A. Definition
Chest mobility exercises are any exercises that combine active movements of the trunk or extremities with deep breathing.
B. Goals
Maintain or improve mobility of the chest wall trunk and shoulders when it affects respiration. For example, a patient with tightness of the trunk muscles on one side of the body will not expand that part of the chest fully during inspiration. Exercises that combine stretching of these muscles with deep breathing will improve ventilation on that side of the chest.
Reinforce or emphasize the depth of inspiration or controlled expiration. For example, a patient can improve expiration by leaning forward at the hips or flexing the spine as he or she breathes out. This pushes the viscera superiorly into the diaphragm and further reinforces expiration.
C. Specific Exercises
1. To mobilize one side of the chest.
While sitting, have the patient bend away from the tight side to lengthen tight structures and expand that side of the chest during inspiration.
Then, have the patient push the fisted hand into the lateral aspect of the chest, as he or she bends toward the tight side and breathes out.
Progress by having he patient raise the arm on the tight side of the chest over the head and side bend away from the tight side, This will place an additional stretch on the tight tissues.
2. To mobilize the upper chest and stretch the pectoralis muscles.
While the patient is sitting in a chair with hands clasped behind the head, have him or her horizontally abduct the arms (elongating the pectoralis muscles) during a deep inspiration.
3. To mobilize the upper chest and shoulders.
With patient sitting in a chair, have him or her reach with both arms over head (180 degrees bilateral shoulder flexion and slight abduction) during inspiration. Then have the patient bend forward at the hips and reach for the floor during expiration.
4. To increase expiration during deep breathing.
Have the patient breathe in while in a hook lying position (hips and knees are slightly flexed)
Then instruct the patient to pull both knees to the chest (one at a time to protect the low back) during expiration (picture). This pushes the abdominal contents superiorly into the diaphragm to assist with expiration.
D. Additional Activities
In addition, to exercises specifically designed to mobilize the chest, the therapist may also instruct the patient in:
- Posture correction.
- Manual stretching of the chest wall, trunk and extremities.