The term “bird chest” is a common, non-medical phrase used to describe an unusual appearance of the chest wall. Clinically, this appearance refers to one of two conditions: Pectus Excavatum or Pectus Carinatum. Pectus Excavatum, or “funnel chest,” is the more common condition, involving the breastbone sinking inward to create a depression. Pectus Carinatum, or “pigeon chest,” is less frequent and involves the breastbone protruding outward. Solutions range from simple physical adjustments to specialized medical interventions, depending on the individual’s specific condition and severity.
Understanding the Condition and Severity
Pectus Excavatum and Pectus Carinatum are both congenital deformities caused by the abnormal growth of the cartilage connecting the ribs to the breastbone. Pectus Excavatum, which affects approximately 1 in 400 births, is the most prevalent chest wall abnormality. This inward depression often becomes more pronounced during the rapid growth phase of adolescence. Pectus Carinatum, in contrast, is characterized by an outward protrusion of the sternum, making it the anatomical opposite of Pectus Excavatum.
Mild cases are often purely a cosmetic concern, though they can still cause significant psychological distress and body image issues, especially in younger patients. More severe cases of Pectus Excavatum can compress the underlying heart and lungs, leading to symptoms like shortness of breath during exercise, fatigue, or chest pain. To objectively assess the degree of Pectus Excavatum, physicians utilize a measurement called the Haller Index, calculated from a CT scan of the chest. A Haller Index greater than 3.25 is typically considered severe and is one of the criteria used to recommend surgical correction.
Non-Invasive Physical Correction Strategies
For individuals with mild Pectus Excavatum, or those seeking to improve their appearance without medical devices or surgery, specific physical strategies can be highly effective. The goal of these non-invasive methods is not to correct the skeletal deformity itself but to minimize its visual impact and improve overall function through muscular development and posture correction. This approach focuses on building muscle mass around the chest depression and strengthening the muscles that support a healthy spinal alignment.
Exercises that target the back, shoulders, and core are particularly beneficial as they help pull the shoulders back and keep the spine straight, which immediately reduces the sunken appearance of the chest. Rowing motions, such as dumbbell rows, strengthen the upper back muscles, directly counteracting the forward-slumped posture often associated with the condition. Consistent practice of posture-improving exercises, like “wall angels” or overhead arm sliders performed against a wall, helps maintain a more upright stance throughout the day.
Strengthening the chest muscles, specifically the pectorals, through exercises like push-ups and chest flies, is also helpful. The increased muscle volume on the sides of the chest can soften the contrast with the sunken area, making the indentation less noticeable. Incorporating deep breathing exercises, such as diaphragmatic breathing, can also help expand the rib cage and improve lung capacity. These strategies require consistent dedication, with strength work performed three to five times per week for noticeable results.
Specialized External Correction Devices
When physical exercises alone are not sufficient, a doctor may recommend specialized external devices, especially for younger patients whose bone structure is still flexible. For Pectus Excavatum, the primary non-surgical medical option is the Vacuum Bell device. This device is placed over the chest depression, and a hand pump creates a vacuum that gently pulls the breastbone forward.
This non-invasive method works best for patients with mild-to-moderate deformities and a pliable chest wall, often those under the age of 12. Treatment typically requires the device to be worn for several hours a day over a period ranging from 12 to 24 months to achieve a sustained correction. For Pectus Carinatum, a custom-fitted chest brace is used to apply constant pressure to the protruding sternum, gradually pushing it back into a normal position over a similar time frame.
Medical and Surgical Solutions
For the most severe cases of Pectus Excavatum, particularly when the deformity causes functional impairment of the heart or lungs, surgical correction is the definitive solution. Surgery is also considered when non-surgical methods have failed or when the psychological impact is profoundly debilitating. The two main surgical techniques are the minimally invasive Nuss procedure and the open Ravitch procedure.
The Nuss procedure involves making small incisions and inserting a curved metal bar beneath the sternum using a video-assisted technique. This bar is then flipped to push the breastbone outward, instantly correcting the depression, and remains in place for two to three years before removal. The Ravitch procedure is a more traditional, open surgery involving a larger incision, the removal of abnormally grown rib cartilage, and manual repositioning of the sternum. While the Nuss procedure is often favored in pediatric patients, the Ravitch procedure may be preferred for older patients or those with rigid deformities. Both procedures boast high success rates in correcting the anatomical deformity and alleviating associated symptoms.