T Nation

Pec Tear Surgery/Recovery

I’ve read every thread I could that addressed pec tear surgeries and subsequent recoveries. Seeing as it’s been 3+ years since the most recent post on the topic, I thought I would start a new thread to get a conversation going.

As a quick summary as to my background: I’m a 44 yo former athlete; I’ve been strength training for 30+ years and continue to do so because I just love it. I no longer compete in any sport, I just enjoy staying in shape, strong, and dangerous :slight_smile: Long story short, training is part of my mental, physical, and spiritual health practice. My lifts are nothing special. I just love training.

On October 9, 2021 I was doing a typical upper body day. I hit my Wenning Warmups, then proceeded to a simple 5x5 flat bench. My flat bench max hovers between 330-340 lbs. I never truly max out. In fact, I rotate the flat bench in and out of my programming. On this particular day I was doing a 5x5 with 280 - a very sub-maximal weight with which I work often. I was on set 5, rep 2 when I felt the dreaded feeling in my right pec that is comparable to jeans tearing.

I soon began bruising pretty heavily down the inside portion of my right arm. I took ibuprofen sporadically and iced as often as possible over the next several days. On Tuesday, October 12, 2021, I went to an orthopedic doctor. He conducted a visual/physical examination, then did an ultrasound during which he could see some tearing, which prompted him to schedule me for an MRI.

My MRI was the morning of October 23, 2021. I received a call that following Monday asking me to come in for a surgical consult. My consult was on Thursday, October 28, at which time the doctor told me surgery was essential as the tendon needed to be reattached to the humerus, which would be accomplished via a “button”.

Surgery was Tuesday, November 2, 2021. I was in quite a bit of pain when I woke up from anesthesia. I used the pain medications extensively the following 2 days, but began weaning myself off of them on Friday (3 days post-op) and completely stopped using them by Sunday (5 days post-op). The day after surgery I had my first PT session in which he just moved the arm a bit and changed the dressing (no stitches, the incision was closed using glue).

One week post-op (November 9, 2021) I had my first “real” PT session. By this time, I had fabulous range-of-motion; I could completely move the arm on my own, including overhead, with very little pain. The main pain is at the attachment site, and (for some reason - seems weird to me) in my biceps when I try to flex. And just to be clear, this pain is not constant, just if I move my arm certain ways. At this PT session, as well as at the PT session on Friday, November 12, 2021, they had me do the following:

  • Walkouts (stand with hands on a table, then walk backwards until arms are in an “overhead” type of position)
  • Isometrics - arm hanging at side, press out on wall; arm bent at 90 degrees (as if shaking hands), press out on wall (outside of hand, away from body), then press in on wall (inside of hand, towards the body), then press towards the wall (fist on wall, like punching); arm bent at 90 degrees, elbow on the wall pushing back into the wall
  • Shoulder shrugs
  • scapula retractions

I have already noticed muscle atrophy and have been taking walks and keeping my calories in check to try to avoid as much fat gain as possible. I feel really good that they are already allowing me to do the isometrics, but I AM DYING not being able to lift. Has anyone on here gone through this surgery and recovery process? Anyone on here an expert on the topic so I can pick your brain? I’m now 5+ weeks since the injury and 2 weeks post surgery. I would love to be doing SOMETHING. I work out at home (free weights - barbell, dumbbells, rack, trap bar, etc), so I don’t have access to machines. I’m just hoping to lift SOMETHING. Perhaps some legs, some unilateral stuff on my left side (one arm DB press? etc…I’ve read how lifting your non-injured side can have positive effects on the injured side).

I’ll be purchasing a football/swiss bar when I’m able to begin pressing again. I think I’ll focus on utilizing that bar for quite some time before I press a standard barbell again. And when I do press with a standard barbell again I’ll definitely begin with partial ROM exercises (e.g., floor press, board press). I honestly feel so good 2 weeks post-surgery that I feel like I could do some very light pressing now, but I won’t until I have enough info to know I won’t put my repair in jeopardy. I would love to hear from some of you. I’ll take all the advice I can get! Even if some of us just commiserate together, haha.

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Also thinking about doing some occlusion training on my arms. I’m hoping that the surgically repaired side will be able to withstand very light biceps curls and triceps pressdowns but still maintain some muscle/strength by doing them with occlusion bands on.

Again, any help, feedback, personal experiences, professional knowledge would be greatly appreciated.

My 2cents/experience:
Start training the other side straight away will speed up healing. High reps, just get a lot of blood flowing in the upper body so to speak.

For the next couple weeks try get to a commercial gym and train legs hard.

Train non pec related movements on bad side as soon as doc gives ok -tricep pressdowns, side delts etc, light but very high reps. 50 reps even
Do some super gentle stretching afterwards.

If have some coin, MAG 10 or hydrolysed whey products peri workout will help also. Breakfast and pre workout meal load up on good fats

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Thank you so much @RampantBadger. I’m going to get started on the high rep/good side stuff immediately.

Just had PT yesterday. They are allowing isometrics on the bad side but no lifting movements yet. Hoping to do some occlusion training (some simple biceps curls and triceps pressdowns) soon so I can try to get a little training on the bad arm.

Thanks again for the advice. I’ll keep you updated on my progress!

So I’m almost 3 weeks post-surgery. I spent the last 3 days out of my sling moving into my new apartment. I was careful not to lift anything too heavy with the bad arm. Any time I felt a pain or twinge I stopped. I’m sore, but good.

I found a protocol for rehab on https://www.shoulderdoc.co.uk/
It’s much more progressive/accelerated than everything else I’ve come across (SEE BELOW). With how good I feel, I’m thinking about following this as opposed to the slower-moving protocols. I’d love to get thoughts on this. Anyone???

Pectoralis Major Repair

This protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to the last phase.

Pre-op
• ROM Exercises; should have full range of motion pre-op
• Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers.

Day 1 - 3 weeks
• Shoulder immobiliser
• Closed chain exercise as tolerated
• Passive / Active Assisted ROM in **[safe zone]as tolerated
• Do not force or stretch
• Avoid pendular exercises and stick exercises
• Wrist/hand/finger exercises
• Elbow flex/ext, pro/supination
• Scapula setting exercises
• ( Level 1 Exercises )

3-6 weeks :
Do not force or stretch
• Gentle isometric exercises in neutral as pain allows
• Wean off sling
• Progress to Open Chain Exercises in **[safe zone]as tolerated
• Do not force or stretch
Avoid pendular exercises and stick exercises
• ( Level 2 Exercises )

6 weeks +:
• Progress to open chain exercises in all ranges as tolerated
• progressive resistance
• sports-specific rehabilitation
• Avoid hyperextending in bench press or flyes or pec-deck.
• Avoid high weights with low reps and warm up slowly
• ( Level 3 Exercises )

Ok, so I’m almost 4 weeks post-op and here’s the workout I did this morning. I’d love feedback. I’m trying to keep it small and focused and I’m working my bad arm in a very safe range of motion, keeping my elbow as close to my side as possible and using very light weights (hence the occlusion/BFR sets).

10-20 min warmup on elliptical

BFR set bi’s/tri’s (30-15-15)

  • Curls
  • Pushdowns

Giant set (3x10-15)

  • Leg extensions
  • Crunches on exercise ball
  • Leg curls
  • Incline shoulder shrugs

BFR set chest/back (30-15-15)

  • one-armed high to low cable (keeping my bad arm close to midline and avoiding abduction to protect the repair)
  • cable rows (hands close with the v-handle to keep elbows in and protect the repair)

I posted 2 days ago about the workout I did. I figured I’d do an A/B workout rotation every other day, so here’s what I did today (B day). By the way, on the days in between, I’ve been just walking either outside or on the treadmill. When I walk on the treadmill, I walk at about a 3.5 pace and increase the incline every 5 minutes; and for the first mile I walk with DBs in each hand (Joe DeFranco always talks about the kettlebell mile, so I like doing it as well!).

10-20 min warmup on elliptical

BFR set bi’s/tri’s (30-15-15)

  • Hammer Curls
  • Skull crushers (but more to the side of my head to keep my elbows in more)

Giant set (3x10-15)

  • Bulgarian split squats
  • Standing abs
  • Single leg RDL
  • High incline front/lateral DB raises (using bench to take chest out of the motion)

BFR set chest/back (30-15-15)

  • DB low to high (keeping DB close to hip at the side to avoid abduction to protect the repair, then move the DB diagonal across midline)
  • prone rear delt flies