(Also known as Torn Pectoral, Pec Strain, Pectoral Muscle Strain, Strained Pectoral, Pectoral Tear)
What is a pectoral strain?
A pectoral strain is a condition characterized by partial or complete tearing of one or more of the pectoral (chest) muscles.
The pectoral muscles are a group of two muscles situated at the front of the chest. The largest of which is the pectoralis major muscle which originates from the sternum (breast bone), ribs and collar bone and attaches to the upper arm bone (humerus). The pectoralis minor is the smaller of the two pectoral muscles originating from the front of the ribs and attaching to a bony process at the front of the shoulder blade. The pectoral muscles are responsible for assisting with movements of the shoulder blade and shoulder (such as pushing movements and taking the arm across the chest).
During contraction of the pectorals, tension is placed through the pectoral muscles and tendons. When this tension is excessive due to too much repetition or high force, damage to the pectoral muscles may occur. This typically presents as a partial or complete pectoral strain and most commonly affects the pectoralis major muscle.
Causes of a pectoral strain
A pectoral strain often occurs suddenly due to a high force going through the muscle and tendon beyond what it can withstand. This typically occurs during weight training especially when performing a bench press or chest press.
Sometimes a pectoral strain may develop over time due to repetitive or prolonged activities placing strain on the pectoral muscles. This may cause gradual degeneration and weakening of the pectorals predisposing them to further injury.
Signs and symptoms of a pectoral strain
Patients with a pectoral strain will often experience a sudden pain or tearing sensation in the chest or front of the shoulder during the provocative activity. In minor pectoral strains, patients may be able to continue sport or activity only to have an increase in pain and stiffness upon resting later (particularly that night or the following morning). In severe cases the pain may be disabling, preventing the patient from performing further activity.
Patients with a pectoral strain usually experience pain that is localized to the chest and front of the shoulder or arm pit. Occasionally, pain may radiate into the upper arm or neck. The pain associated with a pectoral strain is usually experienced as an ache that increases to a sharper pain with activity.
Patients will usually experience pain when attempting to stretch the pectoral muscles or perform activities requiring strong contraction of the pectoral muscles such as pushing activities or taking the arm across the chest against resistance. Bruising, swelling, muscle spasm and weakness may also be experienced.
In patients with a minor pectoral tear, little or no symptoms may be present. In these patients, a minor ache or tightness may be the only complaint. In severe or chronic cases, muscle wasting, weakness and a palpable hole (or noticeable deformity) in the muscle may be detected corresponding to the location of the tear.
Diagnosis of a pectoral strain
A thorough subjective and objective examination from a physician is usually sufficient to diagnose a pectoral strain. Further investigations such as an Ultrasound or MRI scan may be required to confirm diagnosis and assess the severity of injury.
Treatment for a pectoral strain
Most minor to moderate pectoral strains settle well with appropriate physical therapy. In patients with a compete tear of the pectoralis major muscle surgical intervention may be indicated to repair the torn muscle. (It is important that this is identified early as delayed intervention may result in a poor outcome). This is usually followed by a period of rest and then intensive physical therapy treatment aimed at restoring flexibility, strength, posture and function.
The success rate of treatment in all patients with a pectoral strain, whether managed conservatively or surgically, is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Activities which place large amounts of stress through the pectorals should be minimized, these include: pushing activities, weight training involving the pectorals (such as performing a bench press, push ups, chin ups, dips, flys, pec deck etc) throwing, pectoral stretching, overhead activities and heavy lifting. Resting from aggravating activities ensures that the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the problem becoming chronic. Immediate, appropriate treatment in patients with a pectoral strain is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
Patients with a pectoral strain will usually benefit from following RICE. RICE is beneficial in the initial phase of the injury (first 72 hours) or when inflammatory signs are present (i.e. night pain, morning pain or pain with rest). This primarily involves resting from aggravating activities, regular icing and keeping the shoulder region elevated (i.e. sitting up or lying on the opposite side). Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
Manual "hands-on" therapy from the therapist such as massage, trigger point release techniques, dry needling, stretches and electrotherapy can also assist with hastening healing and improving range of movement, pain and function, following a pectoral strain. This can generally commence once the therapist has indicated it is safe to do so.
Patients with a pectoral strain should perform pain free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. The treating therapist can advise which exercises are most appropriate for the patient and when they should be commenced.
In the final stages of rehabilitation, a gradual return to activity or sport is indicated as guided by the treating therapist. Protective taping may be required on return to some sports to reduce the likelihood of re-injury.
Prognosis of a pectoral strain
With appropriate management, most minor to moderate cases of a pectoral strain that have not been present for long can usually recover within a number of weeks. In more severe or chronic cases recovery can be a lengthy process and may take many weeks to months to achieve an optimal outcome. Those patients with a complete pectoral tear that requires surgery, usually require a period of rehabilitation of 3 - 9 months or longer before returning to full activity.
Contributing factors to the development of a pectoral strain
There are several factors which can predispose patients to developing a pectoral strain. These need to be assessed and corrected with direction from a therapist. Some of these factors include:
Physical therapy for a pectoral strain
- abnormal biomechanics (eg. poor weight lifting / bench press technique, throwing technique etc)
- neck, upper back and shoulder stiffness
- muscle imbalances
- muscle weakness (especially the pectoral muscles or scapular stabilizers)
- muscle tightness
- poor posture
- excessive or inappropriate training or activity
- inadequate warm up
Physical therapy treatment for a pectoral strain is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:
soft tissue massage
Other intervention for a pectoral strain
- electrotherapy (e.g. ultrasound)
- joint mobilization
- joint manipulation
- dry needling
- ice or heat treatment
- progressive exercises to improve flexibility, strength and posture
- training and activity modification advice
- technique correction
- postural correction
- anti-inflammatory advice
- devising and monitoring a return to sport or activity plan
Despite appropriate management, some patients with a pectoral strain do not improve. When this occurs the treating therapist or doctor can advise on the best course of management. This may include further investigations such as X-rays, ultrasound, CT scan or MRI, pharmaceutical intervention, corticosteroid injection, autologous blood injection or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. Surgery may be needed to repair the tear in patients with a complete rupture of the pectoralis major muscle.