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Jul
16

Steps to improve your Pectus Excavatum

When improving your pectus excavatum through exercises it is important to create an exercise program which targets the following:

  • 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 areas 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.

An Example Daily Routine

Stretching Exercises

1. Forward arm stretching in pone kneeling

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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 – standing

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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 – sitting

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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

Strengthening Exercise

1. Weight lifting in stretch supine – lying

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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

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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

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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)

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The patient is positioned 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.

Jun
16

1. The first step will be a course of antibiotics at the time of surgery to prevent infection and reduce the development of pneumonia. This surgery is performed under general anesthesia with a muscle relaxant and epidural block for both operation and pain control purposes.

2. The patient is then positioned with both arms extended out sideways to allow better access to chest wall. Padding under the arms will prevent any neurologic injury.

3. The patient is then draped, and the chest is marked and sterilized. The deepest section of the pectus is marked. If the deepest point of the pectus is inferiro to the sternum, then mark the lower end of the sternum. Using this point, establish a horizontal plane across the pectus area. Extend the horizontal plane to the lateral chest wall and mark between the anterior and midaxillary lines for transverse lateral incisions.

4. The preop chest measurements are then double chcked. And the proper bar is then selected for beind into the desired chest wall curvature. A bar will be chosen specifically for your chest that will give you maximum stability and correction.

5. Using the pectus bender, the bar is shaped from the center outward making small gradual bends. It may be necessary to exaggerate the curvature slightly to allow for chest wall pressure downward force on the sternum. Avoid bending the lateral ends of the bar.

6. 2.5cm incisions are then made at the marks previously made. A skin tunnel is raised from both incisions to the top of the pectus ridge at previously selected space. The pectus bar then enters the chest slightly elevated from the pectus ridge.

7. A thoracoscope is used during the procedure to get an idea of where all the surrounding organs are in order not to damage them. The pectus bar is then entered from the patients right side with the proper pectus introducer in order to make a tunnel for the implant. Small introducers are used for patients 4 to 12 years old and the longer one for patients 13 – 20 or older.

8. The introducer is slowly eased in through the side of chest and pushed through to the other side of the chest. From here the surgeons can begin elevating the sternum.

9. The sternum is then lifted into place from both sides. Pressure is applied above and below the sternum to obtain the desired curvature of the sternum. This process may be repeated a few times in order to stretch the connective tissue and correct the deformity prior to inserting the main bar. Two strangs of umbilical tape are then tied through each end of the hole this will be later used to guide the bar through the hole.

The bar is then inserted and flipped into a position that will push the sternum outwards to the desired position.

10. At this point the stability of the bar is checked. Depending on how stable the bar is it will dicatate if any stabilization need take place. Patients typically require one bar to achieve correction but some may have 2 or 3 for more severe deformities.

A stabalizer bar is then fitted to each end of the pectus bar. Patients 4 to 13 years have one stabilizer per bar , and 14 to 18 years of age have one or two depending on patients muscular development and activity level (sports , gym e,g)

11. The bar and stabilizer are then secured to each other and to the chest wall and the bar and stabilizer are covered up. The incisions are then closed up and a chest radiograph is obtained postop to check for pneumothorax and is an excellent way to see final bar placement.

Jun
16

The most important aspect of improving the appearance of pectus excavatum is your posture. Working on general posture correcting exercises will help to bring the sunken sternum back to a normal position.

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