feeling around the underarm and shoulder. Hold 8 seconds (may get a deep breathe and hold to increasingly stretch the chest wall) and release. Repeat for 20 times and 4 sessions per day.  

Purpose: Stretch all anterior chest wall muscles especially pectoralis major (main pec muscles) and extend the upper back. 

2. Upper trunk rotation in standing The patient is to stand side on to a wall. The hand closest to the wall is put on the wall a bit higher than the shoulder level. The patient’s pelvis turns to the opposite side while still leaving the hand fixed on the wall. A stretch is felt at the anterior shoulder and upper chest wall.

Hold 8 second, then release and return to the original position. Take a rest and repeat on the other side. Repeat for 20 cycles and 4 sessions per day.

 Purpose: Rotation gives the greatest range of movement for thoracic vertebrae (fancy word for spine) allowing stretch to ligaments, muscles and joints around the chest wall in a different direction.

 3. Upper trunk side flexion in sitting 

The patient is seated on a chair. Side bend to one side with the opposite hand crossing over the head to another side. A stretching feeling is felt on the other side of trunk. Hold 8 seconds (may get a deep breathe and hold to increasingly stretch the chest wall) and then return to the original position. Take a rest and repeat on the other side. Repeat for 20 times and 4 sessions per day. 

Purpose: Similar to the 2nd exercise 

1. Weight lifting in stretch supine lying

The patient is positioned in supine with the upper trunk on a small foam roll around 2 to 3 inches in diameter (if patient can’t tolerate, just lie flat). The arms are put in an upward stretched position. The hands should hold on a fixed wall bar or hardly movable weight about 10 inches from the surface of the bed (pillows may be used to support the weight) . Deeply inspire and exert maximal force in lifting the wall bar or weight. Hold 8 seconds and relax. Repeat 10 times as 1 lot. Take rest then and repeat another 2 lots performing a total of 30 repetitions and 4 sessions per day. 

Purpose: By the technique of “reverse origin and insertion”, the arms are being fixed and the anterior chest wall is lifted up mainly by the pectoralis major and minor. Maximal force exertion allows recruitment of surrounding respiratory muscles for training. The foam roll under the upper to middle part of the trunk exerts postero-anterior force to the thoracic spine helping in extension, which mobilizes and corrects any unnatural bends in the back (poor posture related usually). The depressed chest will also be “opened” up facilitating the elevation of the chest wall. Arms, being in a mid-length muscle range, are capable to exert the greatest force to elevate the depressed chest. Tone of pectorlis major is built up for better posture and outlook. 

2. Upper trunk extension in prone lying

The patient is positioned in prone lying with one or two pillows under the tummy (avoiding the lower anterior chest pressing on the pillow, area where lungs and heart are keep pillow lower down) . The hands are placed behind the head. The feet may be fixed on wall bar. Deeply inspire and extend the upper trunk with arms arching back. Stay and hold 8 seconds and then relax. Repeat 10 times as 1 lot. Take rest then and repeat another 2 lots. Perform a total of 30 repetitions and 4 sessions per day.  

Purpose: The strengthened upper back muscles help to balance the improved muscle force of the anterior chest wall muscle. This prevents the development of Poor back posture due to strong anterior muscle pull and keeps a good posture.  

3. Push up

The patient is positioned in prone lying and both hands are used to push up his body. The level of difficulty depends on the actual ability of the patients (1st level – upper trunk pushed up, 2nd level – whole body pushed up in one piece, 3rd level – push and clap both hands in mid air). Start with the 1st level and when the patient is able to finish the level easily, he may proceed to next level). Repeat 10 times as 1 lot. Take rest and then repeat another 2 lots performing a total of 30 repetitions and 4 sessions per day.   

Purpose: The exercise aims at general strengthening of the chest wall. Moreover, the high intensity but low frequency impacting force may be advantageous to stimulate remodeling and shaping of the chest wall deformity. Bone mineralization may also be enhanced.  

4. Hands up and down movement behind and by the sides of body (with theraband or stretchy rope/velcro)

The patient is positioned in sitting or standing with both arms in a stretched position. Each hand holds one end of a theraband or a spring (resistance should be set at 10 repetitive maximum, RM, i.e. theresistance that one can perform 10 repetitions but no more). Then stretch the theraband and maintain the elbows straight . Slowly put the hands behind and pass by the sides of body and then down below buttock. After 3 seconds rest, the hands slowly go up and along the same track to the starting position. Repeat 10 times as 1 lot. Take rest and then repeat another 2 lots performing a total 30 repetitions and 4 sessions per day.  

Purpose: The exercise is used to strengthen the neck, shoulder, upper back and anterior upper chest muscles. It can be treated as a kind of stabilization exercise to the upper thorax.  

The most important aspect of improving pectus excavatum appearance is your posture and working on general posture correcting exercises will help bring your sunken sternum back to a normal chest position, good luck and remember to consult your doctor before commencing any sort of physical or exercise program and most of all take it easy. I also recommend a yoga mat for some of these exercises definitely beats breaking your ribs on a hard floor. Any questions, leave them in comment area