Exercises for Pec Strains

Pec Anatomy & Function

The pectoralis (pec) muscle is comprised of two muscles, the pec major and the pec minor. The pec major is a fan-shaped muscle that is located superficially (closer to the surface), and has two heads of muscle - the sternal head and the clavicular head. The main actions of the pec major are adduction (pulling the arm toward the body), internal rotation (rotation toward the body), and flexion (elevating) of the arm. Some of the movements that the pec major is responsible for are push up, bench press, and pushing or sliding an object forward.

Appreciate the insertion and attachment points for the pectoralis major muscle and how that plays a role in the actions of this muscle.

The other pec muscle is called the pectoralis minor. The pec minor is located under the pec major (deeper toward the chest), and is mainly responsible for movements of the scapula (shoulder blade). Some of the movements that pec minor assists with are scapular stabilization when needed as well as muscular assistance with deep breathing. Tightening of the pec minor can cause significantly rounded shoulders and bent/slumped posture.

The Pec Minor with it's own insertion and attachment points.

When & How Do Pec Strains Occur?

The majority of pec strains occur when the pec is placed under maximal tension or pressure, or put into a position that compromises the muscle’s ability to produce enough protective force to prevent injury.

Should I Get Surgery for a Pec Strain or Tear?

After an injury, it can be difficult to decide on the best course of treatment action. For pec strains, it will largely depend on the symptoms, extent of damage, and activity level of the person injured to determine the treatment plan. If the damage to the pec was extensive and the tendon or muscle belly was fully ruptured, a surgical approach will likely be recommended.

For a partial tear or strain, conservative treatment such as medications, manual therapies, and physical therapy will be the most effective treatment. In an article by Bayer et al in 2017, conservative treatment such as PT that happens early and often is BEST for optimal outcomes! (3) It has been shown that waiting to start rehab will ultimately result in less than optimal recovery and pain control after a pec strain. 

This notion appears to remain consistent for the athlete population according to research, the group in which pec strains occur most frequently. In an article by Sahota et al in 2020, a cohort of football players with pec strains were shown to have increased recovery times when a delayed surgical approach was taken, versus a non-operative, conservative approach with rehab and PT (4). Similarly for baseball players and most specifically, pitchers, a study done in 2022 looked at 138 people with pec strains. The vast majority of these players were treated conservatively and experienced similar, if not better, outcomes than those who underwent surgical treatment (5).

The moral of the story - treatment that occurs EARLY and OFTEN is BEST! Don’t wait!!

Exercises for Pec Strains

Since optimal treatment protocols typically start early when the injury is acute, rehab can be broken up into phases. These are most often classified as early, middle, and late stages of treatment. Below we will go through some exercises for pec strains.

Closing Thoughts:

Takeaways and learning points from this article are the following:

1. Rehab should occur early and often! Full ruptures will likely require a surgical approach, but the vast majority of pec strains can be managed with a conservative approach such as PT with a multiphase treatment plan with specific exercises for pec strains.
2. Listen to your body! Pain should not exceed 4/10 at any time you are exercising and rehabbing.
3. Rehab does not stop when your pain is gone! Continue to build capacity safely and slowly over time with a monitored rehab program.
4. With a pec strain there is a higher risk of restrain, so again, we should continue to rehab progressively over time.

References:

1. Solari F, Burns B. Anatomy, Thorax, Pectoralis Major Major. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525991/
2. Haley CA, Zacchilli MA. Pectoralis major injuries: evaluation and treatment. Clin Sports Med. 2014 Oct;33(4):739-56. doi: 10.1016/j.csm.2014.06.005. PMID: 25280620.
3. Bayer et al. Early versus Delayed Rehabilitation after Acute Muscle Injury September 2017 New England Journal of Medicine 377(13):1300-1301 DOI:10.1056/NEJMc1708134
4. Sahota S, Gibbs DB, Lawton CD, et al. Pectoralis Major Injuries in the National Football League. Sports Health. 2020;12(2):116-123. doi:10.1177/1941738119885867
5. Heather S. Haeberle, Prem N. Ramkumar, Travis L. Frantz, Grant L. Jones, Frank C. Curriero, Anne Corrigan, Lonnie Soloff, Mark S. Schickendantz, Salvatore J. Frangiamore, Pectoralis muscle injuries in Major and Minor League Baseball, Journal of Shoulder and Elbow Surgery, Volume 31, Issue 8, 2022, Pages e363-e368, ISSN 1058-2746, https://doi.org/10.1016/j.jse.2022.01.134. (https://www.sciencedirect.com/science/article/pii/S1058274622002300)