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The pectoralis muscle, commonly known as the pec, is a large, powerful muscle that plays a significant role in various upper-body movements, including pushing and lifting motions. The pec muscle is comprised of two muscles: the pectoralis major and the pectoralis minor. The pec major is a fan-shaped muscle located closer to the surface, while the pec minor lies underneath and is responsible for movements of the scapula (shoulder blade). A pec strain or tear can occur during intense exercises, especially those involving bench-pressing, throwing, or lifting heavy objects, and can result in pain, weakness, and restricted movement. Treatment for a pec strain depends on the severity of the injury and can range from conservative treatments such as rest, ice, medication, and physical therapy to surgical intervention in more severe cases. Early rehabilitation is crucial for optimal recovery, focusing on light activation and progressive strengthening of the injured area.
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What You'll Learn
Rest and ice the injured area
Rest and ice are two key components of the RICE (rest, ice, compression, elevation) method, which has been widely recommended by sports physicians for muscle injuries. In the case of a pec muscle injury, resting the injured area is crucial to prevent further damage and to promote healing.
Immediately after a pec muscle injury occurs, it is advisable to cease any activity that may have caused the injury. This is because, in the first 24-48 hours after a pec muscle injury, there is active bleeding and swelling around the injured muscle. Although swelling is a necessary part of the healing process, excessive swelling can delay healing and cause additional tissue damage. Therefore, resting the injured muscle is essential to control the amount of swelling and limit further damage to the muscle.
In addition to rest, icing the injured area is an effective way to decrease swelling and control pain. When icing a pec muscle injury, it is recommended to use crushed ice wrapped in a moist cloth or towel. This should be applied for 10 minutes on, then 10 minutes off, and then 10 minutes on again, every 2 hours. This timing is designed to reduce the risk of nerve damage from ice burn. Icing can be continued until you are able to consult a sports medicine professional, which should be done as soon as possible, ideally within the first couple of days following the injury.
It is important to note that the guidance on muscle injury treatment is evolving. While rest and ice have traditionally been recommended, some sports medicine physicians now suggest that movement, rather than rest, may aid recovery in certain cases, and that icing is not always the most effective treatment. That said, for pec muscle injuries, rest and ice can still play an important role in the initial phases of recovery, helping to control swelling and pain.
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Avoid activities that increase blood flow to the injured muscle
To fix a pec muscle injury, it is important to avoid activities that increase blood flow to the injured muscle, especially in the first few days following the injury. This is because bleeding and swelling around the injured muscle are most active during the first 24-48 hours. Although swelling is a necessary step in the healing process, excessive swelling can delay healing and cause further tissue damage.
- Hot showers
- Pectoralis stretching
- Heat rubs
- Massage
- Alcohol consumption
- Excessive use of the arm
These activities can prolong muscle bleeding and exaggerate swelling, resulting in increased pain and a longer recovery period. It is important to give the body time to repair itself and to seek professional advice if needed.
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Seek professional help to determine the extent of the injury
It is important to seek professional help to determine the extent of the injury and receive personalised advice on the appropriate treatment plan. A trained health professional, such as a physiotherapist, can assess the severity of the injury and provide guidance on the next steps. This is particularly crucial if there is a complete tear of the pectoralis major muscle, as a referral to an orthopaedic surgeon or radiologist may be necessary.
The first 24-48 hours after a pectoralis major strain are critical, as this is when the majority of the bleeding and swelling around the injured muscle occurs. To manage this, it is essential to rest the muscle and apply ice to reduce swelling and limit further damage. Consulting a sports medicine professional or a physiotherapist during this initial phase is highly recommended to optimise recovery and prevent long-term complications.
A physiotherapist can advise on specific treatments, such as the R.I.C.E. method (Rest, Ice, Compression, and Elevation), and prescribe targeted exercises to aid healing and prevent future injuries. They can also determine when it is safe to initiate stretching exercises, as stretching the pec muscles too early may worsen the injury.
In some cases, particularly for younger and athletic individuals with complete or near-complete ruptures, surgery may be required to restore function. Surgical intervention involves repairing the ruptured tendon back to its original location on the upper arm, and patients typically return to competitive activity around six months after surgery.
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Minor tears: rest and graded return to strength training
Minor tears in the pec muscle can be treated with rest and a graded return to strength training. The first 24 to 48 hours after the injury are critical, as this is when bleeding and swelling are most active. To reduce swelling and limit damage to the muscle, it should be rested and iced. Crushed ice wrapped in a moist cloth or towel can be applied for 10 minutes on, 10 minutes off, every 2 hours. This process should be continued until you consult a sports medicine professional, ideally within the first few days after the injury. During this early phase, light activation of the injured area is recommended, along with building up the scapular stabilizers surrounding the pec.
In the first few days following the injury, activities that increase blood flow to the injured muscle should be avoided. These include hot showers, heat rubs, massage, alcohol consumption, and excessive use of the arm. Such activities can prolong muscle bleeding and increase swelling, resulting in prolonged pain and recovery time.
During the middle phase of rehabilitation, the pectoralis muscle can be challenged with more intense exercises, such as push-ups. Starting with wall push-ups and progressing to eccentric push-ups can help stimulate growth and repair.
In the late phase of rehabilitation, the focus shifts to building and strengthening the pec muscle, gradually increasing weight and load. It is important to consult a physiotherapist for targeted exercises that aid healing and prevent future injuries. They can assess the extent of the injury and provide personalized advice on the appropriate treatment plan and when to initiate stretching exercises.
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Major tears: surgery and immobilisation
Pectoralis major tears are uncommon but are increasingly becoming a frequent cause of disability. The injury typically occurs in males between the ages of 20 and 40 years, with the most common cause being weight lifting or chest exercises. The pectoralis tendon tearing away from the bone is the most common injury pattern.
Once the pectoralis is torn away from the shoulder bone (humerus), it will not grow back and heal on its own. While other arm muscles can enable the shoulder to move, they cannot fulfill all the functions of the shoulder, especially the motions of adducting the shoulder and internally rotating the shoulder with force.
Surgery is recommended for patients with complete tears of the pectoralis muscle tendon and those who need to regain full strength and function, such as athletes. The surgical procedure generally involves making a small incision on the upper arm where the tendon attaches or, in some cases, a 4 cm incision about the shoulder. The muscle is then repaired to the humerus bone by creating a small trough in the bone and attaching the muscle with non-dissolvable stitches or small screws.
Post-surgery, patients are recommended to keep the affected arm immobilized in a sling for 3 to 6 weeks to facilitate initial healing. Passive and active exercises are introduced over the following months, with light weightlifting allowed at approximately four months. Patients typically return to competitive activity around six months after surgery, although full function is expected between 6 to 12 months.
Some potential risks and complications of pectoralis major repair surgery include bleeding, infection, stiffness, failure to heal, blood clots, and damage to nerves, blood vessels, and surrounding tissues.
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Frequently asked questions
A pec muscle strain is a tear in the main muscle across the front of the chest. The pectoralis (pec) muscle is comprised of two muscles, the pec major and the pec minor. The pec major is the biggest of the chest muscles and is located superficially (closer to the surface). The pec minor is located under the pec major and is mainly responsible for movements of the scapula (shoulder blade).
The first sensation felt when the pec muscle is torn is sudden pain, usually felt at the front of the armpit and sometimes across the chest. Other symptoms include bruising, weakness, and a "pop" in the upper arm. There may also be a visible change to the contour of the upper arm and armpit.
A pec muscle strain can be caused by various activities that put additional strain on the pectoral muscles, such as intense exercises, especially those involving bench pressing or throwing, or strenuous workouts involving lifting heavy objects. Poor form during exercises can also contribute to a pec muscle strain.
The treatment for a pec muscle strain depends on the severity of the injury. Minor tears may only require rest, ice, and pain medications. More severe tears may require surgery, especially if the tendon or muscle belly was fully ruptured. Physiotherapy and targeted exercises are also important for the rehabilitation process to aid healing and prevent future injuries.
To prevent a pec muscle strain, it is important to practice good form during exercises and avoid overloading the muscles with excessive weight or strain. Maintaining proper upper body posture and mobilizing the upper back joints can also help reduce chest muscle tightness and improve long-term chest muscle mobility.
