Posture and pectus excavatum: rounded shoulders and rib flare
By Javier Santana, founder of Pectus Academy · Updated October 2026
Short answer: posture does not cause pectus or correct it, but it affects how it looks. A rounded back and forward shoulders make the dip stand out more, and flared lower ribs accentuate it by contrast. It is the part that depends most on you and carries the least risk, although it has been little studied.
How are posture and pectus related?
- Spine changes such as kyphosis (a rounded back) and scoliosis often appear together with chest wall deformities.
- Mayo Clinic describes that many people with pectus adopt a hunched posture and avoid activities such as swimming.
- In a trial of 26 boys aged 11 to 18, adding physical therapy to the vacuum bell improved posture more than the bell alone.
For me, posture is the main thing. When I improved it, I looked and felt better. That is my experience, not a finding from studies.
What is rib flare?
It is when the lower edge of the ribs sticks out forward below the dip. Because it protrudes, it makes the center of the chest look even more sunken. It is often described alongside pectus, but we have not found studies measuring how much it changes with exercise.
What do people usually work on?
| What you see | What you work on |
|---|---|
| Forward head | Deep neck muscles and awareness of position |
| Rounded shoulders | Chest stretching and upper-back strength |
| Rounded upper back | Mobility into extension of the upper spine |
| Flared lower ribs | Breathing with rib control and deep abdominal strength |
This is the standard approach in physical therapy. None of these points has its own studies in people with pectus.
Do posture correctors help?
A corrector reminds you of the position while you wear it, but it does not strengthen anything. It can serve as an occasional reminder, not as a substitute for muscle work. We have not found studies on correctors in pectus.
When is it not just posture?
If you also have persistent back pain, a visible sideways curve in your spine, or symptoms such as shortness of breath or palpitations, see a doctor: the scoliosis and kyphosis associated with pectus are assessed in the clinic.
What we know and what we don't
What we know
- Postural changes often go together with pectus.
- Physical therapy improved posture in one small trial.
What we don't know
- How much the look of the chest changes with posture work alone.
- Whether rib flare decreases with exercise.
Where to start
With the free guide to the 4 posture mistakes. Then read which exercises help and which don't and how to work on breathing.
This content is educational and does not replace the advice of a healthcare professional. We do not promise a specific result.
Sources
- Sharma G, Carter YM. Pectus Excavatum. StatPearls, updated February 15, 2026. ncbi.nlm.nih.gov/books/NBK430918
- Mayo Clinic. Pectus excavatum: symptoms and causes. mayoclinic.org
- 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
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