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Minor Pec Strain

I think I strained my right pec benching the other day, had a sudden cramp in the middle of a rep and dumped the bar rather than try to push through it because I instantly thought it was something bad. I wasn’t sure what really happened at first and I thought maybe it was just a muscle cramp but two days later if I stretch my pec there is this weird feeling in the muscle, not pain but something just feels off so I’m assuming it’s a very minor strain.

Any advice on how to deal with this? I was looking at the Bill Starr rehab protocol, but that seems to be more for serious muscle tears and not minor stuff like this. I’m trying to avoid letting it become a serious injury and I want to get back to training as normal soon.

@j4gga2 - you seem to have some useful ideas on stuff like this

If you do have a muscle strain/tear, when you poke around in the muscle belly you should find/feel a small, distinct region that feels very tight and sore. In a full tear, you might even feel a palpable hole/gap in the muscle fibres.

Management wise, break it down into progressions. Here are some principles:

  • Do not rest the muscle. Return to suitable training ASAP and modify the training accordingly. As time goes on, you can start to reintroduce “normal” training activities. Training will be quite different for 1-2 weeks, and then start to “return to normal”
  • Training through/with pain is okay, as long as it’s tolerable (~4-5/10 or less) and does not get significantly worse through training. This will require minimising load to start with
  • At the beginning, stay away from heavy loading at endranges. As time moves on and symptoms improve, return to end-range loading. For example, you could consider replacing comp benching with floor pressing or benching against chains/bands/reverse bands for a period of time. This may have to be in “middle-stages” from about 1-2 weeks from now. DB Flyes are definitely out right now, but would be a useful activity to use at end-stages (probably 2-3 weeks from now) depending on symptoms
  • Lots of reps early on. The muscle probably can’t tolerate very high-tension environments now, so lots of volume is a good option

I guess, if I had to summarise it:

  • Tolerable levels of pain are okay (~4-5/10) as long as it doesn’t get worse during or after training
  • Lots of volume early on
  • Maintain the skill of benching
  • Minimise eccentric loading and loading at end-range early on
  • Emphasise eccentric loading and loading at end-range at the end
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Can vouch, this is spot on for minor strains.

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Yeah I have something like that, it feels sort of like DOMS but only in one spot. I didn’t do enough benching before the injury to cause any soreness and I cut it right after.

Is it better to do something for the pecs more often, like every day? I was thinking maybe do a few sets of pushups or band flys daily. I normally bench twice a week.

What about overhead pressing? It doesn’t really involve the pecs a whole lot so is it ok to push that or should I take it easy on all pressing for now?

We don’t rest injured muscles anymore? :thinking:

If you slow down, You Go Down!

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Not really.

In the management of acute soft-tissue injuries, “rest” is a relative term. We shouldn’t be “resting” injured sites outright, but we should be protecting them from inappropriate stressors. An inappropriate stress in this case would be benching maximally or doing 8-12RM DB flyes. An appropriate stress would be sets of 12-15 reverse-banded bench at an RPE 6, or banded crossovers.

In line with this, current acute injury management guidelines are not exactly like the RICER we’re used to. BJSM published “peace & love” relatively recently. This is the most up-to-date consensus on acute injury management

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I don’t think it’s a bad idea, but you might see diminishing returns with frequency above 3-4x per week. I particularly like the idea of push-ups. You can start with shortened/partial ROM early on (may not need to, depending on symptoms), but over time progress to using handles/blocks/pates/whatever to increase your ROM and get that end-range loading we need in later stage management.

If pushups exceed the current 5/10 pain ceiling, then the banded flyes are an awesome choice since you can load the pec through an almost complete ROM whilst greatly minimising the load required when the muscle is lengthened

It should be okay, but it’s up to you to test the waters. No need to deload all pressing - as with all injuries, find what you can push, and push it hard

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Also FWIW, this is completely normal.

Clinically, muscle strains are graded 1-3, with 1 being mild and 3 being full thickness. DOMS often presents so similarly to a muscle strain that some guidelines refer to it as a Grade 0 strain (symptoms but no loss in strength)

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Interesting. But a little internet sleuthing indicates the ‘P’ is in fact ‘R,’ with the proviso that the rest period should be as short as possible.

So respectfully, I would suggest the admonition ‘do not rest the muscle’ might be better phrased along the lines of ‘rest the muscle for as brief a period as possible–preferably no more than 3 days. Use compression (rather than NSAIDs) to minimize swelling. Return to loaded activities ASAP, using pain level as a guide.’

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I was just wondering if maybe it would speed up healing, the Starr rehab protocol involves training the muscle daily with light weights for two weeks and people who tried it said it works, although it’s not exactly a scientific approach.

re:NSAIDs - what about CBD oil? Good, bad, or inconclusive?

I truly appreciate you taking the time to discuss this. I love getting to discuss this stuff with other experienced professionals.

I have no doubt that resting the muscle for 3-4 days will not delay anybody’s recovery significantly, however I don’t think early return to activity will delay his recovery either.

The way I see it is that we can alter the loading activities so provide a stimulus without breaking our pain threshold or contributing to further damage. Early loading should, in fact, improve arrangement of new collagen and reduce pain sensitisation in the area. It will also help restore full range of motion sooner. As such, we can load immediately, especially with a mild injury such as this one, if the loading parameters are appropriate. Also, if I interpreted Chris’s initial post correctly, a few days have already passed since he got the injury, so he should be ready to with loading.

There isn’t much data on pec strains at all, but there’s good data to show early strength training and pain-threshold training post hamstring strains leads to similar outcomes, sooner, in comparison to more conservative approaches. Anecdotally, and again with hamstrings, most pro teams use quite aggressive RTP protocols for hamstrings, similar to what I’ve described

Ill also add that I am fairly aggressive with RTP/rehab protocols, and these recommendations fall in line as such

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Pharmacology is out of my wheelhouse so this is probably a question for @EyeDentist

My understanding is that CBD works by affecting your descending pain modulation system, like a native painkiller. In contrast, NSAIDs block production of inflammatory mediators called prostaglandins. My inference then, is that CBD could help manage symptoms but not necessarily accelerate healing, unless it helps you return to loading sooner, and thus speed up RTP

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It was Wednesday, about 48 hours now. Tomorrow is supposed to be an other bench workout, I’m going to do overhead press and see how that goes then do some real light benching, maybe sets of 25 or so. I did a few band flys with a super mini band (very low resistance) and when I squeeze the pec there is a sort of pinching feeling but I wouldn’t even describe it as pain, more like a minor discomfort.

My plan is to keep reps high and stay away from failure on anything involving the pecs. I’m going to see if I can push OHP instead for now and do a bunch of tricep work. Maybe a reactive slingshot (the blue one) would be useful? I have a yellow one which is too tight on my arms and the black one which is double ply, not exactly a rehab tool.

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In that case, I’m sure @EyeDentist and I agree that you’re good to go tomorrow. Your plan sounds good. Don’t be afraid to hit the pecs with some volume, banded pec decks/crossovers would be $$$ at this time to load the pecs

I don’t know man… I’ve never messed with it but it could be something useful. Maybe not in your case, but in someone who had to take 4-6 weeks off, this could be really useful in early to mid stages to reintroduce heavy loading whilst reducing strain on the injury site

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Indeed, NSAIDs work by blocking the production of pro-inflammatory cytokines–PGs as you mentioned, along with several other cytokine families. The upside is that NSAIDs reduce the magnitude of the deleterious effects of these pro-inflammatory cytokines, eg, swelling and pain. The downside is that NSAIDs also block the healing effects induced by these cytokines. Apparently, PEACE practitioners have concluded the ‘cost’ (in impaired healing) of NSAID use outweighs the benefits (reduced swelling and pain) it imparts.

Relatedly, and in case anyone is wondering: Because of the similarity in mechanism of action, the same cost/benefit analysis would apply to (cortico)steroid use. So, no kenalog/prednisone either.

As for the use of non-NSAID analgesics: I suspect that, in the context of an aggressive rehab approach such as being advocated by @j4gga2, one would need to be very cautious in this regard. This is because the PEACE approach is heavily dependent upon accurate self-assessment of pain levels in order to determine how hard to work the injured muscle. Given this, the last thing one would want to do is to mask pain, as a spuriously low pain self-assessment would lead to an inappropriately high work demand.

I know nothing about the use of CBD oil in situations such as this. My advice in that regard would be to prioritize info coming from well-regarded sources (eg, the Mayo Clinic) rather than elsewhere.

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Regrettably, no. In the interest of not jeopardizing my good standing with the Board of Medicine in my state, I must adhere to customary medical practice, which dictates that I refrain from dispensing anything that might be construed as medical advice to someone with whom I do not have a doctor-pt relationship.

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Very understandable. Nonetheless, your advice and input is greatly appreciated :slight_smile:

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The thing is that I need about 400 on the bar to use the black slingshot, and that’s around my max bench. If anything maybe I will try to squeeze into the yellow one, it’s a size too small for my arms so it’s pretty uncomfortable.

I’m training in my basement so I have bands and adjustable dumbbell handles. I was thinking to do some high rep flys after benching.

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I think that’s a good idea. Just remember that if your pain increases during or after, you probably went a bit overboard with it

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