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Pectoralis (pec) muscle strain

 The pectoralis (pec) muscles are large, highly visible muscles located on each side of the chest. Their primary job is to help the shoulders and arms move and lift. When you perform a push-up or chest fly, you are activating the pecs. Because they are among the strongest muscles in the body, they are less likely to be strained (pulled), but it can happen.

  • Grade 1 strains involve a few torn muscle or tendon fibers. Loss of strength is minimal, and recovery quite manageable.
  • Grade 2 strains involve more torn fibers, some loss of strength, and a longer rehab period.
  • Grade 3 pectoralis strains are rare, painful, debilitating, and can have long-term effects on strength, power, range of motion, and sports performance. In most cases, the muscle will never regain it original strength.

How It Happens

A strained pec can occur in two ways: a traumatic event or long-term overuse. An athlete can be injured when taking a hard blow to the upper body that the pecs cannot withstand.

A chronic strain is less dramatic—overusing the pecs to the point where they begin to tear, either in the muscle tissue or in the tendons that connect the pecs to the ribs and breast bone (sternum). The The Journal of the Academy of Orthopaedic Surgeons is more specific: “Pectoralis major muscle tears are relatively rare injuries that occur while lifting weights, particularly when doing a bench press.”

Who’s At Risk

Weightlifters are in the highest risk group, but the injury has been reported in rugby players, wrestlers, rodeo athletes, boxers, skiers, sailboarders, football players, hockey players and pole vaulters.

Symptoms

  • Severe pain in the chest area
  • Swelling, bruising (may extend into the shoulder and upper arm in severe cases)
  • Loss of strength, particularly when lifting
  • Difficulty in moving the arm across the chest

Initial Treatment

  • Apply ice packs for 15-20 minutes, 3-4 times a day for the first 48-72 hours
  • Avoid or limit any activity that causes chest wall pain
  • Get immediate medical attention if the strain is severe. Surgery is usually required for a complete pec rupture
  • Aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain. Aspirin, ibuprofen, and naproxen may relieve pain and reduce inflammation.

Comeback Strategy

As in recovering from any other muscle strain, think about returning to training and competition when pain has subsided, strength has been regained, and range of motion is back to normal, regardless of how much time has elapsed.

  • Grade 1 recovery takes a matter of days. You can return to training when the symptoms have disappeared.
  • Grade 2 recovery is a matter of weeks—approximately 2-6.
  • Grade 3 complete tears usually require surgery; full recovery takes months.
  • Cross-train in activities that do not stress the pectoralis muscles (walking, jogging, riding a stationary bicycle, lower body water exercises).
  • Go through each movement required in your sport without pain before resuming training or competition.

Prehab

Incorporate these exercises into your comeback routine:

1. Active Isolated Pec Stretch

  • Stand with one leg behind the other, keeping good posture
  • Lift your arms up, elbows straight out in front of you with palms up
  • Contract your back muscles to bring your arms out to the side, keeping your palms facing up
  • You will feel a gentle stretch in your chest
  • Don’t stretch to the point of pain
  • Repeat 10 times

2. Quadruped Stance

  • Start on your hands and knees
  • Comfortably shift your weight back and forth over your hands
  • Once you feel comfortable there, you can extend into a push-up position
  • Simply hold yourself in this plank position, gradually increasing your time
  • Do not hold until the point of pain

3. Resisted Internal Rotation

  • Starting with your arm at your side, hold a Thera-band or elastic tube that is tied off to the side on a stable surface
  • Using your right arm, the band should be on your right side
  • Gently rotate your hand in toward your belly button and then release
  • Repeat 10-15 times
  • Use a band that provides a gentle amount of resistance, but no pain.

How to Avoid This Injury

  • Allow more time for warm-up in cold weather.
  • Get help from a certified strength and conditioning coach to ensure proper lifting technique.
  • Do not increase exercises intensity, duration, or frequency more than 10 percent a week.

Movement Prep

Incorporate these exercises into your warm-up routine:

1. Hand Walks

  • Start standing up straight
  • Put your palms on the floor, keeping your legs as straight as you can
  • Walk your hands forward until you are in a plank position
  • Once you are there, leave your hands where they are and walk your feet towards your hands
  • Repeat 10 times

2. Active Isolated Pec Stretch

  • Stand with one leg behind the other, keeping good posture
  • Lift your arms up, elbows straight out in front of you with palms up
  • Contract your back muscles to bring your arms out to the side, keeping your palms facing up
  • You will feel a gentle stretch in your chest
  • Don’t stretch to the point of pain
  • Repeat 10 times

3. Resisted Internal Rotation

  • Starting with your arm at your side, hold a Thera-band or elastic tube that is tied off to the side on a stable surface
  • Using your right arm, the band should be on your right side
  • Gently rotate your hand in toward your belly button and then release
  • Repeat 10-15 times
  • Use a band that provides a gentle amount of resistance, but no pain.

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