Pectus Posture

Evidence Based This post has medical citations

Both pectus excavatum and pectus carinatum deformities are associated with skeletal problems. The term “Pectus Posture” is a series of postural issues and signs that occur simultaneously due to pectus excavatum.

Pectus posture can also be described as “poor posture.” However, there are a few typical patterns that pectus excavatum sufferers have. In my experience as a personal coach, the majority of patients with the deformity suffer from this.

They often overlook the bad posture caused by pectus excavatum. They pay zero attention to how they carry themselves throughout the day. The exact reason why the pectus sufferers acquire such posture is unclear.

However, it is likely caused by multiple factors, including poor thoracic mobility (shortened and tight chest muscles), weak and inflexible shoulders, poor upper back strength, and weak core strength.

5 Most Common Postural Problems

Pectus excavatum sufferers usually have a posture that further worsens the deformity. It is worsened by a forward slouching of the shoulders, kyphosis, and belly that sticks forward.

For example, a moderate case of the deformity will appear as severe, simply because the posture is terrible. Most pectus excavatum sufferers in today’s age have a kyphotic spine (head rounding forward), especially teenagers.

They are a part of the generation that plays a lot of video games throughout the day. That makes the indentation appear worse. The point of the stretches and exercises is to open your chest up and pull the shoulders back.

If you stand upright with a robust posture, it can instantly make the hole in the chest appear less prominent. In everyday life, it is critically important to walk around with a good posture. Corrective stretches and exercises help you make this a habit.


Kyphosis of the thoracic spine can often be seen in patients with pectus excavatum. Additionally, rounded shoulders are also extremely common.

You can easily recognize kyphosis by the forward curve in the upper part of the back and a head that sticks forward. However, if the kyphosis is moderate, it can’t be easily recognized.

If it is severe, it looks like the person is bending forward. Most patients that have kyphosis don’t have any physical symptoms. But, in more severe cases, it can cause back pain, muscle stiffness, hunched back, and stiff hamstrings.

The way to fix this is based on the severity of the kyphosis. Physical therapy and stretching the tight musculature is essential to improve thoracic mobility and strengthen the postural musculature.

I Had a Severe Kyphosis

I used to have a very kyphotic posture. That was something that I grew up with. It was the result of playing video games on my computer, and sitting on the desk at school for most of my days.

My upper back was rounded, and my pec minors were extremely tight. Additionally, I injured my left shoulder severely when I played soccer with my friends and almost broke my collar bone. As a result, I was wearing a splint for about a month.

To correct the kyphotic posture, you need to fix and stretch every single day. I make all of my young clients who have kyphosis (rounded upper backs and forward sticking head) do a prehab exercise before doing a bodybuilding workout.

Strengthen Scapular Muscles

First and foremost, they must stretch their pec minor on the wall, and the lats using a rubber band attached to the pull-up bar of a squat rack.

Doing that will pull them back in a proper posture automatically. Then, I make them do resistance band pull-apart and band dislocations.

The point of these exercises is to pull back the scapula muscles that are weak and long. I want them to tighten those muscles up and make them healthy. You must loosen up the chest muscles first, and then, strengthen the back muscles across the midsection.


Kyphosis is one of the most common pectus excavatum postural problems. You can recognize it by forward bend in the upper back and a head that sticks forward.

Forward Head posture

As I previously said, for many years, I had a horrible posture because of playing video games all the time. My posture was awful.

When I started strength training, I paid particular attention to strengthening my upper back muscles. I worked on thoracic extension, stretching, foam rolling, and doing every other physical activity that supported a good looking physique.

The problem was that I had a lump on the back on my neck, that when I stood straight, it looked like a pile of meat. Nowadays, my body and the bump is corrected.

Dowager’s Hump

After extensive research on the subject, I discovered that it was called “Dowager’s Hump.” It is a byproduct of your head “falling off” while being hunched forward.

When I played video games with my face close to the screen, and with my neck unnaturally extended, my body had to protect and respond to my head’s unnatural placement.

When you bend forward all the time, the posterior part of the vertebra starts to open up. When you crunch down on the anterior portion on the vertebrae, you can even end up with a bulging disk.

Your body responds by creating a hypertrophy response in the back of the neck.

Stretch and Strengthen

So, what you need to do is the following:

You need to use corrective stretching. Often, the damage is so severe that it is tough to bring yourself back to balance. However, I assume you’re young and pliable enough for the exercises I will show you.

The muscles within the neck muscles in the front, help support the “tucking in” of the head. These muscles are called deep neck flexors.

The stretching and corrective exercise routine balance out the neck muscles, so the deep cervical muscles are developed in proportion to the cervical extensors (muscles on the back of the neck).

Often, the long muscles of the back are very tight, and the deep neck flexors in the front are weak. This causes an imbalance that results in an ugly head posture in pectus excavatum patients.

You need to create balance by strengthening the front neck muscles and stretching the tight muscles at the back of the neck. You might need to get neuromuscular therapy and get someone skilled to mobilize the vertebrae for you.

The forward head posture can worsen with time. It would be in your interest to integrate the exercises I showed you in your daily life. When you do core exercises, try to press with your tongue on the roof of the mouth.

It will contract and strengthen the cervical flexors, which is usually the weak part of the neck.


Forward head posture is a byproduct of kyphosis, but it is so common that it needs to be resolved on its own. You need to stretch the mucles of the back of the neck and strengthen the muscles on the front.

Shoulder Issues

In pectus deformities, the shoulders can be affected in several ways.

Uneven Shoulders

In this case, the shoulders don’t appear to be on the same level. They are imbalanced, which can cause problems if left untreated.

Scoliosis is often the cause of uneven shoulders in pectus excavatum patients. It puts excessive and uneven pressure on the sternum and ribs, which tilts the sunken breastbone. This usually happens in patients with asymmetric pectus excavatum.

Rounded Shoulders

This is a synonym for bad posture. This happens when the shoulders are hunched over.

Scapula Winging

This is also known as winging of the shoulder blades. It happens by lateral rotation of the shoulder. It causes the shoulder blades to stick out and look prominent.

As with other chest wall deformities, pectus excavatum patients can have scapulothoracic dysfunction. That’s when the scapula of the shoulders moves in an unnatural pattern.

It is caused by weakness, imbalance, muscular tightness, detachment of scapulothoracic muscles such as the serratus anterior, latissimus dorsi, rhomboids, and trapezius muscles.


Scoliosis is an irregular, sideways curving of the spine, which can often be seen in patients with pectus excavatum. Usually, such spinal problems can be seen in asymmetric pectus deformities.


If you want a good posture, you must have strong and healthy shoulders. Fixing shoulder problems will have amazing impact on your overall well-being.


Even though most pectus excavatum sufferers are skinny, their stomach and belly can look swollen, as if they have a “potbelly”.

Most of the time, this is further exaggerated if the patient has flared ribs. Forward pelvis rotation (anterior pelvic tilt) makes the spine curve, making the abdomen protrude more. This is related to poor muscular tone.

On rare occasions, the potbelly appearance can be caused by a posterior pelvic tilt, in which the hips are tilted ahead or behind.


There is a natural lordotic curve that is entirely normal. However, if the curve bends too far inward, it will affect the lower back, and sometimes, even the neck.

This is called Lordosis. You can feel muscle pains because of this. Lordosis is often related to anterior pelvic tilt and “potbelly”. This can be fixed with proper physical therapy and strengthening the abdominal and lower back musculature.


Potbelly and Lordosis are less common than the previously mentioned posture issues. However, if you notice some of the symptoms, make sure you correct these problems.

Importance of Fixing Pectus Posture

The purpose of a corrective exercise program to fix “Pectus posture” is to make patients straighten their thoracic spine, and pull their shoulders back and down, establishing a “military” posture.

In actuality, every type of exercise is useful for dealing with a “Pectus posture.” Take running, for example. It forces the patient to stand up straight and breathe deeply.

This also helps with improving muscle tone. The same goes for other sports like basketball, football, swimming, etc. In general, exercising is proven to improve the patient’s well-being.

It will also help with confidence, which will allow the patient to stand more upright, which will improve its posture.

What to Do Before Starting

Before starting any posture correcting exercise plan, the pectus excavatum sufferer needs to be motivated.

If not, he/she will feel like it is a waste of time. In my experience, the quickest way to motivate yourself is to look yourself in the mirror and observe how attractive your body looks when you stand up straight with a good posture.

See how much of a role the posture plays in the sunken chest appearance.

Biggest Problem

Most patients trying to repair their pectus excavatum deformity don’t focus enough on improving their posture. They think that adding muscle mass to the chest muscles will “fill” the dent so that it will be less noticeable.

Unfortunately, things aren’t as easy as this. In some cases, working out the chest muscles will worsen your posture, making the sunken chest appearance more evident.

I was a victim of this mentality. All I focused on were my chest workouts. I wanted to build those flashy mirror muscles without paying any attention to the back muscles needed for optimal posture.

I thought stretching was for women, and that it was a waste of time. Surprisingly, the more I went to the gym, the more my inverted chest deformity worsened.

Then I realized that improper workouts made my posture worse. I was skipping days when I was supposed to work my muscles on the back and legs.

I replaced them with chest workouts. It was like that until I felt a sharp pain in my shoulders. I decided to find the source of the pain, and I realized that I was simply working out improperly


Improving your Pectus posture will make you a lot more confident. You will be finally walking upright, and people will notice. Good posture will also make your deformity less obvious.

4 Exercises to Fix Pectus Posture

I stumbled upon an article that described what a “Pectus posture” was. It was an article written by the McMaster Children’s Hospital, and it included corrective pectus excavatum exercises for the posture.

I started implementing those exercises and saw a noticeable improvement in my appearance, mainly because my posture improved. Let me share with you these exercises, with a slight modification that I figured out would be even more beneficial.

1. Sacrospinalis Exercise

To start this exercise, you need to put the hands behind your head, with the fingers interlocked. Pull the elbows back as much as you can, while keeping your head and neck in a straight position.

In this position, you can feel how your chest is filling up anteriorly. When you achieve this position, bend from the hips forward and down until you reach a horizontal position.

Hold here for two seconds, then straighten up again. It is critically important for the elbows to stay in the first place. Try to endure any type of discomfort you feel.

Make sure you don’t flex the neck in this position. You will activate muscles that you don’t need. Ensure that your spine is in a straight line when you reach the horizontal position without flexing the neck muscles.

Repeat this exercise for 30 times in a session.

2. Pec Strengthening Exercises

There are two beginner-friendly pec strengthening exercises that you can safely do to improve your “Pectus posture.”


The first one is a simple push-up. This is probably the most popular exercise worldwide. However, not everybody knows how to perform it properly.

On the other hand, if you execute this exercise correctly, it will activate a lot of muscles required for a healthy posture, including your core.

Aim to perform 30 push-ups in each session. If you can’t do them at once, try to divide them into two or more sets. Make sure you’re performing the exercise correctly, so it will activate your pec muscles.

Dumbbell Fly

Do this dumbbell fly modification if you suffer from a very poor posture, and you already have pain in your shoulders.

The classic dumbbell fly is done on a bench, with heavier dumbbells, which puts a lot of excessive stress on the shoulders, which in your case are probably more prone to injury as a result of poor posture.

To do the second exercise, you need to lay on the ground, on your back. Bend at the knees for more stability. Grab some small dumbbells in both hands.

Then, straighten your arms and position them to a 90-degree angle to your body. While keeping your arms straight, bring them together at the midline above your chest.

As I said, this exercise is a lot easier on your shoulder joints because it starts on the ground. This is more of a beginner-friendly dumbbell fly, suitable for strengthening the chest without any negative consequences on your joints.

3. Chest Expansion

You start this exercise by inhaling as much air as possible while pulling the shoulders back and down. Then, hold the breath for as long as you can with the chest pushed outwardly.

Do this while you’re standing up straight with a robust posture, with your shoulders back. When you’re inhaling, you should expand your chest as much as you can, until you reach the “military” position.

The point of this exercise is to see how long you can hold the air while keeping the posture stable. This exercise will increase your VO2 max capacity and expand your lungs.

Repeat it 30 times in a session. This short workout program doesn’t take any time at all. All you need is 10 minutes of your day.

The authors of the article recommended that the patients execute the exercises immediately after waking up in the morning and the last thing before going to bed in the evening.

Keep in mind that this program won’t pull the sternum out of the dent. However, it will improve your “Pectus posture,” which will make your abnormality less evident.


Performing the four exerises will improve your Pectus posture and strengthen the musculature in your chest and back.


What You Shouldn’t Do

You shouldn’t train your chest only, while neglecting your back muscles. Don’t ever walk, or sit, with your shoulders rounded and with your head sticking forward.

Even though you may feel the urge to do this, try to fight it off. The best way to walk straight with a robust posture is to walk with an upright posture. Fake it till you make it.

What To Do

You must stretch the tight musculature in your neck, shoulders, chest, and hips, daily. Focus on building your back musculature, by working out the musculature responsible for the “pulling” pattern more than the muscles for the “pushing” pattern.

Practice proper posture in your everyday life. Perform yoga in addition to the posture improving exercises I mentioned above. Exercises that contribute to strengthening the back and improving “Pectus posture are:

  • Deadlifts
  • Wide-grip pull-ups
  • Face pulls
  • Rear delt flys
  • Dumbbell or Barbell rows
  • Supermans
  • Cobra stretch
  • Downward facing dog stretch
  • Chest wall stretch on the wall

Performing these exercises, in addition to the three exercises I showed you above, and practicing proper posture throughout your day will do wonders for your poor “Pectus posture” and your chest wall appearance.

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