Physical Therapy
Overview
Physical therapy can be a valuable tool to minimize pain and improve athletic performance for patients with pectus excavatum of all ages. It's also used after corrective surgeries like the Nuss and Ravitch procedures to bring the body back to its normal strength. Physical Therapists are experts at postural correction and strengthening chest and back muscles, which can help with pectus excavatum, especially for patients with an exaggerated, forward rounding of the upper back (thoracic hyperkyphosis).
The aim of physical therapy for pectus excavatum is to:
1) Loose and lengthen tight or contractured tissues.
2) Improve chest wall and spinal mobility.
3) Strengthen muscles needed for chest expansion and elevation.
4) Restore and maintain normal posture.
5) Improve and maintain lung compliance.
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To do this, physical therapists use:
- Manual therapy: Also called hands-on therapy, where physical therapists use their hands to engage, relax, or mobilize muscles and tissue.
- Neuromuscular re-education (NMR): A hands-on technique used to treat soft-tissue.
- Therapeutic exercises: Movements and physical activities designed to restore function and flexibility, improve strength and decrease pain.
- Therapeutic activities: Exercises that are used to help a patient go back to normal activities, ex. getting out of bed or reaching shelves.
- Modalities: for example, electrical stimulation, hot packs or cold packs, and dry needling.
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What should I look for when selecting a physical therapist?
A physical therapist who can help treat the symptoms of pectus excavatum doesn't always need to know all of these techniques, but when looking for a physical therapist online, looking for a "PT" with these skills can help you make a decision on which physical therapist is right for you [1]. Some skills to look for are:
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Fascial Counterstrain Technique
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Used to loosen and lengthen tight tissues to reduce pain, tightness, and muscle spasms.
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Postural Restoration Institute
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Used to address posture issues, like hyperkyphosis (a forward rounding of the back). ​
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A type of hands-on therapy where physical therapists use pressure on the head to release restrictions in the body to help body systems like the nervous system or the digestive system work better. ​
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What do pectus physical therapy excecises look like?
Every patient will be given a different treatment plan and exercises, depending on the extent and symptoms caused by the pectus. On the left is a selection of exercises from a Nuss procedure recovery exercise plan created by Dr. Katy Lyons, a physical therapist from Back In Motion Physical Therapy. It's important to emphasize again that every patient will have their own targeted exercises.
References
1. Lyon, K. (2023, October 7). [Personal interview by the author].
Dr. Katy Lyon, PT, DPT, is a physical therapist at Back in Motion Physical
Therapy, in Lorton, Virginia.
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2. Alaca N, Alaca I, Yüksel M. Physiotherapy in addition to vacuum bell therapy in patients with pectus excavatum.
Interact Cardiovasc Thorac Surg. 2020 Nov 1;31(5):650-656. doi: 10.1093/icvts/ivaa161. PMID: 32960955.
3. Amăricăi E, Suciu O, Onofrei RR, Miclăuș RS, Cațan L, Cerbu S, Popoiu CM. Assessment of children
with pectus excavatum without surgical correction. Wien Klin Wochenschr. 2019 Mar;131(5-6):126-131. doi: 10.1007/s00508-018-1406-0. Epub 2018 Nov 12. PMID: 30421282.
4. Alaca N, Yüksel M. Comparison of physical functions and psychosocial conditions between adolescents
with pectus excavatum, pectus carinatum and healthy controls. Pediatr Surg Int. 2021 Jun;37(6):765-775.
doi: 10.1007/s00383-021-04857-7. Epub 2021 Jan 16. PMID: 33454849.
5. Canavan PK, Cahalin L. Integrated physical therapy intervention for a person with pectus excavatum and
bilateral shoulder pain: a single-case study. Arch Phys Med Rehabil. 2008 Nov;89(11):2195-204.
doi: 10.1016/j.apmr.2008.04.014. PMID: 18996250.
6. Schoenmakers MA, Gulmans VA, Bax NM, Helders PJ. Physiotherapy as an adjuvant to the surgical treatment of anterior
chest wall deformities: a necessity? A prospective descriptive study in 21 patients. J Pediatr Surg. 2000 Oct;35(10):1440-3. doi: 10.1053/jpsu.2000.16409. PMID: 11051146.