Pectus excavatum exercises: which to do and how to start

By Javier Santana, founder of Pectus Academy · Updated October 2026

Short answer: yes, exercise helps. Working on posture, breathing and the muscles of the chest changes how the chest sits and how it looks, and it is the core of our 16-week program. What works is not “doing chest”, but combined, consistent work: opening the upper back, expanding the ribs as you breathe and strengthening the muscles that support the rib cage. Below you will find seven exercises to start at home, explained step by step.

Why can pectus change with exercise?

Because the chest is not a rigid block. The ribs join the breastbone through cartilage, and rib cartilage is a flexible tissue, more so the younger you are. Posture, the way you breathe and the muscles around the rib cage all affect how that whole structure sits: a rounded back and forward shoulders make the dip stand out more, and correcting them changes it.

I started at 33 and managed to change mine with exercise and posture work; that is why Pectus Academy exists.

What does the evidence say?

• Mayo Clinic notes that some physical therapy exercises may improve posture and increase how far the chest can expand.
• In a randomized trial of 26 boys aged 11 to 18, the group that did physical therapy on top of the vacuum bell improved more in depth of the dip, posture and satisfaction at 12 weeks. We cover it in vacuum bell and exercises.
• In a published case, a 22-year-old man with moderate-to-severe pectus followed three months of individualized physical therapy, with breathing and therapeutic exercises. The severity index the authors used, measured in milliliters of water, fell from 50 to 20, and the shoulder pain he had went away. It is a single case, but it is an adult and the change was measured.
• More research is under way: in 2025 the protocol was published for a study that will measure how posture changes with physical therapy in people with pectus excavatum.
• Published studies are still few and small, so this work also draws on biomechanics and practical experience. You can find them all in the research library.

What do you work on, and why?

These are standard exercises in physical therapy and strength training. Weighted chest work is covered in pectus and the gym; here are the ones you can do at home.

7 pectus excavatum exercises you can do at home

All you need is a mat, a resistance band and a foam roller; if you have no roller, a large towel rolled up tightly will do. Do them slowly and without pain: precision matters here, not load.

1. Thoracic extension over a foam roller

• How to do it: sit on the floor with the roller behind you, at a right angle to your spine, and lie back until it sits at shoulder-blade height, never under the lower back or the neck. Hips on the floor, knees bent, feet flat and hands behind your head to support your neck. Let your upper back extend over the roller, without forcing it, and breathe deeply.
• How much: 30 seconds in each position, moving the roller an inch or so up or down without leaving the shoulder-blade area; 2 or 3 minutes at first.
• Common mistake: arching the lower back or letting your head drop back.

2. Thoracic cat-cow

• How to do it: on all fours, hands under your shoulders and knees under your hips. Bring your breastbone toward the floor, eyes slightly ahead of your hands, trying to move the middle of your back and not just the lower back. Then push the floor away and round your back, lifting the middle of it toward the ceiling.
• How much: 10 slow cycles, about 3 seconds each way; 2 sets.
• Common mistake: moving only from the waist or rushing.

3. Rib breathing with your hands

• How to do it: sitting tall, place your hands on the sides of your ribs. Breathe in through your nose, trying to push your hands outward with your ribs, hold for 3 seconds and let the air out slowly.
• How much: 3 sets of 10 breaths. If you feel dizzy, stop and breathe normally.
• Common mistake: lifting your shoulders or filling only your belly.

4. Forearm wall slides

• How to do it: stand facing a wall, about 12 inches (30 cm) away, with your forearms resting vertically on it, parallel and shoulder-width apart, and your elbows at 90 degrees. Without lifting your forearms off the wall, slide them up until your arms are almost straight, pressing gently into the wall, hold for 2 seconds at the top and come back slowly. This works the serratus anterior, the muscle that holds the shoulder blade against the ribs.
• How much: 2 or 3 sets of 12 to 15 reps.
• Common mistake: shrugging your shoulders toward your ears or arching the lower back.

5. Prone chest lift

• How to do it: lie face down, arms by your sides and palms facing the floor. Lightly squeeze your glutes, draw your shoulder blades together and down toward your waist, away from your ears, and lift your chest an inch or two off the floor, eyes on the floor and neck long. Hold for 1 or 2 seconds and lower slowly.
• How much: 2 or 3 sets of 10 to 12 reps.
• Common mistake: craning your neck back, using momentum to come up or arching your lower back by lifting too high.

6. Band row

• How to do it: sit on the floor with your knees slightly bent and the band hooked securely around the arches of your feet (check that it cannot slip off), or stand with the band tied to a solid fixed point at navel height. First squeeze your shoulder blades together, then bend your elbows and bring your hands toward your abdomen, elbows close to your body. Squeeze for a second and return slowly.
• How much: 2 or 3 sets of 10 to 12 reps.
• Common mistake: pulling only with your arms or leaning your torso back.

7. Doorway chest stretch

• How to do it: stand next to the door frame and rest your forearm on it with your elbow bent to 90 degrees, at shoulder height or slightly higher, then turn your torso away from that arm until you feel the stretch across your chest and the front of your shoulder, with no sharp pain. Breathe deeply, opening the chest.
• How much: 30 seconds, 3 times per side.
• Common mistake: pushing until you feel pain or tingling in your arm.

How do you put a session together?

In this order: mobility first (1 and 2), then breathing (3), then activation and strength (4, 5 and 6) and, to finish, the stretch (7). With 2 sets, all seven take about 25 minutes. For the strength exercises (4, 5 and 6), start with 2 sets and move to 3 once the reps are clean.

Mobility and breathing can be done every day. Do the strength exercises 3 or 4 days a week, never more than two days in a row.

How long and how often?

Consistency matters more than intensity: a little every day beats a lot once in a while. Our 16-week program proposes 30 to 40 minutes a day, and for the first three days it starts with a 12-minute, no-equipment activation protocol. These seven exercises are the way in; in the program they are laid out week by week, with progression, gym work and a breathing protocol. For reference, in the trial above the physical therapy program lasted 12 weeks.

What can you expect?

• Posture and appearance: this is where you notice it first. As the chest opens and the shoulders sit back, the dip stands out less.
• Breathing: more chest expansion and more control over your breathing.
• Muscle: a more developed chest and back change the outline around the dip.
• The dip itself: this takes the longest and varies the most from person to person: the younger and more flexible the chest, the more room for change there is. In my case it changed, and an improvement was also measured in the published case of the 22-year-old adult. If you are over twenty, see pectus excavatum in adults.

Every case is different: what changes, and how much, depends on age, the depth of the dip and consistency. We do not promise a specific result, and exercise does not replace a medical assessment if you have symptoms.

Can any exercise make pectus worse?

No specific exercise deepens the dip, as far as we know. What makes it look worse is imbalance: training only chest and abs and leaving out the upper back encourages a closed posture, which is what makes the dip stand out most. That is why back, serratus and mobility work always goes together with chest work.

When should you stop and see a doctor?

Before you start, talk it over with your doctor, especially if you have symptoms. If you notice shortness of breath, chest pain, palpitations or dizziness during exercise, stop and see a doctor. In some cases pectus reduces exercise tolerance, and that is assessed with tests, not with a routine; we explain it in pectus excavatum and sports. If you have had surgery and have a bar in place, follow your surgeon's instructions.

In short

• Exercise improves posture and can increase chest expansion, and that changes how the chest looks.
• It works as a whole: mobility, breathing, serratus, upper back and chest, done consistently.
• With seven exercises and about 25 minutes you can start at home.
• In one trial with teenagers, adding physical therapy to the vacuum bell gave better results than the bell alone.
• The result depends on age, the depth of the dip and consistency.

Where to start

With posture: get the free guide to the 4 posture mistakes. If you want the work laid out week by week, with every exercise explained, there is the 16-week program.

To go deeper: posture and rib flare, breathing, and pectus and the gym.

This content is educational and does not replace the advice of a healthcare professional. We do not promise a specific result.

Sources

1. Mayo Clinic. Pectus excavatum: diagnosis and treatment. mayoclinic.org
2. Alaca N, Alaca I, Yuksel M. Physiotherapy in addition to vacuum bell therapy in patients with pectus excavatum. Interactive Cardiovascular and Thoracic Surgery, 2020;31(5):661-668. doi.org/10.1093/icvts/ivaa161
3. Canavan PK, Cahalin L. Integrated physical therapy intervention for a person with pectus excavatum and bilateral shoulder pain: a single-case study. Archives of Physical Medicine and Rehabilitation, 2008;89(11):2195-2204. doi.org/10.1016/j.apmr.2008.04.014
4. Rezumeș MZ, Cațan L, Amăricăi E et al. The Impact of Physical Therapy on Postural and Myotonometric Disorders in Patients with Pectus Excavatum: Study Protocol. Life, 2025;15(10):1624. doi.org/10.3390/life15101624
5. Sharma G, Carter YM. Pectus Excavatum. StatPearls, updated February 15, 2026. ncbi.nlm.nih.gov/books/NBK430918